Quality of life several years after orthodontic-surgical treatment with bilateral sagittal split osteotomy.

Objective: To analyse oral health related quality of life (OHRQoL) several years after orthognathic treatment in patients who had Class II malocclusion with retrognathic mandible.Material and methods: The initial study cohort comprised 151 patients with orthognathic treatment in 2007-2011. Of them, 77 patients (Group 1, mean age 41 years, range 19-71 years, 71% women) were clinically examined 6 years (range 4-8 years) after bilateral sagittal split osteotomy (BSSO). Group 2 included 24 former patients (mean 48 years, range 25-79 years, 50% women) who were willing to participate in a structured telephone interview. Group 3 consisted of 22 prospective patients (mean 35 years, range 18-56 years, 86% women) with a recent orthognathic treatment plan and awaiting treatment. QoL was assessed using two questionnaires, OHIP-14 and OQLQ.Results: Based on responses, patients who had received orthognathic treatment (Groups 1 and 2) had better QoL than those awaiting treatment (Group 3).Conclusion: Conventional orthognathic treatment, including mandibular advancement with BSSO, seems to have a positive long-term effect on patients' QoL. More long-term follow-up studies are needed to assess the real impact of treatment on patients' lives in the long run.

Components of Patient Satisfaction After Orthognathic Surgery.

The purpose of this study was to compare overall patient satisfaction after orthognathic surgery with the following specific categories: appearance, functional ability, general health, sociability, and patient-clinician communication. A 16-question survey was developed and administered to include patients at either 6 or 12 months after orthognathic surgery between June 2013 and June 2014 at the University of Pennsylvania and Massachusetts General Hospital. The predictor variables included age, sex, type of procedure, medical comorbidities, intra- or postoperative complications, and presence of paresthesia. The outcome variable was patient satisfaction overall and in each category based on a Likert scale (0: not satisfied at all to 5: very satisfied).A total of 37 patients completed the survey and had a high overall rate of satisfaction (100% of responses were 4 or 5 on Likert scale). Overall satisfaction had the highest correlation with appearance (ρ=0.52, P=0.0009) followed by sociability (ρ=0.47, P=0.004), patient-clinician communication (ρ=0.38, P=0.02) functionality (ρ=0.19, P=0.26), and general health (ρ = -0.11, P = 0.51). Patients had high satisfaction scores for orthognathic surgery. Satisfaction with postoperative appearance had the strongest correlation with overall satisfaction.

Satisfaction with orthognathic surgery of skeletal Class III patients.

INTRODUCTION: Class III relationships can be corrected with single-jaw or bimaxillary surgery. The purpose of this research was to assess patient satisfaction after bimaxillary surgery, compared with setback surgery alone, for Class III corrections. Identifying patients' relative levels of satisfaction will provide guidance for the selection of surgical options. METHODS: The cephalometric outcomes for 25 patients who underwent 2-jaw surgery were compared with the outcomes in 40 patients who had mandibular setback. Soft and hard tissue changes were evaluated using initial and postsurgical lateral cephalograms. The patients were asked to complete self-administered questionnaires after orthognathic treatment. Correlations between cephalometric improvement and patient satisfaction were evaluated. RESULTS: The patients in the 2-jaw group reported significantly higher satisfaction in the appearance of the mouth (P <0.05), smile (P <0.05), and treatment outcome (P <0.001). These item scores and the changes in ANB, ANS-M, and nasolabial angle showed strong correlations in the 2-jaw group and moderate correlations in the 1-jaw group. CONCLUSIONS: ANS-M and nasolabial angle should be considered in the conventional diagnosis of skeletal Class III orthognathic surgery to obtain adequate correction of facial esthetics and patient satisfaction. Esthetic needs contribute to surgical decisions when treating patients with skeletal Class III malocclusions and dentofacial deformities such as maxillary deficiency and long facial height that causes a turned-up upper lip.

Assessing Patient-Reported Outcomes Following Orthognathic Surgery and Osseous Genioplasty.

