The psychological impact of orthognathic surgery: a 9-month follow-up

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.

Cephalometric evaluation of soft tissue changes following Anterior Maxillary Osteotomy setback in Southern Dravidian population

Introduction

Anterior Maxillary Osteotomy (AMO) is one of the commonly done orthognathic surgical procedure in maxilla. Though a lot of research have been done in the Caucasian population regarding soft tissue changes after AMO, there are only few studies for the southern Dravidian poplation. The purpose of this study was to evaluate the soft tissue changes in association with AMO setback in the southern Dravidian population

Materials and methods

The study included a series of 10 patients of age group 20–40 years who underwent AMO. Lateral cephalograms were taken for each patient 2 weeks before and 6 months after the surgery. Three parameters namely, nasolabial angle, upper lip protrusion and interlabial gap were used to evaluate the soft tissue changes.

Results

Mean values of pre and post-surgery were taken for nasolabial angle, upper lip protrusion and interlabial gap and were compared. Soft tissue changes in all the three parameters were found to be statistically significant.

Conclusions

From the limited evidence of the study, it can be concluded that soft tissue changes following AMO setback in southern Dravidian population and the Caucasian population are almost similar.

Psychosocial changes in patients submitted to orthodontic surgery treatment: a systematic review and meta-analysis

OBJECTIVE

This systematic review aims to answer the following question: What is the psychological impact of orthognathic surgery on patients with dentofacial deformities undergoing orthodontic-surgical treatment?

MATERIAL AND METHODS

The search was adapted for each of the following databases: American and Caribbean Center on Health Sciences (LILACS), Cochrane Library, Embase, Psychinfo, PubMed/Medline, Scopus and Web of Science, and gray literature using Google Scholar, OpenGrey, and ProQuest. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. This study performed estimates of interest, random-effects meta-analyses, and calculated heterogeneity using Higgins inconsistency index (I²).

RESULTS

A total of 6751 references were found in all searches. After applying the eligibility criteria after full-text reading, 37 studies comprised the final qualitative synthesis. Thirteen studies were included in quantitative synthesis, and it was possible to meta-analyze data from the following questionnaires: GHQ-28, MMPI, RSES, and SCL-90-R. There was an improvement in psychological aspects related to depression, hysteria, self-esteem, anxiety, obsessive-compulsiveness, interpersonal sensitivity, paranoid ideas, and psychoticism (p < 0.05).

CONCLUSIONS

Correction of dentofacial deformity through orthodontic-surgical treatment is associated with improvements observed in several psychological domains, especially in relation to depressive states.

CLINICAL RELEVANCE

This result highlights the importance of surgeons and orthodontists in promoting adequate control of patients' expectations and treatment goals taking into account the individual's psychological aspects.

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.

Association between quality of life and severity of profile deviation in prospective orthognathic patients

Aim

to evaluate whether severity of skeletal facial profile deviation assessed by professionals associates with quality of life and psychosocial factors in patients with dentofacial deformities and prospective orthognathic treatment.

Materials and method

The study consisted of 55 patients admitted to orthognathic treatment. Skeletal profile was assessed from lateral head films using cephalometric analysis. The following angles were used to assess the sagittal position of upper and lower jaw and profile: Sella-Nasion-A-point-angle, Sella-Nasion-B-point-angle, and A-point-Nasion-B-point-angle (ANB). For vertical assessment, gonial angle and the angle between Sella-Nasion and mandibular plane were used. Merrifield’s Z-angle was used to assess soft-tissue profile. Severity of skeletal facial profile deviation was assessed with deviation in ANB angle. Orthognathic quality of life (OQoL) and psychosocial factors were defined with four questionnaires: Orthognathic Quality of Life Questionnaire, Symptom Checklist-90, Rosenberg Self-Esteem Scale, and a body image questionnaire.

Results

Increase in ANB deviation was associated with increased awareness of dentofacial deformity [Orthognathic Quality of Life Questionnaire subscale awareness of dentofacial deformity (OQLQ-AoDD), r = 0.319, P = 0.017). OQOL-AoDD was not found to be equal when ANB angle was divided into three different categories (χ 2 = 6.78, P = 0.034): G1. ANB = 0–4 degrees; G2. ANB &lt;0 degrees; and G3. ANB &gt;4 degrees. Furthermore, categories G1 and G2 differed significantly (U = 50.5, P = 0.017). Increase in ANB angle was also associated with a more positive body image (r = 0.342, P = .023). There were no significant correlations between other cephalometric variables, quality of life, and psychosocial factors.

Conclusion

Skeletal facial profile seems to associate with some aspects of orthognathic quality of life. Professional cephalometric analysis of the severity of facial profile deviation correlates with patients’ awareness of their own facial and dental appearance. Patients with more deviating skeletal profile are more aware of their dentofacial deformities compared to patients with normal values.

The impact of surgery-first approach on the oral health-related quality of life: a systematic review and meta-analysis

Background

The oral health-related quality of life (OHRQoL) is affected by dentofacial deformity. Patients with dentofacial deformity are normally treated with orthognathic surgery, including conventional three-stage method (CTM) and surgery first approach (SFA). The aim of this systematic review and meta-analysis was to compare the impact of SFA with CTM on the OHRQoL of patients with severe dentofacial deformity.

