Improvement of Esthetic, Functional, and Social Well-Being After Orthognathic Surgical Intervention: A Sampling of Postsurgical Patients Over a 10-Year Period From 2007 to 2017

Orthognathic surgery improves quality of life: a survey clinical study

BACKGROUND

The aim of this study was to evaluate the quality of life (QoL) of patients with dentofacial deformity (n = 107) compared with that of healthy individuals (n = 108) from 2019 to 2020.

METHODS

Oral Health Impact Profile 14 (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ) were administered to the individuals before surgery (T1) and 6 months after surgery (T2).

RESULTS

Preoperative scores (T1) were greater in the surgical group than in the control group in all domains of both surveys (p ≤ 0.001). Postoperative scores (T2) in the surgery group decreased significantly after surgery in all domains in both surveys (p < 0.001). The OHIP-14 scores in the control group at T2 were significantly greater than those in the other domains except for functional limitation at T1. The type of surgery had no effect on quality of life. Class III patients had higher preoperative scores in certain domains. Postoperative physical disability (p = 0.037), physical pain (p = 0.047), and preoperative social disability (p = 0.030) scores of OHIP-14 awareness of dentofacial aesthetics of OQLQ (p = 0.019) were found to be higher in females than in males.

CONCLUSIONS

The results showed that orthognathic surgery positively affected quality of life. The control group showed differences in T1 and T2 scores, which can be attributed to their psychological status.

Comparison of Skeletal Stability after Le Fort I Osteotomy With Bone Fixation Using Biodegradable and Titanium Systems: A Retrospective Study

The titanium osteosynthesis system used for fixing bone segments after maxillary osteotomy provides reliable outcomes owing to its biocompatibility and adequate strength. In addition, several studies have evaluated the skeletal stability after maxillary osteotomy with fixation using a biodegradable system. However, the indications for applying a biodegradable system after maxillary osteotomy remain controversial. Therefore, this study aimed to compare the long-term skeletal stability of bone segments after maxillary osteotomy with bone fixation using biodegradable and titanium osteosynthesis systems and to assess the usefulness of a biodegradable osteosynthesis system. Patients who underwent Le Fort I osteotomy of the maxilla to correct jaw deformities between April 2008 and March 2021 were included in this study. A total of 45 patients were included, with 28 in the biodegradable osteosynthesis system group and 17 in the titanium group. Cephalometric and computed tomography analyses were performed to evaluate the skeletal stability of the bone segments after maxillary osteotomy with bone fixation using biodegradable or titanium osteosynthesis systems. The maxillary segment was repositioned anteriorly with a clockwise rotation. Skeletal stability was similar between the biodegradable and titanium osteosynthesis systems. Segmental changes occurred mainly in the first 6 months after surgery, and the segment was completely stable between 6 and 12 months after surgery. This study revealed no significant differences in skeletal stability after maxillary osteotomy between the biodegradable and titanium osteosynthesis systems. However, the findings in this study should be interpreted with caution owing to the small sample size and small amount of maxillary-segment movement.

Occlusal Plane Angle as a Key Factor for Chin Protrusion After Mandibular Osteotomy in Skeletal Class III

There is no treatment algorithm to decide whether maxillomandibular or mandibular osteotomy alone should be performed in borderline cases. This study assessed the factors that affect the changes in soft tissue after mandibular setback. Patients who underwent mandibular osteotomy alone to correct mandibular protrusion were included in this study. Hard and soft tissue analyses were performed on lateral cephalograms before and 12±3 months after surgery. The popular points were set for referencing hard and soft tissues on the lateral cephalogram. Nasolabial, labiomental, and soft tissue facial plane angles were measured for the soft tissue assessment. To assess the mandibular setback amount, SNB was calculated. Twenty-one patients were included in this study. The nasolabial angle was increased after surgery and its change significantly correlated with the change in SNB ( P =0.00815). The change in soft tissue facial plane angle after surgery per change in SNB significantly correlated with the occlusal plane angle ( P =0.0009). An occlusal plane angle of at least 15.45 degrees was required for the SNB and soft tissue facial plane angle to change to the same degree. The occlusal plane angle (whether or not it was ≥15.45 degrees) may help in determining the surgical approach in borderline cases, specifically on whether maxillomandibular or mandibular osteotomy alone should be performed if the mandibular setback is simple.

Measurement of quality of life in orthognathic surgery using an original questionnaire: About a series of 123 cases

INTRODUCTION

The aim of this study was to measure changes in the quality of life of patients who had orthognathic surgery using an original questionnaire, designed for this purpose.

MATERIAL AND METHOD

This single-center retrospective study included all patients who had orthognathic surgery in our center between 2014 and 2019. An original questionnaire comprising 13 items in 4 domains was sent to patients postoperatively by email after telephone contact and obtaining their consent. Items were scored on a 5-point scale ranging from (-1), worse than before surgery, to (+3), better than before surgery.

RESULTS

All data were collected in a standardized way. In total, 123 patients responded. The mean score for all surgeries combined was +1.14, indicating an improvement in QOL considered to be "low to moderate". A total of 118 patients (95.9%) reported an improvement following surgery, including 18 patients (14.6%) who reported a marked improvement. The greatest improvement was observed for psychosocial aspects and morphology.