Primary outcomes for orthognathic surgery and genioplasty patients include satisfaction with appearance, improved motor function, and enhanced quality of life. The goal of this study was to assess outcomes among patients undergoing these procedures, and to highlight the potential use of FACE-Q instrument for use in patients with dentofacial deformities. A total of 56 patients presenting for orthognathic surgery and/or osseous genioplasty completed the FACE-Q during preoperative and/or at postoperative visits. FACE-Q scores increased following surgery in satisfaction with facial appearance overall (+24.5, P < 0.01), satisfaction with lower face and jawline (+40.7, P < 0.01), and in all satisfaction with chin items (profile, prominence, shape, and overall). Patients also demonstrated increased social confidence (+8.9, P = 0.29). There was no improvement in psychologic well-being (-0.8, P = 0.92). All 3 surgical groups of patients experienced gains in satisfaction with appearance following surgery. Patients who underwent orthognathic surgery either alone or in combination with genioplasty demonstrated statistically significant improvements in satisfaction with facial appearance overall (P < 0.01 for both groups), whereas patients who underwent genioplasty alone did not (P = 0.13). In addition, patients who underwent orthognathic surgery combined with genioplasty demonstrated greater improvement in satisfaction with chin than patients who underwent genioplasty alone. In conclusion, patients who underwent orthognathic surgery and/or genioplasty demonstrated improvement in appearance and social confidence. The use of this model supports the successful outcomes possible for patients undergoing these procedures.

Nerve manipulation during bilateral sagittal split osteotomy increases neurosensory disturbance and decreases patient satisfaction.

PURPOSE: The extent to which neurosensory disturbance (NSD) affects patients after bilateral sagittal split osteotomy (BSSO) was investigated 1 year postoperatively. An additional aim was to identify related factors. MATERIALS AND METHODS: In this prospective study, the fate of the mandibular nerve during BSSO was recorded. The predictor variable was the degree of nerve injury during BSSO, and the outcome variable was the effect of NSD 1 year postoperatively. Statistics were computed and a P value less than .05 was considered significant. RESULTS: Forty-one patients (27 women; average age, 37 yr) completed the study. Of these patients, 90.2% had NSD, but most (89.2%) were satisfied with the treatment and would choose it again. The NSD was greater when the nerve had been manipulated more during surgery. The 4 patients with visible nerve lacerations had severe NSD and were unsatisfied with the treatment at the endpoint. CONCLUSIONS: Although NSD was frequent 1 year after BSSO, most patients were satisfied with the treatment. However, a risk for severe NSD or neuropathic pain does exist in a small group of patients. These patients should be identified at an early stage so that proper medical and supportive treatment can be initiated. If necessary, a multidisciplinary pain center should be consulted. The importance of accurate patient information preoperatively cannot be overstated.

Asymmetric mandibular prognathism: outcome, stability and patient satisfaction after BSSO surgery. A retrospective study.

PURPOSE: To investigate surgical outcome, long-term stability, the time course of relapse, neurosensory disturbances, and patient satisfaction after BSSO for correction of mandibular asymmetry. Another objective was to examine whether osteotomies for transverse rotation of the distal segment represent an increased risk for nerve injury. SUBJECTS AND METHODS: In a retrospective study lateral and postero-anterior cephalograms, information from patient files and questionnaires were analysed for 38 patients having more than 4 mm asymmetry at the chin pre-treatment (mean 8.4 mm). The radiographs were analysed preoperatively, postoperatively, after 6 months and 3 years. RESULTS: Asymmetry of the chin to the facial midline improved on average by 56%. Skeletal relapse was about the same for transverse and antero-posterior surgical changes (10-15%). 58% of the patients had asymmetry of more than 3 mm at menton 3 years post-surgery. Discrepancy between upper and lower dental midlines improved on average 80%. Normal or near normal sensation to the lower lip/chin was reported by 44% of the patients which is similar to sensory disturbances after BSSO straight set-back performed by the same surgical team. A difference in the incidence of neurosensory disturbance between the two osteotomy sides was observed. Satisfaction with the treatment result was reported by all patients except for two. CONCLUSION: Correction of mandibular asymmetry by BSSO is fairly stable. Although the risk for sensory impairment for the individual patient was similar to impairment in a sample having straight setback, rotation of the distal segment during surgery may represent an increased risk for sensory impairment on the deviating side (P = 0.06). Three years after surgery patients were generally satisfied with the result even if more than 3 mm of asymmetry at the chin remained for 58%. The findings have implications for treatment planning and the decision to elect one-jaw, bimaxillary surgery and/or additional genioplasty.

