Patients’ perception of improvement after orthognathic surgery: Pilot study

Health-related quality of life and satisfaction following orthognathic surgery: a prospective cohort study

PURPOSE

This study investigates the motivations for orthognathic surgery and assesses the quality of life (QoL) and satisfaction among patients treated at a hospital over 12 months.

METHODS

We employed an Arabic version of the Orthognathic Quality of Life Questionnaire (OQLQ), used pre-surgery and at 2 weeks, 3 months, and 6 months post-surgery. This included demographic data, the OQLQ, and visual analogue scales (VAS). The OQLQ, originally by Cunningham et al., was translated and adapted by Al-Asfour et al. Additional validated questions were added to both pre- and post-operative surveys.

RESULTS

Of 136 participants (51 males, 85 females, average age 25.1), most underwent surgery for facial aesthetics (85.2%) and bite correction (57.3%). Treatments included various osteotomies. OQLQ scores significantly dropped from 63.3% pre-surgery to 23% at 6 months, showing QoL improvement. 97.8% reported better psychological status post-surgery (p = 0.0001), with 94.1% satisfaction at 6 months (p = 0.0001).

CONCLUSION

The orthognathic surgery yielded positive outcomes in functional and psychological aspects, leading to high satisfaction and improved QoL in patients with dentofacial deformity.

Investigation of orthognathic surgery indicators-combination with index of orthognathic functional treatment needs (IOFTN) and maxillofacial morphometric analysis

PURPOSE

The aim of this retrospective study was to determine orthognathic surgery indicators for Japanese patients with jaw deformities using both Index of Orthognathic Functional Treatment Needs (IOFTN) and maxillofacial morphometric analysis.

SUBJECTS AND METHODS

The subjects were 89 patients treated with orthognathic surgery and 92 patients treated with orthodontic treatment alone, and were classified as class I, II, or III according to the ANB angle. Based on the results for IOFTN and the results of cephalometric analysis, the indication criteria for orthognathic surgery were examined.

RESULTS

In IOFTN analysis, none of patients in the orthognathic surgery group were classified as category 1 or 2, while 48% of the patients in the orthodontic treatment group were classified as category 4 or 5. The results of the cephalometric analysis of patients in classified categories 4 and 5 showed that the orthognathic surgery group had significantly greater lateral mandibular deviation in Class I cases, significantly more severe degree of mandibular retrusion in Class II cases, and significantly more severe degree of mandibular prognathism in Class III cases. The results of the logistic regression analysis showed that IOFTN was a common variable as an indication criterion for orthognathic surgery, and several different variables were also selected from the cephalometric measurements in each group.

CONCLUSION

IOFTN is a highly sensitive and useful indicator as a criterion for orthognathic surgery. However, in the choice of treatment strategy, maxillofacial morphometric analyses and the patient's desired goal are important.

Improvement on oral health related quality of life after orthosurgical treatment: a mixed methods study

The aim of this study was to understand the influence of orthosurgical treatment on oral health-related quality of life (OHRQoL) in patients with Class II and III skeletal malocclusion by conducting a mixed method case series study. Nineteen patients submitted to orthosurgical treatment in a private practice in Brazil were included in the sample. Data were collected retrospectively and interviews were held from March 2020 to July 2021. Patients answered to the Oral Health Impact Profile (OHIP-14) in the first part of the interview and subsequently answered the qualitative questions. The overall mean of OHIP-14 after treatment was 4.21 (SD 4.68). The qualitative data were analyzed according to thematic analysis and four themes emerged from the interviews: a) concept of quality of life, b) pre-treatment life, c) post-treatment life, and d) positive and negative aspects of treatment. Quality of Life was reported by the patients as the absence of feeling pain, having emotional and physical health, having a satisfactory esthetic appearance and self-esteem. Before treatment, most Class II patients used to complain about breathing and sleeping problems, while Class III patients complained more intensely about esthetics. Pain was a common problem reported by both Class II and Class III patients. In general, improvement was perceived in self-esteem, esthetics, function and pain. Complaints about negative aspects of the treatment were restricted to the postoperative period. The orthosurgical treatment was important for improving the OHRQoL of patients in terms of esthetic, functional and psychosocial aspects.

What factors influence the cost of orthognathic surgery among patients in the US?

OBJECTIVE

The purpose of our study was to analyze what factors influence the cost of orthognathic surgery performed within the US.

STUDY DESIGN

This retrospective cohort study was completed using the Kids' Inpatient Database (KID) from 2000 to 2012 on all patients aged 14 to 20 years who had undergone orthognathic surgery. The predictor variables included patient and hospitalization characteristics. The primary outcome variable was hospital charge ($). Multivariate linear regression was conducted to determine independent predictors for increased/decreased hospital charge.

RESULTS

The final sample consisted of 14 191 patients (mean age, 17.4 ± 1.6 years; females, 59.2%). Each additional day in the hospital added $8123 in hospital charges (P < .01). Relative to mandibular osteotomy, maxillary osteotomy (+$5703, P < .01) and bimaxillary osteotomy (+$9419, P < .01) were each associated with increased hospital charges. Genioplasty (+$3499, P < .01), transfusion of packed cells (TPC) (+$11 719, P < .01), continuous invasive mechanical ventilation (CIMV) <96 hours (+$23 502, P < .01), and CIMV ≥96 hours (+$30 901, P < .01) were each associated with significantly increased hospital charges. Obstructive sleep apnea (OSA) added $6560 in hospital charges (P < .01).

CONCLUSIONS

Maxillary osteotomy and bimaxillary surgery were each associated with significantly increased charges relative to mandibular osteotomy. Concomitant genioplasty, TPC, CIMV, and OSA each significantly increased the charges. Each additional day to the length of stay significantly increased the charges.

