Optimizing drug regimens and supplementation in orthognathic surgery: A comprehensive and practical guide.

OBJECTIVE: This study aimed to comprehensively review the literature and provide a practical guide for optimizing drug regimens and supplementation related to orthognathic surgery. METHODS: The authors conducted a thorough review of the existing literature, following the PRISMA-ScR guidelines. Various types of studies except case reports and reviews were included. The study applied specific inclusion criteria, focusing on perioperative and/or postoperative drugs, medications, or supplementation related to orthognathic surgery. RESULTS: This guide included 78 studies on various medications in orthognathic surgery. It encompasses clinical trials, cohort studies, cross-sectional studies, prospective and retrospective studies. The topics covered include antibiotics, analgesics, corticosteroids, antiemetics, hemostatic agents, local anesthetics, herbal medicine, and botulinum toxin. Pain and edema control involved specific medications, while local anesthesia utilized ropivacaine and bupivacaine. The guide also discusses mineral and vitamin supplementation. The effectiveness of hemostatic agents and antiemetics was highlighted. CONCLUSION: Pain management, reduced swelling, enhanced wound healing, and faster recovery are among the advantages. In addition to the standard drugs and medications, the inclusion of vitamin and mineral supplements, tranexamic acid, postoperative anesthetic blocks, and preemptive antiemetics is anticipated to offer various benefits in orthognathic surgery, despite the limited available evidence.

Predictors of Blood Loss During Orthognathic Surgery and the Need for Pre-Deposit Autologous Blood Donation.

ABSTRACT: The aim of this study was to identify the clinicolaboratory predictors of relative blood loss (RBL) during orthognathic surgery and determine the need for predeposit autologous blood donation (PABD) for the surgery. Using a retrospective study design, 297 patients who underwent bimaxillary orthognathic surgery between 2016 and 2020 were enrolled. To investigate patient-specific risk factors, we calculated the allowable blood loss (ABL) for each patient and RBL as the ratio of estimated intraoperative blood loss (EiBL) to ABL. The correlations between the clinico-laboratory variables and EiBL and RBL were analyzed using stepwise multivariate regression analysis, and independent t test and one-way ANOVA were performed.There was no significant difference in transfusion rate between the PABD group (N = 202/279) and non-PABD group (N = 77/279) ( P   =  0.052). Sex ( P   <  0.001), body mass index class ( P   =  0.001), operative time ( P  < 0.001), and baseline hematocrit ( P  < 0.001) were significant predictors of EIBL and RBL. EIBL exceeded ABL in only 2 patients. The significant factors of RBL in orthognathic surgery were hematocrit, body mass index, and operative time. Clinicians should be more careful about bleeding in patients with low baseline hematocrit level or high body mass index, or those expected to undergo prolonged surgeries owing to a complicated surgical plan. The need for PABD before orthognathic surgery is low.

[Surgery first as an alternative approach in patients treated for dentofacial deformities]. / Chirurgia jako pierwsza ­ alternatywne podejscie do leczenia chirurgiczno-ortodontycznego pacjentów z wadami zgryzowotwarzowymi.

Recently surgery first became more popular alternative for treatment of dentofacial deformities. In this approach treatment starts from orthognathic surgery. Immediately after othognathic surgery facial aesthetics and oral function are improved. Thus main complaints of the orthognathic patients are resolved early during treatment period. Indications for surgery first approach are wider than years ago and include: skeletal Class II and III malocclusion, skeletal open bite, bimaxillary protrusion, even cases with severe facial asymmetry are reported. The key point for gaining stable results and total treatment time shortening is an appropriate surgical occlusion. For higher precision of treatment 3D virtual planning is recommended. Total treatment time depends on: number of contact points in surgical occlusion, number of extracted teeth and postsurgical midline deviation. Surgery first is a good alternative approach in some patients treated for dentofacial deformities. Stability in this approach is similar to conventional method of treatment and both methods result in quality of life improvement. As there is lack of presurgical orthodontics in surgery first approach patients avoid transient deterioration in facial aesthetics and oral function that results in higher satisfaction and shorter total treatment time.