Patients offered orthognathic surgery: why do many refrain from treatment?

AIM: To examine factors associated with patients' decision to decline surgery. MATERIAL/METHODS: Of 470 consecutive patients referred to the University of Oslo from 2007 to 2009, a sample of 160 subjects who had not undergone surgery was identified and contacted. 236 operated patients from the same period served as a comparison group. Morphology was assessed from cephalograms and photographs, and the individuals' opinions were recorded using questionnaires. RESULTS: Dentofacial morphology represented normative treatment need and was generally similar except for a higher rate of severe negative overjet in the operated group (p < 0.001). The most prevalent reasons for declining surgery were risks of side effects, the burden of care, and a general reluctance to undergo surgery. Many un-operated subjects were dissatisfied with their masticatory function and dentofacial appearance. CONCLUSION: Informed consent to orthognathic surgery represents a challenge both to the patient and the professional. The findings imply that patients' motives and fears should be explored during consultation and that the information provided should be adapted to the potential risks and benefits related to the actual treatment.

Reduction genioplasty enhances quality of life in female patients with prognathism and maxillary hypoplasia undergoing bimaxillary osteotomy.

The structure of the chin determines facial attractiveness and is directly linked to quality of life (QoL). In patients with prognathism and maxillary hypoplasia, bimaxillary osteotomy (BIMAX) with mandibular setback does not always lead to a more slender chin or improved aesthetics. The aim of the present study was to evaluate whether QoL differed between females undergoing BIMAX alone (group I; n=30) and those undergoing BIMAX combined with reduction genioplasty (group II; n=30). Presurgical and postsurgical evaluations included cephalography, photogrammetry, and the Oral Health Impact Profile with one additional domain (aesthetics). Setback of the hard tissue pogonion was significantly greater (P=0.006) in group II (7.1mm) than in group I (2.7mm). Only in group II were soft tissue pogonion changes highly significant (P<0.001), amounting to a mean of 5mm. In both groups, the QoL domains 'social disability', 'psychological discomfort', and 'dissatisfied with aesthetics' changed significantly towards lower impact scores. Changes in the latter two domains were significantly greater in group II patients than in group I patients (P=0.021; P<0.001) and were correlated with changes in the soft tissue pogonion in the horizontal (P=0.024; P=0.022) and vertical directions (P=0.037; P=0.042). Genioplasty addresses both psychological and aesthetic concerns, and therefore significantly enhances postsurgical QoL.

Temporomandibular joint and psychosocial evaluation of patients after orthognathic surgery: a preliminary study.

PURPOSE: The purpose of this study was to evaluate the psychological and psychosocial status of patients prior to and after orthognathic surgery. MATERIALS AND METHODS: Twenty-two patients (13 males and 9 females) who underwent orthognathic surgery were examined in this study. The bilateral sagittal split ramus osteotomy (BSSRO) group included 10 patients, and the Le Fort I osteotomy and BSSRO group included 12 patients. We continued RDC/TMD Axis II research for 12 patients who had preoperative temporomandibular joint disorder (TMD). The RDC/TMD Axis II charts were recorded preoperatively and 6 months after surgery. The Wilcoxon signed rank test was used for statistical analysis. RESULTS: Overall, there was no significant difference between the preoperative and 6-month postoperative depression indices. The non-specific physical symptoms score (NPS) with pain score decreased significantly (p < 0.05), but the NPS without pain score decreased insignificantly. In terms of the graded pain score for the preoperative group, 75.0% of the patients were in the low disability group, whereas 25.0% were in the high disability group. In contrast, patients in the postoperative group only fell into the low disability group (p < 0.05). CONCLUSION: The RDC/TMD Axis II was developed to diagnose TMD, but we believe the RDC/TMD Axis II can help to establish postoperative treatment plans by evaluating a patient's psychological and psychosocial state.

Patients' perceptions of improvements after bilateral sagittal split osteotomy advancement surgery: 10 to 14 years of follow-up.