Methods

Five English databases, three Chinese databases, and six grey literature databases were searched (January 2000 to July 2018). Randomized controlled trials, controlled clinical trials, and cohort studies assessing the OHRQoL of patients who underwent SFA or CTM were included. After selecting studies, extracting data, and assessing risk-of-bias according to the Cochrane Handbook for Systematic Reviews of Interventions and the Newcastle-Ottawa Scale, meta-analysis was performed to elucidate the effects of SFA on the changes of OHRQoL of patients with dentofacial deformity at each stage and made a comparison with CTM.

Results

There were 4 studies with 122 participants were selected for the final analysis. Three among these studies were included in meta-analysis, 2 of which were included in each forest plot. All the included studies were graded as moderate value of evidence according to GRADE quality analysis. Over the period of 2-year follow-up after bonding, the OHRQoL of the patients in SFA group showed an improving trend and was better than those in CTM group generally. After debonding, the summary scores of the 14-item Oral Health Impact Profile (OHIP-14) (− 2.92, P = 0.12) and Orthognathic Quality of Life Questionnaire (OQLQ) (− 5.59, P = 0.01) were smaller in SFA group than CTM group.

Conclusions

Clinical evidence indicates that SFA can contribute to the better OHRQoL in patients with dentofacial deformity immediately and persistently.

Condition-specific Quality of Life Assessment at Each Stage of Class III Surgical Orthodontic Treatment -A Prospective Study

Surgical orthodontic treatment has been reported to improve oral health-related quality of life (OHRQL). Such treatment comprises three stages: pre-surgical orthodontic treatment; orthognathic surgery; and post-surgical orthodontic treatment. Most studies have focused on change in OHRQL between before and after surgery. However, it is also necessary to evaluate OHRQL at the pre-surgical orthodontic treatment stage, as it may be negatively affected by dental decompensation compared with at pre-treatment. The purpose of this prospective study was to investigate the influence of surgical orthodontic treatment on QOL by assessing change in condition-specific QOL at each stage of treatment in skeletal class III cases. Twenty skeletal class III patients requiring surgical orthodontic treatment were enrolled in the study. Each patient completed the Orthognathic Quality of Life Questionnaire (OQLQ), which was developed for patients with dentofacial deformity. Its items are grouped into 4 domains: "social aspects of dentofacial deformity"; "facial esthetics"; "oral function"; and "awareness of dentofacial esthetics". The questionnaire was completed at the pre-treatment, pre-surgical orthodontic treatment, and post-surgical orthodontic treatment stages. The results revealed a significant worsening in scores between at pre-treatment and pre-surgical orthodontic treatment in the domains of facial esthetics and oral function (p<0.01), and between at pre-surgical orthodontic and post-surgical orthodontic treatment in all domains except awareness of dentofacial esthetics (p<0.05, p<0.01). A significant correlation was observed between a negative change in overjet and worsening OQLQ scores at the pre-surgical orthodontic treatment stage. Significant correlations were also observed between improvement in upper and lower lip difference, soft tissue pogonion protrusion, and ANB angle and improvement in OQLQ scores at the post-surgical orthodontic treatment stage. These results indicate that morphologic change influences OHRQL in patients undergoing surgical orthodontic treatment not only after surgery, but also during pre-surgical orthodontic treatment.

Impact of Orthognathic Correction of Class II Malocclusion on the Perception of Social Characteristics

Objective

To evaluate the influence on the perception of social characteristics after orthognathic treatment for the correction of Class II malocclusion.

Methods

A cross-sectional study was conducted with the participation of 240 observers who evaluated images of individuals before and after orthognathic surgery for the correction of malocclusion. Based on the images, two different questionnaires were applied containing 44 questions each for evaluating social competence, intellectual ability, psychological adjustment, and attractiveness. The mean scores for evaluations of the images were compared using the Mann-Whitney U test at 5% level of significance (α=0.05).

Results

Orthognathic treatment significantly (p<0.05) improved the evaluation of individuals in the requisites of the score attributed to the image (p=0.008), extroversion (p=0.026), happiness (p=0.006), self-confidence (p=0.046), and attractiveness (p=0.015).

Conclusion

Orthognathic treatment for the correction of Class II malocclusions has a positive effect on the perception of social characteristics of individuals. The individuals subjected to orthognathic surgery were evaluated as being more attractive, intelligent, socially competent, and psychologically adjusted.