Assessment of Quality of Life in Class III Patients Undergoing Orthognathic Surgery

Objective

This study sought to evaluate the quality of life in patients with class III malocclusion and dentofacial deformity undergoing orthognathic surgery.

Materials and Methods

This study evaluated 25 patients with Angle's class III malocclusion submitted to orthognathic surgery through the application of the B-OQLQ questionnaire, over two periods: 30 days before surgery (T0) and 6 months after surgery (T1). The B-OQLQ is a specific questionnaire to assess quality of life in patients with dentofacial deformities.

Results

The average age for women was 26.11 years and for men 31.13 years. The dental discrepancy between the incisors (overjet) was on average 2.55 ± 4.36 mm. There was no correlation between overjet and the level of satisfaction after surgery. There was no statistically significant relationship between patient satisfaction and the type of surgery performed. The results revealed statistically significant differences, showing improvement in the quality of life in the postoperative period of 6 months (p < 0.05), with a positive effect in all four domains of the questionnaire.

Conclusion

Orthognathic surgery significantly improved the quality of life of patients, and the type of questionnaire used (B-OQLQ) proved to be appropriate for the proposed analysis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-022-01771-w.

Causes of Reoperation Consultation and Clinical Review of Actual Reoperation After Previous Orthognathic Surgery

OBJECTIVE

To investigate the causes of reoperation consultation, and the actual percentage and procedures of reoperation after previous orthognathic surgery.

METHODS

The samples consisted of 30 patients who visited our clinic for reoperation consultation from October 2015 to September 2021 (6 males and 24 females; mean age at reoperation consultation, 28.4 y). Patient's causes of reoperation consultation were divided into "esthetic dissatisfaction," "airway changes," "temporomandibular disorders," "uncomfortable occlusion," and "other complications". In terms of esthetic dissatisfaction, the more detailed esthetic problem was evaluated by the clinical chart, facial photographs, and radiographs. In patients who actually underwent reoperation, the actual percentage and procedures of reoperation were investigated.

RESULTS

The most prevalent causes for reoperation consultation were "esthetic dissatisfaction" (n = 21, 70.0%), followed by "airway changes" (n = 11, 36.7%), "uncomfortable occlusion" (n = 8, 26.7%), "other complications" (n = 5, 16.7%), and "temporomandibular disorder" (n = 4, 13.3%). Less than half of patients actually underwent reoperation (n = 13, 43.3%). Actual reoperation procedures included minor revision surgery, reconstruction surgery, or complete reoperation according to the patient's need. In case of complete reoperation, more accurate and predictable results were obtained by using virtual surgical planning, customized surgical guides, titanium surgical plates made with computer-aided design and computer-aided manufacturing technique, and a 3-dimensional printing method.

CONCLUSION

It is important to communicate with patients about expectations for facial esthetic improvement by orthognathic surgery for obtaining the patient's postoperative satisfaction.

Starting a Swedish national quality registry for orthognathic surgery: a tool for auditing fundamentals of care

BACKGROUND

National quality registries (NQRs) provide open data for user-directed acquisition. National Quality Registry (NQR) data are often used to analyze the rates of treatment success and adverse events for studies that aim to improve treatment quality and patient satisfaction. Thus, NQRs promote the goal of achieving evidence-based therapies. However, the scientific literature seldom focuses on the complex process of initiating, designing, and implementing an NQR. Starting an NQR may be particularly challenging in a setting where specialized care is decentralized, such as orthognathic surgery in Sweden. The present study describes the initiation and early phases of a new NQR for orthognathic surgery in Sweden.

METHODS

The initial inventory phase included gaining knowledge on regulations, creating economic plans, and identifying pitfalls in existing NQRs. Next, a crude framework for the registry was achieved. Outcome measures were selected with a nation-wide questionnaire, followed by a Delphi-like process for selecting parameters to include in the NQR. Our inclusive process comprised a stepwise introduction, feedback-based modifications, and preparatory educational efforts. Descriptive data were collected, based on the first 2 years (2018-2019) of registry operation.

RESULTS

Two years after implementation, 862 patients that underwent 1320 procedures were registered. This number corresponded to a 91% coverage rate. Bimaxillary treatments predominated, and the most common were a Le Fort I osteotomy combined with a bilateral sagittal split osteotomy (n = 275). Reoperations were conducted in 32 patients (3.6%), and the rate of patient satisfaction was 95%.

CONCLUSIONS

A National Quality Registry should preferentially be started and maintained by an appointed task force of active clinicians. A collaborative, transparent, inclusive process may be an important factor for achieving credibility and high coverage, particularly in a decentralized setting.

Patients Satisfaction and Nasal Morphologic Change after Orthognathic Surgery

Background:

Patients’ attitudes about their nose changes after orthognathic surgeries. We aimed to evaluate the patient’s opinion about nasal change and morphologic changes following orthognathic surgery.

Methods:

This was a cross-sectional study. The sample was derived from the population of patients who underwent orthognathic surgery in the Oral and Maxillofacial Surgery Department of Shahid Beheshti University of Medical Sciences, Tehran, Iran between 2017 and 2019. Subjects who underwent orthognathic surgery were studied. Subjects filled a modified nose evaluation form before and nine months after orthognathic surgery. For objective assessment, the nasolabial angle, nasofrontal angle, nasofacial angle, tip projection, and tip deviation and alar width were evaluated. Sixty-two patients were studied.

