Orthognathic Surgery in Syndromic Craniosynostosis: A Narrative Review of Predictive Factors and Outcomes

Syndromic craniosynostosis presents significant surgical challenges, requiring staged management from infancy through adolescence. Early interventions such as cranial vault expansion and midface advancement address intracranial pressure, airway compromise, and psychosocial concerns, yet often residual midface retrusion and malocclusion persists or re-develops by skeletal maturity. Orthognathic surgery is therefore frequently required, but early predictors of this long-term need remain poorly defined. For this narrative review, relevant English-language articles published between 2004 and 2024 were identified by searching PubMed using a combination of MeSH terms and free-text keywords (“Craniosynostoses/surgery,” “Orthognathic Surgery,” and “Syndromic Craniosynostosis”). Reference lists of key papers were manually searched to identify additional studies. Eligible publications included peer-reviewed clinical studies, outcome reports, and reviews describing orthognathic surgery in syndromic craniosynostosis, with particular focus on prognostic factors. Data were extracted and synthesised thematically. Eighteen studies met the inclusion criteria. The severity of midface hypoplasia, especially as measured by SNA angle and morphometric CT analyses, emerged as the most consistent indicator of orthognathic need. Most Apert and Crouzon patients required definitive orthognathic procedures despite earlier midface advancement, while Muenke patients demonstrated a lower likelihood of further intervention. Orthognathic surgery was consistently reported as safe and produced occlusal outcomes comparable to nonsyndromic populations. In conclusion, although midface retrusion severity correlates with surgical need, validated predictive tools are lacking. Exploratory and further longitudinal research is required to improve prognostication tools and guide surgical sequencing in this high-need patient group.