Scientific Abstract Presentations: Craniomaxillofacial Session 6 Friday, October 16 Fri, Oct 16 5:00-6:00 p.m. CDT

Introduction

The optimal timing of ORIF of mandible fractures, particularly whether intervention within 72 hours leads to better outcomes, remains unclear. This study aims to analyze the impact of timing on postoperative complications in patients undergoing ORIF for mandibular fractures.

Methods

A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Four databases were searched. Studies were included if they compared outcomes based on timing of ORIF. Outcomes analyzed included infection, malunion, non-union, mal-occlusion, hardware complications, sulcus loss, TMJ complications, wound dehiscence, reoperation and paresthesia.

Results

A total of 14 studies met the inclusion criteria with a total of 10,315 patients with 11,069 mandible fractures. Average age was 28.9 years. Most patients were male (n=8,712; 88.12%) with mean follow-up of 163 days (range: 1-365). Mean time to ORIF was 6.7 days (range: 0-46).

The most common site of mandible fracture was the angle (n=3,401; 37.78%), followed by the symphysis (n=2,342; 26.02%), while the coronoid process was the least common (n=4; 0.04%).

Meta-analysis of ORIF performed within 3 days showed no statistically significant difference in overall complications reported by individual studies (p=0.67, OR 1.08, 95% CI 0.75-1.57, I²=52%). However, combined surgical complications, including infection, malocclusion, non-union, malunion, plate exposure, reoperation, and wound dehiscence showed a statistically significant lower risk of occurrence with early intervention < 3 days vs > 3 days (p=0.0003, OR 0.65, 95% CI 0.51-0.82, I²=9%) and this significance persisted for comparisons of < 7 and > 7 days (p=0.002, OR 0.59, 95% CI 0.42-0.82, I²=35%). Stratification of complications showed a statistically significant lower risk of infection (p=0.02, OR 0.45, 95% CI 0.22-0.9, I²=18%) with ORIF performed < 3 days but not when comparison was done between < 7 and > 7 days. Analysis of wound dehiscence also favored intervention < 3 days over < 7 days. Other specific surgical complications (malunion, non-union, malocclusion, reoperation, plate extrusion, and wound dehiscence) when analyzed alone, did not show a statistically significant difference with intervention time due to study under power (p > 0.05).

Conclusion

This systematic review and meta-analysis demonstrate that early ORIF within 72 hours is associated with a significantly lower risk of surgical complications when these outcomes are analyzed collectively, as well as a markedly reduced risk of postoperative infection. Surgical benefits of early intervention extend to <7 days. Although individual complications, such as malocclusion, non-union, malunion, hardware issues, and wound complications, did not show statistically significant differences when examined separately, meta-analysis revealed that this was due to limited study power rather than a true absence of effect. Taken together, the findings suggest that earlier intervention offers meaningful clinical advantages, particularly in reducing infection risk and surgical complication burden or mandible fracture ORIF.

Background: Salivary leak remains a morbid complication following microvascular head and neck reconstruction, with an incidence of 10–20% (1). Yet, its clinical picture and relationship with infection are incompletely characterized. This study aims to characterize the clinical course, infectious associations, and management patterns of salivary leaks in a large reconstructive cohort.

Methods: A prospective database of consecutive microvascular head and neck reconstructions was queried (08/2019–12/2025). Inclusion criteria were reconstruction of oropharyngeal defects and development of postoperative salivary leak. Demographics, clinical disease characteristics, complications, and management strategies were analyzed using descriptive and comparative statistics, as well as Cochran–Armitage trend tests. Patients who developed a salivary leak were compared with those without leak to assess complications.

