Pseudoaneurysm After Orthognathic Surgery: Expanding the Evidence and Proposing a Framework for Diagnosis and Management After 38 Years of Publications

BACKGROUND: Pseudoaneurysm is a rare but serious vascular complication of orthognathic surgery, typically presenting with delayed or recurrent bleeding. Evidence is limited to small case series. This systematic review provides the largest synthesis to date and includes 1 new institutional case. METHODS: Following PRISMA 2020 and PROSPERO registration (CRD420251207990), we searched PubMed, Scopus, Web of Science, and Google Scholar (1987-2025) for imaging-confirmed pseudoaneurysms after orthognathic surgery. Demographic, clinical, diagnostic, and therapeutic data were extracted and analyzed descriptively. RESULTS: Fifty-five published cases met the inclusion criteria, plus 1 institutional case (n=56). Most occurred after Le Fort I or bimaxillary surgery and involved branches of the internal maxillary artery, particularly the sphenopalatine and maxillary arteries. Median time to first symptoms was 14 days, with over half of patients experiencing recurrent bleeding before diagnosis. Endovascular embolization was used in 85% of cases and had the lowest failure rate (14.3%). Complications were uncommon and generally transient. CONCLUSION: Pseudoaneurysm after orthognathic surgery is rare but potentially life-threatening. Prompt angiographic evaluation and super-selective embolization are critical for effective management.