Effect of Preoperative Botulinum Toxin A on Pain and Opioid Consumption After Bilateral Sagittal Split Osteotomy: A Randomized Clinical Trial

Preoperative BoNT-A was associated with reduced preanalgesic pain and lower postoperative opioid use following mandibular advancement via BSSO. Although temporal trends favored BoNT-A, differences in daily trajectories of pain, muscle spasms, and nonopioid use were not statistically significant. These findings provide preliminary support for BoNT-A as a potential adjunct in postoperative pain management, warranting further evaluation in larger, adequately powered trials.