Evaluation of the Changes in the Quality of Life in Patients Undergoing Orthognathic Surgery: A Multicenter Study

Orthognathic surgery can affect patients' quality of life. The aim of the present study was to assess changes in quality of life during combined orthodontics-surgery treatment and effect of orthodontist-surgeon teamwork on final patient's satisfaction. Twenty-six orthognathic patients who were referred to oral and maxillofacial department of 3 hospitals in Tehran were included in the study. Orthognathic quality of life questionnaire (OQLQ) was given to patients 1 week before, 4 weeks and 4 months after surgery. Two self-designed forms were used for evaluating mood and comfort of patients 1 week before surgery and 4 days after surgery. Self-designed forms were given to the orthodontists and the maxillofacial surgeons to assess quality of teamwork and difficulty of the procedure. Twenty-four patients (15 females and 9 males) with the mean age of 22.62 ± 3.57 completed the study. Quality of life increased from 1 week before surgery to 4 months after surgery (P < 0.013) and the difference was statistically significant between OQLQ score at 1 week before surgery and that of 4 months postoperative. Esthetic and social domain showed significant changes during the studied period. Orthognathic quality of life questionnaire at 4 months postoperative was correlated with surgery difficulty and duration. It can be concluded that orthognathic surgery can improve quality of life, especially in esthetic and social aspects.

Orthognathic Surgery: Outcome in a Facebook Group

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

Impact of orthosurgical treatment phases on oral health-related quality of life

INTRODUCTION

In this cross-sectional study, we investigated the impact of the orthosurgical treatment phases on the oral health-related and condition-specific quality of life (QoL) of patients with dentofacial deformities.

METHODS

Two hundred fifty-four orthognathic patients were allocated into 4 groups according to treatment phase: initial (not yet treated), presurgical orthodontics, postsurgical orthodontics, and retention. Data were collected using the Oral Health Impact Profile to evaluate the oral health-related QoL, the Orthognathic QoL Questionnaire to analyze the condition-specific QoL, and the Index of Orthodontic Treatment Need to assess malocclusion severity and esthetic impairment. Specific malocclusion characteristics were also documented.

RESULTS

A negative binomial regression analysis showed that the initial group had a more negative oral health-related QoL than did the postsurgical, presurgical, and retention groups (relative risks, 1, 0.79, 0.74 and 0.25, respectively). The initial group had a more negative condition-specific QoL than did the presurgical, postsurgical, and retention groups (relative risks, 1, 0.77, 0.38 and 0.15, respectively) regardless of age, income, or education; women reported greater negative impacts than men. Certain occlusal traits were related to higher Orthognathic QoL Questionnaire scores (P <0.01).

CONCLUSIONS

Patients who completed their orthosurgical treatment had a significantly better oral health-related QoL and a more positive esthetic self-perception than did those undergoing treatment and those who were untreated. Crowding, crossbite, open bite, concave profile, edge-to-edge overjet, or Class III malocclusion negatively affected oral health-related QoL.

Seeking beauty: understanding the psychology behind orthognathic surgery

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

Motivation of adult female patients seeking orthodontic treatment: an application of Q-methodology

BACKGROUND

Motivation is the impetus for patients to seek orthodontic treatment, affecting adherence, treatment outcomes, and satisfaction. The aim of this study was to assess the motivation of adult female patients seeking orthodontic treatment, and classify the patients according to their motivations.

METHODS

This study used Q-methodology as the main tool. Q-samples were collected and categorized (35 items). Forty-two adult female patients were interviewed before treatment as the P-sample, and their responses were categorized into the Q-methodology grid. Participants were asked to rank-order a set of 35 statements (Q-sample) from "agree most" to "disagree most" (Q-sorting). The finished Q-grids were analyzed using PQ method 2.35.

RESULTS

Four main factors were identified based on how adult female patients ranked statements: factor 1, patients who focus on their self-perception of their appearance; factor 2, patients who are concerned about the esthetics and function of their teeth; factor 3, patients who are easily influenced by others; factor 4, patients who want to improve their confidence and avoid negative thoughts caused by their teeth. The remaining patients who had other views did not match any of the above four groups.

CONCLUSION

The motivations of adult female patients seeking orthodontic treatment are complex. This study found that most adult female patients fell into one of four typical factor groups. Our findings may improve the adherence of adult female patients by developing a more ideal treatment program.

The development of a patient-centered measure of the process and outcome of combined orthodontic and orthognathic treatment

OBJECTIVE

The aim of this study was to develop a patient-based measure of the process and outcome of combined orthodontic and orthognathic care in the National Health Service in the UK.

DESIGN

Identification of relevant dimensions through qualitative methods, design of form, determination of psychometric properties of the scale, specific readability, reliability and validity.

SETTING

NHS hospitals in the South West Region.

SUBJECTS

The sample comprised patients who had received combined orthodontic and orthognathic treatment between 01 January 1998 and 31 December 2000. Twenty-six participants (a 25% response rate) took part in four focus group meetings. Thirty subjects (65% response rate) took part in a pilot study to test the properties of the questionnaire.

MAIN OUTCOME MEASURES

Six broad themes emerged from the focus groups. These formed the basis of the sections in the questionnaire.

RESULTS

The questionnaire developed had a Flesch reading ease score of 72.9 or US grade level 4 equivalent to aged 9-10 years. Test-retest reliability gave kappa values for most questions that exceeded 0.4. Criterion validity of the measure was established by comparing responses to the questionnaire over two periods with a telephone interview on a sample of 30 patients. Criterion related validity was poor for nine of the 16 items. By contrast the construct validity of the questionnaire was satisfactory.