Results: Of a total of 847 microvascular head and neck reconstructions, 764 met inclusion criteria. Of those, 87 developed a salivary leak (11.4%), with the majority diagnosed clinically (87.4%, n = 76) and a mean onset at 6.1 days postoperatively. Leaks significantly prolonged postoperative length of stay (18.4 vs 10.9 days, P < .001) and increased risk of bleeding (14.9% vs 6.8%, P = .02) and flap loss (6.9% vs 1.9%, P = .01). Antibiotics were administered in 92.0% (n = 80) of salivary leaks, with ampicillin/sulbactam (58.7%, n = 47) being the most commonly used regimen, followed by cefazolin/metronidazole (16.2%, n = 13) and amoxicillin/clavulanate (12.5%, n = 10). Purulent neck infection developed in 44.8% (n = 39) of cases. Forty-four (50.6%) patients with salivary leaks returned to the operating room (RTOR), on average at 10.1 days postoperatively. Top reasons prompting RTOR were persistent or worsening drainage (81.8%, n = 36), wound breakdown (68.2%, n = 30), and neck erythema/pain (43.2%, n = 19). Operative management of leaks employed debridement and re-inset without additional flap surgery in 88.6% of cases (n = 39). Patients requiring a second RTOR after the initial debridement were more likely to require flap-based coverage (44.4% vs 11.4%, P = .02). Overall, repeat RTOR was needed in a minority of cases (20.5%, n = 9/44; P > .99 between debridement/re-inset and flap-based groups). Notably, the proportion of infected salivary leaks significantly increased (P < .001) as management escalated from conservative (25.6%) to first RTOR (60.0%), to repeat RTORs (77.8%).

Conclusions: Salivary leaks carry significant risk for bleeding and flap loss and may present with infection despite antibiotic use. Concurrence of infection with salivary leak drives escalation towards more aggressive management. Flap-based coverage or flap-preserving debridement with re-inset showed comparable effectiveness; yet both may require repeat RTORs and still culminate in adverse outcomes such as persistence and readmission. Future directions can be targeted to identify risk factors of salivary leak development, adverse progression, and implementation of preventive strategies to improve outcomes.

References: 1. Piazza C, Montenegro C, Vander Poorten V. Preventing and managing pharyngocutaneous fistula after total laryngectomy - A narrative review. Front Oncol. 2025;15. doi:10.3389/fonc.2025.1597538

Background: Orbital compartment syndrome (OCS) is a vision-threatening emergency caused by acute elevation of intraorbital pressure, requiring prompt recognition to prevent irreversible visual loss. Despite its heterogeneous etiologies, the literature remains fragmented and predominantly focused on traumatic and postoperative causes. Objectives: This scoping review aimed to comprehensively identify and classify all etiologies of OCS reported in the literature. Methods: This scoping review followed PRISMA-ScR guidelines. MEDLINE, Embase, Scopus, Cochrane Library, and Web of Science were searched through May 2025 for studies reporting cases of OCS with clearly defined etiologies. Etiologies were classified according to the primary triggering event. Management strategies and visual outcomes were evaluated as secondary endpoints. Results: A total of 126 studies were included, yielding 128 etiological attributions across nine categories. Iatrogenic (41/128; 32.0%) and traumatic (34/128; 26.6%) causes were most frequent, followed by vascular, infectious, and inflammatory/autoimmune etiologies (10/128 each; 7.8%), burn- or fluid resuscitation - related (8/128; 6.3%), neoplastic (6/128; 4.7%), orbital emphysema (5/128; 3.9%), and other causes (4/128; 3.1%). Overall, 1,361 patients were identified. Etiological classification prioritized the initiating cause rather than secondary mechanisms. Emergent cantholysis represented the cornerstone of management, with visual outcomes strongly influenced by etiology and timing of intervention. Conclusions: This review highlights the underrecognized etiologic spectrum of OCS. Prompt cantholysis remain central to management, while visual outcomes vary according to etiology and disease severity.

