Evaluation of quality of life in chilean patients with orthognathic surgery: a cohort study / Evaluación de la calidad de vida

Abstract: to compare the presurgical and immediate postsurgical quality of life in Chilean patients with orthognathic surgery. Material and Methods: Cohort study. The study included 30 patients (mean age 20.73, 53.33 percent male) who underwent orthognathic surgery primarily for severe skeletal abnormalities, (17 surgeries, 56.7 percent) and moderate skeletal abnormalities (12 surgeries, 40 percent), from three Chilean hospitals between February and June 2016. Patients were asked to answer the World Health Organization quality of life Bref version questionnaire (WHOQOL-BREF) validated in Spanish to measure quality of life (QoL) two weeks before and three months after the surgery. Scores for general QoL and for every domain of QoL were described. Variations in the scores of general QoL were analyzed according to sex and severity of orofacial malformation (mild, moderate or severe) (t-test p<0.05; STATA 10.0). Results: The average score for QoL according to the WHOQOL-BREF scale was 76.43 +/- 13.83 before surgery and 90.5 +/-7.18 three months after surgery (p<0.001). Statistically significant differences according to sex and type of orofacial malformation were found (p<0.01). An increase in the score in all the domains of the WHOQOOL-BREF scale was observed. Conclusion: Orthognathic surgery significantly improved QoL scores in Chilean patients according to the WHOQOL-BREF scale.

Resumen: comparar la calidad de vida pre y postquirúrgica inmediata en pacientes chilenos sometidos a cirugía ortognática. Materiales y método: Estudio de cohorte. Participaron 30 pacientes (edad promedio 20.73, 53.33 por ciento hombres) sometidos a cirugía ortognática, principalmente por anomalía esqueletal severa (17 cirugías, 56.7 por ciento) y moderada (12 cirugías, 40 por ciento) de tres hospitales chilenos entre los meses de febrero y junio del 2016. Cada paciente respondió el cuestionario autocumplido World Health Organization Quality of Life Bref version (WHOQOL-BREF) validado en español para el registro de la calidad de vida (CV) en cirugía ortognática, previo a la cirugía y luego de tres meses postoperatorio. Se describieron los puntajes de CV general y por dominios, se analizaron los cambios en la CV general según sexo y severidad de la malformación orofacial (leve, moderada o severa) (t-test p<0.05; STATA 10.0). Resultados: El promedio del puntaje de CV fue 76.43 +/- 13.83 antes de cirugía y 90.5 +/- 7.18 después de tres meses de cirugía (p<0.001). Las diferencias fueron estadísticamente significativas según sexo y tipo de malformación orofacial (p<0.01). Se observó un aumento de los valores en todos los dominios de la encuesta WHOQOOL- BREF. Conclusión: La cirugía ortognática mejoró significativamente los puntajes de CV en pacientes chilenos según la escala WHOQOL-BREF.

Evaluation of the impact of orthognathic surgery on quality of life

Dental treatment and surgery is a well-established method of correcting dentofacial deformities, and such treatment has an impact on the quality of life of individuals. The objective of this study was to evaluate the effect of orthognathic surgery on the quality of life of patients receiving treatment at the Universidade Federal do Paraná – UFPR. Clinical data were evaluated for the control group, and a quality-of-life evaluation questionnaire was completed [Oral Health Impact Profile (OHIP-14)]. For the case group, the same data were gathered along with information regarding their dentofacial deformity. The OHIP-14 questionnaire was also completed at three distinct stages of the experiment. The median age in the control group was 23.5 years. In the case group, the predominant gender was female, and the mean age of patients was 29.4 years. There was a statistically significant association between gender and OHIP-14 (p< 0.001). No such association was observed between age and OHIP-14 scores (p= 0.616). In the control group the OHIP-14 median score was 11.5. In the case group, the average OHIP-14 score at was 18 at T0, 21 at T1, and 8 at T2. The results demonstrated a statistically significant association between the three time stages at which OHIP-14 was analyzed (p< 0.001). There was a smaller reduction in the negative impact for transversal deformities of the jaw when compared with other deformities. Orthognathic surgery led to a reduction in the negative effects on the quality of life of patients.

Life-quality of orthognathic surgery patients: The search for an integral diagnosis

The decision on whether starting an orthosurgical treatment depends on the negative esthetic, functional and social impact the dentofacial deformity has on the quality of life of each patient. The objective of this article is to demonstrate the importance of assessing the quality of life of these individuals by means of applying specific questionnaires before treatment onset in order to increase the success rate of orthosurgical treatment. These questionnaires assess not only the esthetic factor, but also the functional conditions that may be affected as well as the psychological issues related to self-esteem and sociability, all of which must be assessed in order to enable the development of an individual treatment plan that meets patient's expectations. Thus, a more predictable level of satisfaction can be achieved at treatment completion, not only from a normative standpoint stated by professionals, but also from a subjective standpoint stated by patients. Although not enough comparable data is available in the literature for us to assess the extent of improvements produced by orthosurgical treatment, a few recent reports conducted by different universities around the world reveal a good response from the majority of patients after surgery, demonstrating great satisfaction with regard to esthetic, functional and psychosocial factors. Therefore, it is reasonable to conclude that the current objective of orthodontic treatment associated with orthognathic surgery consists not only in treating the esthetic functional components of dentofacial deformities, but also in considering patients' psychological factor.

