Quality of life assessment in patients with dentofacial deformity undergoing orthognathic surgery—A systematic review

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.

Health-related quality of life, jaw function and sleep-disordered breathing among patients with dentofacial deformity

BACKGROUND AND OBJECTIVES

Patients with dentofacial deformity (DFD) requiring orthognathic treatment have poor aesthetics, jaw function and psychological well-being, which potentially affect the quality of life. This study aimed to investigate the health-related general, oral and orthognathic quality of life, jaw function and sleep-disordered breathing at different stages of orthognathic surgical treatment.

METHODS

A total of 120 consecutive patients with DFD were recruited and grouped as pre-orthodontic treatment (group 1), pre-surgery (group 2), 4 months post-surgery (group 3), 24 months post-surgery (group 4) and in addition 30 controls without DFD (group 0). Outcomes were assessed using general health Short Form Survey (SF-36), Oral Health Impact (OHIP-14), Orthognathic Quality of Life Questionnaire (OQLQ), STOP-Bang and Jaw Function Limitation Scale (JFLS) questionnaires. In addition, presence or absence of pain was recorded. Data were tested with analysis of variance, Kruskal-Wallis test, Tukey post hoc test and structural equation modelling (SEM).

RESULTS

Results revealed SF-36 (p = .814) and STOP-Bang (p = .143) total scores did not differ between control and treatment groups. In contrast, OHIP-14, OQLQ and JFLS total scores differed between groups (p = .001). Higher scores were observed in groups 1 (p = .001), 2 (p = .001) and 3 (p = .041) compared to group 0, indicating poor oral health in patients with DFD. Importantly, in group 4, oral health-related quality of life was better, and OHIP-14 (p = .936) and JFLS (p = .572) scores did not differ from controls. OQLQ scores of group 4 were significantly lower than group 1 (p = .001) but higher than group 0 (p = .013). SEM results revealed a significant negative associations of pain with JFLS and OQLQ; OHIP-14 with OQLQ; OHIP-14 with SF-36; and finally STOP-Bang with SF-36. Positive associations were observed between JFLS and OHIP-14; OHIP-14 and OQLQ.

CONCLUSION

Oral health-related quality of life and jaw function appears to be improved 24 months after orthognathic surgery. Pain and limitation in jaw function had a negative association with health-related quality of life.

Exploring the relationship between the number of systematic reviews and quality of evidence: an orthognathic surgery-based study

OBJECTIVE

We analyzed the quality and quantity of systematic reviews (SRs) of orthognathic surgery, the most frequently published topic in maxillofacial surgery.

STUDY DESIGN

We searched the PubMed database for SRs of orthognathic surgery with no restriction on the language of publication date. We assessed the certainty of evidence presented according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and the Leiden Manifesto using the Grading of Recommendations Assessment, Development, and Evaluation approach. We analyzed the data using descriptive statistics, Pearson´s correlation test, and linear regression.

RESULTS

Of the 171 SRs evaluated, approximately one fifth presented evidence with a high level of certainty. The number of orthognathic surgery SRs has been increasing, and many SRs were published after very similar topics had already been published. There is no relationship between the impact factor and the certainty of evidence.

CONCLUSIONS

An excessive number of SRs of orthognathic surgery are published, and many SRs are superfluous, simply reporting previous findings. Clinicians should not base treatment decisions solely on the evidence presented in SRs, and journal editors and reviewers should evaluate these SRs more critically, particularly when they address topics that have already been covered in the literature.

Changes in the quality of life in patients undergoing orthognathic therapy - A systematic review

The aim of this study was to investigate the impact of orthognathic therapy on patients' quality of life. Therefore, a systematic review was conducted including all prospective studies that compared pretherapeutic and posttherapeutic Oral Health Impact Profile (OHIP) or Overall Quality of Life (OQOL) questionnaire scores. Studies in patients with congenital deformities, clefts, or posttraumatic or cancer-associated deformities were excluded. Overall, 23 prospective studies were included; 8 used OHIP, 9 used OQOL and 6 used both questionnaires. A total of 1039 patients were identified (60.29% women, 39.71% men), with a mean age of 45.17 years. All analyzed studies showed in both OHIP and OQLQ an improvement of the quality of life in patients after orthognathic therapy. While improved scores could be observed in all investigated criteria, the studies demonstrated that social and aesthetic aspects showed the most prominent impact. Comparison of different Angle Classes showed, furthermore, that Class III patients had an even greater advantage over those with a Class II deformity. The review confirms that the quality of life in patients with orthognathic therapy improves significantly in all observed aspects. With regard to Angle Classes, Class III patients showed an even greater improvement than Class II patients.

Redefining precision and efficiency in orthognathic surgery through virtual surgical planning and 3D printing: a narrative review

Orthognathic surgery, essential for addressing jaw and facial skeletal irregularities, has historically relied on traditional surgical planning (TSP) involving a series of time-consuming steps including two-dimensional radiographs. The advent of virtual surgical planning (VSP) and 3D printing technologies has revolutionized this field, bringing unprecedented precision and customization to surgical processes. VSP facilitates 3D visualization of the surgical site, allowing for real-time adjustments and improving preoperative stress for patients by reducing planning time. 3D printing dovetails with VSP, offering the creation of anatomical models and surgical guides, enhancing the predictability of surgical outcomes despite higher initial setup and material costs. The integration of VSP and 3D printing promises innovative and effective solutions in orthognathic surgery, surpassing the limitations of traditional methods. Patient-reported outcomes show a positive post-surgery impact on the quality of life, underlining the significant role of these technologies in enhancing self-esteem and reducing anxiety. Economic analyses depict a promising long-term fiscal advantage with these modern technologies, notwithstanding the higher initial costs. The review emphasizes the need for large-scale randomized controlled trials to address existing research gaps and calls for a deeper exploration into the long-term impacts and ethical considerations of these technologies. In conclusion, while standing on the cusp of a technological renaissance in orthognathic surgery, it is incumbent upon the medical fraternity to foster a collaborative approach, balancing innovation with scrutiny to enhance patient care. The narrative review encourages the leveraging of VSP and 3D printing technologies for more efficient and patient-centric orthognathic surgery, urging the community to navigate uncharted territories in pursuit of precision and efficiency in the surgical landscape.

The Dutch Version of the Orthognathic Quality of Life Questionnaire (OQLQ-NL): Validation for Cleft Patients

OBJECTIVE

The aim of this study is to validate the Dutch version of the Orthognathic Quality of Life Questionnaire (OQLQ-NL) for cleft patients who received orthognathic surgery.

METHODS

To compare the OQLQ-NL with the CLEFT-Q, we used a convenience sample of thirty-two cleft patients. Using the Cronbach's alpha coefficient for multiple item scales, internal reliabilities of the OQLQ-NL were evaluated. The OQLQ-NL was repeated at a two-week interval and the intraclass correlation coefficient was calculated, to establish of the test-retest reliability. The construct validity of the OQLQ-NL was evaluated by using Spearman's correlation to test its correlation with the CLEFT-Q.

RESULTS

Thirty-two patients filled in the OQLQ-NL and CLEFT-Q. The OQLQ-NL had excellent results in internal reliability and test-retest reliability. The vast majority of the correlations between the domains and scales of the questionnaires were as expected. Data from this study and previous studies confirm the construct validity of the OQLQ-NL.

CONCLUSION

Our results suggest the OQLQ-NL is a valid and reliable instrument for measuring quality of life in cleft patients who have received orthognathic surgery in the Netherlands.

