How Do Patients Assess Outcomes Of Treatment Of Prognathism?

UNLABELLED: The aim of the study was to analyze the results of patients' subjective self-assessment of surgical treatment of prognathism. MATERIALS AND METHODS: The study included 35 patients who underwent extraoral vertical ramus osteotomy. Each patient responded to 12 questions contained in the questionnaire created by the authors. RESULTS: All respondents positively assessed their appearance after surgery. In most cases they pointed out the positive impact of treatment on their self-confidence (82.9% of responses). The vast majority of respondents felt improvement in biting off food (91.4%). CONCLUSIONS: Patients positively evaluate the outcome of surgical treatment with extraoral vertical ramus osteotomy. The subjective improvement of the facial appearance, as well as chewing and articulation functions took place after the treatment.

Prospective study of the quality of life after treatment of mandibular fractures.

Health-related quality of life (QoL) has become increasingly important, but few studies have dealt with that of patients who have been treated for mandibular fractures. Our aim was to assess this. Patients with mandibular fractures (n=148) were studied prospectively and QoL after treatment was assessed using the General Oral Health Assessment Index (GOHAI). The male-female ratio was 8.3:1 and their ages ranged from 14 to 70 years. QoL after treatment of the fractures declined initially (on the first postoperative day) but thereafter improved steadily. There was no significant difference between the mean QoL of those treated by closed, and those treated with open, reduction. Limitations in the options of food to eat, and difficulty in chewing and swallowing, were identified as their most important concerns in the early postoperative period. The improvement in QoL after the first postoperative day was similar however the patients were treated.

Quality of life in treatment of mandibular fractures using closed reduction and maxillomandibular fixation in comparison with open reduction and internal fixation--a randomized prospective study.

Treatment of mandibular fractures by open reduction and internal fixation (ORIF) is often assumed to be superior to treatment by close reduction and maxillomandibular fixation (MMF) because patients managed by ORIF seem to be rehabilitated earlier according to functional and social aspects. This assumption is often from surgeon's perspective, not taking into account patient's view point. This study highlights a comparative assessment between ORIF and MMF from the patients' perspective. Fifty six patients with mandibular fractures within the tooth bearing areas of the mandible were prospectively studied in a randomized controlled pattern for postoperative Quality of Life (QoL) after ORIF versus MMF. Both groups were analyzed preoperatively, at 1 day, 6 and 8 weeks regarding their QoL using the General Oral Health Assessment Index questionnaire (GOHAI). No significant statistical difference was found between the groups regarding overall QoL. Patients managed by MMF were more affected by psychosocial and physical domains whereas patients managed by ORIF were more affected by the pain domain. The results demonstrate that the treatment affects the psychosocial, physical and pain domain differentially. When both treatments are possible the patient's should be enlightened on the advantages and disadvantages of both treatment modalities to guide their choice of treatment.

Predictors of treatment preference for mandibular fracture.

BACKGROUND: Patient treatment preferences do not necessarily remain stable over time. OBJECTIVE: This study focuses on predictors of patient treatment choice and on the extent to which patients are willing to take risks by choosing surgical versus nonsurgical treatment for mandibular fracture. METHODS: Surveys of African-American and Hispanic adults receiving treatment at King/Drew Medical Center for either a mandibular fracture (n = 98) or third-molar removal (n = 105) were used to investigate patterns of patient preference over the course of a 4-month study period using generalized estimating equations controlling for age, gender, income, and fracture versus third-molar patient. The study examined the effects of symptom rating and a"standard gamble" measure reflecting a patient's willingness to accept scarring or nerve damage. This analysis is based on 169 patients who participated in four waves of data collection. RESULTS: The most salient predictor of patient treatment was the standard gamble measure at 1-month follow-up. Subjects with higher risk tolerance were more likely to select surgery versus jaw wiring. A higher likelihood of choosing surgery was associated with higher income and greater symptom severity. Fracture patients were more likely to select surgery compared with third-molar patients. CONCLUSIONS: The significance of symptom severity 1-month post-surgery raises an important issue regarding the healing process. Moreover, the significance of standard gamble as a predictor of treatment choice for mandibular fracture should encourage other researchers to use this measure of willingness to accept risk when studying acute conditions such as jaw fracture.

Using patient self-report data to evaluate orofacial surgical outcomes.