Background: Severe cherubism is a rare osteoclast-mediated craniofacial disorder characterized by progressive mandibular and maxillary expansive lesions in early childhood. Traditional management relies on serial debulking procedures, often resulting in recurrence, skeletal disruption, and substantial surgical burden. Denosumab, a RANKL inhibitor, represents a novel disease-suppressive alternative; however, safe administration in skeletally immature patients remains undefined. We report longitudinal outcomes from two patients to refine dosing and monitoring strategies and inform pediatric use. Methods: A case series was conducted in patients with genetically confirmed severe, symptomatic cherubism treated with denosumab and who were followed longitudinally. Dosing regimens, metabolic surveillance, skeletal complications, and clinical and radiographic outcomes were analyzed. Results: Patient 1 initiated denosumab at age 2 for refractory disease after five debulking procedures. He received an initial loading dose of 20 mg weekly for 4 weeks followed by 20 mg every 4 weeks. Clinical and radiographic disease stabilization was achieved, but prolonged therapy resulted in multiple long-bone fragility fractures and severe rebound hypercalcemia following cessation (peak Ca 19.6 mg/dL), requiring several hospitalizations. Subsequently, a modified low-dose protocol with structured laboratory surveillance was implemented for Patient 2. Weekly 10 mg loading doses followed by maintenance dosing of 10 mg every 4 weeks, combined with proactive electrolyte management, achieved radiographic and clinical improvement without fractures or metabolic complications at 9-month follow-up.
Conclusion: Denosumab represents a disease-modifying strategy for severe pediatric cherubism that may reduce the need for serial surgery. However, skeletally immature patients are uniquely vulnerable to metabolic and skeletal complications due to increased bone turnover. This series proposes a refined dosing and surveillance algorithm to improve safety and inform use in pediatric osteoclastic-driven disease.

Background: Persistent extradural dead space following cranioplasty has been proposed as a risk factor for infection, implant removal, and repeat reconstruction (1). However, its impact on outcomes remains poorly characterized. This study evaluates the association between dead space and postoperative complications in patients undergoing revision cranioplasty at a single academic center.

Methods: A retrospective chart review was conducted of patients who underwent cranioplasty between 2015 and 2025. Patients (≥18 years) who subsequently required revision cranioplasty with documented follow-up were included. The analysis focused on patients undergoing multiple cranioplasties to identify factors associated with the indication for revision. We evaluated whether the presence of dead space, cranioplasty type, and estimated defect size were associated with revision indications, including intractable infection, exposed hardware, and bone flap resorption. Categorical variables were analyzed using Fisher's exact test, and odds ratios (OR) with corresponding p-values were calculated.

Results: Among 681 cranioplasty patients identified, 97 met inclusion criteria. Dead space was associated with intractable infection as the indication for secondary cranioplasty (p=0.035). Intractable infection occurred in 16/49 (32.7%) patients without dead space compared to 24/43 (55.8%) patients with dead space (OR 2.61). Neither reason for the initial skull defect leading to primary cranioplasty nor operative duration was associated with infection. Frontal sinus involvement was not significantly associated with infection (p=0.52; OR 1.92). Dead space management techniques included vascularized flap coverage (n = 3), fat grafting (n = 1), and dural tacking sutures (n = 2), though case numbers were insufficient for comparative analysis.

Conclusions: Extradural dead space was significantly associated with intractable infection requiring secondary cranioplasty, suggesting that failure to adequately obliterate this space may meaningfully impact reconstructive outcomes. These findings highlight the importance of careful intraoperative assessment and management of dead space during cranioplasty. Further study is needed to define optimal strategies for dead space obliteration.

References: 1. Stefanko A, Daly GE, Alturky S, et al. Management of Extradural Dead Space During Cranioplasty-A Scoping Review. FACE. 2024;5(4):596-604. doi:10.1177/27325016241291241

Background: Orofacial clefts (OFC) arise from a complex of genetic and environmental factors. However, environmental contributions are poorly understood. Prior work from our group demonstrated OFC rates were recorded at nearly 400% higher in the Fox River Valley (FRV) region of Wisconsin than expected in general population studies. This rate declined by 50% after an Environmental Protection Agency (EPA) Superfund cleanup between 1988 and 2025. This temporal pattern suggests an association between environmental contaminants and the pathogenesis of OFC development in utero. The aim of this study is to identify contaminants associated with OFC development in the FRV for further investigation.