Temporomandibular Disorders at the Preoperative Time of Orthognathic Surgery

Individuals seeking orthodontic treatment combined with orthognathic surgery (OS) have a high prevalence of temporomandibular disorders (TMDs), but the relationship between TMD diagnoses and dentofacial deformities (DFDs) is still controversial. Therefore, this cross-sectional study with a comparison group aimed to analyze the association between dentofacial deformities and TMDs.

METHODOLOGY

Eighty patients undergoing OS were consecutively selected from the stomatology department of the Federal University of Paraná between July 2021 and July 2022. Forty patients who would undergo OS composed the group of participants with DFD, and forty who received other types of attention and did not present changes in the dental bone bases formed the group without DFDs (DFDs and no DFDs groups). The groups were matched for sex, age, and self-reported ethnicity. The diagnostic criteria for TMDs (DC/TMDs) were used to diagnose TMD based on the Axis I criteria. The psychosocial aspects, oral behaviors in wakefulness, and sleep bruxism were evaluated through the Axis II criteria. The data were analyzed with a 5% significance level.

RESULTS

The presence of DFDs was significantly associated with arthralgia (p = 0.01). The other types of TMDs were not associated with DFDs. Comorbidities, habits, and psychosocial variables were not associated with DFDs at a level of 0.05. (p > 0.05). In analyzing the participants with arthralgia, the ones with this condition presented higher frequencies of sleep bruxism (p = 0.046).

CONCLUSIONS

Participants with DFDs presented a significantly higher frequency of arthralgia when compared to no DFDs ones. Sleep bruxism was associated with the occurrence of joint TMDs in these participants.

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.

Quality of Life After Orthognathic Surgery in Patients with Cleft: An Overview of Available Patient-Reported Outcome Measures

Measuring the impact of orthognathic surgery on quality of life is of significant importance in patients with cleft deformities. Standardized tools such as patient-reported outcome measures (PROMs) are needed to fully comprehend patients' needs and perceptions. Therefore, the availability of reliable, valid, and comprehensive questionnaires for patients is essential. The aim of this study is to identify PROMs measuring the impact of orthognathic surgery on quality of life in patients with cleft deformities and to evaluate the identified PROMs.

A systematic search of the literature was performed according to the preferred reporting items for systematic reviews and meta-analysis guidelines. All validated PROMs, regarding the impact of orthognathic surgery on quality of life in patients with cleft deformities, were identified and assessed according to the quality criteria proposed for measurement properties of health status questionnaires.

An electronic search yielded 577 articles. After a full-text review of 87 articles, 4 articles met the inclusion criteria, comprising 58 PROMs. Of these 58 PROMs, 1 PROM (the CLEFT-Q) has been validated to measure the impact of orthognathic surgery on patients with a facial cleft. Evaluation of methodological quality of the included articles and assessment of the measurement properties of the CLEFT-Q show that the CLEFT-Q scores relatively good for all available measurement properties, making it suitable for immediate use.

The CLEFT-Q was found to be the only valid instrument so far to measure the impact of orthognathic surgery on the quality of life in patients with cleft deformities.

The Last 40 Years of Orthognathic Surgery: A Bibliometric Analysis

PURPOSE

Bibliometric analyses provide information on the effectiveness, performance, trends, and various other characteristics of research by using mathematical and statistical analysis methods for data related to scientific publications. This study aims to determine the focus of studies in the field of orthognathic surgery, map it, and present the results in a simplified manner through a comprehensive bibliometric analysis of the relevant literature.

METHODS

In this bibliometric analysis study, orthognathic surgery publications from 1980 to 2022 were retrieved from the Web of Science Core Collection database. The independent variables were co-citations, while the outcome variables included cross-country collaboration analysis, keyword analysis, co-citation analysis, and cluster analysis of the co-citation network. Covariates were the number of publications, number of citations, year range, centrality value, and silhouette value. The bibliometric analysis was conducted using CiteSpace, VOSviewer, and R-Studio software.

RESULTS

A total of 7,135 publications and 75,822 references were included in the analysis, and the annual growth rate of publications was 9.52%. The co-citation clustering analysis revealed that the orthognathic surgery literature was organized into 16 subject headings. Patient satisfaction was found to be the most widely published topic. The youngest clusters, representing new topics in the field, were virtual planning and examination of condylar changes after orthognathic surgery.

CONCLUSION

Bibliometric analysis methods were used to evaluate the 40-year history of the orthognathic surgery literature. The analysis identified the most influential publications, the topics in which the literature is divided, and hot spots in the field. By conducting similar bibliometric research studies in the future, the progress and future direction of the literature can be monitored based on evidence.

Impact of malocclusion treatments on Oral Health-Related Quality of Life: an overview of systematic reviews

OBJECTIVE

To perform an overview of systematic reviews (SR) assessing the impact of malocclusion treatments (Orthodontic Treatment - OT and/or Orthodontic Surgical Treatment - OST) on Oral Health-Related Quality of Life (OHRQoL).

MATERIALS AND METHODS

A search strategy was conducted in electronic databases until June 7th, 2021, followed by a manual search in grey literature and registration databases. Two independent authors applied the eligibility criteria, extracted the data, assessed the risk of bias (AMSTAR-2), and performed the certainty of evidence (GRADE) evaluation. Meta-analysis was planned to be carried out in RevMan 5.3 (with 95% confidence intervals (CI) considering p < 0.05), in case of homogeneous studies considering OHRQoL instrument and time of follow-up.

RESULTS

A total of 126 articles were accessed on the database, 18 registers, 33 records on grey literature and 3 articles by means of citation searching. After duplicates removal and eligibility criteria analyses, 15 SR were included. From that, 13 showed improvement in OHRQoL after OT and/or OST. The methodological quality ranges from high (n = 2), to critically low (n = 9). Meta-analysis was conducted. Improvement on OHRQoL after a 6-month OST using the OQLQ-22 (p < 0.00001; 19.65; CI: 12.60-26.70) and OHIP-14 instruments (p < 0.00001; 10.70; CI: 9.89-11.51); and after a 6-month OT using the CPQ 11-14 instrument (p = 0.010; 3.57; CI: 0.86-6.28) with very low certainty of the evidence for all outcomes was observed.

CONCLUSIONS

Although most SR selected in this overview are characterized by a critically low quality, as well as very low certainty of the evidence, OT and/or OST seem to have a positive impact in improving the OHRQoL.

CLINICAL RELEVANCE

The overview of existing systematic reviews compiled that OT and/or OST seem to have a positive impact on improving the OHRQoL. This information will facilitate clinical decision-making considering the clinical and psychological parameters.

The ımpact of orthognathıc surgery on qualıty of lıfe for class ııı dentofacıal deformıtıes

This study aims to evaluate the quality of life in patients with Class III deformities after orthognathic surgery. A total of the 40 patients (26 female and 14 male) were included. The mean age of the patients was 24.85. Patients' ages ranged from 20 to 36 years. All patients received orthodontic treatment before surgery. Sagittal split ramus osteotomy was performed for single jaw patients. Le Fort I osteotomy and sagittal split ramus osteotomy was performed for double jaw patients. Patients completed the Oral Health Impact Profile 14 (OHIP-14) and Orthognathic Quality of Life Questionnaire (OQLQ) three times. [Preoperatively (T0), 1^st week after orthognathic surgery (T1) and in the 6^th - 12^th months after orthognathic surgery (T2)]. There was a statistically significant difference in the dimensions of OHIP-14 when the preoperative (T0) score, postoperative 1^st week (T1) score and postoperative 6^th - 12^th month (T3) score are compared among themselves except for psychological discomfort, physical disability, and handicap. OQLQ total score and preoperative (T0) score was greater than the postoperative 1^st week (T1) score and the postoperative 1^st week(T1) score was greater than the postoperative 6^th - 12^th month (T2) scores except oral function. When single jaw and double jaw surgeries were compared, no statistically significant difference was found between OHIP-14 and OQLQ total scores for preoperative, postoperative 1st week, and postoperative 6^th - 12^th months. When both OHIP-14 and OQLQ scores were examined after orthognathic surgery, the OHRQOL of patients with Class III dentofacial deformity improved significantly.