Results:

Forty (64.5%) patients did not absolutely like their nose before orthognathic surgeries, two (3.2 %) expressed a little satisfaction, 17(27.4%) answered they liked more or less, and three liked very much. Nine months after orthognathic surgeries, 4 (6.5%) patients did not like their nose, nine patients (14.5%) liked a little, 30 (48.4%) liked more or less, and 19 liked very much. Analysis of the data demonstrated a significant difference in patients’ satisfaction with their noses before and nine months after orthognathic surgeries (P<0.001). Patients’ satisfaction nine months after orthognathic surgery was not affected by nasal morphologic changes.

Conclusion:

It seems, patients’ satisfaction with their nose improved after orthognathic surgeries. Patients’ attitude was not associated with nasal morphologic changes.

Impact of orthognathic surgery on quality of life in patients with different dentofacial deformities: longitudinal study of the Oral Health Impact Profile (OHIP-14) with at least 1 year of follow-up

OBJECTIVE

The objective of this study was to assess the impact of orthognathic surgery for dental facial deformities on oral health-related quality of life (OHRQoL) in the immediate postoperative period up to at least 1 year after surgery.

STUDY DESIGN

This prospective study evaluated data from 85 patients. OHRQoL was assessed using the Dutch version of the Oral Health Impact Profile questionnaire (OHIP-14NL) preoperatively (T0), each day for 7 days postoperatively (T1-T7) and 4 weeks (T8), 6 months (T9), and at least 1 year (T10) after surgery. The total OHIP score was calculated for each patient, with higher OHIP scores indicating a worse impact on oral health. Patients also completed an extra questionnaire about self-care, discomfort, and experienced pain (rated on a 10-point scale) in the postoperative period (T1-T10).

RESULTS

The mean OHIP score increased sharply at T1 compared to T0 but decreased significantly in the first postoperative week. The mean OHIP score at T8 was still higher than before surgery. However, at T9 and T10, the mean OHIP score was significantly lower than at T0 (P < .05). No significant difference in OHIP score was found between gender, age, type of surgery, and indication for surgery. Pain significantly decreased from T6 to T0. The OHIP and pain scores significantly positively correlated at every time point except T9.

CONCLUSION

The findings indicate that OHRQoL is reduced from baseline in the immediate postoperative period but improves over time. By 1 year, OHRQoL improves significantly after orthognathic surgery in patients with dentofacial deformities.

Predictability of maxillary positioning: a 3D comparison of virtual and conventional orthognathic surgery planning

Background

Virtual surgery planning (VSP) is believed to reduce inaccuracies in maxillary positioning compared to conventional surgery planning (CSP) due to the elimination of face-bow transfer and laboratory steps. However, there is still a lack of comparative studies for the accuracy of splint-based maxillary positioning in CSP versus VSP. Therefore, the objective of this retrospective, observational study was to compare if splints produced by VSP and CSP reach postoperative outcomes within clinically acceptable limits.

Methods

The planned and actual postoperative results of 52 patients (VSP: n = 26; CSP: n = 26) with a mean age of 24.4 ± 6.2 years were investigated by three-dimensional (3D) alignment with planning software. The conventional treatment plan was digitized, so that the evaluation of both methods was performed in the same manner using the same coordinate system. Inaccuracies were measured by sagittal, vertical and transversal deviations of the upper central incisors and the inclination of the maxillary occlusal plane between the planned and achieved maxillary positions.

Results

Both methods demonstrated significant differences between the planned and actual outcome. The highest inaccuracies were observed in vertical impaction and midline correction. No significant differences between CSP and VSP were observed in any dimension. Errors in vertical and sagittal dimension intensified each other.

Conclusions

In conclusion, splint-based surgeries reached similar results regardless of the applied planning method and splint production.

Decision Making from the Experience of Orthognathic Surgery Patients: A Grounded Theory Approach

Introduction:

Patients’ decisions to undergo major surgery such as orthognathic treatment are not just about how the decision is made but what influences the decision.

Objectives:

The primary objective of the study was to identify the key processes involved in patients’ experience of decision making for orthognathic treatment.

Methods:

This study reports some of the findings of a larger grounded theory study. Data were collected through face-to-face interviews of patients who were seen for orthognathic treatment at a teaching hospital in the United Kingdom. Twenty-two participants were recruited (age range 18–66 y), of whom 12 (male = 2, female = 10) were 6 to 8 wk postsurgery, 6 (male = 2, female = 4) were in the decision-making stage, and 4 (male = 0, female = 4) were 1 to 2 y postsurgery. Additional data were also collected from online blogs and forums on jaw surgery. The data analysis stages of grounded theory methodology were undertaken, including open and selective coding.

Results:

The study identified the central role of dental care professionals (DCPs) in several underlying processes associated with decision making, including legitimating, mediating, scheduling, projecting, and supporting patients’ decisions. Six categories were related to key aspects of decision making. These were awareness about their underlying dentofacial problems and treatment options available, the information available about the treatment, the temporality of when surgery would be undertaken, the motivations and expectation of patients, social support, and fear of the surgery, hospitalization, and potentially disliking their new face.

Conclusion:

The decision-making process for orthognathic treatment is complex, multifactorial, and heavily influenced by the role of DCPs in patient care. Understanding the magnitude of this role will enable DCPs to more clearly participate in improving patients’ decision-making process. The findings of this study can inform future quantitative studies.

Knowledge Transfer Statement:

The results of this study can be used both for informing clinical practice around enabling decision making for orthognathic treatment and also for designing future research. The findings can better inform clinicians about the importance of their role in the patients’ decision-making process for orthognathic treatment and the means to improve the patient experience. It is suggested that further research could be conducted to measure some of the key constructs identified within our grounded theory and assess how these change during the treatment process.