Methods: Contaminant data from Wisconsin Department of Natural Resources (DNR) remediation and EPA Superfund site reports in the FRV were cross-referenced with chemicals identified in a scoping review of environmental exposures associated with OFCs in the published literature. From this, a list of regionally prevalent chemicals with potential links to OFC development was generated. A systematic literature search into ten region-specific candidate chemicals was performed using Pubmed, with priority given to human epidemiological data when available.

Results: 112 studies assessing candidate chemicals in relation to OFC development were identified. Of the ten regionally prevalent chemicals identified in remediation efforts, several inorganic metals-Aroclor 1242, Aroclor 1254, 2,3,7,8-tetrachlorodibenzo-p-dioxin, PFOS, 2,3,4,5,3′,4′-HCB, pyrene, barium, cadmium, and lead-were highly represented as risk factors for OFCs. Zinc was identified as a potential protective factor. However, there is a paucity of data on remediation-targeted contaminants linked to paper mill pollution, including PCBs, PAHs, and chlorinated pesticides in the context of OFC development.

Conclusion: EPA and DNR data were used to identify ten region-specific environmental contaminants with potential links to OFCs. In the FRV, regionally specific contaminants targeted by remediation efforts were shown to be under-represented in OFC risk factor literature, suggesting promising directions for future research. Better understanding of regionally prevalent contaminants in OFC incidence patterns will provide insights into environmental determinants of OFC prevalence, closing a gap in the literature between established risk factors and the complex realities of environmental contamination. Next steps include collaboration with researchers in the Departments of Developmental Biology and Toxicology to conduct in vitro studies examining the epigenetic effects of these contaminants on OFC development. At the policy level, these results may justify stronger regulations and promote education on teratogenic risks and further targeted cleanup efforts, like the Ensuring Lasting Smiles Act.

Introduction: Dental rehabilitation helps to restore functional mastication following mandibular and maxillary oncologic reconstruction. At Memorial Sloan Kettering Cancer Center, immediate dental implant placement (IDIP) is performed at the time of reconstruction. A second operation is needed to uncover the implants and occasionally contour the fibula skin paddle for seating of the dental prosthesis. However, medical, surgical and oncologic factors may delay or prevent timely implant uncovering and subsequent dental rehabilitation. This study evaluates 1) the factors that impact timing of dental implant uncovering and 2) the effect of dental rehabilitation on patient-reported outcomes (PROs) in patients undergoing head and neck reconstruction with fibula free flaps (FFF).

Methods: We identified 149 patients who underwent mandible or maxillary reconstruction with a FFF and IDIP from 2017 to 2025. Demographics, oncologic history, and postoperative surgical complications were collected. PROs were evaluated using the FACE-Q Head and Neck Cancer module. Patients were stratified based on whether they underwent dental rehabilitation. Dental implant uncovering was considered delayed if it occurred after radiation or more than 8 weeks after the index surgery for patients that did not require radiation.

Results: Of 149 patients, 85 (57%) underwent dental rehabilitation. The median age was 65 years, and the median BMI was 25.9 kg/m2. 129 (87%) underwent mandibular reconstruction, and 20 (13%) underwent maxillary reconstruction. The majority of patients were White (67%), male (68%), and never smokers (52%). Adjuvant therapy consisted of radiation in 52% of patients and chemotherapy in 20% of patients. Overall, the rate of surgical complications was similar in the two cohorts. Patients with longer hospital length of stays during the index operation were less likely to undergo subsequent dental implant uncovering (p=0006). Multivariable analysis showed preoperative radiation (OR 0.30, p=0.04) and 30-day complications (OR 0.46, p=0.04) significantly lowered the odds of undergoing dental rehabilitation, and the impact of early complications on delayed implant uncovering trended towards significance (OR 2.56, p=0.07). Temporal trends in FACE-Q analysis revealed patients who underwent dental rehabilitation demonstrated substantial, long-term recovery of postoperative scores compared to those who did not undergo dental rehabilitation. At two years postoperatively, patients with dental rehabilitation had greater satisfaction in the domains of appearance (p=0.04), eating and drinking (p=0.003), eating distress (p=0.006), smiling (p=0.02) and smiling distress (p=0.02). On multivariate linear regression analysis, dental rehabilitation remained a significant predictor of greater satisfaction in all domains when controlling for age at surgery, BMI, smoking status, and radiation.