CONCLUSION

A patient-based measure of the process and outcome of combined orthodontic and orthognathic treatment has been developed. This has sufficient validity and reliability for use in inter-center audit projects.

Psychosocial well-being of prospective orthognathic-surgical patients

OBJECTIVE

To compare the psychosocial well-being of prospective orthognathic-surgical patients and controls.

MATERIALS AND METHODS

Sixty patients referred for assessment of orthognathic-surgical treatment need and 29 controls participated. All participants filled in the modified version of Secord and Jourard's Body Image Questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem scale, the Acceptance and Action Questionnaire II and a structured diary developed by the authors. Patients also filled in the Symptom Checklist 90. Patients assessed their dental appearance on a visual analogue scale modified from the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need. Professional assessment was made from study models with the AC.

RESULTS

Patients rating their dental appearance as AC grades 5-10 suffered from lower orthognathic quality-of-life and poorer body image than the controls, while those with AC grades of 1-4 only had poorer oral function. Self-perceived dental appearance was more important to orthognathic quality-of-life and body image than an orthodontist's assessment. Patients and controls had equal psychological flexibility and self-esteem. In all, 23-57% of patients had significant psychiatric symptoms, which explained the adverse emotions patients felt during the day. Fifteen per cent of the patients had been bullied.

CONCLUSIONS

Many orthognathic-surgical patients cope well with their dentofacial deformities, despite functional masticatory problems. It seems that a subjective view of dental appearance may be a key factor in finding patients with psychosocial problems. It should be a major issue when considering psychosocial support and other treatment options.

Evaluation of life quality of patients submitted to orthognathic surgery

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Surgical treatment of dental and skeletal Class III malocclusion

Orthodontic preparation for surgical treatment of skeletal Class III malocclusion involves joint planning with an oral and maxillofacial surgeon to address the functional and esthetic needs of the patient. In order to allow surgical manipulation of the jaws in the preoperative phase, the need to achieve a negative overjet through incisor decompensation often leads the orthodontist to extract the upper first premolars. This report illustrates an orthodontic preparation case where due to specific factors inherent in the patient's psychological makeup retroclination of the upper incisors and proclination of the mandibular incisors was achieved without removing any teeth. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) in partial fulfillment of the requirements for obtaining the BBO Diploma.

Soft tissue response in orthognathic surgery patients treated by bimaxillary osteotomy: cephalometry compared with 2-D photogrammetry

Purpose

Since improvement of facial aesthetics after orthognathic surgery moves increasingly into the focus of patients, prediction of soft tissue response to hard tissue movement becomes essential for planning. The aim of this study was to assess the facial soft tissue response in skeletal class II and III patients undergoing orthognathic surgery and to compare the potentials of cephalometry and two-dimensional (2-D) photogrammetry for predicting soft tissue changes.

Material and methods

Twenty-eight patients with class II relationship and 33 with class III underwent bimaxillary surgery. All subjects had available both a traced lateral cephalogram and a traced lateral photogram taken pre- and postsurgery in natural head position (median follow-up, 9.4 ± 0.6 months).

Results

Facial convexity and lower lip length were highly correlated with hard tissue movements cephalometrically in class III patients and 2-D photogrammetrically in both classes. In comparison, cephalometric correlations for class II patients were weak. Correlations of hard and soft tissue movements between pre- and postoperative corresponding landmarks in horizontal and vertical planes were significant for cephalometry and 2-D photogrammetry. No significant difference was found between cephalometry and 2-D photogrammetry with respect to soft to hard tissue movement ratios.

Conclusions

This study revealed that cephalometry is still a feasible standard for evaluating and predicting outcomes in routine orthognathic surgery cases. Accuracy could be enhanced with 2-D photogrammetry, especially in class II patients.

Assessment of motivation and psychological characteristics of adult orthodontic patients

INTRODUCTION

In recent years, the demand for adult orthodontic treatment has grown rapidly; yet there is a paucity of information on this subgroup of patients. It is well known that understanding the psychological characteristics and motives of any patient is fundamental and that these factors might affect patient satisfaction and adherence with treatment. There is therefore a need for clinicians to improve their understanding of this subgroup to enhance the patient's experience of treatment delivery and to increase the potential for a successful treatment outcome. The aim of this study was to develop a measure for the assessment of motivating factors and psychological characteristics of adults seeking orthodontic treatment.

METHODS

This study involved the qualitative development of a valid patient-centered questionnaire to assess motivating factors for adults seeking orthodontic treatment. This was achieved through semi-structured in-depth interviews; key themes were identified and used to construct a questionnaire assessing motivation for treatment. This was then combined with 3 previously validated questionnaires to measure self-esteem, anxiety or depression, and body image and facial body image. The questionnaire was distributed to 172 adult orthodontic patients at different stages of treatment in a large teaching hospital in the United Kingdom. In addition, the self-esteem, body image, and facial body image scores were compared with data on orthognathic patients from the same hospital and with data from members of the general public.

RESULTS

Desire to straighten the teeth and improve the smile were the key motivating factors for the adult group studied. Other motives included to improve the bite, improve facial appearance, and close (dental) spacing. With respect to the psychological characteristics of self-esteem, body image, and facial body image, the adult orthodontic group was comparable with the general public. However, differences were noted when comparing data from the adult orthodontic group with previously collected data on orthognathic patients.

