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

Evaluation of social appearance concerns and satisfaction after orthognathic surgery

The main aim of orthognathic surgery is to provide a good occlusion and masticatory function and to achieve positive changes in facial aesthetics. The aim of this study was to determine the reasons behind patients' acceptance of orthognathic surgery and their expectations from this treatment, to assess whether their expectations were met, the change in their self-confidence and their satisfaction, and finally, to use the results obtained to inform future surgical procedures to increase patient satisfaction. The study was designed as a cross-sectional observational study and included 73 people treated with orthognathic surgery (surgery group) and 42 people with minimal crowding who did not require treatment (control group). The study found that the primary reason for requesting orthognathic surgery was to improve facial appearance and that patients had high expectations in this regard. Using the Social Appearance Anxiety Questionnaire and the Expectation and Satisfaction Questionnaire, 73.97 % of patients in our study said the treatment met their expectations and 90.41 % said they were satisfied with the overall results of the surgery. The study also highlighted the importance of surgeon-patient communication and the satisfaction of the patient's environment with the final result in determining patient satisfaction. In conclusion, since patients' high expectations of orthognathic surgery influence treatment success and patient satisfaction, it is important to know and manage patients' expectations before treatment and to have good patient-surgeon communication to increase patient satisfaction after surgery.

Perioperative Patient Perspectives on Orthognathic Surgery - A Prospective Study

Introduction

Understanding patient motivations and expectations of orthognathic surgery are critical aspects of the perioperative assessment, as these factors have been demonstrated to influence patient satisfaction with surgical outcomes.

Materials and Methods

Consecutive patients undergoing orthognathic surgery by a tertiary oral and maxillofacial surgeon underwent two structured interviews to explore their pre-operative motivations for orthognathic surgery, their post-operative reflections on the surgery and their outcomes. Interviews were transcribed verbatim and analysed using thematic analysis.

Results

Eighteen patients were recruited and interviewed preoperatively, and seven completed interviews postoperatively. Pre-operative themes describe patient hopes for aesthetic improvements, socio-emotional improvements, functional improvements and reduced pain, as well as fears about surgical risks, surgical recovery and changing appearance. Post-operative themes describe the challenging recovery process, the absence of regrets and functional, aesthetic and socio-emotional improvements.

Discussion

Orthognathic surgery patients may be motivated by functional, aesthetic and socio-emotional improvements before surgery.

Patient Satisfaction Following Orthognathic Surgery: A Systematic Review

Objective

This study is intended to review data pertaining to patient satisfaction following orthognathic surgery through a systematic literature survey.

Methods and Materials

An electronic search was done on Medline, EMBASE and CENTRAL databases. The inclusion criteria considered were as follows: (1) assessment of patients' satisfaction, (2) one-stage orthognathic surgery, and (3) follow-up period of 8 weeks or more in English literature. The exclusion criteria considered were as follows: (1) presence of craniofacial syndromes, cleft lip and palate or traumatic injuries, (2) previous facial surgery, and (3) psychological problems before surgery. The data were extracted and analyzed under three categories: function, esthetics and overall satisfaction.

Results

Eighteen studies met the inclusion criteria. Esthetic and function were improved in majority of patients; however, it was not possible to assess the overall satisfaction levels statistically. Overall satisfaction analysis revealed that 70-87% of patients were satisfied, while nearly 15% of patients were dissatisfied with the treatment outcome.

Conclusion

Most of the patients were satisfied with the surgical outcome. However, satisfaction seemed to be multifactorial and it was not possible to predict satisfaction prior to the surgery.

Facial scars resulting from a transbuccal approach during osteosynthesis of a sagittal split osteotomy: A retrospective study

The purpose of the current study was to assess the quality of facial linear scars. The Stony Brook Scar Evaluation Scale (SBSES) was developed and validated as a tool to assess postoperative scars. Postoperative facial scars were rated using high-quality macrophotographs and SBSES by three independent raters at baseline and three months thereafter. Percentage agreement (PA) and intraclass correlation coefficient (ICC) were used to measure interrater and intrarater reliability. Scar outcomes ranging from 0 (worst) to 5 (best) were evaluated against age and gender. One-hundred-sixty-six patients with a mean age of 30.6 years (range of 17-59) were included in this study. Forty-four were male (26.5%), and 122 were female (73.5%). Mean total SBSES scores were 4.63 (range of 4.56-4.76) at baseline and 4.60 (range of 4.54-4.72) at three months. As patient's age increased, mean total SBSES scores also decreased significantly (r = -0.216, p = 0.005). Gender did not significantly affect raters' perception of scar cosmesis (p = 0.847). Interrater reliability showed an ICC of 0.675 (95% CI, 0.609-0.731) and a PA of 65.4% at baseline, and an ICC of 0.655 (95% CI, 0.585-0.715) and a PA of 64.2% at three months. Intrarater reliability found ICCs ranging from 0.988 to 0.990 and a PA of 96.8% with 3 separate raters. Within the limitations of the study it seems that the transbuccal approach during osteosynthesis of a sagittal split osteotomy seems still to be acceptable when the patient gives his or her informed consent and advanced instruments like an angled screwdriver are not available.