Conclusion: This is the first study to evaluate the factors delaying dental implant uncovering and the impact of dental rehabilitation on PROs. In this cohort, preoperative radiation and early complications decreased the likelihood of dental rehabilitation. Patients that underwent dental rehabilitation had higher scores across several FACE-Q domains and achieved long-term improvement in satisfaction compared to those that did not receive dental rehabilitation. Our results suggest that dental rehabilitation positively impacts patient-reported recovery trajectories after oncologic reconstruction, emphasizing its importance in improving health-related quality of life.

Background: Midface hypoplasia is a hallmark feature of Crouzon syndrome, and the resulting maxillary retrusion often causes a skeletal Class III malocclusion (1,2). In addition to craniosynostosis, this morphologic difference increases the risk for upper airway obstruction and subsequent obstructive sleep apnea (OSA), which, in severe cases, may require placement of a definitive or surgical airway (3). Therefore, the objective of this study is to determine the degree of midface hypoplasia that may be associated with airway compromise in patients with Crouzon syndrome.

Methods: A retrospective chart review of patients diagnosed with Crouzon Syndrome between 2012-2023 was conducted. Wits appraisal, which measures the degree of anteroposterior dysplasia between the maxilla and mandible at the occlusal plane, was performed to assess the severity of midface hypoplasia on craniofacial computed tomography scans. Negative Wits values indicate that the maxilla is posterior to the mandible at the occlusal plane.

Results: Of the 21 patients included, fifteen (71.4%) were White and thirteen (61.9%) were female. The average age at the time of the index craniosynostosis operation was 2.09 years (range: 0.25 to 10.3 years). Eleven (52.4%) patients had >3 sutures fused preoperatively while the remaining patients (47.6%) had ≤ 3 sutures fused. The coronal suture was most frequently involved (42.9%), followed by sagittal (17.1%) and lambdoid (17.1%), metopic (12.9%), and squamosal (0.1%). Thirteen patients had a diagnosis of OSA, and five patients required tracheostomy placement. While the average Wits appraisal across the entire cohort was -4.54 millimeters (mm), there was no significant difference between the Wits appraisal for the patients diagnosed with OSA versus those without OSA (-4.34 mm vs. -4.83 mm, p = 0.861). However, patients who required tracheostomy placement had significantly lower Wits values compared to patients who did not require a tracheostomy (-9.56 mm vs. -2.86 mm, p = 0.02).

Conclusion: In patients with Crouzon syndrome, the maxilla was positioned 4-5 millimeters posterior to the mandible. Patients requiring a tracheostomy demonstrated greater maxillary discrepancy, approximately 7 millimeters more retrusive, compared to patients who did not receive a tracheostomy. The Wits appraisal may serve as a screening and evaluative tool to identify patients at increased risk of requiring tracheostomy. Future studies with larger sample sizes should be conducted to determine the range of values that increases this risk.

References 1. Dias MS, Samson T, Rizk EB, Governale LS, Richtsmeier JT; SECTION ON NEUROLOGIC SURGERY, SECTION ON PLASTIC AND RECONSTRUCTIVE SURGERY. Identifying the Misshapen Head: Craniosynostosis and Related Disorders. Pediatrics. 2020;146(3):e2020015511. doi:10.1542/peds.2020-015511 2. Abu-Sittah GS, Jeelani O, Dunaway D, Hayward R. Raised intracranial pressure in Crouzon syndrome: incidence, causes, and management. J Neurosurg Pediatr. 2016;17(4):469-475. doi:10.3171/2015.6.PEDS15177 3. Tan HL, Kheirandish-Gozal L, Abel F, Gozal D. Craniofacial syndromes and sleep-related breathing disorders. Sleep Med Rev. 2016;27:74-88. doi:10.1016/j.