CONCLUSION

This study shows a positive effect of orthognathic surgery on patients' QOL, including self-perception, relationships with others, or functional aspects as mastication and breathing. We propose an original tool that is easy to use by patients to measure quality of life following orthognathic surgery.

Facial Contour Refining after Surgery-First SSRO with Computer-Assisted Design in East Asians

BACKGROUND

Surgery-first sagittal split ramus osteotomies (SF-SSRO) are an effective treatment for patients with dental malocclusion. However, some patients with mandibular prognathism usually have facial deficiencies which cannot be corrected completely after orthognathic surgery. These are not accepted because the remaining facial contours are in disharmony.

METHODS

Twenty-five patients, who were unsatisfied with their appearances after SF-SSRO and orthodontics, were included. The preoperative CTs were used to investigate patients for facial deformity. To achieve a harmonious facial contour, mandible long-curve osteotomy/mandible U-shaped osteotomy, genioplasty or facial autologous fat grafting was selected depending on patients' contour deformities with the assistance of CAD.

RESULTS

Among the patients who underwent osteotomy, the gonial angle was improved from 111.16° ± 9 to 111.58° ± 9.06 after SF-SSRO because of distal fragment setback and rotation. After facial refine surgery, the gonial angle was significantly increased to 121.69°±2.41 (p < 0.05). And the mandibular width was decreased from 11.29 cm ± 0.44 to 10.45 cm ± 0.39 (p < 0.05) after mandibular outer plate griding. All patients were shown no signs of infection, massive bleeding, and osteonecrosis in the early stage. After follow-up time, they were all satisfied with their results and most of them recovered from lip numbness.

CONCLUSIONS

This study indicated the clinical feasibility of two-stage orthognathic and facial bone contouring surgery for the treatment of dentofacial deformities. Two-stage facial contouring surgery can provide esthetic improvement for more accuracy in refining the facial contour.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Quantitative sensory testing of mandibular somatosensory function following orthognathic surgery-A pilot study in Chinese with class III malocclusion

BACKGROUND

Somatosensory changes after sagittal split ramus osteotomy (SSRO) have not been fully studied in Chinese patients by the latest technologies.

OBJECTIVE

To provide a comprehensive analysis of somatosensory function at the lower lip and chin at different time points following SSRO in a Chinese population.

METHODS

A total of 22 patients (18-27 years; nine men) with skeletal III malocclusion and scheduled for SSRO were recruited. Quantitative sensory testing (QST) was performed at pre-operation (baseline), 1 week (1W), 1, 3 and 6 months (1M, 3M, 6M) post-operatively. Cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), mechanical detection threshold (MDT), mechanical pain threshold (MPT), pressure pain threshold (PPT) and two-point discrimination threshold (2PD) were tested at the lower lip and chin.

RESULTS

Except for PPT at both test sides at 1W and 1M, all QST values indicated a significantly reduced sensitivity (p < .05). All values had returned to baseline values at 3M with exception of HPT at the right chin which, however, had recovered at 6M (p > .05).

CONCLUSIONS

Somatosensory function at the lower lip and chin appears to be fully recovered in the majority of young Chinese adults 6 months after SSRO for skeletal class III malocclusion.

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.

Dental discoloration following Le Fort 1 osteotomy, a systematic review

INTRODUCTION

This study was conducted to review current knowledge concerning factor and how to proceed with dental discoloration after Le Fort 1 osteotomy (LF1O).

MATERIAL & METHODS

A systematic search of the literature was performed in PubMed/Medline and Cochrane library until December 1, 2020 using the following key words: "dental discoloration and osteotomy", "dental discoloration and Le Fort", "dental discoloration and orthognathic", "dental discoloration and surgery", "tooth discoloration and osteotomy", "tooth discoloration and Le Fort", "tooth discoloration and orthognathic", "tooth discoloration and surgery".

RESULTS

705 studies were located by initial screening; 232 were duplicate, 468 did not meet the eligibility criteria, leaving 5 studies. The post-operative follow-up period of the included studies ranged from 6 months to 2 years.

CONCLUSION

The present revue found dental discoloration can occur after LF1O in 3.56% of the cases. The follow-up before treatment should be around one years. If the discoloration persisted and pulpal sensibility test is negative, the tooth should be treated. If the pulpal sensibility test is positive, follow-up should be carry on.

The effects of orthognathic surgery on auditory function

BACKGROUND

Orthognathic surgery is widely used in treating functional and skeletal problems. Any surgical procedure could cause side effects.

OBJECTIVES

This study aimed to evaluate the potential changes in orthognathic surgery on the hearing function of patients.

MATERIALS AND METHODS

Thirty-one orthognathic surgery candidates were recruited in this study. Patients underwent either single or double jaw surgery. Pure tone audiometry (PTA), tympanometry, and Eustachian Tube Dysfunction Test (ETFT) were performed postoperatively at 24 h, 6 weeks, and 6 months after surgery. Patients were tabulated based on the type of maxilla and mandibular surgical movements (vertical and horizontal).