OBJECTIVES: This study analyzes results of 336 patients treated for mandible fractures at King/Drew Medical Center in South Central Los Angeles, California from August 1996 to December 2001. Subjects were enrolled in a prospective study to evaluate the association between patient's subjective evaluation and objective clinical evaluations on three surgical outcome measures following orofacial surgery. METHODS: Subjects were assessed at four time periods--hospital discharge, 10 days post-discharge, 1 month post-discharge and 6 months post-discharge. Three outcome measures were utilized to represent perceived health and oral health-related quality of life--General Oral Health Assessment Index (GOHAI); Mental Health Inventory (MHI-5); and a single-item self-reported health status measure. RESULTS: GOHAI scores at 1 month (mean=31.5, SD=9.5) were not substantially higher than at 10 days (mean=28.6, SD=8.8), but scores did improve substantially by 6 months (mean=42.6, SD=10.6). Mean mental health scores ranged from 17.7 at 10 days to 18.0 at 1 month and 18.6 at 6 months. Mean self-reported health status score were approximately 2.2 at all recalls, describing health as 'good.' A longitudinal growth curve analysis of GOHAI scores over four time periods indicated a significantly higher average intercept for the maxillomandibular fixation (MMF) treatment group (29.67) than in the rigid internal fixation (RIF) treatment group (25.38). Meanwhile, the increase in GOHAI scores over time was significantly greater in the RIF group than in the MMF group, resulting in scores being comparable between groups after 6 months. CONCLUSIONS: By implication, patients with MMF self-report fewer problems in the early days after placement of the intra-arch wire compared with patients with RIF.

Perceived effectiveness and side effects of intermaxillary fixation for diet control.

Weight loss is one of the major side effects associated with intermaxillary fixation (IMF) following orthognathic surgery or jaw fractures. The aim of this study was to retrospectively interview patients treated with intermaxillary fixation for diet control (IMFDC) to collect base-line information regarding: (1) perceived effectiveness, patients' compliance and patients' satisfaction with the treatment; (2) the frequency of side effects associated with IMFDC. The results show that IMFDC significantly reduced weight by a mean of 6.8 kg during treatment, and a mean of 4.1 kg at a minimum of 1 month following IMFDC removal (P<0.0001). Only 32.5% of the patients complied with the planned period of IMFDC treatment while 70% were satisfied with the treatment results. The most common side effects were speech problems and oral-facial pain with a prevalence of 52.5 and 32.5%, respectively. IMFDC treatment is not effective for long-term weight reduction and may only be used for a very short period of time to initiate weight loss. Exercise and/or special diet programs are healthier and better means to treat obesity and maintain weight loss.

Cirugía ortognática: cirugía de la personalidad / Orthognathic surgery: the surgery of personality

El presente estudio pretende evaluar los resultados de 58 cirugías ortognáticas, medir las actitudes de los pacientes luego de la cirugía ortognática (AU)

Cirugía ortognática: cirugía de la personalidad / Orthognathic surgery: the surgery of personality

El presente estudio pretende evaluar los resultados de 58 cirugías ortognáticas, medir las actitudes de los pacientes luego de la cirugía ortognática

Health-related quality of life and psychosocial function 5 years after orthognathic surgery.

This prospective, multisite, randomized clinical trial evaluated the long-term health-related quality of life and psychosocial function of 93 patients after bilateral sagittal split osteotomy to correct Class II malocclusion. Patients were evaluated approximately 2 weeks before surgery, and 2 and 5 years after surgery. Scores from the Sickness Impact Profile psychosocial dimension and all of its components showed significant improvement from presurgery to 2 and 5 years postsurgery (P <.05). The overall dimension score also showed significant improvement (P <.05). Change between 2 and 5 years postsurgery was not significant, demonstrating that the improvement was stable between 2 and 5 years. The Oral Health Status Questionnaire showed significant improvement at 2 and 5 years relative to presurgery (P <.05). These improvements also remained stable between 2 and 5 years, with the exception of general oral health. The Symptom Checklist 90 Revised demonstrated significant improvements from presurgery to 2 and 5 years after surgery (P <.05) in all areas except somatization. Results other than somatization did not change significantly between 2 and 5 years, showing that improvements were stable. The 7-point satisfaction scale showed that patients were satisfied with postsurgical results, and their satisfaction was maintained 5 years after surgery. It is concluded that general health-related quality of life, oral health-related quality of life, and psychosocial function show significant improvements after bilateral sagittal split osteotomy, and the improvements are stable between 2 and 5 years after surgery.