CONCLUSIONS

The motives for adults to seek orthodontic treatment are numerous and varied, whereas psychological traits appear to be closer to those of the general public than to orthognathic patients.

The association between the psychological status and the severity of facial deformity in orthognathic patients

OBJECTIVE

To evaluate the psychological status and correlate it with the severity of facial deformities of patients with skeletal malocclusions before orthognathic treatment.

MATERIALS AND METHODS

A total of 96 patients aged 15 to 47 with skeletal malocclusions were examined before orthognathic treatment was provided. A photographic analysis was carried out to determine the severity of facial deformity according to the Facial Aesthetic Index (FA1). All patients were divided into three groups according to the FAI score: light (0 to 9), moderate (10 to 19), and severe (>19) facial deformities. Thirty subjects aged 17 to 39 with normal occlusion and attractive harmonious faces without previous orthodontic and/or surgical history were taken as controls. Psychological testing of controls and patients in the study group was performed before orthognathic treatment was provided.

RESULTS

Psychological testing showed no statistically significant differences among groups with light and moderate facial deformity and subjects in the control group. Significant differences were encountered among patients with severe facial deformities compared with controls in a series of personality traits, including introversion, neuroticism, trait anxiety, dependency, unsociability, and leadership.

CONCLUSIONS

Orthognathic patients with different degrees of facial deformity have different psychological profiles. Patients with light and moderate facial deformity have no significant psychological problems. Patients with severe facial deformity show a significantly higher prevalence of emotional instability, introversion, anxiety, and unsociability. Such psychological profiles make orthognathic patients with severe facial deformity prone to psychological distress, depression, and adverse psychological reactions.

Motives for surgical-orthodontic treatment and effect of treatment on psychosocial well-being and satisfaction: a prospective study of 118 patients

PURPOSE

A prospective, controlled study of consecutive surgical-orthodontic patients was performed to assess how treatment affects the patients' psychosocial well-being. We evaluated patients' treatment motivations and motive fulfillment in relation to their satisfaction with the treatment and assessed the correlation between their satisfaction and their psychosocial well-being.

PATIENTS AND METHODS

A total of 118 adult patients (51 men and 67 women, mean age 25 years) who had undergone surgical-orthodontic treatment were examined before the preoperative orthodontic treatment and 12 months after surgery or later. The motives for treatment, fulfillment of those motives, psychosocial well-being, and degree of post-treatment satisfaction were assessed using questionnaires validated for Danish patients. A total of 47 age- and gender-matched subjects without any current or previous need for orthodontic or surgical-orthodontic treatment served as the controls.

RESULTS

The patients stated oral function and appearance as their main treatment motives, and most reported that their motives had been fulfilled. Both their motives and the actual fulfillment of their motives influenced their treatment satisfaction. Another significant outcome of treatment was improved self-concept and social interaction. The more self-concept and social interaction were improved by treatment, the greater the post-treatment satisfaction the patients expressed.

CONCLUSIONS

Surgical-orthodontic treatment has significant potential to improve patients' psychosocial well-being. Patients' satisfaction with treatment correlated with the post-treatment psychosocial status. However, pretreatment motives significantly influenced the overall satisfaction after treatment. Thus, patients who weighted oral function motives greatest expressed the lowest degree of treatment satisfaction.

Patients' perceptions of orthognathic treatment, well-being, and psychological or psychiatric status: a systematic review

OBJECTIVE

To conduct a systematic review of studies concerning the psychosocial well-being of surgical-orthodontic patients.

MATERIAL AND METHODS

Articles published between 2001 and 2009 were searched using PubMed, Web of Science, and PsycInfo. Only articles written in English were included. Articles on methodological issues or on patients with clefts or syndromes or studies in which treatment had included surgically assisted maxillary expansion or intermaxillary fixation were excluded. The exclusion of articles was carried out in collaboration with two reviewers. To find new relevant articles, references from all the obtained review articles were hand-searched. Thirty-five articles fulfilled the selection criteria and were included in this review.

RESULTS

The main motives for seeking treatment were improvements in self-confidence, appearance, and oral function. Patients were not found to suffer from psychiatric problems. Treatment resulted in self-reported improvements in well-being, even though these improvements were not found with current assessment methods. Changes in well-being were most often registered using measures designed for evaluation of the impact of oral health on quality of life (e.g. the Orthognathic Quality of Life Questionnaire and the Oral Health Impact Profile).

CONCLUSIONS

Surgical-orthodontic patients do not experience psychiatric problems related to their dentofacial disharmony in general. However, subgroups of patients may still experience problems, such as anxiety or depression, as many studies only report patients' mean problem scores and compare them to controls' scores or population norms. New assessment methods focusing on day-to-day changes in mood and well-being, as well as prospective studies with controls, are needed.

Factors of importance for the functional outcome in orthognathic surgery patients: a prospective study of 118 patients

PURPOSE

The aim of this study was to assess the influence of orthognathic surgery on patients' stomatognathic function and, further, to evaluate how post-treatment function relates to satisfaction.