RESULTS

PTA evaluation, based on horizontal or vertical movements, did not show significant differences, although vertical movements resulted in less change in hearing threshold. In other words, no significant changes occurred in patients' hearing threshold after surgery. No significant difference was also observed between horizontal and vertical movements in the results of tympanometry. Negative changes were found in the results of ETFT in vertical movements, which returned to pre-surgery values in the final test.

CONCLUSIONS

The risk of minor changes in hearing function is probable during the first week after orthognathic surgery, but these negative changes will either totally fade or remain negligible. Patients gave informed consent preoperatively, and reassurance postoperatively is prudent.

Effects of Water-Circulating Cooling Mask on Postoperative Outcomes in Orthognathic Surgery and Facial Trauma

The purpose of this study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) investigating the efficacy of hilotherapy on postoperative pain, swelling, neurosensory impairment and patient satisfaction. The authors analyzed RCTs comparing the use of hilotherapy versus conventional cryotherapy or no cold treatment for orthognathic surgery and repair of facial trauma. The authors assessed the risk of bias and strength of evidence according to the Cochrane guidelines and GRADE rating system, respectively. Treatment effects were defined as weighted or standardized mean difference using the inverse variance method. Five RCTs were included. Postoperative pain and swelling in patients using hilotherapy were lower comparing to the control group in the postoperative day 2 (Pain: MD -1.75, CI 95% -2.69 to -0.81; Swelling: MD -21.16 mL, CI 95% -38.91 to -3.41) and in the final evaluation (Pain: MD -0.31, CI 95% -0.44 to -0.18; MD -4.45 mL, CI 95% -7.87 to -1.03). Patients reported higher satisfaction with hilotherapy, but no differences were found for neurosensory impairment. Current evidence suggests that hilotherapy is effective in reducing postoperative pain and swelling in orthognathic surgery and repair of facial fractures and may lead to improvements in patient satisfaction in the recovery phase.

Patient's satisfaction with facial appearance and psycho-social wellness after orthognathic surgery among Hong Kong Chinese using the FACE-Q

PURPOSE

To assess and compare the changes in satisfaction with facial appearance and psycho-social well-being in dento-skeletal class II and III patients after orthognathic surgery with the FACE-Q among Hong Kong Chinese.

METHODS

The questionnaires for thirteen orthognathic-relevant FACE-Q scales, translated into Cantonese and validated, were administered to Hong Kong Chinese patients before and after orthognathic surgery in the short- and long-term, respectively. The assessed scales were categorized into four main domains: satisfaction with facial appearance, quality of life, patient's experience of care, and adverse effects.

RESULTS

Generally, highly significant (p < 0.001) improved FACE-Q scores were found in the long-term in the scales investigating the satisfaction with overall facial appearance, lower face and jawline, and chin. Although dento-skeletal class III patients demonstrated significantly improved satisfaction with their post-surgical nostril appearance (p = 0.003), this was not evident in dento-skeletal class II patients (p = 0.231). Nonetheless, both class II and class III subjects have also revealed significantly improved psychological well-being (0.003; <0.001) and social function (0.001; <0.001) in the long-term. Age was not found to be correlated with all scales for satisfaction of facial appearance.

CONCLUSION

Previously validated Face-Q scales are valuable instruments to measure clinical outcomes, psychological well-being and social function in Cantonese speaking patients. Both Class II and Class III patients showed significantly improved satisfaction with facial appearance, psychological well-being and social function after orthognathic surgery regardless of skeletal pattern and gender, confirming findings in other ethnicities.

Facial Versus Skeletal Landmarks for Anterior-Posterior Diagnosis in Orthognathic Surgery and Orthodontics: Are They the Same?

PURPOSE

The purpose of this investigation was to evaluate diagnostic agreement in anterior-posterior (AP) categorization of the maxilla and mandible between a skeletal-landmark analysis and a facial-landmark analysis for treatment planning of orthognathic surgery and orthodontics.

MATERIALS AND METHODS

This retrospective, consecutive case series of adult patients who presented to the Mayo Clinic orthodontic department compared maxillary and mandibular AP diagnoses. Steiner's analysis of the sella-nasion-A point angle and sella-nasion-B point angle was used for a skeletal-landmark diagnosis. Element II of Andrews' 6 elements of orofacial harmony was used for a facial-landmark diagnosis. Both diagnoses were categorized as either deficient, optimal, or excessive for each jaw. Categorization of the skeletal landmark was determined by normative data, whereas the facial landmark provides a customized categorization unique to each individual.

RESULTS

Weighted κ statistics were completed to test agreement between the categories determined by the skeletal and facial landmarks. The maxilla showed poor agreement, and the mandible showed slight agreement.

CONCLUSIONS

No agreement was found for AP categorization of the maxilla and mandible between skeletal-landmark and facial-landmark analyses. Most mandibles were diagnosed as retrognathic by the facial landmark, whereas most were diagnosed as optimal by the skeletal landmark. When the 2 landmarks disagreed, the facial landmark defined the optimal position farther anterior. The landmark chosen for diagnosis will impact the optimal jaw position and can affect orthognathic and orthodontic outcomes.