RETRACTED: Does Low-Level Laser Photobiomodulation Improve Neurosensory Recovery After Orthognathic Surgery? A Clinical Trial With Blink Reflex.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. The article includes material that had already appeared in de Oliveira RF, da Silva AC, Simoes A, Youssef MN, de Freitas PM. Laser Therapy in the Treatment of Paresthesia: A Retrospective Study of 125 Clinical Cases. Photomed Laser Surg. 2015 Aug; 33(8)415-23. doi: 10.1089/pho.2015.38888. PMID:26226172 in the journal Photomedicine and Laser Surgery by Mary Ann Liebert Publishing. Any re-use of any material should be appropriately cited and published with permission of any relevant copyright owner. As such this article represents a misuse of the scientific publishing system. Apologies are offered to readers of the journal that this was not detected during the submission process.

The effect of manual lymphatic drainage on patient recovery after orthognathic surgery-A qualitative and 3-dimensional facial analysis.

OBJECTIVE: The aim of this study was to investigate the effect of manual lymphatic drainage (MLD) on postoperative facial swelling and pain. STUDY DESIGN: A randomized, single-center, prospective, 2-arm clinical trial with blinded endpoint assessment was set up. Patients were enrolled from the Maxillofacial Department of the Ghent University Hospital (Belgium) between January 2015 and March 2018. Both the intervention group (n = 13) and the control group (n = 13) received the same postoperative care; in addition, the intervention group underwent 6 sessions of MLD after orthognathic surgery. Three-dimensional facial scans were performed and questionnaires administered on postoperative days 3, 7, 14, 30, 90, and 180. A linear mixed model was performed, and statistical significance was assumed at the 5% level. RESULTS: In total, 26 patients (mean age 29 years; range 16-57 years) were included for statistical analysis. A faster decrease in swelling in the intervention group was observed on 3-dimensional scans. Furthermore, patients receiving MLD reported reduction in swelling and pain within the first month after surgery. However, no statistically significant difference could be detected in these observations (P > .05). CONCLUSIONS: Within the limitations of this study, no statistically significant difference could be found between patients treated with or without MLD after orthognathic surgery with regard to swelling and pain.

Low-level laser therapy for neurosensory recovery after sagittal ramus osteotomy.

BACKGROUND: Dento-skeletal deformities are treated combining orthodontic treatment with orthognathic surgery. One of the techniques most used in this type of surgery is the sagittal osteotomy of the mandible. This technique offers many advantages, but within its disadvantages is the inferior alveolar nerve paresthesia. There are various treatments that aim to recovery of the nerve bundle, and one of them is low intensity laser treatment. The aim of this study was to evaluate the effectiveness of low intensity laser therapy in the recovery of neurosensorial tissues after mandibular sagittal osteotomy during orthognathic surgery. METHODS: Twelve patients submitted to surgery, using mandibular sagittal osteotomy, were treated unilaterally with low intensity infrared (808 nm, GaAIAs active medium) laser, following the inferior alveolar nerve path. The other part of the mandible was treated by placebo. The parameters used were 100 mW of power, irradiancy of 3.6 W/cm2, 2.8J energy per point, an energy density of 100 J/cm2, 28 seconds at each point with a distance of 1.0 cm between points, two sessions per week with a minimum of 10 sessions, starting 48 hours after surgery. Mechanical evaluation was performed in first, fourth, seventh and tenth session. RESULTS: Significant improvement on the treated side was observed. Comparing the behavior among the variables between the treatment (T) group and the control (C) group in the General Recovery was showed a tendency to better results in the T group when compared to the C group, with statistical difference (P≤0.05) after the 10th laser therapy session. CONCLUSIONS: The treatment of neurosensorial disorders with infrared low intensity laser could be effective in accelerating recovery, providing greater comfort to the patient, and it presents advantages over other existing methods.

Photobiomodulation as oedema adjuvant in post-orthognathic surgery patients: A randomized clinical trial.

