Objective To explore the effect of modified oral nursing combined with standardized four-handed operation on facial symmetry and surgical scar appearance in patients after oral and maxillofacial surgery. Methods A total of 76 patients who underwent elective maxillofacial surgery in the Department of Stomatology, China-Japan Friendship Hospital from May 2022 to May 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 38 patients in each group. The control group received conventional oral nursing and single-person surgical cooperation, and the observation group received modified oral nursing combined with standardized four-handed operation. The facial symmetry, surgical scar appearance, subsidence time of facial swelling, excellent and good rate of oral hygiene and facial aesthetic satisfaction were compared between the two groups. Results The scores of facial symmetry and surgical scar appearance in the observation group were higher than those in the control group (P <0.05). The subsidence time of facial swelling in the observation group was shorter than that in the control group (P <0.05). The excellent and good rate of oral hygiene in the observation group (94.74%) was higher than that in the control group (76.32%) (P <0.05). The facial aesthetic satisfaction rate of the observation group (97.37%) was higher than that of the control group (78.95%) (P <0.05). Conclusion Modified oral nursing combined with standardized four-handed operation can reduce intraoperative soft-tissue traction injury, accelerate postoperativefacial edema absorption, improve surgical wound healing quality, optimize facial symmetry and surgical scar appearance, and help to improve oral hygiene level. At the same time, it meets patients’ demands for postoperative facial appearance rehabilitation, which has definite clinical application value.