Distribution of orthognathic surgery among the Swedish population: a retrospective register-based study

OBJECTIVE

The aim of this study was to provide a nationally representative assessment of orthognathic procedures performed in hospitalised patients in Sweden and study regional differences in prevalence, demographic parameters and hospitalisation time.

MATERIAL AND METHODS

From the Swedish National Board of Health and Welfare's register, all the patients undergoing orthognathic surgery between 2010 and 2014 were identified. Outcome variables were categorised into: (1) Surgical methods and regional distribution (2) Demographic variations (3) Hospitalisation time.

RESULTS

The population-prevalence-rate of orthognathic procedures over the 5-year period was 6.3 (SD 0.4) per 100,000 persons, a regional difference in the prevalence was found. Most common were Le Fort I osteotomies (43.4%) and bilateral sagittal split osteotomies (41.6%), 39% of the patients had bimaxillary surgery. The majority of the surgery was performed in the age group 19-29 (68.8%). The mean hospital stay was 2.2 days (SD = 0.9, range 1.7-3.4). A significant regional difference (p ≤ 0.001) was found in hospitalisation time for single-jaw versus bimaxillary surgery.

CONCLUSIONS

Regional differences in the distribution of orthognathic surgery and demographic variations were found in Sweden in 2010-2014. The underlying causes of variations are still unknown and request further investigation.

Perioperative therapies to reduce edema after orthognathic surgery: a systematic review and meta-analysis

Objective To systematically review the literature and assess the effectiveness of perioperative systemic and nonsystemic therapies in reducing edema after orthognathic surgery. Study Design Four databases (PubMed, Web of Science, Bireme, and Scopus) were searched. Only randomized clinical trials were included and assessed using the RoB 2.0 software (Cochrane Collaboration, London, UK). Studies were grouped into time of assessment and systemic/nonsystemic therapy. Results Eighteen studies were included in this review (8 in the meta-analysis, n = 349). The qualitative assessment of systemic (enzyme therapy, dexamethasone, betamethasone, and Venoplant) and nonsystemic therapies (thermotherapy and K-Taping) appear to reduce edema. Manual lymphatic drainage (MLD) after 72 hours (CI: -1.03 to 2.31; P = .45), and 30 days (CI: -1.53 to 0.49; P = .49), and laser after 24 hours (CI: -1.36 to 1.48; P = .93), 72 hours (CI: -4.81 to 2.92; P = .63), 30 days (CI: -3.44 to 0.99; P = .28), and 90 days (CI: -1.83 to 0.96; P = .54) showed no significance. Thermotherapy reduced edema after 48 hours (CI: -48.47 to -13.31; P = .0006) and 30 days (CI: -14.73 to -1.98; P = .01). Conclusion The Grading of Recommendations, Assessment, Development and Evaluations tool showed moderate evidence for thermotherapy (significant reduction of edema), whereas the MLD and laser results were rated as high certainty of evidence (no reduction of edema).

Accuracy and safety of in-house surgeon-designed three-dimensional-printed patient-specific implants for wafer-less Le Fort I osteotomy

OBJECTIVES

The design and fabrication of three-dimensional (3D)-printed patient-specific implants (PSIs) for orthognathic surgery are customarily outsourced to commercial companies. We propose a protocol of designing PSIs and surgical guides by orthognathic surgeons-in-charge instead for wafer-less Le Fort I osteotomy. The aim of this prospective study was to evaluate the accuracy and post-operative complications of PSIs that are designed in-house for Le Fort I osteotomy.

MATERIALS AND METHODS

The post-operative cone beam computer tomography (CBCT) model of the maxilla was superimposed to the virtual surgical planning to compare the discrepancies of pre-determined landmarks, lines, and principal axes between the two models. Twenty-five patients (12 males, 13 females) were included.

RESULTS

The median linear deviations of the post-operative maxilla of the x, y, and z axes were 0.74 mm, 0.75 mm, and 0.72 mm, respectively. The deviations in the principal axes for pitch, yaw, and roll were 1.40°, 0.90°, and 0.60°, respectively. There were no post-operative complications related to the PSIs in the follow-up period.

CONCLUSIONS

The 3D-printed PSIs designed in-house for wafer-less Le Fort I osteotomy are accurate and safe.

CLINICAL RELEVANCE

Its clinical outcomes and accuracy are comparable to commercial PSIs for orthognathic surgery.

TRIAL REGISTRATION

Clinical trial registration number: HKUCTR-2113. Date of registration: 29 July 2016.

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.

"Surgery First" vs "Traditional Sequence" Surgery: A Qualitative Study of Health Experiences in 46 Bimaxillary Orthognathic Patients

Introduction

Orthognathic patients are advocating an active role in selecting their appropriate ortho-surgical treatment, between the surgery first (SF) and the traditional sequence (TS) approaches. The aim of this study was to evaluate, through qualitative analysis, the subjective perceptions of the outcomes of each protocol.

Methods

In-depth interviews were conducted with 46 (10 male and 36 female) orthognathic patients (23 SF and 23 TS) treated with bimaxillary orthognathic surgery by the same surgeon, between 2013 and 2015. Average treatment duration was 6.5 months for SF and 12 months for TS. Inclusion criteria were: the presence of Class III or Class II asymmetries and open bite. Patients were excluded if they refused interviews or stopped attending post-treatment follow-up. Investigated health experiences included overall satisfaction with appearance, self-confidence after surgery, perceived treatment time, functional recovery, and diet restrictions.

Results

All SF and TS patients showed overall satisfaction with their appearance (though TS showed more enthusiastic tones) and approved their degree of functional recovery after surgery. Class III SF patients had earlier improvements in self-confidence after surgery. Orthodontics was considered enduring by both SF and TS patients.

Conclusions

SF patients expressed a higher degree of satisfaction with the reduction in overall treatment time and with the early psychological benefit deriving therefrom. Both SF and TS patients completely approved of the aesthetic outcomes and the functional recovery from which they benefitted due to the entire procedure.

Association of the estrogen receptor gene with oral health-related quality of life in patients with dentofacial deformities

This study aimed to evaluate the associations between oral health-related quality of life (OHRQoL) and patient-associated factors and polymorphisms in the estrogen receptor 1 (ESR1) and 2 (ESR2) genes in patients with dentofacial deformities (DFD). This cross-sectional study included 234 adult individuals. Data such as age, sex, and the type of facial profile (I, II, or III), were collected, and the short-form oral health impact profile 14 (OHIP-14) questionnaire was used to assess their OHRQoL. DNA was collected from oral mucosa cells, and the polymorphisms in ESR1 (rs2234693 and rs9340799) and ESR2 (rs1256049 and rs4986938) were evaluated using real-time polymerase chain reaction. The data were subjected to statistical analysis at a significance level of 5%. Individuals over 28 years of age exhibited worse OHRQoL (p = 0.003) than individuals aged less than or equal to 28 years. Women had worse OHRQoL than men (p < 0.001). Profile II individuals had worse OHRQoL in the social disability domain than profile III individuals (p = 0.030). Genetic analysis showed that rs9340799 was associated with OHRQoL in the functional limitation domain, and GG individuals exhibited worse OHRQoL than individuals carrying the AA/AG genotypes (p < 0.030). In the social handicap domain, individuals with GG genotype in rs9340799 exhibited worse OHRQoL than AG individuals (p < 0.043). Collectively, our results reveal that factors including age, sex, and type of facial profile, are associated with OHRQoL in patients with DFD. In addition, individuals with the GG genotype in rs9340799 (ESR1) may experience a negative impact on OHRQoL in the functional limitation and social handicap domains.