OBJECTIVE: Photobiomodulation therapy (PBMT) has been used in multiple applications in general medicine as powerful anti-inflammatory, analgesic and reducing oedema in different parts of the body. The aim of this study is to compare the effect on post-surgical oedema after mandibular orthognathic surgery, between two different laser power densities and oral medication with non-steroidal anti-inflammatory. MATERIALS AND METHODS: In a randomized clinical trial, on 60 patients who were subject to mandibular orthognathic surgery were divided into three groups. All groups received sodium naproxen 250mg every 8hours for 6days. Two groups were irradiated with two different laser application protocols and the other was a control group. In G1 group the irradiation parameters three times per week for two weeks were: 940nm, in continuous mode, 2.5W, 120s, 85.71J/cm2, 0.89W/cm2, over the right and left side with a distance from the skin surface of 1mm with the whitening handpiece (spot size of 2.8cm2). In G2, the irradiation parameters three times a week for two weeks were: 940nm, in continuous mode, 4.1W, 120s, 68.33J/cm2, 0.58W/cm2 over the right and left side with a distance from the skin surface of 15mm, with the deep tissue handpiece (spot size of 7.1cm2). In all the groups, millimetric facial measurements were taken from tragus to lateral commissure, and from lateral commissure to gonion in both sides. RESULTS: All differences between T1 and T6 were significant for the three groups, (paired T, P<0.05). The differences between the groups were generally not significant (P>0.05) except for commissure - right and left gonion when compared G1 vs CG (P<0.05) and G2 vs CG (P<0.05). Initial changes (T1-T2) between groups were significantly different except for the measurement from commissure to right tragus G1 vs CG (P=0.411) and from commissure to left tragus G2 vs CG (P=0.94). The faster resolution of the oedema occurred in G2 group. PTBM with an energy density of 68.33J/cm2 was the most effective adjuvant to oral medication with non-steroidal anti-inflammatory, to decrease post-surgical oedema after mandibular orthognathic surgery.

Surgery-First Approach in the Orthognathic Patient.

The surgery-first approach (SFA) has become a recent alternative to the conventional 3-stage approach to orthognathic surgery. Skeletal anchorage in orthodontics has facilitated the resurgence of this treatment sequence. By eliminating the presurgical phase of orthodontic treatment, patients have immediate resolution to their facial deformity. Treatment duration has been shown to be reduced; the difference with the conventional approach being approximately 5 months. Patient satisfaction with this approach is very high as measured by quality-of-life surveys. This article describes the indications and step-by-step approach of this technique in conjunction with virtual surgical planning.

Incidence of Pneumothorax Experienced After Orthognathic Surgery.

The purpose of this study is to evaluate the frequency of pneumothorax following orthognathic surgery and describe its clinical presentation. A retrospective analysis of a hospital database was carried out on consecutive patients with normal presurgical clinical assessment, laboratory findings, and chest X-ray who underwent orthognathic surgery from January 2007 to September 2018 in the Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Two patients (0.038%), 1 male (age 20 years) and 1 female (age 32 years), complained of respiratory difficulty and chest pain and were clearly diagnosed with postoperative pneumothorax by radiographic chest X-rays from a sample of 5229 consecutive patients during the study period. Intercostal drainage under local anesthesia was performed immediately and the treatment effects for both patients were satisfactory. The present study findings indicate that although orthognathic surgeries can be safely performed in patients with craniofacial anomalies, some unexpected complications such as pneumothorax may occur. Therefore, accurate postoperative follow-up must be done in every patient to monitor possible clinical complications. Patients who experience respiratory difficulty and postoperative chest pain may have pneumothorax, and once it is diagnosed, treatment should be promptly carried out to eliminate further severe sequelae.

Is Low-Level Laser Therapy Effective on Sensorineural Recovery After Bilateral Sagittal Split Osteotomy? Randomized Trial.

PURPOSE: When performing a sagittal osteotomy of the mandibular ramus, one must consider the risk of long-term postsurgical sensory abnormalities from lesions to the inferior alveolar nerve. One treatment for these changes is low-level laser therapy (LLLT). Thus, the aim of this research was to evaluate the effectiveness of LLLT on sensorineural recovery after split ramus osteotomy of the mandible. MATERIALS AND METHODS: This randomized, double-blinded, split-mouth design trial included patients who underwent advanced surgery of the mandible and then received LLLT on 1 side of the mandible (experimental) and a random placebo (control) treatment on the opposite site. Patients were divided into 2 groups: group 1 was treated during the short postoperative period (within 30 days) and group 2 was treated for persistent sensory abnormalities during the late postoperative period (6 months to 1 yr). Each patient received 5 LLLT and control sessions with intervals of 3 to 4 weeks between sessions. The experimental side in each patient received LLLT in the extraoral area (mandibular ramus and entire length of the inferior alveolar nerve to the mental region) and the intraoral area (mental foramen region). The control side received simultaneous placebo treatments. The sensorineural response was analyzed before the onset of treatment and after each LLLT and control session using the Semmes-Weinstein monofilament test. RESULTS: Twenty adult patients (mean age, 35.6 years; 70.0% women) showed improvement in the experimental and control sides during the follow-up period. However, the experimental side in groups 1 and 2 exhibited a marked improvement in sensorineural recovery over the course of the sessions, and group 1 had the best results. CONCLUSION: LLLT was effective in the recovery from sensorineural disorders after orthognathic surgery during the short postoperative period, particularly in the fifth session.

