Factors associated with quality of life before and after orthognathic surgery.

PURPOSE: Evaluate which factors compromise patients' quality of life who have undergone orthognathic surgery in the pre and postoperative period of 2 years. STUDY DESIGN: In this longitudinal prospective study, 46 adult patients undergoing orthognathic surgery were evaluated. The primary outcome variable was quality of life, assessed using the overall score of the orthognathic quality of life questionnaire (OQLQ) in the pre and 2-year postoperative periods. The predictor variables were axis I (temporomandibular dysfunction) and axis II (psychosocial) RDC/TMD diagnoses, assessed preoperatively and 2 years postoperatively; profile, asymmetry, and open bite preoperatively; and orthodontic treatment active 2 years postoperatively. The covariables were age and sex. The OQLQ score was compared preoperatively and postoperatively using the Wilcoxon test and with the other variables using the Mann-Whitney and Kruskall-Wallis tests. RESULTS: Preoperatively, higher OQLQ scores were associated with myofascial pain (P = .012) and severe depression (P = .030). Two years after surgery, there was an improvement in overall OQLQ (P < .001), myofascial pain (P = .012) and chronic pain (P = .001). However, higher OQLQ scores were associated with individuals who had myofascial pain (P = .012), active orthodontic treatment (P = .007), and other nonspecific physical symptoms including pain (NSPSIP) (P = .049). CONCLUSION: Quality of life was affected preoperatively by myofascial pain and depression, and although it improved significantly 2 years after surgery, it continued to be affected by myofascial pain, NSPSIP, and active orthodontic treatment.

Orthognathic surgery in class II patients: a longitudinal study on quality of life, TMD, and psychological aspects.

OBJECTIVES: To evaluate, longitudinally, the impacts of orthognathic surgery in patients with skeletal class II malocclusion on oral health-related quality of life (OHRQoL), temporomandibular disorders (TMD) and psychological symptoms. MATERIALS AND METHODS: Forty-three patients with skeletal class II malocclusion who were submitted to orthognathic surgery were evaluated during their preoperative and postoperative periods. They answered the short version of the Oral Health Impact Profile (OHIP-14) and were also diagnosed according to Axes I and II of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The evolution of OHRQoL and TMD before and after surgery was verified, and the relationships among these variables were found through statistical analysis using Wilcoxon, McNemar, chi-square, and Mann-Whitney tests, with a 5% significance level. RESULTS: The median of the overall OHIP-14 score and five domains decreased after orthognathic surgery (p < 0.05), the functional limitation domain increased (p = 0.014), and the physical disability domain did not show an association (p = 0.133). There were improvements in articular pain (p = 0.016), chronic pain (p = 0.019), and nonspecific physical symptoms excluding pain (p = 0.013). In addition, an association was found between poorer OHRQoL (overall scale and domains) and the Axis II variables of the RDC/TMD (p < 0.05). CONCLUSION: Orthognathic surgery improved perceived OHRQoL, articular pain, and chronic pain. The conditions of Axis II of the RDC/TMD interfered with OHRQoL postoperatively. CLINICAL RELEVANCE: Although orthognathic surgery improves QoL and some TMD conditions in skeletal class II patients, poorer postoperative outcomes are observed when psychological conditions are present.

Atypical Mandibular Angle Fracture.

The mandibular fracture takes the second position among facial bones fractures, with significant increase of cases in the last years. The aim of this paper is to report a clinical case of a patient with facial trauma due to an automotive accident, resulting in an atypical fracture in a unilateral mandibular angle. In the image examinations an atypical favorable fracture in the right mandibular angle region involving the apex of the erupted 48 tooth was found. The fracture line started in the posterior region of mandibular ramus, below mandibular condyle, and spread out until inferior border of the mandible in premolar region. Despite the atypical design of the mandibular angle fracture described in this paper, the treatment showed satisfactory results, without any aesthetic or functional changes for the patient.

Total Mandibular Subapical Alveolar Osteotomy to Correct Class II Division I Dentofacial Deformity.