Patient satisfaction after orthognathic surgery: a 3 year follow-up of 60 high-angle Class II individuals

BACKGROUND AND OBJECTIVES

High-angle Class II malocclusion is considered challenging to treat to a stable result and, although studies report treatment outcome in terms of morphology, patient satisfaction has not been addressed. The objectives of the present study were to examine patients' motives for treatment and satisfaction with the results.

MATERIAL AND METHODS

A structured questionnaire was distributed 3 years post-operatively to 93 consecutively treated patients with an initial diagnosis of mandibular-plane angle (ML/NSL) ≥34.0 degrees and ANB angle ≥4.0 degrees. Three surgical subsamples were defined: one-piece Le Fort I, bilateral sagittal split osteotomy, or a combination of the two (Bimax). Lateral cephalometric radiographs were used to assess morphological characteristics and post-treatment changes.

RESULTS

Questionnaire participation was 69.8 per cent. The most frequently reported motives for seeking treatment were to improve oral function (85.0 per cent) and dental appearance (71.7 per cent). Thirty per cent were very satisfied, 53.3 per cent were satisfied, and 16.7 per cent were dissatisfied with the overall treatment result. Dissatisfaction was associated with a persisting post-treatment anterior open bite (AOB), horizontal relapse at B point, and with sensory impairment.

CONCLUSIONS AND IMPLICATIONS

A higher rate of dissatisfaction was found than what has usually been reported for othognathic surgical patients, and this was associated with a persisting AOB. In addition, mandibular relapse and impaired sensory function were related to dissatisfaction and are associated with mandibular surgery. Prospective high-angle Class II patients should be comprehensively informed about the unpredictability of treatment outcomes in terms of occlusion and facial appearance.

Personality traits, psychosocial effects and quality of life of patients submitted to dental bleaching

Background

Perception is defined as the ability to distinguish through the senses. All perception is dependent on factors such as personality, previously lived experiences and cultural elements. When planning an aesthetic treatment, consider the way the patients perceive the changes and outcomes is essential for reaching their expectations. The objective of this study was to assess if there was predominance of a personality trait of patient undergoing dental bleaching and if this treatment could promote changes in this traits, in the psychosocial impact and quality of life of these individuals.

Methods

The assessment of personality characteristics, quality of life, psychosocial and self-perception was a cross-sectional observational study and it was carried out by applying questionnaires to 55 patients that were submitted to a clinical phase. The psychometric instruments used were NEO FFI-R (personality), PIDAQ (psychosocial effect) and WHOQOL-BREF (quality of life). Each test domain was prior and after bleaching by Wilcoxon Signed Rank test (α = 0.05). The internal consistencies of each scale were evaluated by Cronbach's alpha.

Results

No statistical significant differences among personality traits means were observed among participants but there was predominance of two predominant personality traits in this study: conscientiousness (45.5%) and extraversion (34.5%). In four test domains of the PIDAQ, significant differences were observed before and after dental bleaching. The overall perception of the PIDAQ was also statistically significant demonstrating an improvement. There were no differences on overall or specific domains scores of the WHOQOL before and after treatment.

Conclusions

Subjects who underwent dental treatment improved their self-confidence and reduced concerns about dental aesthetics, social and personality impact of dental alterations.

Trial registration

This study was conducted in parallel to a clinical investigation that aimed to evaluate tooth sensitivity related to dental bleaching technique and registered in REBEC clinical registry under protocol RBR-6pt2n3 in 13 November 2013.

Cephalometric and Anthropometric Changes and Their Relation to Patients' Satisfaction After Orthognathic Surgery

OBJECTIVE

The aim of this prospective study was to evaluate the correlation between cephalometric and anthropometric facial changes and satisfaction level of class III patients after bimaxillary orthognathic surgery.

METHODS AND MATERIALS

Totally, 29 class III patients (mean age = 24.23 ± 4.2) undergoing one-piece Lefort 1 osteotomy and mandibular setback were included. Pre- and postoperative lateral cephalograms were taken. Thirteen cephalometric and 17 anthropometric facial measurements were evaluated. A 6-item questionnaire of Rustemeyer's study was used to assess patient's satisfaction after surgery. The Wilcoxon signed-rank test, paired sample t test and Spearman's correlation analysis were used as statistical analysis.

RESULTS

Facial aesthetic and masticatory improvement was highly significant (P < 0.001), while opinion differences between patients and relatives/friends were not significant (P = 0.334). Increased upper lip length (P = 0.037) and decreased nasal tip protrusion-nose height index (P = 0.017) correlated positively with aesthetic improvements after surgery.

CONCLUSION

Although the association between parameters and satisfaction questionnaire was found, other influential factors should be considered before surgery as well.

The Chinese version of Orthognathic Quality of Life Questionnaire (OQLQ-C): translation, reliability, and validity

OBJECTIVES

The aims of this study were to describe the development of a Chinese version of the Orthognathic Quality of Life Questionnaire (OQLQ) and examine its reliability and validity.

METHODS

The original English version of the OQLQ was translated into Chinese (OQLQ-C) by a forward-backward translation method. Psychometric evaluation of the OQLQ-C was carried out on a sample of 126 patients with dentofacial deformities. Reliability of the OQLQ-C was determined by means of internal consistency and test-retest methods, while validity was ascertained by content validity and construct validity.

RESULTS

Internal consistency for total OQLQ-C score was 0.932 (Cronbach's alpha), and the test-retest reliability was 0.913 (Spearman correlation coefficient). Content validity of OQLQ-C was supported by content validity index (CVI) with scale-level (S-CVI) of 0.99 and item-level (I-CVI) of 0.875 to 1. The OQLQ-C was distributed to 4 different factors, and the total variance explained was 67.049%.