PATIENTS AND METHODS

A total of 118 adult patients (51 men and 67 women) who were treated with orthognathic surgery were examined before and a minimum of 12 months after the surgical intervention. The stomatognathic function was evaluated with Helkimo's Anamnestic and Clinical Dysfunction index. The former was also used to assess a control group of 47 individuals with the same age and gender distribution and with no history of or present need for orthodontic treatment.

RESULTS

A total of 76 patients (64.4%) reported severe dysfunction at the beginning of the treatment, and 24 patients (20.3%) reported severe dysfunction at the end of the treatment. Clinical assessment showed that 36 patients (30.5%) had severe dysfunction symptoms upon inclusion versus only 5 (4.2%) at the final examination. However, 3 patients (2.5%) without clinical dysfunction at the time of inclusion developed mild dysfunction during treatment, and 8 patients (6.8%) developed increased dysfunction during treatment. The patients' functional status after treatment and their degree of satisfaction with the treatment were positively correlated. Although a general improvement was verified, the functional status of those who were treated never reached that of the control group.

CONCLUSION

This study indicates that orthognathic surgery improves patients' stomatognathic function in most cases, and that patients' satisfaction correlated with perceived, reported, and measured function at the end of the treatment.

Prospective, multi-center study of the effectiveness of orthodontic/orthognathic surgery care in the United Kingdom

INTRODUCTION

The aim of this study was to evaluate the effectiveness of orthodontic/orthognathic surgical care provided in the North West region of England. It was an observational, prospective cohort study at 13 maxillofacial clinics in the United Kingdom.

METHODS

The 131 patients comprised 47 males (35.9%) and 84 females (64.1%), with an average age of 22.6 years. They received orthodontic/orthognathic treatment according to the normal protocols of the operators. They were then followed until all orthodontic treatment was completed. Final skeletal pattern, final peer assessment rating score, number of attendances, and duration of treatment were recorded.

RESULTS

At the end of the 5-year study, 94 patients had completed treatment, and 71 had complete data. Data analysis showed that, overall, the treatments provided were effective in terms of skeletal and dental occlusal outcomes; the final mean peer assessment rating score was 10.58. However, treatment duration was longer than commonly expected, with a mean length of 32.8 months (SD,11.3). The outcome of treatment was influenced by only pretreatment skeletal discrepancy.

CONCLUSIONS

This prospective investigation showed that orthodontic/orthognathic surgical care was effective. The outcome of treatment was influenced only by the severity of the pretreatment skeletal discrepancy.

Perceptions of preoperative expectations and postoperative outcomes from orthognathic surgery: part I: Turkish female patients

This study was conducted in Turkish female patients to investigate their preoperative concerns, motivation, expectations, preoperative preparation for surgery and perception of outcomes concerning orthognathic surgery. Thirty women, with an age range of 18 to 31 years (mean age 21.8+/-3.8 years), participated in the study. The expectations and the results of orthognathic treatment were assessed based on the patients' subjective appraisal. Patients completed questionnaires before and after the operations, designed to investigate the preoperative and postoperative psychological impact of the surgery, the perception of problems with physical and psychological functioning, self-image, body image and satisfaction with surgical outcome. The questionnaires were evaluated statistically with SPSS 11.5 for Windows. The patients' perception of their psychological improvement, faith in the surgical team, physical functioning, self-esteem, social confidence, body image and satisfaction after dentofacial correction were higher than the preoperative levels. The conclusions of the study support the theory that enhancement of facial appearance by orthognathic surgery improves the psychological status of females with growth disturbances of the jaw.

Complex orthognathic surgery: assessment of patient satisfaction

PURPOSE

The purpose of our survey study was to determine if bimaxillary orthognathic surgery with simultaneous intranasal surgery and other procedures carried out primarily for the correction of a developmental dentofacial deformity can be completed with a high level of patient satisfaction and minimal complications.

PATIENTS AND METHODS

A consecutive series of 42 patients entered in the study from senior surgeon's (J.P.) patients at a single institution who underwent the minimum designated simultaneous procedures (Le Fort I, sagittal osteotomies of the mandible, septoplasty, inferior turbinate reduction) during a 1-year period. Patient satisfaction was assessed through analysis of data gathered from a postsurgical patient satisfaction questionnaire. The questionnaire is used to assess overall postsurgical/orthodontic patient satisfaction and patient assessment of head and neck function. The questionnaire was independently completed by each subject at least 6 months after surgery and only after removal of all orthodontic appliances and planned dental rehabilitation.

RESULTS

The results of our study clarify that bimaxillary orthognathic surgery including simultaneous intranasal (septoplasty and turbinate reduction) and other procedures (genioplasty, liposuction, and removal of third molars) can be carried out with a high level of patient satisfaction (89% of our study patients). Nevertheless, 2 of 42 patients (5%) in our study group were dissatisfied despite the absence of surgical or orthodontic complications and the clinicians' feelings that the results achieved were an improvement.

CONCLUSIONS

The results of our study clarify that complex bimaxillary orthognathic surgery including simultaneous intranasal and other procedures can be carried out with a high level of patient satisfaction.