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.

Do Specific Craniomaxillofacial Features Correlate with Psychological Distress in Adult Pretreatment Orthodontic Patients? A Cephalometric Study

Purpose

To explore the relationship between craniomaxillofacial features and psychological distress among adult pretreatment orthodontic patients.

Methods

A group of 190 patients (95 males and 95 females) was included. Questionnaires including the Kessler psychological distress scale (K10) were sent to patients, and cephalograms were collected. Patients were divided into two groups according to K10 score: psychological distress group (score ≥ 20) and no psychological distress group (score < 20). Nineteen hard tissue and thirteen soft tissue parameters were traced on cephalograms to characterize the craniomaxillofacial features.

Results

There was no significant difference in gender or age distribution between the two groups. Male patients with psychological distress showed statistically significantly larger anterior facial height (AFH) (126.62 mm vs. 120.97 mm), upper lip length (25.11 mm vs. 23.26 mm), and smaller overbite (1.21 mm vs. 2.75 mm) than patients without psychological distress. Male patients with hyperdivergent pattern and open bite were more likely to have psychological distress. None of the parameters showed statistical differences across groups in females. Frankfort-mandibular plane angle (r = 0.235), Bjork's sum (r = 0.311), AFH (r = 0.322), overbite (r = −0.238), AFH/posterior facial height (r = 0.251), and upper anterior facial height (UAFH)/lower anterior facial height (LAFH) (r = −0.230) were correlated with K10 score in males. After adjusting gender and age, the AFH (B = 0.147) and UAFH/LAFH (B = −14.923) were significantly related with the K10 score.

Conclusion

Psychological distress was mainly correlated with hyperdivergent pattern, open bite, and larger lower anterior facial height proportion in pretreatment orthodontic patients. Orthodontists should be aware of the possible underlying psychological distress in patients with specific craniomaxillofacial features. Clinical assessment of psychological distress may need to take into account gender differences in patients.

Influence of personality traits on a patient's decision to accept orthognathic surgery for correction of dentofacial deformity

OBJECTIVES

To investigate the influence of personality traits in addition to quality of life (QoL) on the decision to accept orthognathic surgery.

MATERIALS AND METHODS

A total of 108 patients (68% female) aged 14-53 years (median, 18 years; interquartile range, 17-25.75 years), with skeletal malocclusions of Index of Orthognathic Functional Treatment Need grades 3-5 (moderate to very great need for surgery) were included in this cross-sectional study. Personality traits of extraversion, neuroticism, agreeableness, openness, consciousness, perfectionism, and self-esteem and dimensions of Orthognathic Quality of Life Questionnaire were compared between patients who accepted orthodontic preparation for orthognathic surgery and those who refused (n = 55 vs 53).

RESULTS

Patients who accepted the suggested surgical procedure had higher age, perfectionism, facial esthetic (FE) concern, social aspect, and impairment of oral function (OF) as well as lower self-esteem with small to medium effect sizes (P ≤ .040; r = 0.198-0.399). Other personality traits and awareness of dentofacial deformity did not differ between the groups. In multiple logistic regression analysis, while controlling for sex, perfectionism, and self-esteem, the following predictors of acceptance of orthognathic surgery were higher: FE concern (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.3-9.1), OF (OR, 3.0; 95% CI, 1.0-8.6), and age ≥18 years (OR, 2.7; 95% CI, 1.0-7.1; P < .001).

CONCLUSIONS

Extraversion, neuroticism, agreeableness, conscientiousness, and openness do not significantly affect a patient's decision to accept orthognathic surgery. The influence of self-esteem and perfectionism is primarily on perception of alteration of QoL induced by dentofacial deformity.

Oral Health-Related Quality of Life Changes in Patients with Dentofacial Deformities Class II and III after Orthognathic Surgery: A Systematic Review and Meta-Analysis

Our aim was to assess the impact of combined orthodontic–surgical treatment on patients’ oral health-related quality of life (OHRQoL) according to type of dentofacial deformities, by synthesizing the available evidence. Methods: Search was conducted in the PubMed, Embase/MEDLINE, Scopus, and Cochrane databases. The eligibility criteria were studies that measured OHRQoL before–after orthognathic surgery, with results disaggregated by Class II and III. Two researchers independently performed the selection process, data extraction, and methodological quality assessment. Meta-analysis of the standard mean differences (SMD) was performed using random effect models. Results: The search identified 1047 references. Thirteen studies met the inclusion criteria, and four were included in the meta-analysis. The SMD of OHRQL global score showed large improvement 4–7 months after surgery in Class II and III patients (2.09, 95% CI 0.68 to 3.49 and 1.96, 95% CI 1.22 to 2.70, respectively). The sensitivity analyses, excluding studies with weak methodological quality, showed that Class III patients’ improvement in functional limitation was significantly higher than in Class II patients (SMD 0.57, 95% CI 0.12–1.02). Conclusions: There is not enough evidence to support differences between Class II and III patients in the OHRQoL impact after orthognathic surgery, but findings suggest lower improvement of some domains in Class II patients.

Prevalence of mandibular asymmetry in different skeletal sagittal patterns

OBJECTIVES

To analyze the prevalence of mandibular asymmetry in skeletal sagittal malocclusions.

MATERIALS AND METHODS

PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO and gray literature (OpenGrey, ProQuest, and Google Scholar) were electronically searched. Two independent investigators selected the eligible studies, and assessed risk of bias and certainty of evidence (GRADE). One reviewer independently extracted the data and the second reviewer checked this information. Any disagreement between the reviewers in each phase was resolved by discussion between them and/or involved a third reviewer for final decision.

RESULTS

Electronic search identified 5,132 studies, and 5 observational studies were included. Risk of bias was low in two studies, moderate in one, and high in two. The studies showed high heterogeneity. Mandibular asymmetry ranged from 17.43% to 72.95% in overall samples. Horizontal chin deviation showed a prevalence of 17.66% to 55.6% asymmetry in Class I malocclusions, and 68.98% in vertical asymmetry index. In Class II patients, prevalence of mandibular asymmetry varied from 10% to 25.5% in horizontal chin deviation, and 71.7% in vertical asymmetry index. The Class III sample showed a prevalence of mandibular asymmetry ranging from 22.93% to 78% in horizontal chin deviation and 80.4% in vertical asymmetry index. Patients seeking orthodontic or orthognathic surgery treatment showed greater prevalence of mandibular asymmetry.

CONCLUSIONS

Skeletal Class III malocclusion showed the greatest prevalence of mandibular asymmetry. Mandibular vertical asymmetry showed a marked prevalence in all malocclusions. However, conclusions should be interpreted with caution due to use of convenience samples and low-quality study outcomes.

Sleep, Distressed Appearance, and Quality of Life Relate to Satisfaction with Orthognathic Surgery

BACKGROUND

In this study, we aimed to identify factors correlating with satisfaction with orthognathic surgery in order to improve its outcome.

METHODS

We recruited 77 participants who had received orthognathic surgery and 32 age- and gender-matched normal-controls. Questionnaires that included devised questions for family support, Big Five Inventory, Derriford Appearance Score, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, 36-Item Short-Form Health Survey, and a visual analogy scale for satisfaction, were completed before and one month and nine months after the surgery. The statistical analysis methods included descriptive statistics, t-test, and Pearson correlation.