CONCLUSIONS

The Chinese version of the OQLQ demonstrated acceptable reliability and good validity in patients with dentofacial deformities.

CLINICAL RELEVANCE

These findings enable assessments of oral health-related quality of life in Chinese literate patients with dentofacial disorders.

TRIAL REGISTRATION

ChiCTR1900028206.

Satisfactory outcomes after orthognathic surgery with surgically assisted rapid maxillary expansion using a hybrid device

The self-reported functional outcomes, clinical findings, and results of dental cast analysis before and after orthognathic surgery with surgically assisted rapid maxillary expansion (SARME) using a hybrid rapid maxillary expander (RME) were evaluated. Data were collected from 43 patients who underwent orthognathic surgery with SARME using a hybrid RME between 2001 and 2013. The patients were recruited during a follow-up clinical examination and were required to complete a questionnaire about their opinions and self-reported functional outcomes. Dental casts were used to analyze posttreatment palatal expansion. The mean follow-up time was 68 months (range: 25-135 months). The most common indication for SARME was the presence of a crossbite. Of the 30 patients who underwent a follow-up clinical examination (69.8% answer rate), 4 (13.3%) had symptoms of temporomandibular disorder (TMD), 1 (3.3%) experienced myalgia, and 3 (10.0%) experienced arthralgia on clinical palpation. Cast analysis revealed significant palatal expansion. The intercanine distance, intermolar distance, and palatal height were increased by 3, 5, and 2 mm, respectively. Overall, the patients were satisfied with the preoperative information, improved functions, and aesthetic results. The prevalence of TMD symptoms and other side effects following orthognathic surgery with SARME using a hybrid RME was low, and significant palatal expansions were achieved.

Impact of Orthognathic Surgery on Quality of Life in Patients with Dentofacial Deformities

The aim of this investigation was to determine the impact of orthognathic surgery on quality of life in patients with dentofacial deformities at immediate presurgery and at 3-week, 3-month, and 6-month intervals following the surgery. Subjects included forty-three 18–40-year-old Iranian orthognathic patients who were referred to private offices in Isfahan. Data collection was performed using the 22-item Orthognathic Quality of Life Questionnaire (OQLQ). Participants completed the questionnaire prior to surgery and 3 weeks, 3 months, and 6 months after it. Differences and correlations were calculated by the two-tailed t-test, ANOVA with Repeated Measure test, and the Pearson correlation coefficient. The results showed significant reduction returned to baseline in OQLQ mean scores and aesthetic, awareness, and social subdomains in all 3 intervals after surgery. However oral function domain showed an increase at T₂ and then a decrease at next intervals. Maximum and minimum effect size were observed in aesthetic (ES = 0.7) and oral function (ES = 0.3) domain, respectively. Based on the finding of this study, in 6-month interval after surgery, orthognathic surgery causes significant improvements in quality of life in patients with dentofacial deformities as assessed in emotional, psychological, oral function, and social domains and maximum changes occurred in emotional domain.

Timing of orthognathic surgery on the changes of oral health-related quality of life in Chinese orthognathic surgery patients

INTRODUCTION

Although the association between orthognathic surgery and oral health-related quality of life (OHRQoL) has been explored, few studies have been carried out to describe the influence of surgery type on perceived OHRQoL. The aim of this study was to evaluate the difference of OHRQoL between a surgery-first approach and an orthodontics-first approach, using the 14-item Oral Health Impact Profile questionnaire (Chinese version).

METHODS

Fifty adult Chinese orthodontic patients who received either surgery-first or orthodontics-first treatment completed 5 distinct sections of the questionnaire. Chi-square tests were used to compare categorical variables. All analyses were carried out with Stata software (version 11.2; StataCorp, College Station, Tex).

RESULTS

The quality of life significantly improved after treatment in both groups. However, overall scores were highest before treatment in the surgery-first group but increased significantly from before treatment to 6 months after surgery and then significantly decreased after surgery in the orthodontics-first group. There were relatively lower scores in the surgery-first group than in the orthodontics-first group before surgery, at 12 months after beginning orthodontics, and at the end of treatment, although these differences did not reach significant levels.

CONCLUSIONS

Both treatment methods can obtain the same results. The timing of the orthognathic approach did not affect the final OHRQoL in Chinese orthognathic surgery patients.

Orthognathic Surgery: Outcome in a Facebook Group

The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were enrolled in the study. The respondents consisted of 12 men and 93 women, with a mean age of 27 ± 9 years. Fifty-four percent replied that esthetic concerns were the reason for the OS. Eighty-four percent reported improvement in facial esthetics after the OS. Men indicated a higher degree of improvement in beauty than women (P = 0.030). Sixty-four percent replied that their attractiveness had been increased after OS. Eighty-six percent were happy with the results and 89% would recommend the surgery to others in need. No significant differences in esthetic results and satisfaction were seen with regard to sex, age, and somatosensory change. High satisfaction and improvement in facial esthetic after OS were seen. Young patients (16-25 years) and men indicated a higher degree of satisfaction than old (>25 years) patients and women. The use of social media seems to be an interesting platform for qualitative scientific research in certain age groups. Further prospective and objective studies about the esthetic improvement after OS should be performed.

Patient's Satisfaction in Skeletal Class III Cases Treated With Two-Jaw Surgery Using Orthognathic Quality of Life Questionnaire: Conventional Three-Stage Method Versus Surgery-First Approach

OBJECTIVE

To compare the quality of life (QoL) of Class III patients between conventional three-stage method (CTM) and surgery-first approach (SFA) using Orthognathic QoL Questionnaire (OQLQ).