Introduction: Postoperative pain following orthognathic surgery is commonly managed with opioid analgesics, which carry significant adverse effects and public health implications. Regional nerve blocks have emerged as an adjunct strategy to reduce pain and opioid consumption, but variability in technique and outcome reporting limits definitive surgical recommendations. This study evaluates the impact of perioperative nerve blocks on postoperative pain and related outcomes in orthognathic surgery.

Methods: A PRISMA-adherent systematic review was conducted and registered in PROSPERO (ID: 1276580). PubMed/MEDLINE, Embase, Scopus, and CENTRAL were searched from inception through December 2025 using a predefined keyword search strategy. Eligible studies included patients undergoing Le Fort I osteotomy, bilateral sagittal split ramus osteotomy (BSSO), or bimaxillary surgery with bilateral nerve blocks and reported postoperative pain outcomes. The primary outcome was postoperative pain, measured using patient-reported scales and linearly transformed to a standardized 0–100 scale. Secondary outcomes included postoperative nausea and vomiting (PONV) and analgesic use. Meta-regression was performed to evaluate associations between block type, anesthetic composition, ultrasound guidance, injector specialty, and postoperative pain outcomes.

Results: Twenty-one studies (n = 1,417 patients; mean age 22.7 ± 8.5 years) met inclusion criteria. Nerve block approaches included maxillary/mandibular (11 studies), inferior alveolar (5), trigeminal (1), cervical plexus (1), and mixed techniques (3). Five studies were included in quantitative pooling of pain outcomes. Nerve blocks were associated with significantly lower postoperative pain on the standardized 0–100 scale (MD –12.25; 95% CI –17.25 to –8.32, I2 = 93.9%). The test for subgroup differences across time windows was not significant (p = 0.99), suggesting no effect modification by postoperative time window in the first 24 hours. No significant difference was observed in PONV across seven studies (RR 0.82; 95% CI 0.35 to 1.95; p = 0.66). Meta-regression demonstrated lower pain scores with maxillary blocks compared to inferior alveolar blocks (estimate –16.24, 95% CI –23.10 to –9.37, p < 0.001) and lower scores with bupivacaine compared to ropivacaine (estimate –8.91, 95% CI –16.03 to –1.79, p = 0.014). Ultrasound guidance and injector specialty were not associated with pain outcomes.

Conclusions: Our study confirms the analgesic benefit of nerve blocks within 24 hours of orthognathic surgery, with significant pain reduction compared to control groups. Given the variety of variables influencing nerve block efficacy, including anatomical target, surgical procedure, and anesthetic composition, additional research is warranted to elucidate optimal methods of perioperative anesthesia in orthognathic surgery.

Introduction: Infants born with cleft lip and/or palate experience disrupted oral pressure mechanics that compromise effective feeding and leave exposed structures vulnerable to mechanical trauma. This can result in irritation and eventual ulceration of oral structures such as the vomer, which may further impair feeding and contribute to poor weight gain. This study aims to characterize the incidence of vomer ulceration and evaluate its impact on feeding and investigate the risk of failure to thrive. Methods: We retrospectively identified infants born with cleft lip and/or palate <6 months old initial presentation to our institution. Patient demographics, cleft phenotype, growth and feeding parameters, and presence of vomer ulceration, and history of failure to thrive. Failure to thrive was determined by ICD-10 code diagnoses or inpatient readmission for failure to thrive or poor weight gain. Results: In a cohort of 114 patients, we had 62 (54.4%) males and 52 (45.6%) females. Mean birth weight was 3.10 +/- 0.66 kg and 10 patients (9.6%) were preterm. Vomer ulceration was identified in 17 infants (14.9%). Cleft phenotypes among affected patients included complete unilateral cleft lip and palate (6/17, 35.3%), bilateral complete cleft lip and palate (9/17, 52.9%), and Veau II cleft palate (2/17, 11.8%). The average age at identification was 7.3 days of life. All ulcerations resolved without intervention aside from modification of bottle type and feeding technique, but exact time to resolution could not be fully characterized. Using Fischer exact test, the presence of vomer ulceration was not found to be significantly associated with failure to thrive in both the overall cohort (p=0.175), and upon sub-analysis of patients with combined cleft lip and palate (p=0.45). Conclusion: Vomer ulceration in patients with oral clefts appear to transiently arise in the first weeks of life from improper bottle feeding with spontaneous resolution following modification. Early analysis suggests a potential predilection for combined cleft lip and palate phenotypes while definitive association with failure to thrive cannot be presently established.