A Descriptive Study of Chlorhexidine as a Disinfectant in Cleft Palate Surgery.

OBJECTIVES: Chlorhexidine is seen as the golden standard of disinfectants. It is widely used to clean surgical sites; however, many studies indicate resistance of pathogens to chlorhexidine. One study indicated that pathogenic microorganisms were isolated from the soft palate cleft region in 57% of patients with facial clefts. The objectives of our study were to determine (1) if chlorhexidine application is effective in removing pathogens from the surgical site in these patients, and (2) if any pathogens are isolated, determine if they are resistant to other antimicrobials. DESIGN: A descriptive observational study. SETTINGS: A private practice that specializes in facial cleft surgery, with a country-wide patient base. All procedures were executed by one oral and maxillofacial surgeon. PARTICIPANTS: All patients (N=50) who presented for primary repair of the soft palate cleft were included in the study. INCLUSION CRITERIA: written consent from parent(s), and patient cleared as systemically healthy by a pediatric physician. EXCLUSION CRITERIA: patient(s) with systemic infections (eg, flu) and/or any local infections (eg, tonsillitis). There were 25 males and 25 females with an average age of 7 months and 16 days included in the study. METHODS: Swabs were taken from the surgical site of all 50 patients with cleft soft palate and were sent for culture, identification and antimicrobial sensitivity. The swabs were taken before disinfecting the site as well as after 2 minutes of disinfecting the surgical site with chlorhexidine. Results were compared against each other. RESULTS: Positive cultures with 28 different pathogenic microorganisms that were identified in 47 patients before cleaning the surgical site with the chlorhexidine. The most dominant pathogens were K. pneumonia (n=22), H. influenza (n=18) and S. aureus (n=10). Of the pathogens found, 13 (46%) were still present on the swabs taken after disinfecting with chlorhexidine. K. pneumonia (n= 13), H. influenza (n=11) and S. aureus (n=9) were still the most prevalent pathogens. CONCLUSIONS: This study demonstrated that 61 of the total of 113 pathogens isolated (54%), survived after 2 minutes of disinfecting the surgical and surrounding area with chlorhexidine, thus intensifying the chances of post-operative infection.

Effects of orofacial myofunctional therapy on masticatory function in individuals submitted to orthognathic surgery: a randomized trial.

OBJECTIVES: The esthetic and functional results of orthognathic surgery of severe dentofacial deformities are predictable, however there are differences regarding the effects on stomatognathic system. The aim was to investigate the effects of orofacial myofunctional therapy (OMT) on the masticatory function in individuals with dentofacial deformity submitted to orthognathic surgery (OGS). MATERIAL AND METHODS: Forty-eight individuals (18-40 years) were evaluated, 14 undergoing OMT (treated group-TG), 10 without this treatment (untreated group-UTG) and 24 in a control group with normal occlusion; for clinical aspects the data of an individual was missed (n=46). Chewing was performed using the Expanded protocol of orofacial myofunctional evaluation with scores (OMES-E). Muscle tone and mobility were also analyzed before (P0), three (P1) and six months (P2) after OGS. Surface electromyography of the masseter and temporalis muscles was performed, considering the parameters amplitude and duration of act and cycle, and the number of masticatory cycles. The OMT consisted of ten therapeutic sessions along the postoperative period. The results were compared using parametric and non-parametric tests. RESULTS: TG showed higher scores in P1 and P2 than P0; for the masticatory type the scores in P2 were significantly higher than P0. In addition, the proportion of individuals with adequate tone of lower lip and adequate tongue mobility for TG increased significantly from P1 and P2 in relation to P0. The EMG results showed a decrease in act and cycle duration in P2 in relation to P0 and P1 for the TG; furthermore the values were close to controls. An increase in the number of cycles from P0 to P2 was also observed, indicating faster chewing, which may be attributed to an improvement of balanced occlusion associated with OMT. CONCLUSION: There were positive effects of OMT on the clinical and electromyography aspects of chewing in individual submitted to orthognathic surgery.