RESULTS

All participants received the preoperative and one-month follow-up, while 28 also completed the nine-month follow-up. Satisfaction was not significantly related to demographic data, but long-term satisfaction was related to an extraverted personality. The preoperative and postoperative results of the Derriford Appearance Scale were related to short-term and long-term satisfaction. Furthermore, both the preoperative and one-month postoperative Pittsburgh Sleep Quality Index findings were significantly related to short-term satisfaction. The postoperative 36-Item Short-Form Health Survey was significantly related to short-term and long-term satisfaction.

CONCLUSIONS

Not only subjective distress and dysfunction of appearance but also sleep problems and quality of life were correlated to satisfaction with orthognathic surgery. In the future, relevant interventions can be developed to further improve patient's satisfaction and their physical and mental health.

Do the stages of orthodontic-surgical treatment affect patients' quality of life and self-esteem?

The orthodontic-surgical treatment comprises different stages from diagnosis to final soft tissue accommodation, but there are no data regarding the patient's perception during these phases. This study aimed to investigate the impact of these stages on quality of life and self-esteem of patients with dentofacial deformity. Patients were divided into 4 groups according to the treatment stage: initial orthodontic pre-treatment (1), one week before surgery (2), three months after surgery (3), and after the removal of the orthodontic appliance (4) (n = 20 / group). They filled the following questionnaires: Oral Health Impact Profile (OHIP-14), Orthognathic Quality of Life Questionnaire (OQLQ) and Rosenberg Self-Esteem Scale (RSES). Data were evaluated by Kruskal-Wallis test. Differences among groups were noticed in all evaluated scales (p = 0.001 for all). No statistically significant differences between patients in groups 1 and 2 (OHIP, OQLQ, and RSES, p >0.05 for all), while patients at group 4 presented different scores in all questionnaires compared to 1, 2, and 3 (p < 0.05 for all), irrespective of the type of dentofacial deformity (p > 0.05). The results indicate that dental decompensation stage did not negatively affect patient's confidence and well-being. Despite the improvement noticed few months after the orthognathic surgery, the main impact on patient's quality of life and self-esteem was evidenced after the removal of the orthodontic appliance. We highlight the important role of counselling patients to discuss all the treatment stages to clarify patients' subjective expectations before any intervention is carried out.

Quality of Life After Class III Repair Orthognathic Surgery: Five-Year Retrospective Study

OBJECTIVE

To evaluate the effect of orthognathic surgery on the long-term quality of life of patients with presurgical skeletal Class III and to identify its strongest effect-whether esthetic, social, or functional.

MATERIALS AND METHODS

In this retrospective cohort study, the subjects were patients after orthognathic surgery for repairing skeletal Class III. Fifty-five patients who had undergone orthognathic surgery from 2013 to 2018 in the oral and maxillofacial surgery department participated in this study. Each participant completed a modified questionnaire used to assess the patient's esthetic, social, and functional abilities after orthognathic surgery.

RESULTS

The rate of esthetic improvement in orthognathic surgery patients was 88%. More than four-fifths (81.8%) of the patients reported improvement in their personal and social self-esteem and confidence. Finally, 40.7% of the patients reported functional improvement. No significant differences between male and female patients were found. All but one of the patients recommended orthognathic surgery for patients with similar problems. One in six (17.3%) patients was dissatisfied with the nasal appearance after the surgical procedure, while almost a quarter (21.8%) reported worsening of their mouth opening, and 25.4% reported worsening of TMJ (Temporo-Mandibular Joint) symptoms. Analysis of the results revealed no statistically significant pattern connecting preoperative overjet or overbite measures with satisfaction rates.

CONCLUSIONS

In this study, patient satisfaction with the orthognathic surgical procedure was mostly a result of improvements in facial esthetics, followed by psychological well-being and functional abilities. Most dissatisfaction after the orthognathic surgical procedure was related to nasal appearance, mouth opening, and TMJ complaints.

Short-term and Long-term Psychological Impact and Quality of Life of Patients Undergoing Orthognathic Surgery

Background

Orthognathic Surgery (OGS) is a surgery for patients with dento-facial deformity but not all patients are satisfied with its outcome. The purpose of this study is to find out the short-term and long-term psychological impact and quality-of-life of OGS.

Methods

77 participants receiving OGS and 32 age and gender-matched controls were enrolled. The data of questionnaires were collected before OGS, one month and 9 months after OGS, including short form of the Derriford-Appearance-Scale (DAS-24), Big-Five-Inventory (BFI), Hospital-Anxiety-and-Depression-Scale (HADS), Pittsburgh-sleep-quality-index (PSQI), and 36-Item Short-Form-Health-Survey (SF-36). Variables were presented as mean ± standard deviation or frequency. Paired t-test, ANOVA and MANOVA were used to evaluate the pre-and post-surgery data.

Results

Short-term and long-term satisfaction of OGS was high. Before OGS, BFI showed the extraversion had significant difference between the male and female OGS subgroups. Several domains of DAS-24 were significantly different between the OGS and the control groups. Both groups had no significant difference in PSQI, HADS and SF-36, except sleep-efficiency. After OGS, many domains of DAS-24 were significantly improved and the improvement persisted to 9 months later. Sleep-latency, physical-function, role-limitations-due-to-physical-health and social-functioning exacerbated after OGS. Sleep-latency, physical-function, and social-functioning were improved 9 months after OGS, but sleep-efficiency and role-limitations-due-to-physical-health were still significantly worse than controls.

Conclusion

People received OGS for unfavorable appearance and the surgery could decrease their distress of appearance and impact to their daily living. Through long-term assessment, we should pay attention to sleep problems and role-limitations-due-to-physical-health after OGS.

Orthognathic Surgery: A Bibliometric Analysis of the Top 100 Cited Articles

PURPOSE

An increasing number of articles on orthognathic surgery are published every year. This paper aims to provide a list of the top 100 cited articles on orthognathic surgery to help any professional level with interest in this topic and to map the trends of orthognathic surgery publications over time.

METHODS

A bibliographic search (retrospective study) following STROBE guidelines was performed on Google Scholar (GS) and Dimensions with the term "orthognathic surgery" in the title, abstract, and keywords. The number of citations, citations per year, authors, and publication year were evaluated. A ranking was created in GS citations order with the top 100 cited articles and variables discussed individually. A graphical illustration of keywords was created using VOSviewer. These steps are fundamental in creating this list and relating it to all published articles on the topic.

RESULTS

A helpful list of the top 100 articles was developed to help professionals in entirely different manners. Virtual planning and complications in orthognathic surgery were the most cited topics, with a 95% confidence interval (P < .05). Some curiosities are discussed, such as increasing interest in surgery first and the relation between airway/obstructive sleep apnea and orthognathic surgery.

CONCLUSIONS

Bibliometric and altmetric analysis for free using Google Scholar and Dimensions is laborious but possible. Bibliometrics is a powerful tool to become actualized at any health professional level, from students to academics; and could save considerable effort and time for parties interested in the topic. Appropriate keywords are a crucial step to wider article dissemination.

The Orthognathic Quality of Life Questionnaire: Translation and Validation into Dutch

OBJECTIVE

The aim of this study is to translate and validate the Orthognathic Quality of Life Questionnaire (OQLQ) in the Dutch language (OQLQ-NL).

METHODS

The translation of the OQLQ into the Dutch language was performed following the guidelines for the Process of Cross-Cultural Adaption of Self-Report Measures. Sixty-two patients who received orthognathic surgery in the past 10 years were included for participation. Internal reliabilities of the OQLQ-NL were evaluated for multiple item scales with the use of the Cronbach alpha coefficient. For the establishment of the test-retest reliability, the OQLQ-NL was repeated with a 2-week interval and the intraclass correlation coefficient was calculated. Spearman correlation was used to test the correlation with the OHIP-49NL and the FACE-Q, to be able to evaluate the construct validity of the OQLQ-NL.