Beneficial effects of orthodontic treatment on quality of life in patients with malocclusion

Patients with malocclusion, especially those in need of surgical correction, have lower health related quality of life (HRQOL) and higher anxiety. We investigated the changes of HRQOL and psychological status following jaw surgery in the patients with facial deformities. Thirty-one adult orthodontic patients admitted to Tohoku University Hospital and diagnosed as malocclusion requiring jaw surgery were recruited for the study. The severity of malocclusion was assessed by Severity Score (SS) which is based on their cephalometric radiographs. They were divided into three groups according to the severity of malocclusion, i.e. Low-SS, Moderate-SS and High-SS. The subjects also completed a generic HRQOL (entire body health) instrument, and three disease-specific oral HRQOL instruments. HRQOL and psychological status of the patients were assessed before (T1) and at debonding of multibracketed appliances after surgery (T2). SS in each group significantly decreased to normal occlusion level (SS = approximately 0-1). Oral function significantly improved from 11.8 +/- 5.4 to 5.9 +/- 4.3 in the Low-SS (p < 0.01), from 13.7 +/- 6.5 to 8.8 +/- 5.1 in the Moderate-SS (p < 0.05), and from 14.7 +/- 6.7 to 7.8 +/- 5.7 in the High-SS (p < 0.01). The patients after the surgical correction had improved disease-specific HRQOL and state anxiety irrespective of the severity before surgery, although the generic HRQOL, trait anxiety and depression were equal to that before the surgery. Furthermore, both postoperative anxiety and HRQOL were estimated by the preoperative anxiety and HRQOL. These results indicated that jaw surgery markedly improved the disease-specific HRQOL and psychological status in the present patients. We therefore suggest that assessments of the HRQOL and psychological status before treatment might predict the HRQOL and psychological status after the treatment to a certain extent.

Orthodontic Treatment Following Orthognathic Surgery: How Long Does It Take and Why? A Retrospective Study

PURPOSE

This study was conducted to examine the duration of postoperative orthodontic treatment of patients who underwent combined orthodontic and orthognathic treatment and investigate factors that might influence this, to assess the strength of association between preoperative and postoperative orthodontic treatment duration, and to perform a retrospective power calculation to assess the likelihood of this study detecting a clinically significant (weeks) difference.

PATIENTS AND METHODS

Records of patients who had undergone combined orthodontic and orthognathic treatment between 1998 and 2003 (n = 69) were obtained from 3 consultant orthodontists at 3 major hospitals in Leeds, UK. The duration of postoperative orthodontic treatment was calculated as the date of the operation to the date of fixed appliance removal. Variables investigated included patient age and gender, malocclusion, type of operation, presence of open bite, extractions (excluding third molars), hospital, operator, missed appointments/breakages and debonding, and retainer arrangements.

RESULTS

The median duration of postoperative treatment was 7.5 months (range, 5 to 11 months). None of the variables clearly affected this duration; no correlation was found between preoperative and postoperative treatment times (r(s) = -.07; P > .05). A retrospective power calculation demonstrated a 57.5% likelihood of this study detecting a difference of 8 weeks between 2 groups.

CONCLUSIONS

Patients should be informed that the postoperative orthodontic phase of combined orthognathic-orthodontic treatment may last approximately 5 to 11 months. No association was found between preoperative and postoperative treatment duration. Many more patients will have to be recruited to assess whether specific variables result in a clinically significant difference in treatment duration.

Cirurgia ortognática: abordagem psicossocial em pacientes Classe III de Angle submetidos à correção cirúrgica da deformidade dentofacial

OBJETIVO: investigar aspectos psicossociais relacionados à mudança da aparência facial em 29 pacientes, de ambos os gêneros, com idades entre 17 e 46 anos, com indicação de tratamento cirúrgico, nos períodos pré-operatório (durante preparo ortodôntico) e pós-operatório (transcorridos 6 meses da intervenção cirúrgica). MÉTODOS: utilizou-se questionários, aplicados na forma de entrevistas, com perguntas baseadas na proposta de Grossbart e Sarwer. Utilizou-se a técnica de análise de conteúdo, representando-se o motivo da procura pela correção cirúrgica em Categoria 1 (C1); as fantasias relacionadas aos resultados da correção cirúrgica (pré-operatório) e realização (pós-operatório) em Categoria 2 (C2); e as expectativas e a satisfação quanto aos resultados da correção cirúrgica em Categoria 3 (C3). As respostas foram reagrupadas nas subcategorias: estética (SC1), funcional (SC2), situações sociais (SC3), auto-estima (SC4) e profissional (SC5). RESULTADOS: os resultados indicaram que os pacientes procuraram a correção cirúrgica por motivos funcionais (34,5%), estéticos (30,9%) e sociais (29,1%); desejavam melhorar as situações sociais (40%) e a estética (32%), com realização destes desejos, depois da cirurgia. Quanto às expectativas, 49,4% dos pacientes esperavam melhorar o aspecto funcional, seguido da estética (26,9%), situações sociais (11,2%) e auto-estima (6,7%). Em todos os aspectos, os pacientes ficaram muito satisfeitos pela melhora na dicção, na estética, na beleza e no retorno à vida sem discriminação. CONCLUSÕES: os pacientes procuraram a correção cirúrgica motivados a melhorar o aspecto funcional e a estética; fantasiavam melhorar as relações sociais e a aparência; esperavam, de forma realista, que a correção cirúrgica reparasse a função e a estética - objetivos propostos pela cirurgia ortognática.