MATERIALS AND METHODS

The subjects consisted of 26 Class III patients treated with nonextraction and two-jaw surgery. They were divided into CTM group (N = 15) and SFA group (N = 11). They retrospectively rated the OQLQ scores of 4 domains (social relationship, facial esthetics, function, and awareness of dentofacial deformity) using 0 to 4 scale at initial (T0), just before surgery (T1), 3 month after surgery (T2), and at debonding (T3). Mann-Whitney test and Wilcoxon signed-rank test were performed for statistical analysis.

RESULTS

After total OQLQ score of CTM group was deteriorated at T1 stage compared with T0 stage, it was improved at T2 and T3 stages (T0 = 53.9, T1 = 58.1, T2 = 23.5, and T3 = 11.6). Total OQLQ score of SFA group, however, was improved at T2 and T3 stages compared with T0 stage (T0 = 51.6, T2 =  3.1, and T3 = 11.4; T1 was omitted.). Orthognathic QoL Questionnaire scores and their amounts of change did not show any significant difference in each domain and at each stage between 2 groups (T0, T2, T3, ΔT2 - T0, ΔT3 - T2, ΔT3 - T0; all P > 0.05). Both groups showed large change in effect size (ES) of all domains with descending order during T3 - T0: facial esthetics, oral function, social relationship, and awareness of dentofacial deformity (CTM group: -3.97, -3.40, -2.23, -1.25; SFA group: -2.83, -2.33, -1.76, -1.73) CONCLUSIONS: SFA might have an advantage over CTM group in terms of no deterioration stage of OQLQ score.

The index of orthognathic functional treatment need accurately prioritises those patients already selected for orthognathic surgery within the NHS

The index of orthognathic functional treatment need (IOFTN) is a newly-proposed system to help to prioritise patients for orthognathic treatment. The five categories are similar to those used in orthodontics, but include additional parameters such as sleep apnoea and facial asymmetry. The aim of this audit was to validate the index and find out the potential future implications, should such a system ever be adopted by commissioners. We calculated the IOFTN category of 100 consecutive patients who had orthognathic surgery between 2010-14 using clinical notes, photographs, study models, and radiographs, and determined the number in categories 4 or 5, analogous to the current indications for orthodontic treatment within the NHS. Sufficient clinical information was available to categorise 59/100 patients, and 56 of the 59 (95%) were in either category 4 or 5. All three of the remaining patients (in categories 1-3) who were operated on were treated because of the anticipated favourable impact on their quality of life. The IOFTN has been proposed for use in future commissioning of orthognathic services within the NHS, and this study has confirmed its efficacy in prioritising treatment accurately, with 95% of patients being in categories 4 or 5. We recommend that the orthognathic treatment index be adapted to include additional psychosocial assessment so that patients who fall into the lower functional categories are not automatically excluded from this potentially life-changing treatment.

The changes of oral health-related quality of life and satisfaction after surgery-first orthognathic approach: a longitudinal prospective study

BACKGROUND

To our best knowledge, there was little research to assess the changes of quality of life and satisfaction after orthognathic in one trial. The aim of this study was to evaluate the changes of oral health related quality of life and satisfaction between surgery-first and orthodontic-first orthognathic surgery.

METHODS

Fifty Chinese orthognathic adluts patients completed two questionnaires: the Dental Impact on Daily Living questionnaire for assessment of his/her satisfaction and 14-item Oral Health Impact Profile for assessment of patient's quality of life. The subjects completed six sets of interviews and clinical evaluations at before treatment; 1 month after surgery (surgery-first); 6 months after treatment; 12 months after treatment ; and 18 month after treatment ; the finished treatment. The pre and post surgical orthodontic period was also recorded. Chi square tests and repeated-measures analysis of variance (ANOVA) were used to compare categorical variables and measure results. All analyses were carried out used Stata software.

RESULTS

The quality of life was significant improved when finished treatment and the amounts of change did not show any significant difference in each domain and at 1, 6, 12 month after orthognathic surgery between two groups. However, in orthodontic-first group, the quality of life was deteriorated before orthognathic surgery. In surgery-first group, the quality of life was immediately improved which lead to better satisfaction.

CONCLUSIONS

Although the quality of life scores was no significant difference between two groups, surgery-first treatment could significant reduce treatment during and no deterioration stage of quality of life score which lead to better satisfactory compare to orthodontic-first group. However, some of limitations we need take caution. In future we still need conduct more study to assess the influence of surgery-first method on quality of life.

Seeking beauty: understanding the psychology behind orthognathic surgery

Orthognathic surgery to correct serious skeletal discrepancies of the jaw improves both function and appearance, but patients should spend a lot of time thinking about, discussing, and planning operations that have such a considerable impact. The drive to improve appearance by such radical means is based on social and personal reasons, and this must be understood before treatment is considered. In this paper, we will review studies on the psychology of orthognathic surgery.

Psychosocial Outcomes in Orthognathic Surgery: A Review of the Literature

Objective

To identify and critically appraise the literature on the psychosocial outcomes of orthognathic surgery, reflect on the clinical and theoretical implications, and suggest avenues for future research.

Design

A search of the literature was completed using the databases Web of Science, MEDLINE, and PsycINFO to identify English-language articles published since January 2001 that have reported a measure of psychosocial functioning posttreatment.

