Abstract

Quali sono i rischi reali della chirurgia ortognatica?

di Nicolescu Ion

Orthognathic surgery is now a well-established and predictable procedure, with a low incidence of major complications. Nevertheless, camouflage treatment remains the preferred option for many orthodontists when treating patients with skeletal discrepancies. This choice is often influenced by concerns regarding surgical risks and the possibility of short- or long-term complications, uncertainty about achieving the expected aesthetic outcome, concerns about long-term stability and relapse, limited collaboration with the surgeon, treatment costs, prolonged treatment time, and the increasing popularity of less invasive alternatives that promise comparable aesthetic improvements. While camouflage treatment may represent an acceptable solution in selected cases, it cannot reproduce the facial aesthetic changes achievable through skeletal correction, nor can it address the functional consequences of dentofacial deformities, particularly in patients with compromised upper airway dimensions or obstructive sleep apnea. This lecture will explore the distinction between the perceived and the actual risks of orthognathic surgery. Drawing on clinical experience and evidence from the literature, it will discuss the incidence and prevention of surgical complications, the importance of patient selection, and the role of comprehensive treatment planning and precise surgical execution in reducing morbidity and ensuring long-term stability. Particular emphasis will be placed on the surgeon's responsibility to guide the surgical planning according to established principles of facial aesthetics, in close collaboration with the orthodontist, to ensure predictable facial harmony while maintaining functional objectives and long-term stability. The aim is not to suggest that orthognathic surgery is risk-free, but rather to demonstrate that its real risks are measurable, manageable, and often outweighed by the functional and aesthetic benefits when treatment is appropriately planned and executed. By understanding the true balance between risks and benefits, orthodontists and surgeons can make more confident treatment decisions and offer patients predictable outcomes that are both aesthetically and functionally superior.