RESULTS

Thirty-five patients filled in the OQLQ-NL, OHIP49NL, and FACE-Q upon arrival and 22 patients returned the OQLQ-NL after 2 weeks (response rate of 56.6% and 62.9%, respectively). The OQLQ-NL showed excellent results in internal reliability and test-retest reliability. The vast majority of the correlations between the domains of the questionnaires were as expected. Data from this study and previous studies confirm the construct validity of the OQLQ-NL.

CONCLUSION

The OQLQ-NL appears to be a valid and reliable instrument to measure quality of life for patients receiving orthognathic surgery in the Netherlands.

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.

Impact of orthognathic surgery on quality of life and comparison of patients' postoperative experience after single- and double-jaw surgery: a longitudinal study

OBJECTIVE

To evaluate the impact of orthognathic surgery on quality of life (QoL) and to compare single- and double-jaw surgeries in terms of ratio and patient perceptions of the postoperative period.

STUDY DESIGN

A prospective, longitudinal observational study was conducted. The short form Oral Health Impact Profile (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ) were applied preoperatively and 6 months postoperatively to evaluate oral health-related QoL (OHRQoL). Additionally, patient perceptions of the immediate postoperative period were assessed at the first and fourth week after surgery.

RESULTS

One hundred consecutive patients were recruited and assigned to the single-jaw group (n = 24) or the double-jaw group (n = 76) according to the characteristics of each facial or occlusal deformity. The questionnaires showed lower scores for both groups after surgery, indicating significant benefits to OHRQoL. The whole sample OHIP-14 mean total scores decreased from 10.5 to 2.8 (P < .001, d = 1.35), whereas OQLQ showed a decrease from 48.4 to 11.6 (P < .001, d = 1.75).

CONCLUSIONS

Orthognathic surgery can improve OHRQoL, and long-term benefits outweigh the risks and discomfort associated with the treatment.

Influence of Orthognathic Surgery on Oral Health and Quality of Life

ABSTRACT

Orthognathic surgery is a common treatment modality for moderate to severe dentofacial deformities. This study aimed to determine the early postoperative changes in quality of life (QoL) after orthognathic surgery.Twenty patients were evaluated preoperatively (T0), postoperatively after 1 month (T1), and postoperatively after 3 months (T2). Short Form Oral Health Impact Profile and Orthognathic Quality of life Questionnaire were used as generic oral health-related and condition-specific QoL measures.Oral Health Impact Profile -14 and Orthognathic Quality of life Questionnaire scores significantly decreased from T0-T2. Physical pain, psychological disability, social disability, and handicap scores significantly decreased during this interval. Facial esthetic, function, awareness of facial deformity, and social aspects of deformity were also found to significantly improve. No significant difference was found between age groups; female patients had significantly greater preoperative Oral Health Impact Profil-14 scores than did male patients.Orthognathic surgery not only enhances the skeletal and facial relations, but also has significant positive effects on the patients' QoL, oral health, and psychological status.

The impact of a surgery-first approach on oral health-related quality of life

Orthognathic surgery using a surgery-first approach (SFA) has been shown to result in better quality of life (QoL) throughout the treatment duration; however, the effects of gender, age and type of dentofacial deformity on SFA-related QoL remain unknown. In total, 228 consecutive patients underwent SFA for correction of dentofacial deformities (skeletal class III, bimaxillary protrusion and facial asymmetry). We assessed their QoL before surgery and at 1, 6 and 12 months after surgery using the Orthognathic Quality of Life Questionnaire (OQLQ). The results indicated a significant decrease in the total OQLQ, facial aesthetics and social aspect domain scores 1, 6 and 12 months after surgery. Among all domains, the greatest improvement was noted in the facial aesthetics domain. The oral function scores declined significantly immediately after surgery, but improved significantly 6 and 12 months after surgery; however, the awareness scores remained relatively stable. At each time point, women and the bimaxillary protrusion group exhibited a significantly higher total and specific domain scores. Patients aged 18-22 years exhibited lower total and four specific domain scores than older patients. Thus, QoL improves in all aspects, except awareness domain, by 12 months after SFA, but gender, age, and type of dentofacial deformity affect this improvement.

Dentofacial deformity and orthognatic surgery: Influence on self-esteem and aspects of quality of life

This study aimed to assess the extent to which psychosocial and functional aspects are affected in orthognathic surgery patients. The Oral Health Impact Profile (OHIP-CRO14), Orthognathic Quality of Life Questionnaire and Self-Esteem (SE) Scale were used. The sample included 110 Caucasian subjects (73% females) aged 19-54 years. Fifty-five patients with dentofacial deformities were treated by combined orthodontic-orthognathic surgical treatment, and 55 others, matched by sex and age, were untreated controls without dentofacial deformities. In comparison with the untreated subjects, patients before surgery had a poorer quality of life, with the largest effect size in oral function (OF) and OHIP (average differences 8.0 and 14.7, respectively; p < 0.001; r = 0.65 and 0.63), while the lowest effect sizes were in awareness of facial aesthetics (AW) and SE. The treatment induced statistically significant changes in all psychosocial and functional aspects, mainly with a large effect size (p < 0.001; r = 0.48-0.78). The major effect size was a decrease in facial aesthetic concerns (FE; 7.6 ± 6.2; p < 0.001; r = 0.78), followed by a decrease in impairment of OF and OHIP (8.0 ± 7.1 and 16.6 ± 14.6; p < 0.001; r = 0.75). The lowest effect size was in the decrease in AW and increase in SE. After surgery, all aspects were similar to those in the untreated subjects. In conclusion, facial deformity raises many issues, primarily related to aesthetic concerns and functional impairment; however, orthognathic surgery manages to improve quality of life to be similar to that of the population without deformities.

Quality of life after distraction osteogenesis in TMJ ankylosis patients

OBJECTIVE

The aim of our study was to evaluate the success of distraction osteogenesis in temporomandibular joint (TMJ) ankylosis patients with facial deformities at our maxillofacial unit; assess the psychosocial and well-being outcomes of distraction osteogenesis and its impact on oral health; and discriminate the differences in quality of life (QoL) with application of external or internal devices, unilateral or bilateral, linear or multivector, and maxillomandibular or mandibular distraction.

STUDY DESIGN

QoL and the Oral Health Impact Profile (OHIP) were prospectively studied in 42 consecutive patients with facial deformities, planned for maxillofacial distraction osteogenesis, using 2 validated questionnaires, the Orthognathic Quality of Life Questionnaire and OHIP-14. Patients who had undergone any previous surgeries were excluded.

RESULTS

Among these patients, 16 were female, 26 male; mean age was 14.98 ± 4.88 years, and all had prearthroplastic distraction. The shortening in the mandible was in the proportion 29:01:12 in the body, ramus, and ramus-body, respectively. Mean QoL scores before and after distraction were 68.52 ± 9.50 and 26.62 ± 3.51; and mean OHIP scores before and after distraction were 33.88 ± 6.26 and 15.36 ± 2.54, a highly significant difference (P < .001) suggesting improvement. Significant improvement was identified on all QoL and OHIP questions after distraction (P < .01). The postdistraction overall mean QoL score among patients with extraoral or intraoral distractor did not have a significant difference (P = .32), but facial appearance in the bilateral distraction group; jaw function and overall well-being in the multivector distraction group; and facial appearance, jaw function, and overall well-being in maxillomandibular distraction group had significant improvements (P < .05).

CONCLUSIONS

Distraction osteogenesis considerably improves oral health and health-related QoL in patients with TMJ ankylosis with facial deformities. The use of an external or internal distractor did not make any difference in the QoL; however, bilateral distraction, multivector distraction, and maxillomandibular distraction resulted in better QoL outcomes.

Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery-a retrospective, cross-sectional long-term analysis

OBJECTIVES

The aim of this clinical analysis was to evaluate intraoperative and early postoperative complications as well as late findings and the overall patient satisfaction following orthognathic surgery.

MATERIALS AND METHODS

In a retrospective, cross-sectional study, 119 patients after orthognathic surgery were included. Surgical approaches were single bilateral sagittal split osteotomy (BSSO (n = 52)), single LeFort-I osteotomy (n = 5) and bimaxillary osteotomy (LeFort-I + BSSO (n = 62)). Intraoperative and early (0-4 weeks postoperative) complications were investigated retrospectively (n = 119), whereas late findings and quality of life were assessed via clinical follow-up and survey (mean: 59 months postoperative) on 48 patients.

RESULTS

Bad split (n = 4/114) was the most common intraoperative complication followed by one case of severe bleeding. Regarding early postoperative complications, temporary damage of the inferior alveolar nerve after BSSO was most common (n = 33/114), followed by facial nerve dysfunction (n = 3), failed osteosynthesis (n = 2) and one case of postoperative dyspnoea. Permanent hypaesthesia of the lower lip was the most prevalent (n = 28/45^{(BSSO and LeFort-I + BSSO)}) late finding with varying extent, followed by temporomandibular dysfunction (TMD) (n = 25/48). Skeletal relapse mostly occurred after class II treatment, followed by class III, posterior crossbite and open bite. Overall, the surgery improved the patients' self-perception (85.4%), with 60.4% of patients opting for surgery again.

CONCLUSIONS

Long-term complications after orthognathic surgery occurred more frequently than commonly described in the literature, and analyses of the quality of life show the need for more comprehensive preoperative patient education.

CLINICAL RELEVANCE

Hypaesthesia of the lower lip presented less as complication but rather as side effect following BSSO. As orthognathic surgery is mostly elective, preoperative patient education is of pivotal importance and should include proactive risk stratification.

Distraction Osteogenesis Versus Orthognathic Surgery: Demystifying Differences in Concepts, Techniques and Outcomes

Introduction

The popularity and interest evoked by orthognathic surgery and distraction osteogenesis are undisputed in the field of oral and maxillofacial surgery. However, questions regarding the individual identities of either of them with clarity in their concepts, techniques and outcomes have remained unanswered. The aim of this review is to shed light on these questions.

Methods

This review is structured as a narrative review of thirty years of literature available in the specialities of orthognathic surgery and distraction osteogenesis.

Conclusion

The authors present a review of existing literature combined with contrasting experience gained over the years in providing an overview of the merits and demerits of the two surgical techniques which will aid the clinician in justifying the use of one technique over the other.

Evaluation of long-term hard tissue relapse following surgical-orthodontic treatment in skeletal class II patients: A systematic review and meta-analysis

This systematic review and meta-analysis was performed to evaluate the long-term hard tissue stability and relapse factors following surgical-orthodontic treatment in skeletal class II patients. A literature search was conducted using Embase, Cochrane Central, Web of Science, and PubMed, yielding 3184 articles published up to January 2019. Risk of bias was assessed following the Cochrane handbook. Ten articles met the inclusion criteria. A total of 1079 patients were followed up for 5-13 years. The qualitative findings showed a variety of extrinsic and intrinsic factors affecting long-term stability. Meta-analysis for the amount and direction of cephalometric landmark displacement in the vertical and sagittal planes showed significant angular increases of ANB and backward relapse of SNB, however within the clinically acceptable range of 4°. In relation to linear measurements, the mean differences in all landmarks were within the clinically acceptable range of 2mm except for gonion. In conclusion, this systematic review showed multiple intrinsic and extrinsic factors responsible for relapse. However, the outcomes of the meta-analysis are limited due to the heterogeneity of data, small number of studies, and inconsistent methods of evaluation. Further high-quality studies utilising standardised three-dimensional methodologies are required to improve the level of evidence.

A Meta-analysis and Systematic Review Comparing the Effectiveness of Traditional and Virtual Surgical Planning for Orthognathic Surgery: Based on Randomized Clinical Trials

PURPOSE

To explore the advantages of virtual surgical planning (VSP) and traditional surgical planning (TSP) to determine whether the current VSP technique is superior to the TSP technique for orthognathic surgery.

METHODS

An electronic search was carried out in the CENTRAL, PubMed, and Embase databases to identify randomized clinical trials (RCTs) that compared the VSP and TSP techniques regarding their surgical accuracy for hard tissue, prediction precision for soft tissue, required time for planning and surgery, cost and patient-reported outcomes.

RESULTS

Eight articles from 5 RCTs, involving 199 patients, were identified. The findings showed that the VSP and TSP techniques were similar in surgical accuracy for hard tissue in the sagittal plane, although the VSP technique was significantly more accurate in certain reference areas, especially in the anterior area of the maxilla. Both the VSP and TSP techniques had significantly better surgical accuracy for the maxilla than for the mandible. The VSP technique showed clinically significantly greater precision for soft tissue prediction in the sagittal plane. Patients who were treated via the VSP technique presented a more symmetrical frontal view, regardless of whether hard or soft tissue was involved. The VSP technique required more time for software planning, but it showed an advantage in time savings when considering the entire preoperative process. Accompanied by the use of an accurate computer-aided splint, the VSP technique could effectively reduce the operative time. Apart from the initial financial investment of software and hardware, the total cost of the VSP technique was similar to that of the TSP technique. Patients who were treated via the VSP or TSP technique showed similar improvements in quality-of-life.

CONCLUSIONS

Currently, the VSP technique has become a good alternative to the TSP technique for orthognathic surgery, especially regarding frontal-esthetic considerations. Studies reporting indicators with good representativeness and sensitivity using an identical comparative method are recommended.

Orthodontic and surgical management of a patient with severe mandibular deficiency and asymmetry with condylar hypoplasia using 3-dimensional surgical planning in combination with a modified surgery-first approach

Progressive improvements in digital technology and surgical techniques have synergized the speed, predictability, and favorable outcomes for patients undergoing surgical-orthodontic treatment with handicapping dentofacial deformities. This case report will demonstrate the management of a patient with severe mandibular hypoplasia, condylar hypoplasia, and mandibular asymmetry. The dentofacial deformity, and consequently, the unaesthetic facial appearance, led to psychosocial stress, symptoms of excessive daytime sleepiness, and functional limitations, especially related to mandibular movements. A modified surgery-first approach was used, which was successfully performed using computer-assisted surgical planning. Postsurgical orthodontics was accomplished with the aid of temporary skeletal anchorage mini-plates. An additional alloplastic enhancement of the chin addressed the severe microgenia, which the osseous advancement could not achieve. This resulted in a total advancement of the pogonion by 26 mm yielding a remarkable improvement in the patient's facial esthetics. Furthermore, a considerable improvement in mandibular function and reduction in daytime sleepiness occurred. The severe malocclusion with a discrepancy index value of 47 was treated to a successful final occlusion in 21 months of treatment time.

Impact of orthognathic surgery on quality of life of patients with dentofacial deformity: a systematic review and meta-analysis

The aim of this study was to evaluate the impact of orthognathic surgery on the quality of life (QoL) of patients with dentofacial deformity. This systematic review was performed through the survey of observational studies that had evaluated the impact of orthognathic surgery on the QoL of patients with dentofacial deformity. The article databases included PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and grey literature. The risk of bias was analysed according to the Newcastle-Ottawa Scale for quality assessment. The meta-analysis was performed considering the exposure before and after orthognathic surgery using the Oral Health Impact Profile (OHIP-14) versus the Orthognathic Quality of Life Questionnaire (OQLQ). A total of 2,263 articles were identified. Twelve studies remained in the qualitative synthesis and seven studies were included in the meta-analysis. The impact of QoL both preoperatively and postoperatively with the OHIP-14 questionnaire was 7.63 (95% confidence interval (CI) = 1.62 to 13.65; p = 0.01) and the OQLQ questionnaire was 20.53 (95% CI = 14.27 to 26.79; p < 0.0001). Overall impact of QoL was 16.01 (95% CI = 10.50 to 21.52; p < 0.0001), which showed that orthognathic surgery has an influence on the QoL. Orthognathic surgery generates positive impact on the QoL of patients with dentofacial deformity.