Results

A total of 38 articles were eligible for inclusion in the review. The studies reported improvements in areas such as satisfaction with facial appearance, self-confidence, self-esteem, anxiety, and social functioning. Small percentages of patients were left dissatisfied or had difficulty adjusting to appearance change despite the absence of treatment complications. Gains in psychosocial functioning were maintained over several years, and satisfaction increased over time.

Conclusions

There are consistent positive outcomes reported as a result of orthognathic surgery, but conclusions are limited by methodological issues in study design such as small sample sizes, limited use of control groups, and measures that fail to tap into relevant areas of psychosocial functioning. In addition, further exploration is required of processes such as adjustment to facial change and the role of psychological support during treatment.

Secondary Genioplasties for the Treatment of Chin Deformities After Orthognathic Surgery in Asian Women: Defining the Aesthetic Importance of Managing the Chin Shape in Orthognathic Surgery

BACKGROUND

Achieving aesthetically favorable results in orthognathic surgery is equally as important as good postoperative occlusion and jaw function. Orthognathic surgery that only changes profile or proportion in the vertical dimension can often lead to patient's dissatisfaction and additional surgical revision. To achieve maximal aesthetic improvement and postoperative patient's satisfaction, the chin shape should be considered as important a component of orthognathic surgery as dental occlusion or jaw function.

METHODS

From April 2010 to January 2014, 82 female patients with aesthetic complaints after previous orthognathic surgery visited our clinic for reevaluation and management. Among those 82 patients, 54 patients who were dissatisfied with their lower facial shape from the frontal view underwent revision surgery with narrowing genioplasty and contouring of the lower border of the mandible.

RESULTS

Facial shapes, when viewed from the front in all patients, became more slender and balanced postoperatively, and there was no need for additional surgical revisions in this series. There were no significant complications caused by our surgical revisions.

CONCLUSIONS

Good aesthetic results were obtained after 54 secondary genioplasties for chin deformities after orthognathic surgery. These results suggest that surgeons should give more attention to managing chin shape when performing orthognathic surgery to meet the high aesthetic demands of patients and to avoid surgical revisions.

Evaluation of life quality of patients submitted to orthognathic surgery

OBJECTIVE

To compare changes related to self-esteem and appearance satisfaction between pre and postsurgical phases in patients undergoing orthognathic surgery and to assess the quality of life and psychosocial changes of these patients six months after surgery.

METHODS

A longitudinal observational qualitative study was performed. The sample comprised 15 patients with dentofacial deformities who underwent orthognathic surgery. One questionnaire and two forms were answered during pre and postoperative phases.

RESULTS

The results showed that 13.3% of patients demonstrated self-esteem improvement, especially in relation to appearance satisfaction. Improvements were also noted in social, occupational and family relationships. With regard to the assessment of quality of life, according to the World Health Organization questionnaire, the lowest improvement averages corresponded to environmental control.

CONCLUSION

Orthognathic surgery brings along many emotional changes that should be considered before and after surgery, since the patients' psychological state may be favorable and/or unfavorable during recovery, influencing their quality of life, self-esteem and appearance satisfaction.

Qualidade de vida em pacientes submetidos à cirurgia ortognática: saúde bucal e autoestima

A cirurgia ortognática é o ramo da cirurgia bucomaxilofacial que trata das deformidades dentofaciais, buscando a correção da oclusão e melhora articular, respiratória e fonética, que geram benefícios funcionais e harmonizam a face, o que acarreta aspectos positivos em relação à estética e ao fator psicossocial do paciente. Objetivou-se avaliar a qualidade de vida desses pacientes, através dos aspectos funcionais, estéticos e psicossociais. O presente estudo foi realizado em clínica odontológica particular, na cidade de Taubaté. Foram avaliados 33 pacientes, 12 do gênero masculino e 21 do gênero feminino, com idades entre 18 a 45 anos, com tratamento ortocirúrgico indicado ou já realizado, utilizando-se os questionários Escala de Autoestima de Rosenberg/UNIFESP-EPM, Oral Health Impact Profile-14 - OHIP14 e PIDAQ-Brasil/UNIFESP e o Teste não Paramétrico de Mann-Whitney. Os resultados evidenciaram que a cirurgia ortognática é um procedimento capaz de oferecer melhora da qualidade de vida para pacientes portadores de deformidades dentofaciais, por meio dos aspectos funcionais, estéticos e psicossociais.

Orthognathic surgery: pretreatment information and patient satisfaction

OBJECTIVES

This study sought to (1) analyze the demographic profile of patients who completed combined orthodontic and surgical treatments at the Kuwait Ministry of Health dental clinics, (2) evaluate the source, type, amount and timing of preoperative patient information, (3) determine posttreatment patient satisfaction and (4) examine whether patient satisfaction is associated with preoperative information.

SUBJECTS AND METHODS

Of the 145 patients who completed combined orthodontic and surgical treatments at least 6 months prior to the initiation of this study, 74 agreed to be interviewed by telephone by means of a structured survey including questions covering the study's objectives.

RESULTS

The mean age of participants was 21.1 years; 52 (70.3%) were female and 22 (29.7%) were male. Of these 74 patients, 70 (94%) did not regret their decision to undergo orthognathic surgery and 62 (83.8%) would repeat the same treatment if it was needed. The majority of the respondents reported that the importance of treatment compliance had been explained very well prior to surgery, but that information about the associated functional and social problems was lacking. The orthodontist was the most prominent source of information before treatment began. As the presurgical orthodontic treatment phase progressed, the roles of the surgeon and orthodontist became more evenly distributed.

CONCLUSION

The patients who underwent orthognathic surgery were satisfied and generally well informed. However, information regarding surgical risks and functional discomforts was not adequate. Participants were more likely to be satisfied when they were provided with more information about discomfort and surgical risks.