INTRODUCTION: Class II division I malocclusions are the most common dentofacial deformities seen in clinical practice. Severe cases or cases in which growth has ceased may require full correction combining orthodontic and surgical treatment. We report a case of a total mandibular subapical alveolar osteotomy, performed to correct a class II division I dentofacial deformity. CASE REPORT: A 19-year-old female patient was referred to the oral and maxillofacial surgery department at the Federal University of Paraná with chin aesthetic complaints as well as class II malocclusion. The proposed treatment was total mandibular subapical alveolar osteotomy, retaining the chin position and eliminating the need for genioplasty, since, although the patient presented with a class II dentofacial deformity, the chin was well positioned. Under general anesthesia, a "V-shaped" incision was conducted from the right retromolar region to the left retromolar region. A ring of cortical bone was removed around the mental foramen, with the aim to create a space around the mental nerve. Fixation was conducted with plates and screws of the 2.0 system. The patient on six-year follow-up showed osteotomy stability, a better overall occlusion, and outcome satisfaction.

Análise dos fatores que motivam pacientes jovens e adultos a buscarem tratamento ortodôntico / Analysis of factors tht motivate young and adult patients to seek orthodontic treatment

Introdução: as más oclusões apresentam alta prevalência na população brasileira e causam grande impacto funcional e psicossocial, interferindo na qualidade de vida dos indivíduos e sendo consideradas um problema de saúde pública. A satisfação do paciente com os resultados da correção ortodôntica está diretamente relacionada à compreensão dos fatores que o motivaram na busca pelo tratamento. O objetivo do presente estudo foi conhecer os motivos que levam pacientes jovens e adultos a buscarem tratamento ortodôntico em um curso de pós-graduação. Materiais e Métodos: foram selecionados 60 participantes, de am-bos os gêneros, com idades entre 14 e 18 anos (grupo de jovens) e de 30 a 55 anos (grupo de adultos), divididos igualmente entre os grupos. Os dados foram coletados mediante a aplicação de dois questionários distintos (um aos jovens e outro aos adultos) e os resultados foram tabulados e comparados através de estatística descritiva. As variáveis quantitativas foram analisadas através do teste t de Student para amostras independentes, sendo adotado o nível de significância de 5% (p<0,05). Resultados: a correção de problemas dentários foi o fator motivador mais apontado pelos jovens (55%) e pelos adultos (45%). Como fator desmotivador para se submeter ao tratamento ortodôntico, 28% dos adultos mencionaram a possibilidade de longa duração do tratamento. Conclusões: a principal motivação na busca por tratamento ortodôntico, tanto para os jovens como para os adultos, foram os fatores relacionados com a estética dentária e do sorriso. De modo geral, os pacientes estudados não estiveram dispostos a pagar custos adicionais para reduzir o tempo de tratamento ou para o tornar mais estético (AU)

Introduction: malocclusions have high prevalence in the Brazilian population and cause great functional and psychosocial impact, interfering in quality of life, and being considered a public health problem. Patients' satisfaction with orthodontic correction results is directly related to the understanding of the factors that motivated them to seek orthodontic treatment. The aim of the present work was to study the reasons that lead young and adult patients to seek orthodontic treatment in a post-graduation program. Materials and Methods: 60 individuals of both genders, aged between 14 and 18 years (young people group) and between 30 and 55 years (adult group), were selected and equally divided between groups. Data were collected through the application of two different questionnaires (one to the young people and the other to the adults), and the results were tabulated and compared through descriptive statistics. Quantitative variables were analysed using Student's t-test for independent samples. Level of significance of 5% (p <0.05) was adopted. Results: correction of dental problems was the main motivatin factor pointed by young people (55%) and adults (45%). As demotivating factors to submit themselves to orthodontic treatment, 28% of adults mentioned the possibility of long-term treatment. Conclusions: the main motivation for seeking orthodontic treatment for both, young people and adults, were factors related to dental aesthetic and smile. In general, studied patients were not willing to pay for additional costs to reduce treatment time or to make it more aesthetic (AU)