Exploring patient perspectives: orthognathic surgery outcomes and experiences assessed by patient-reported outcome measures and patient-reported experience measures

Evaluating the effectiveness of orthognathic treatment can be difficult. To address this issue, patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) have been proposed as valuable instruments for understanding the quality of healthcare from the patients' standpoint. Therefore, the aim of this project was to employ PROMs and PREMs questionnaires to capture the patients' perspectives regarding their experience during the orthognathic treatment process, as well as their perception of their postoperative state. Preoperative and postoperative questionnaires were offered to patients at consenting appointment and at various timepoints after the surgery. The assessment of statistical relationships was carried out by means of Fisher's exact test. A total of 64 preoperative and 126 postoperative responses were received. The primary motivators for pursuing the surgery were the improvement of facial and dental aesthetics, as well as increased satisfaction with photographic and video appearances. These three factors were also cited as the most important postoperative benefits. Of the respondents, 58% reported experiencing altered sensation to the lower lip at the 24-month follow up (p = 0.02); however, the affected patients reported that this did not have an impact on their daily activities. The use of PROMs and PREMs to appraise the quality of life constitutes a valuable method for surgeons to gauge their treatment efficacy. Above all, such tools are particularly useful for evaluating patient satisfaction, which is the ultimate objective of any treatment.

Systematic Review and Meta-Analysis of the Index of Orthognathic Functional Treatment Need for Detecting Subjects with Great Need for Orthognathic Surgery

Index of Orthognathic Functional Treatment Need (IOFTN) Identifies patients with greatest need for orthognathic surgery. This systematic review looks into the available evidence on prevalence of patients with great treatment need (IOFTN 4&5) who had orthognathic surgery in previous studies. Literature search of the major electronic databases was carried out for articles published between 2014 and September 2023, looking for "Index of Orthognathic Functional Treatment Need","Orthognathic Surgery","IOFTN", "Epidemiology" and "Dentofacial Deformity". The prevalence of patients identified with IOFTN grades of 4&5 was calculated. A random-effect model was employed and the Forest and Galbraith plots were produced. The pooled prevalence estimate for subjects with IOFTN scores of 4&5 was calculated. The heterogeneity among studies was assessed with the I2 statistics. In total, 14 retrospective studies conducted between 2015 and 2019 in 7 countries (UK, New Zealand, Iran, Pakistan, Turkey, Malaysia, Japan) were included, reporting on 1339 orthognathic patients. The sample sizes ranged from 30 to 200. Only 7 studies reported on the subcategories of the IOFTN for grades 1, 2&3. The prevalence of orthognathic patients with IOFTN scores of 4 & 5 ranged from 79% to 100%. The heterogeneity I2 statistics was high (76%, random effects model) for 14 studies, but after removing 3 outlier studies reduced to zero. The pooled prevalence estimate for subjects with IOFTN scores of 4&5 was 93% (95% CI, 0.91-0.94%). According to this meta-analysis, IOFTN successfully identified 93% of patients who underwent orthognathic surgery with a great need for treatment (Grade 4 & 5). To enhance the identification of patients with well-compensated malocclusions, previous orthodontic treatment, or extreme occlusal deviations (e.g., proclination or retroclination of incisors), it would be advantageous to employ additional means alongside IOFTN for assessing orthognathic need in this group.

Characteristics of orthognathic multidisciplinary team clinics in England. Part 2: A qualitative study

OBJECTIVE

The aim of the study was to explore the orthodontist's perspective of the strengths and weaknesses of their current multidisciplinary team (MDT) design for orthognathic treatment.

PARTICIPANTS AND METHODS

This was a qualitative study using online interviews of orthodontic consultants across England. The data were analysed using thematic analysis. This was the second part of a two-part study, where the first part, an online questionnaire survey, identified the variation in design of orthognathic MDTs across England and was the source of the 19 participants for this study.

RESULTS

Seven themes were identified that influenced the design of orthognathic MDTs across England. Close working relationship with the team, access to closed surgery space to conduct the MDT and access to 3D planning were identified as definite strengths of some MDT clinics. Lack of a team psychologist and long waiting lists were identified as weaknesses of some orthognathic MDTs. Teaching and training within MDT clinics were highlighted as a strength of MDTs where surgery spaces were not restricted due to the pandemic. Finally, there was general agreement about revising the orthognathic minimum dataset for records collection as it was not thought to be in the patient's best interest.

CONCLUSION

This study was able to identify key areas considered to be determinants of a successful orthognathic MDT design from the orthodontic consultant's perspective. Orthodontic consultants across England prioritised the need for a psychologist in the orthognathic MDT to improve the effectiveness of these clinics.

Does a surgery first approach to orthognathic treatment of class III skeletal relations result in a shorter duration of treatment? A systematic review

The objective of this study was to review the evidence relating to treatment duration and the surgery first approach (SFA) in managing class III skeletal discrepancies to determine whether there is sufficient evidence to show that it results in a shorter duration of treatment compared to a conventional orthodontics first approach (OFA). Analytical and observational studies that compared both approaches and recorded treatment duration as an outcome were included. MEDLINE, EMBASE, CENTRAL and Dental Oral Sciences Source databases were searched along with a review of reference lists. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool. Eleven observational studies met the inclusion criteria. No experimental studies were identified. The SFA was reported to have a shorter duration of treatment in all studies. All included studies showed a significant risk of bias, particularly in relation to selection of participants, allocation to groups and in the measurement of treatment duration. There is no quality evidence to suggest that using a surgery first approach to orthognathic treatment of class III skeletal patterns results in a shorter duration of treatment.

Establishing a clinical psychology team within the orthognathic service: A triad model of orthodontic, maxillofacial and psychological care

The importance of psychological support for orthognathic patients has taken an increasing precedence over recent years and is embedded in orthognathic commissioning guidelines. Furthermore, attention towards mental health-related conditions and their management is of prime importance and continues to be a key area of focus within healthcare settings. With this in mind, this paper aims to outline our experience of establishing a need for and subsequently securing funding to establish a clinical psychology service within an existing orthognathic service in the NHS. The information outlined may be of benefit to orthognathic teams seeking to secure such psychological support within their respective units.

Novel Sub-Clustering of Class III Skeletal Malocclusion Phenotypes in a Southern European Population Based on Proportional Measurements

Current phenotypic characterizations of Class III malocclusion are influenced more by gender or ethnic origin than by raw linear skeletal measurements. The aim of the present research is to develop a Class III skeletal malocclusion sub-phenotype characterization based on proportional cranial measurements using principal component analysis and cluster analysis. Radiometric data from 212 adult subjects (115 women and 96 men) of southern European origin affected by Class III skeletal malocclusion were analyzed. A total of 120 measurements were made, 26 were proportional skeletal measurements, which were used to perform principal component analysis and subsequent cluster analysis. The remaining 94 supplementary measurements were used for a greater description of the identified clusters. Principal component analysis established eight principal components that explained 85.1% of the total variance. The first three principal components explained 51.4% of the variance and described mandibular proportions, anterior facial height proportions, and posterior-anterior cranial proportions. Cluster analysis established four phenotypic subgroups, representing 18.4% (C1), 20.75% (C2), 38.68% (C3), and 22.17% (C4) of the sample. A new sub-clustering of skeletal Class III malocclusions that avoids gender influence is provided. Our results improve clinicians' resources for Class III malocclusion and could improve the diagnostic and treatment approaches for this malocclusion.