Purpose: Antidepressant medications are among the most commonly prescribed drugs in the United States. As demand for aesthetic facial plastic surgery continues to rise, perioperative management of patients receiving these agents has become increasingly relevant. Prior studies have primarily focused on serotonergic antidepressants, suggesting potential effects on platelet aggregation, hemostasis, and wound healing (1). However, antidepressants encompass multiple pharmacologic classes with diverse mechanisms, and their overall impact on postoperative outcomes in facial plastic surgery remains incompletely defined. This study aims to evaluate the association between preoperative antidepressant exposure and postoperative complications following aesthetic facial plastic surgery procedures.

Methods: A retrospective cohort study was conducted using the TriNetX Research Network, a multicenter electronic health record database. Patients undergoing rhinoplasty, blepharoplasty, or rhytidectomy were identified. Patients were stratified into two cohorts: those with documented antidepressant use, including SSRIs, SNRIs, TCAs, MAOIs, and atypical agents, within six months prior to surgery, and those without antidepressant exposure. Propensity score matching (1:1) was performed to adjust for age, sex, race, body mass index, hypertension, diabetes, and nicotine dependence. Postoperative outcomes were assessed at 30 days, 90 days, 6 months, and 1 year, including surgical site complications, wound-related complications, wound disruption, infection, postoperative bleeding, seroma or hematoma, and emergency department visits or hospital readmission. Risk ratios (RR) with 95% confidence intervals (CI) were calculated.

Results: After propensity matching, 36,128 patients were included (18,064 per cohort). At 1 year, antidepressant exposure was associated with higher rates of any surgical site complication (3.40% vs. 2.30%; RR 1.48, 95% CI 1.30–1.69; p<0.0001). Infection was significantly more common among antidepressant users (3.19% vs. 2.21%; RR 1.44, 95% CI 1.26–1.65; p<0.0001), along with wound-related complications (1.22% vs. 0.91%; RR 1.34; p=0.0047) and seroma or hematoma (0.28% vs. 0.16%; RR 1.73; p=0.0175). Postoperative bleeding (0.47% vs. 0.34%; RR 1.39; p=0.0495) and wound disruption (0.93% vs. 0.74%; RR 1.26; p=0.0489) were also increased. Emergency department visits or readmissions were more frequent among antidepressant users (3.85% vs. 3.27%; RR 1.18; p=0.0114). Similar trends were observed at earlier intervals. At 6 months, antidepressant users had higher risks of overall complications (RR 1.35; p<0.0001), infection (RR 1.47; p<0.0001), and seroma or hematoma (RR 1.85; p=0.0237). At 90 days, increased risks of overall complications (RR 1.25; p=0.011) and infection (RR 1.52; p<0.0001) were observed. At 30 days, infection was the only outcome reaching statistical significance (RR 1.44; p=0.0098).

Conclusion: Preoperative antidepressant use was associated with increased postoperative complications following aesthetic facial plastic surgery, particularly infection, wound-related morbidity, and unplanned readmissions. Risk differences became more pronounced over longer follow-up intervals. These findings represent associations rather than causation but suggest that antidepressant exposure should be considered during preoperative risk assessment and patient counseling. Further prospective studies are needed to clarify underlying mechanisms and inform perioperative management strategies.

References: 1. Grech J, Chan MV, Ochin C, et al. Serotonin-Affecting Antidepressant Use in Relation to Platelet Reactivity. Clin Pharmacol Ther. 2022;111(4):909-918. doi:10.1002/cpt.2517