INTRODUCTION: The aims of this study were to determine reasons for orthodontic-surgical treatment, to quantify the perceptions of possible improvement 10 to 14 years after treatment, and to assess factors that affect treatment satisfaction and socio-dental impacts on quality of life. METHODS: The participation rate was 36 of 78 patients; their mean age was 45.7 years (SD, 10.7 years; range, 29-62 years). The presurgical anatomic occlusions were measured on dental casts. Visual analog scales allowed the participants to rate their perceived treatment outcome on 7 oral health-related items. A 3-point scale rated satisfaction with orthodontic-surgical treatment. The oral impact of daily performances index was included to assess socio-dental impacts on quality of life. RESULTS: Most responders reported improvements on the 7 items. The most significant change was reported for chewing. "Very satisfied" with the treatment was reported by 13 responders; 19 of 36 persons were "reasonably satisfied." Reporting "very satisfied with treatment" was 8 times more likely when peers had noticed a changed in the participant's appearance after surgery. Sex was significantly associated with quality of life. CONCLUSIONS: The most frequently reported reason for treatment was to improve chewing, and the item that showed the most pronounced improvement was also chewing. Most responders were only reasonably satisfied with the treatment. Whether peers noticed a change in appearance after treatment was a significant factor affecting both treatment satisfaction and reporting a good quality of life.

Quality of Life in orthognathic surgery patients: post-surgical improvements in aesthetics and self-confidence.

The objective of this prospective study was to assess changes of Quality of Life (QoL) in patients undergoing bimaxillary orthognathic surgery. Questionnaires were based on the Oral Health Impact Profile (OHIP, items OH-1-OH-14) and three additional questions (items AD-1-3), and were completed by patients (n=50; mean age 26.9±9.9 years) on average 9.1±2.4 months before surgery, and 12.1±1.4 months after surgery, using a scoring scale. Item scores describing functional limitation, physical pain, physical disability and chewing function did not change significantly, whereas item scores covering psychological discomfort and social disability domains revealed significant decreases following surgery. AD-2 "dissatisfying aesthetics" revealed the greatest difference between pre- and post-surgical scores (p<0.001). If there was a perception of aesthetic improvement of facial features post-surgery, the benefit in QoL was generally high. The significant correlation of the pre- to post-surgical changes of item OH-5 "self conscious" to nearly all other item changes suggested that OH-5 was the most sensitive indicator for post-surgical improvement of QoL. Psychological factors and aesthetics exerted a strong influence on the patients' QoL, and determined major changes more than functional aspects did.

Changes in quality of life and their relation to cephalometric changes in orthognathic surgery patients.

OBJECTIVE: To evaluate correlations between presurgical and postsurgical changes in quality of life (QoL) and cephalometric hard and soft tissue changes in patients undergoing orthognathic surgery. MATERIALS AND METHODS: The study sample consisted of 30 patients (mean age 24.3 ± 4.5 years) with Class III malocclusion undergoing orthognathic surgery for mandibular setback with a median follow-up of 8.3 ± 1.2 months. Presurgical and postsurgical cephalograms were traced and Oral Health Impact Profile (OHIP) questionnaires were completed. Each questionnaire consisted of 14 items designed to evaluate functional, physical, psychological, and social impacts. RESULTS: Significant correlations between significant presurgical-to-postsurgical changes in individual items and OHIP parameters were found between labiomental angle (LA) and question 5 ("feeling self-conscious"; correlation coefficient [r]  =  0.530), between LA and question 6 ("feeling tense"; r  =  0.598), between nasion-pogonion and question 5 (r  =  0.523), and between facial convexity and question 5 (r  =  -0.540). Hence, reduction of both LA and nasion-pogonion led to a significant decrease in the impact scores of items covering psychological discomfort, while reduced facial convexity led to increased impact scores. CONCLUSIONS: Although the associations were moderate, changes in QoL following cephalometric modifications should be considered as a major concern when planning orthognathic surgery. Postsurgical changes to a more convex profile after mandibular setback should be emphasized before surgery to help patients become accustomed to their new appearance more easily without negatively affecting QoL.