Enhanced Recovery Pathway for Orthognathic Surgery: An Evidence-Graded Framework for Individualized Care

Purpose: Orthognathic surgery remains one of the most complex procedures in craniofacial practice, associated with significant intraoperative risks, postoperative complications, and prolonged recovery. The purpose of this review is to synthesize current evidence supporting enhanced recovery strategies following orthognathic surgery and to develop a comprehensive, evidence-informed framework that can be adapted to various clinical settings. Methods: A structured narrative literature review was conducted, with literature searches performed through November 2025, to identify perioperative practices shown to improve recovery, patient safety, and overall outcomes in orthognathic surgery. Relevant studies were analyzed for quality and applicability. When high-level data were unavailable, low-risk measures with clinical consensus support were included to maintain a pragmatic approach. Results: The review identified key perioperative principles that collectively enhance patient recovery and reduce complications. These were organized into a structured framework encompassing preoperative preparation, perioperative optimization, and postoperative care. A practical checklist was developed to facilitate consistent implementation and multidisciplinary coordination. Conclusion: The integration of evidence-based recovery principles into orthognathic surgery offers a structured, adaptable approach to improving surgical outcomes and patient experiences. This framework serves as a practical guide for clinicians seeking to incorporate evidence-based strategies into their surgical practice while maintaining flexibility for individual patient and institutional needs.