Patient motivation and satisfaction from orthognathic surgery-a case series.

OBJECTIVE: This study attempted to understand the specific motivations of patients who undergo orthognathic surgery and determine their satisfaction with the surgery. The study also assessed the prevalence of complications and how they may impact patient satisfaction. STUDY DESIGN: Patients who underwent orthognathic surgery at the University of California between 2016 and 2019 and had completed postoperative orthodontic treatment for ≥9 months were interviewed. They responded to an open-ended telephone interview regarding their motivations, satisfaction, and complications. RESULTS: The patients showed a high level of satisfaction with the surgery, but there were persistent complications that affected satisfaction. The predominant complication was paresthesia over the distribution of the inferior alveolar nerve. The majority of patients who reported prior headaches and temporomandibular joint problems described improvement in those areas. Comparing the patients' motivations before and after surgery showed that before surgery, patients reported functional concerns, whereas postoperatively they were much more likely to recall aesthetic reasons for the surgery. CONCLUSION: This study showed that although patients are generally satisfied after orthognathic surgery, patients need to be realistically informed of their expectations and adequately informed of possible complications.

Behavior of major and trace elements in a transient surface water/groundwater system following removal of a long-term wastewater treatment facility source.

In many aquatic environments, municipal wastewater treatment facility (WWTF) effluent discharges influence local hydrologic and chemical connectivity between the surface-water and adjacent alluvial shallow-groundwater systems. Fourmile Creek located in Polk County, Iowa received effluent from the Ankeny WWTF for nearly forty years before it was shut down in November 2013. The decommissioning of the municipal WWTF provided a unique opportunity to characterize the recovery from impacts of treated wastewater discharge on water quality at the surface-water/groundwater interface in a shallow, unconfined alluvial aquifer. Dissolved major element and trace element concentrations in Fourmile Creek surface water, hyporheic-zone water, and shallow, unconfined groundwater were monitored upstream and downstream from the WWTF discharge before and after the shutdown. Multivariate statistical techniques including principal component analysis (PCA) and agglomerative hierarchical clustering (AHC) were used to differentiate source-water contributions, characterize elemental components, and describe surface-water/groundwater interaction dynamics. During the post-closure assessment, there was subsurface attenuation of wastewater constituents including Al, B, Cu, Gd, K, Mo, Na, P, Pb, Sb, and Zn. During the same time, groundwater concentrations increased for As, Ba, Ca, Fe, Mg, Mn, SiO2, Sr, and U and represented a profile characteristic of the shallow alluvial aquifer. Hydrologic conditions transitioned from predominantly wastewater infiltration and hyporheic exchange before the WWTF shutdown, to predominantly discharge of native groundwater. Precipitation-driven streamflow events created fluctuations in the groundwater water-table elevations, resulting in variable contact between the saturated and unsaturated zones within the unconfined, alluvial aquifer and intermittent exposure to constituents stored in the sediments. The inorganic fingerprint of municipal wastewater was flushed relatively quickly (≤19 weeks) from the hyporheic zone indicating that processes like diffusion or sorption/desorption that might extend recovery may not be important for many trace elements in this system.