Recreational and social activities of orthognathic surgery patients

Orthognathic surgery induces genomewide changes longitudinally in DNA methylation in saliva

OBJECTIVE

Orthognathic surgery dramatically changes morphology of the maxillofacial deformity and improves the malocclusion morphologically and functionally. We investigated the influence of orthognathic surgery on genomewide DNA methylation in saliva.

METHODS

Saliva was obtained from nine patients undergoing orthognathic surgery and two healthy reference individuals before and 3 months after orthognathic surgery. Genomewide DNA methylation profiling of saliva (341,482 CpG dinucleotides) was conducted using Infinium HumanMethylation450 BeadChips.

RESULTS

Comparison between pre- and postsurgery saliva samples revealed significant changes in DNA methylation patterns at 2,381 CpG sites (p < 0.01) with suggestive significance. The differentially methylated probe sets were significantly associated with the cancer pathway (p = 2.8 × 10^-7 ; a false discovery rate q-value = 3.7 × 10^-4 ) and PI3K-Akt signalling pathway (p = 2.4 × 10^-5 ; a false discovery rate q-value = 3.1 × 10^-2 ).

CONCLUSION

Pathway enrichment analysis of genes with suggestive significance demonstrated that altered DNA methylation in saliva of patients undergoing orthognathic surgery, possibly as a response to surgical stress or bone injury. Further studies with a large sample size and long-term observation are needed to validate the phenomena identified in this study.

Short-term recovery after orthognathic surgery: a medical daily diary approach

This study assessed the utility of a quality-of-life diary for the assessment of postoperative recovery following orthognathic surgery. A 20-item daily recovery diary was designed to assess the patients' perception of recovery in 4 domains (postoperative sequelae; pain/discomfort; oral function; daily activities) during each of the first 90 days after surgery. Fifteen of 185 patients who had agreed to participate did not return any portion of the diary. Of the remaining patients, 87% returned the full 90 days requested. Younger patients were more likely to complete the entire protocol (P=0.01). At 30 days, a lower percentage, in general, of patients who completed all 90 days reported recovery in oral function and general activity compared with those who did not complete all diary days. This study confirms that patients will cooperate with the completion of structured medical / health-related quality-of-life diaries during the first few months after orthognathic surgery. Information from such diaries would be valuable to patients deciding on treatment options and to the clinicians counseling them.

Long-term assessment of psychologic outcomes of orthognathic surgery

PURPOSE

This long-term study of post-orthognathic surgery patients aimed at assessing perceptions of problems with physical and psychologic functioning, self-concept, body image, and satisfaction with the surgical outcome based on subjective evaluations. In addition, the patient's perception of self-concept, body image, and function was compared with the perception of pretreatment patients and controls with no treatment need.

PATIENTS AND METHODS

One hundred seventeen patients who underwent orthognathic surgery 10 to 14 years earlier and participated in a psychologic study 10 years earlier received questionnaires that were composed of 4 instruments designed to assess these factors. A sample of 92 persons representing a population without treatment need and 39 patients requesting treatment for a malocclusion served as control groups.

RESULTS

The findings of this study support the hypothesis that improvement in appearance brought about by orthognathic surgery is associated with improvement in psychosocial adjustment. Orthognathic surgery resulted in subjective estimation of function, appearance, health, and interpersonal relationships that was higher than that among pretreatment and no-treatment control groups. The level of body image and self-esteem approximated but did not reach that of a nonpatient population.

CONCLUSIONS

In view of the current psychologic and social environment, patients should be offered the appropriate treatment to correct a disfigurement if it is subjectively perceived by them as a handicap, in part to improve the psychologic outcome.

Assessment of the combined orthodontic-surgical treatment from the patients' point of view. A longitudinal study

In a longitudinal study, 40 patients who underwent a combined orthodontic-surgical treatment, were interviewed 4 weeks before operation and 1 week and/or half a year after surgery in order to evaluate patients' expectations and appraisal of the operation and their psycho-social situation. The comparisons between the patients' pre- and postoperative statements yielded the following picture: the patients showed a high degree of satisfaction with the result of the operation. They judged their postoperative facial appearance, with the help of a "semantic differential', to be significantly more attractive. Satisfaction also was expressed in a higher degree of psychological well-being and thus an increase in self-confidence and motivation. Postoperatively, the "Giessen test' showed also a distinctly positive change of the patients' mood and improved experiences with social interaction. Before the operation almost half of the patients feared sensitivity loss or disturbance. One out of 5 patients did in fact suffer from this problem--but not from pain--half a year after the operation. Some patients felt they had received insufficient prior information about the procedure and the risk of the operation. In spite of all burdens for the patients, the assessment of the result of the operation is (generally) positive, not only from the medical point of view.

The pain experience and psychological adjustment to orthodontic treatment of preadolescents, adolescents, and adults

Age-related changes in psychological measurements of pain and well-being were studied in patients undergoing full fixed appliance orthodontic treatment. A longitudinal series of four questionnaires was used to obtain measurements of these factors after the separation phase of treatment, banding (2 to 7 days after separation), the first adjustment visit (3 to 4 weeks after placement of full fixed appliances), and the second adjustment visit (3-4 months after banding was completed). The results suggest an interaction between the phases of treatment and reported pain and psychological well-being and significant differences in the response profiles of the adolescent age group (14 to 17 years) compared to the preadolescent (11 to 13 years) and adult groups (18 years and older). These findings did not appear to be due simply to group differences in the use of analgesics, class of malocclusion, or type of full fixed appliance used. The profile comparisons indicated that the adolescent age group generally reported lower levels of psychological well-being and higher levels of pain during the phases of treatment examined. Consistent with these results was the finding that the adolescents differed from the preadolescents and adults in the quality of the pain experience reported during treatment. The results indicate an age difference in adjustment to fixed orthodontic therapy, which suggests that adolescents are more vulnerable to undesirable psychological effects of treatment.