A common predictive measure of postoperative nausea and vomiting (PONV) is the 
Apfel score. Although tested in many different operations, it has not been 
tested extensively in oral and maxillofacial surgery (OMFS). This study was 
designed to determine whether it applied to OMFS and whether there were other 
factors in this population that would improve its accuracy. A retrospective 
chart review was carried out on a randomly selected group of patients who had 
OMFS during a 10-month period. In addition to the Apfel score risk factors, PONV 
data were collected in relation to type of anesthetic induction and maintenance, 
type of surgery, use of maxillomandibular fixation (MMF), use of opioids, and 
anesthesia and surgery times. One-hundred and sixty-seven patients were included 
in the analysis; 24% had nausea and 11% had nausea and vomiting. Patients who 
had orthognathic or temporomandibular joint surgery had the highest rate of 
PONV. Young age, anesthesia and operation time, and use of MMF were also 
associated with increased PONV. Adding age, MMF or limited postoperative mouth 
opening, and surgery type to the Apfel score should make it more predictive in 
OMFS.