Individualized perioperative nutritional management in orthognathic surgery: an evidence-graded, integrated framework...

Orthognathic surgery corrects dentofacial deformity and increasingly addresses upper-airway obstruction, but postoperative dietary restriction may cause inadequate intake, weight loss, and lean-mass depletion. Nutritional care remains underexamined and rarely treated as a multidimensional problem. This mini-review synthesizes evidence across three interacting determinants of postoperative nutrition: upper-airway morphological change, temporary impairment of mastication and swallowing, and perioperative psychological status. We grade each domain by its proximity to measured nutritional outcomes because the evidence is markedly asymmetric. Only feeding function has direct longitudinal support: intake, weight, muscle mass, and serum markers track masticatory recovery, with intake lowest in week one, weight recovering by about 4 months, and muscle mass remaining incompletely restored at 6 months. Evidence for airway and psychological pathways remains indirect. Mandibular setback reduces airway volume and may increase obstructive sleep apnea risk, whereas advancement enlarges the airway; both may alter swallowing mechanics. Anxiety, depression, and body dysmorphic disorder are also common, but no study has related airway change or psychological status to intake, weight, or body composition in this population. Effects cannot be extrapolated from general populations, where sleep restriction may increase energy intake, and depression affects appetite bidirectionally. We therefore present an explicitly hypothesis-generating, risk-stratified framework. Its feeding-function arm can inform practice; its airway and psychological arms support low-risk precautions and targeted research. We outline minimum study designs needed to convert inferred links into measured ones and identify priorities for individualized nutritional management.