Ultrasound assessment of soft tissue augmentation around implants in the aesthetic zone using a connective tissue graft and xenogeneic collagen matrix - 1-year randomised follow-up.

PURPOSE: A comparative, ultrasound evaluation of the thickness of keratinized mucosa (TKT) around implants one year after gingival augmentation (GA) by means of a connective tissue graft (CTG) and the xenogeneic collagen matrix (CMX). MATERIALS AND METHODS: A total of 75 bone level tapered implants (Conelog® Camlog) were inserted in 57 patients in the aesthetic area of both jaws. The patients were divided into 3 groups: control group I- without GA; group II- GA 3 months before implantation, and group III- GA 3 months after implantation. Groups II and III were divided into two subgroups depends on type of material used for GA: (a) CMX (Mucograft®, Geistlich Pharma AG) and (b) CTG. The patients underwent a clinical and ultrasound examination before, then after 3 and 12 months following GA respectively to evaluate TKT at two points using ultrasound equipment (Pirop®, Echoson). Point 1 was considered to be in the middle of the line connecting the cemento-enamel junction (CEJ) to the adjacent teeth, and point 2 on the mucogingival junction (MGJ). RESULTS: Three months after GA, the highest increase in gingival thickness was noted in group IIIb (point 1 - 0.95mm, 2 - 1.01mm). However, 12 months after GA the highest gingival thickness was observed in group IIb (point 1 - 1.76mm, 2 - 1.36m) and next IIIb (point 1 - 1.52mm, 2 - 1.15mm). CONCLUSIONS: Both CTG and Geistlich Mucograft® increased TKT, but higher values were noted using CTG augmentation before implantation. An ultrasonic device can be used as a non-invasive, reliable, and reproducible method for evaluating TKT.

Effects of orofacial myofunctional therapy on masticatory function in individuals submitted to orthognathic surgery: a randomized trial

Abstract Objectives: The esthetic and functional results of orthognathic surgery of severe dentofacial deformities are predictable, however there are differences regarding the effects on stomatognathic system. The aim was to investigate the effects of orofacial myofunctional therapy (OMT) on the masticatory function in individuals with dentofacial deformity submitted to orthognathic surgery (OGS). Material and Methods: Forty-eight individuals (18-40 years) were evaluated, 14 undergoing OMT (treated group-TG), 10 without this treatment (untreated group-UTG) and 24 in a control group with normal occlusion; for clinical aspects the data of an individual was missed (n=46). Chewing was performed using the Expanded protocol of orofacial myofunctional evaluation with scores (OMES-E). Muscle tone and mobility were also analyzed before (P0), three (P1) and six months (P2) after OGS. Surface electromyography of the masseter and temporalis muscles was performed, considering the parameters amplitude and duration of act and cycle, and the number of masticatory cycles. The OMT consisted of ten therapeutic sessions along the postoperative period. The results were compared using parametric and non-parametric tests. Results: TG showed higher scores in P1 and P2 than P0; for the masticatory type the scores in P2 were significantly higher than P0. In addition, the proportion of individuals with adequate tone of lower lip and adequate tongue mobility for TG increased significantly from P1 and P2 in relation to P0. The EMG results showed a decrease in act and cycle duration in P2 in relation to P0 and P1 for the TG; furthermore the values were close to controls. An increase in the number of cycles from P0 to P2 was also observed, indicating faster chewing, which may be attributed to an improvement of balanced occlusion associated with OMT. Conclusion: There were positive effects of OMT on the clinical and electromyography aspects of chewing in individual submitted to orthognathic surgery.

Orthodontic-surgical treatment: electromyographic and kinesiographic evaluation in follow up period. Experimental study.