The Use of TADs in the Mandibular Arch to Prevent Proclination of the Lower Incisors during the Use of the Mini Scope Herbst Appliance

Class II malocclusions are the most frequent within the Italian population. Normally, these malocclusions are caused by a reduction in a mandibular component whose functional stimulus is still very much cause for debate. The negative effect of all types of Class II functional appliances is in the proclination of the lower incisors, which, in subjects whose incisors are already labially inclined, must be checked at all times to avoid serious consequences to these elements. In this case study, a girl aged 14 years and 5 months presented with Class II malocclusion, 2nd division with a convex profile and a visibly retruded chin. The lower incisors presented a marked proclination (-1/Go-Gn ini = 107.7°) in a brachyfacial patient. To avoid further inclination of the lower incisors a Herbst appliance was mounted in two separate sittings. The first part of the appliance including the tubes was mounted to the upper jaw allowing the vestibularisation of the upper incisors in order to increase the overjet. Once this was obtained the lower part of the appliance was mounted together with the telescopic arms associated with two temporary anchorage devices (TADs) in positions 36-37 and 46-47, and an anterior section 33-43 with distal loop to which two double metallic ligatures were anchored at the TADs to contrast the negative effect of the appliance. At the end of the first functional phase, the treatment was refined using MBK fixed therapy to finish the case. The orthodontic therapy led to a visible improvement of the profile and the achievement of a first-class dental-skeletal result on both sides. From the cephalometric evaluation carried out immediately after the Herbst appliance treatment at time T1 and at the end of the orthodontic therapy T2 it was possible to verify a slight increase in the inclination of the lower incisors (-1/Go-Gn fin = 108°). In conclusion, it can be said that the use of the skeletal anchorage avoided, in this case, the proclination effect in the lower incisors due to the use of a Herbst appliance.

In Vivo Accuracy of a New Digital Planning System in Terms of Jaw Relation, Extent of Surgical Movements and the Hierarchy of Stability in Orthognathic Surgery

This retrospective cohort study compares the virtual planned and postoperative jaw positions in patients undergoing orthognathic surgery. Surgery was virtually planned with the Digital Münster Model Surgery system (DMMS). Primary outcome: Spatial difference in the maxillo-mandibulo relation between virtual planning and postoperative result. Secondary outcome: Possible relationship between the measured differences and surgical movements as well as the postoperative stability according to Proffit. Ninety female and sixty-one male patients were included in the study. The average translation errors were 0.54 ± 0.50 mm (anteroposterior), 0.37 ± 0.33 mm (mediolateral), and 0.33 ± 0.28 mm (superoinferior). Orientation errors were 0.86 ± 0.79 degrees (yaw), 0.54 ± 0.48 degrees (roll), and 0.90 ± 0.72 degrees (pitch). The surgical procedures do not differ with respect to their error sizes. Maxilla forward and class II maxilla up with mandible forward are the most precise procedures. Most significant differences were found in the anteroposterior direction, whereby the extent of the surgical movement has no effect on the magnitude of the error. The process of planning with the DMMS followed by surgery is highly accurate and shows error values well below the clinically accepted limit of two millimeters in translation and four degrees in rotation.

Does orthognathic treatment improve patients' psychosocial well-being?

OBJECTIVE

To analyse changes in patients' psychosocial well-being from before treatment until post-surgical orthodontic treatment (including retention) is completed.

MATERIALS AND METHODS

Data was collected six times: before treatment (T0), 6-8 weeks after the placement of orthodontic appliances (T2), 3-4 weeks before surgery (T3), six weeks after surgery (T4), one year after surgery (T5) and after completing orthodontic treatment (T6; 20-57 months after surgery). At T0, 60 patients participated while at T6, data was available for 15 patients. All patients completed the Orthognathic Quality of Life Questionnaire (OQLQ), Rosenberg Self-Esteem Questionnaire (RSES), Acceptance and Action Questionnaire II (AAQ-II) and the Symptom Checklist 90 (SCL-90). All pairwise comparisons between variables were conducted with the Wilcoxon signed-rank test.

RESULTS

OQLQ function, RSES, AAQ-II and SCL GSI worsened from T0 to T2. At T5, improvements compared to T0 were found in all aspects of OQLQ and SCL GSI. When comparing results at T6 to T0, improvements where only found in OQLQ sum, OQLQ facial aesthetics and OQLQ function.

CONCLUSIONS

Although well-being of orthognathic patients seems to improve during treatment, many improvements cannot be verified anymore at the completion of the retention period. Most stable changes are found in the oral function component and in the facial aesthetics component of the OQLQ.