Changes in quality of life and impact on patients' perception of esthetics after orthognathic surgery

OBJECTIVES

The aim of our study is to determine the changes in quality of life and patient's perception of esthetic improvement after anterior maxillary osteotomy.

MATERIALS AND METHODS

Our prospective study consisted of 14 patients who had been diagnosed of skeletal orthodontic deformity and underwent anterior maxillary osteotomy, along with orthodontic correction. The quality of life was evaluated using questionnaires based on Oral Health Impact Profile-14 questionnaire (OHIP-14) and a 22-item orthognathic quality of life questionnaire. They were evaluated at baseline pre-surgical, 8 weeks postoperatively, and 24 weeks postoperatively.

RESULTS

Our results showed mild improvement in generic health related quality of life immediately following surgery, while condition-specific quality of life and patient's perception of esthetic improvement were noted only at 24 weeks following anterior maxillary osteotomy.

CONCLUSION

We conclude that anterior maxillary osteotomy had a positive impact on the quality of life. The improvement in patient's perception of esthetics is seen only 2 months after surgery, while improvements in oral health and function were seen within 2 months following surgery. The acceptance and satisfaction of patient toward surgery was more positive 2 months after surgery.

Impact of dentofacial deformity and motivation for treatment: a qualitative study

INTRODUCTION

Satisfaction with the outcome of orthognathic treatment is generally high; however, an important minority remains dissatisfied with the results. The reasons for this could be inadequate patient understanding and preparation, external motivation, and unrealistic expectations. In-depth appreciation of these issues can be obtained using qualitative research methods, but there is a paucity of qualitative research in this field.

METHODS

This was a cross-sectional qualitative study of orthognathic patients conducted at a teaching hospital. In-depth interviews were conducted with 18 prospective orthognathic patients. The data were managed by using the framework approach and analyzed by using the critical qualitative theory.

RESULTS

Two main themes were explored in the interviews: the impact of the dentofacial deformity and the motivation for treatment. Both the everyday problems of living with a dentofacial deformity and the motivation for seeking treatment could be classified either as exclusively practical (including functional and structural), exclusively psychological (including psychosocial and esthetic), or a combination. Different coping strategies were also described. The sources of motivation ranged between purely external to purely internal, with most subjects between these 2 extremes.

CONCLUSIONS

In this article, we present a classification of the impact of dentofacial deformity that is a refinement of the traditional one that includes esthetic, functional, and psychosocial factors. The motivating factors, together with the triggers for accessing treatment and the source of motivation, are generally linked directly or indirectly to the problem and the impact of the condition. However, in a few patients, the motivation might not relate to the impact of the problem but to a complex array of other factors such as personality, upbringing, and relationships. Therefore, clinicians should not make assumptions but explore these factors on an individual basis without preconceived ideas.

Lip competence in Class III patients undergoing orthognathic surgery: an electromyographic study

PURPOSE

The aim of this study was to compare the presurgical and postsurgical electromyographic (EMG) activities of the lips in patients with skeletal Class III treated with combined orthognathic surgery and contrast these data with those obtained from a control group with skeletal Class I.

PATIENTS AND METHODS

Ten patients with skeletal Class III underwent the registration of EMG activity before an orthognathic surgical procedure and 4 months after surgery. The results were compared with a control group of 11 healthy patients with skeletal Class I and clinical and EMG lip competence. EMG activity was recorded from the upper orbicularis oris and mentalis muscles during swallowing, lips in contact (LC), and lips apart (LA) using bipolar surface electrodes. The competence condition was assessed by determining the difference in the EMG activity of the mentalis muscle (LC-LA ≤0 for lip competence).

RESULTS

Patients with skeletal Class III showed greater EMG activity than the control group before and after surgery. Patients with skeletal Class III showed a significantly greater difference in LC-LA than the control group before surgery for the 2 muscles (P < .05). No significant difference was found between the skeletal Class III group after surgery and the control group for the mentalis muscle (P > .05).

CONCLUSIONS

Four months after treatment with orthognathic surgery, patients with skeletal Class III and an initial muscle activity pattern of lip incompetence different from the control group (P < .05) showed EMG values compatible with lip competence. These values were similar to the control group.

Patients' perceptions of improvements after bilateral sagittal split osteotomy advancement surgery: 10 to 14 years of follow-up

INTRODUCTION

The aims of this study were to determine reasons for orthodontic-surgical treatment, to quantify the perceptions of possible improvement 10 to 14 years after treatment, and to assess factors that affect treatment satisfaction and socio-dental impacts on quality of life.

METHODS

The participation rate was 36 of 78 patients; their mean age was 45.7 years (SD, 10.7 years; range, 29-62 years). The presurgical anatomic occlusions were measured on dental casts. Visual analog scales allowed the participants to rate their perceived treatment outcome on 7 oral health-related items. A 3-point scale rated satisfaction with orthodontic-surgical treatment. The oral impact of daily performances index was included to assess socio-dental impacts on quality of life.

RESULTS

Most responders reported improvements on the 7 items. The most significant change was reported for chewing. "Very satisfied" with the treatment was reported by 13 responders; 19 of 36 persons were "reasonably satisfied." Reporting "very satisfied with treatment" was 8 times more likely when peers had noticed a changed in the participant's appearance after surgery. Sex was significantly associated with quality of life.

CONCLUSIONS

The most frequently reported reason for treatment was to improve chewing, and the item that showed the most pronounced improvement was also chewing. Most responders were only reasonably satisfied with the treatment. Whether peers noticed a change in appearance after treatment was a significant factor affecting both treatment satisfaction and reporting a good quality of life.