Psychological Considerations in Orthognathic Surgery

More adolescents and young adults are requiring facial skeletal surgical procedures. They are vulnerable in emotional development, and the stress of surgery adds to this. Interaction between adolescent patients and caregivers must be assessed in treatment planning for a successful outcome. Focus is on correcting the morphologic deformity, but assessment and planning should also include psychosocial aspects of the patient. Adolescents and young adults who need psychological support should be followed closely from the beginning, until at least 1 year postsurgery. Success of surgical intervention should be measured both in terms of the occlusal function and morphological improvement, and changes in psychosocial interaction and an improved quality of life for the patient.

Difference in Quality of Life According to the Severity of Malocclusion in Japanese Orthodontic Patients

Although quality of life (QOL) assessment is important in dentistry, it has not been fully investigated in orthodontic patients. We investigated the health-related generic QOL (entire body health) and disease specific QOL (oral health) in adult patients with malocclusions at the first visit. One hundred and twenty-seven orthodontic patients and 66 persons with normal occlusion were recruited for the study. The subjects were divided into the three following groups based on their treatment: 61 patients in need of surgical correction (SURG), 66 patients in need of non-surgical correction (NONS), and 66 control subjects with normal occlusion. Their dentofacial morphology was assessed using a specific Severity Score (SS), which was set up originally based on their cephalometric radiographs and their plaster models of arrangement of their teeth. The subjects also completed a generic QOL assessment questionnaire, the SF-36, and two disease-specific QOL instruments. The patients with malocclusions, especially SURG, had lower disease-specific QOL, although the generic QOL was equal to that of control subjects. Furthermore, in patients with the same severity of dentofacial deformities, especially SS 4 and SS 5, the borderline cases of surgical correction and non-surgical correction, there were differences between SURG and NONS in some items of the QOL. The severity of malocclusion evidently plays an important role in patients' choice of treatment, but also QOL appeared to play a significant role. The QOL assessment may contribute to the selection of the best treatment for improving QOL, especially for borderline cases with moderate degrees of orthodontic abnormality.

The Early Psychological Adjustment of Cleft Patients After Maxillary Distraction Osteogenesis and Conventional Orthognathic Surgery: A Preliminary Study

PURPOSE

To compare the early psychological changes of cleft lip and palate (CLP) and noncleft patients after maxillofacial corrective surgery, including maxillary distraction osteogenesis and conventional orthognathic surgery.

MATERIALS AND METHODS

Nine CLP patients were compared with a group of 9 non-CLP patients having similar dentofacial deformities in a prospective longitudinal cohort study. Five of the CLP patients underwent maxillary distraction osteogenesis and 4 underwent conventional orthognathic surgery. A control group of 9 noncleft patients received conventional orthognathic surgery. All patients completed a set of questionnaires to enable their psychological profile to be assessed. The data were collected immediately before surgery (T1), and at 3 weeks (T2) and 12 weeks (T3) after surgery.

RESULTS

The CLP patients treated with distraction osteogenesis were happier, but had a higher level of social anxiety and distress than the CLP patients receiving conventional orthognathic surgery. On the other hand, the CLP patients overall were happier, with lower social anxiety and distress, than the noncleft control group. The CLP patients showed a higher level of parental self-esteem than the noncleft patients.

CONCLUSION

This preliminary study shows that CLP patients were generally happier, and had a higher level of parental support, than normal patients suffering from dentofacial deformities. Maxillary distraction osteogenesis seemed to induce a higher level of anxiety and distress in CLP patients than conventional orthognathic surgery in both cleft and noncleft patients.

[Patient perception of functional and cosmetic outcome of orthognathic surgery. Retrospective analysis of 45 patients]

INTRODUCTION

Orthognathic surgery is generally indicated for the treatment of maxillo-mandibular deformities. Surgery is performed to repair functional abnormalities, but also has a cosmetic impact.

MATERIAL AND METHODS

We conducted a retrospective study of 60 patients who underwent orthognathic surgery in 1996 and 1997 in order to assess patient perception of functional and cosmetic outcome. A questionnaire was sent to all patients one year after their surgery; 45 responded.

RESULTS

We noted cosmetic, functional, and psychological changes. Patients considered that the changes were for the better. For functional abnormalities, 88.9% considered their occlusion had improved and 80% their chewing; 73.4% reported psychological improvement stating they had more self-confidence; 97.8% considered their cosmetic aspect had improved.

DISCUSSION

This study enabled us to assess patients' perception of surgical outcome. It must be recalled that the patient basically decides to undertake surgery for cosmetic reasons while the surgeon proposes surgery to improve function. The psychological consequences of orthognathic surgery must be taken into account because the impact is considerable.