A decisão de iniciar um tratamento ortodôntico-cirúrgico depende do impacto negativo estético, funcional ou social gerado pela deformidade dentofacial na qualidade de vida de cada paciente. O objetivo deste artigo é demonstrar a importância da avaliação da qualidade de vida desses indivíduos para elevar a taxa de sucesso no tratamento ortodôntico-cirúrgico, por meio da aplicação de questionários específicos antes do início do tratamento. Esses instrumentos avaliam, além do fator estético, as condições funcionais que podem estar afetadas e os problemas psicológicos relacionados à autoestima e à sociabilidade, que devem ser identificados para possibilitar a elaboração de um plano de tratamento individualizado para as expectativas subjetivas do paciente. Assim, torna-se mais previsível obter um alto grau de satisfação ao final do tratamento ortodôntico-cirúrgico, tanto do ponto de vista normativo avaliado pelos profissionais quanto do ponto de vista subjetivo dos pacientes. Apesar da deficiência de dados comparáveis suficientes na literatura disponível para avaliar a extensão da melhora após o tratamento ortodôntico-cirúrgico, há relatos recentes de universidades em diversos países que demonstram uma boa resposta da maioria dos pacientes após a cirurgia, com alto grau de satisfação dos pontos de vista estético, funcional e psicossocial. Conclui-se que o objetivo atual do tratamento ortodôntico associado à cirurgia ortognática consiste em não apenas tratar os componentes estético e funcional da deformidade dentofacial, mas, também, o de considerar o componente psicológico do paciente.

Translation and cross-cultural adaptation of an instrument designed for the assessment of quality of life in orthognatic patients

INTRODUCTION: The Orthognathic Quality of Life Questionnaire (OQLQ) was developed in 2000 and validated in 2002, aiming at assessing the impact and the benefits of orthosurgical treatment on patients' quality of life. OBJECTIVE: Cross-culturally translate into Brazilian Portuguese and back-translate into English a quality of life instrument, assuring maintenance of its properties. METHODS: At first, equivalence of concepts and items was discussed by a group of specialists who scrutinized all questionnaire items. Additionally, four patients in need of orthosurgical treatment were interviewed by means of the focus group methodology. Relevance of the questionnaire items was assured prior to its translation which was carried out by two translators who worked independently. Both translations were tested in 20 patients and then consolidated. The consolidated questionnaire version was back-translated into English by two translators who worked independently, and the consolidated back-translation was assessed by the authors of the original questionnaire as well as by the researchers. RESULTS: The OQLQ was translated into Brazilian Portuguese. This translation was tested in a pilot study comprising 12 patients, aged between 16 and 34 years old. CONCLUSION: The OQLQ Brazilian Portuguese translation proves to be an appropriate instrument to access the impact of dentofacial deformities on the quality of life of patients in the Brazilian public health system and who are in need of orthosurgical treatment.

INTRODUÇÃO: o Questionário de Qualidade de Vida para Pacientes Orto-cirúrgicos (Orthognathic Quality of Life Questionnaire - OQLQ) foi desenvolvido em 2000 e validado em 2002, com o objetivo de analisar os impactos e benefícios do tratamento ortodôntico-cirúrgico na qualidade de vida dos pacientes. OBJETIVO: realizar a tradução e adaptação transcultural desse instrumento para o português, assegurando a manutenção de suas propriedades. MÉTODOS: primeiramente, realizou-se a equivalência conceitual e de itens, onde um grupo de especialistas debateu cada item do questionário, e quatro pacientes com necessidade de tratamento ortodôntico-cirúrgico foram entrevistados, utilizando o método de grupo focal. Após verificar a pertinência e relevância dos itens, o questionário foi traduzido por dois tradutores, de forma independente. As duas versões foram testadas em 20 pacientes e, depois, unificadas. Essa versão unificada foi retraduzida para o inglês por dois tradutores independentes, e a unificação das retraduções foi avaliada pelos autores do questionários original e pela equipe de pesquisa. RESULTADOS: a partir dessas avaliações, foi produzida a versão brasileira do OQLQ, a qual foi testada em um estudo piloto que envolveu 12 pacientes, com idade entre 16 e 34 anos. CONCLUSÃO: a versão brasileira do questionário OQLQ pode ser considerada um instrumento apropriado para acessar o impacto da deformidade dentofacial na qualidade de vida de pacientes da rede pública de saúde com necessidade de tratamento ortodôntico-cirúrgico.

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.

OBJETIVO: comparar as mudanças relacionadas à autoestima e satisfação com aparência, entre o pré-operatório e o pós-operatório, de pacientes submetidos à cirurgia ortognática, e avaliar a qualidade de vida e mudanças psicossociais desses pacientes seis meses após a cirurgia. MÉTODOS: estudo qualitativo, de caráter observacional do tipo longitudinal, com amostra de 15 pacientes que apresentavam deformidades dentofaciais e que foram submetidos à cirurgia ortognática. Foram aplicados um questionário e dois formulários, em duas fases: uma pré-cirúrgica e outra pós-cirúrgica. RESULTADOS: os resultados mostraram que 13,3% dos pacientes obtiveram melhora em relação à autoestima e, principalmente, em relação à satisfação com a aparência. Foi também constatada melhoria nas relações sociais, profissionais e familiares. Em relação à avaliação da qualidade de vida segundo o questionário da Organização Mundial da Saúde, observou-se que a média mais baixa correspondeu ao domínio meio ambiente. CONCLUSÕES: a cirurgia ortognática traz consigo uma carga emocional elevada, que deve ser considerada antes e após o ato cirúrgico, pois o estado psicológico do paciente repercute em fatores favoráveis ou desfavoráveis durante a sua recuperação, influenciando de diferentes formas na qualidade de vida, autoestima e satisfação com a aparência.