The effect of manual lymphatic drainage on patient recovery after orthognathic surgery-A qualitative and 3-dimensional facial analysis

OBJECTIVE

The aim of this study was to investigate the effect of manual lymphatic drainage (MLD) on postoperative facial swelling and pain.

STUDY DESIGN

A randomized, single-center, prospective, 2-arm clinical trial with blinded endpoint assessment was set up. Patients were enrolled from the Maxillofacial Department of the Ghent University Hospital (Belgium) between January 2015 and March 2018. Both the intervention group (n = 13) and the control group (n = 13) received the same postoperative care; in addition, the intervention group underwent 6 sessions of MLD after orthognathic surgery. Three-dimensional facial scans were performed and questionnaires administered on postoperative days 3, 7, 14, 30, 90, and 180. A linear mixed model was performed, and statistical significance was assumed at the 5% level.

RESULTS

In total, 26 patients (mean age 29 years; range 16-57 years) were included for statistical analysis. A faster decrease in swelling in the intervention group was observed on 3-dimensional scans. Furthermore, patients receiving MLD reported reduction in swelling and pain within the first month after surgery. However, no statistically significant difference could be detected in these observations (P > .05).

CONCLUSIONS

Within the limitations of this study, no statistically significant difference could be found between patients treated with or without MLD after orthognathic surgery with regard to swelling and pain.

Combined Orthodontic-Orthognathic Approach for Dentofacial Deformities as a Risk Factor for Gingival Recession: A Systematic Review

PURPOSE

The objective of this systematic review was to evaluate the risk of development of gingival recession (GR) as a result of the combined orthodontic-orthognathic approach.

MATERIALS AND METHODS

The PubMed, Google Scholar, ClinicalTrials.gov, and Cochrane Library databases were searched. Included articles mentioned gingival parameters in their materials and methods sections; specifically, they evaluated GR, which was measured before and after the surgical procedure. Study parameters such as methodology, evaluation period, sample characteristics, and follow-up were extracted by 2 authors independently.

RESULTS

In total, 133 relevant articles were identified from the databases; after screening and full-text analysis, 9 studies were included in this systematic review. Meta-analysis could not be conducted because of considerable heterogeneity in methods. The incidence of GR in the range of 0.5 to 3.0 mm as a significant clinical finding after orthognathic surgery showed statistically significant differences in all included articles. Among patients with GR, the mean age was 23.0 to 29.5 years and the mandibular incisors were the most common site. However, no case of recession greater than 3.0 mm was associated with surgery.

CONCLUSIONS

On the basis of the findings of this review, GR of approximately 0.5 to 3.0 mm is a common finding after the combined orthodontic-orthognathic approach. Although periodontal damage up to 3 mm can be observed as an isolated finding in mainly the incisors, true recession is not associated with orthognathic surgery in general.

Orthodontic-surgical treatment for a patient with Class II malocclusion and inadequate maxillary incisor inclination

Dental health and patient satisfaction at the end of orthodontic treatment are needed if the treatment is to be considered successful. This case report highlights the importance of proper diagnosis for a patient initially treated with camouflage, despite the indications for surgery. A 16-year-old male patient sought treatment complaining about his appearance. He had been using an appliance for 6 years without improvement. He had a convex profile, an enlarged lower third of the face, reduced cervical-mandibular line, and Class II molar relationship. The maxillary incisors had excessive buccal root torque, throbbing pain, and dental mobility, with no visible bone coverage in the tomographic sections. The cephalometric analysis confirmed the skeletal Class II relationship (ANB, 11.6°; Wits appraisal, 14.2 mm) because of severe mandibular deficiency (SNB, 71.2°), aggravated by the vertical growth tendency (FMA, 27.3°). Changes in IMPA (108.1°) and U1-NA (0.9°; -2.9 mm) reflected the previous orthodontic attempt to compensate for the malocclusion. After periodontal and endodontic evaluation, a new treatment plan was developed. The incisors would be positioned in their bone bases, the mandibular first premolars would be extracted to create space for the second molars and increase the overjet, and the patient would be referred for orthognathic surgery. The patient was satisfied with the esthetic and functional results of this treatment.

The Psychosocial Patient-Reported Outcomes of End of Pathway Cleft Surgery: A Systematic Review

OBJECTIVE

To identify and review the literature on the psychosocial patient-reported outcomes (PROs) of surgery at the end of the cleft treatment pathway.

DESIGN

A systematic literature search was performed using electronic databases (Medline, PubMed, EMBASE, PsycInfo, Web of Science, and Science Direct) from database inception to September 2017, to identify studies measuring and reporting the psychosocial PROs of end of pathway cleft surgery.

RESULTS

Of 263 identified papers, 22 studies were eligible for inclusion. Apart from one randomized controlled study, studies were largely observational and adopted a cross-sectional or retrospective design. The majority (n = 16) were small-scale studies. The methodological quality was variable in terms of what, how, and when psychosocial outcomes were measured and reported. None of the studies utilized a psychosocial PRO measure validated in the cleft population, and few studies measured outcomes prospectively. A high proportion of studies utilized bespoke measures of patient satisfaction. Taken together, findings from the included studies are tentative but seem to suggest patients derive some benefit from undergoing end of pathway cleft surgery, in terms of increased satisfaction, quality of life, social interactions, and decreased appearance-related distress.

CONCLUSIONS

Due to methodological challenges and the heterogeneity of what, how, and when outcomes are measured and currently reported, it is difficult to determine the psychosocial PROs of end of pathway cleft surgeries. Consequently, this review advocates the conduct of well-designed, longitudinal studies using cleft-sensitive tool/s to capture the psychosocial PROs of end of pathway cleft surgery at various time points.

Measuring patient-reported outcomes in orthognathic surgery: Linguistic and psychometric validation of the Mandarin Chinese version of FACE-Q instrument

Background

Orthognathic surgery is useful for correction of dental malocclusion and improvement of facial appearance. The FACE-Q is a patient-reported outcome instrument for evaluation of surgical and psychosocial effect. The purposes of this study were to conduct a linguistic validation of all FACE-Q scales to Mandarin Chinese, to test the orthognathic surgery-related scales for reliability and validity, and to evaluate the effect of orthognathic surgery.

Methods

All FACE-Q scales and checklists were translated from English to Mandarin Chinese according to international recommendations: forward translations, backward translation, and cognitive interviews. Psychometric testing of orthognathic surgery-related scales of translated version was administered to patients with facial deformities and history of orthognathic surgery (n = 53; 17 scales) or no history of orthognathic surgery (n = 44; 11 scales), and control subjects (n = 57; 11 scales).

Results

All FACE-Q scales and checklists were linguistically validated into Mandarin Chinese. The contents were confirmed valid among Mandarin Chinese-speaking population. The FACE-Q scales had excellent internal consistency (Cronbach's alpha >0.70) and discriminated (p < 0.05) well between patients before and after orthognathic surgeries and normal subjects.

Conclusions

This study discovered significant benefit of orthognathic surgery on improving facial appearance and psychosocial function, as compared with the non-surgical patients and normal controls.