INTRODUCTION: The aim of this study was to investigate muscular function and mandibular kinesiology of patients undergoing orthodontic-surgical treatment by electromyography and kinesiography. Electromyographic evaluation is essential to estimate masticatory forces in patients undergoing combined surgical-orthodontic treatment. MATERIALS AND METHODS: 60 patients referred for orthodontic surgical treatment were included in the study, 43 patients presented a class III while 17 presented a class II. The patients underwent electromyographic and kinesiographic examinations during all the therapeutic orthodontic-surgical phases. RESULTS: The relationship between fundamental electromyographic values and age, weight, asymmetry and activation was weak. A strong and positive relationship was observed between the relaxation percentage after TENS (transcutaneous electrical neuromuscular stimulation), the steepness of the post-surgery rehabilitation curve, the initial POC (percentage overlapping coefficient), and for the values in microvolts of the right and left temporal and masseters at the beginning of treatment. CONCLUSIONS: Patients with dentofacial deformities corrected by surgical treatment, have a significant positive treatment outcome in respect of masticatory activity and performance electromyographic evaluation on, before, during and follow up period of the analized patients permit to underline that this examination can predict long term stability.

Low-level laser therapy for treatment of neurosensory disorders after orthognathic surgery: A systematic review of randomized clinical trials.

BACKGROUND: Low-level laser has been widely used in Dentistry and many studies have focused on its application in oral surgeries. This study was conducted with the aim of searching for scientific evidence concerning the effectiveness of laser to reduce pain or paresthesia related to orthognathic surgery. MATERIAL AND METHODS: An electronic search was performed in PubMed, Scopus, Science Direct, LILACS, SciELO, CENTRAL, Google Scholar, OpenGrey, and ClinicalTrials.gov, up to November 2016, with no restrictions on language or year of publication. Additionally, a hand search of the reference list of the selected studies was carried out. The PICOS strategy was used to define the eligibility criteria and only randomized clinical trials were selected. RESULTS: Out of 1,257 identified citations, three papers fulfilled the criteria and were included in the systematic review. The risk of bias was assessed according to the Cochrane Guidelines for Clinical Trials and results were exposed based on a descriptive analysis. One study showed that laser therapy was effective to reduce postoperative pain 24 hours (P=0.007) and 72 hours (P=0.007) after surgery. Other study revealed the positive effect of laser to improve neurosensory recovery 60 days after surgery, evaluated also by the two-point discrimination (P=0.005) and sensory (P=0.008) tests. The third study reported an improvement for general sensibility of 68.75% for laser group, compared with 21.43% for placebo (P=0.0095), six months after surgery. CONCLUSIONS: Individual studies suggested a positive effect of low-level laser therapy on reduction of postoperative pain and acceleration of improvement of paresthesia related to orthognathic surgery. However, due to the insufficient number and heterogeneity of studies, a meta-analysis evaluating the outcomes of interest was not performed, and a pragmatic recommendation about the use of laser therapy is not possible. This systematic review was conducted according to the statements of PRISMA and was registered at PROSPERO under the number CRD42016043258.

Postoperative Orthognathic Surgery Edema Assessment With and Without Manual Lymphatic Drainage.

OBJECTIVE: To evaluate the effects of manual lymphatic drainage (MLD) on facial edema and pain in patients who underwent orthognathic surgery from patient and professional perspectives and clinical measures. METHODS: It is a randomized double-blind clinical trial, where 30 patients who underwent bimaxillary orthognathic surgery were divided into 2 groups (treatment and placebo). One group (treatment) received MLD from 2nd postoperative day, besides cryotherapy and postoperative medications. The other group (placebo) received cryotherapy, medications, and manual superficial sliding movements as placebo. For edema evaluation, facial measurements with tape and photographs were used. To evaluate patients' perception, visual analog scale for pain and edema was used. In statistical analysis, quantitative data were analyzed using Student t test for normally distributed variables and Mann-Whitney test for non-normal to find differences between groups; 5% significance level was adopted. RESULTS: No difference was found between groups in the amount of maximum developed edema (P = 0.290) nor on what day the edema peak occurred (P = 0.091). However, it was found that treatment group showed faster and greater regression of swelling compared with placebo (P < 0.001). Manual lymphatic drainage was not effective in relieving pain in these patients and nor in edema perception (P = 0.784 and P = 0.946, respectively). CONCLUSION: Manual lymphatic drainage was effective in reducing facial measurements in orthognathic surgery postoperatory. When considering patient's pain and swelling perception, no difference was found between groups.