Internal Distraction Resulted in Improved Patient-Reported Outcomes for Midface Hypoplasia.

BACKGROUND: Both internal and external distraction devices have been used successfully in correcting midface hypoplasia. Although the indication for surgery and the osteotomy techniques may be similar, deciding when to use internal versus external devices has not been studied. The authors studied patient-reported outcomes with FACE-Q and functional surveys for internal and external devices for midface distraction patients. METHODS: Patients who underwent distraction advancement after Le Fort I and Le Fort III were surveyed using the FACE-Q survey and a functional survey. Equal groups of internal and external device patients were compared (n = 64). Data recorded included: sex, age, follow-up, diagnosis, operating room time, expected blood loss, length of stay, distraction length, consolidation time, and complications. RESULTS: Internal and external device groups were similar with regards to patient diagnosis, operative time, expected blood loss, distraction length but consolidation times differed (internal = 3.6 versus external = 1.1 months). For FACE-Q appearance appraisal, there were similarities in domain and scale. For the functional survey (airway/breathing, ocular/vision, occlusion/eating, speech/articulation), there was also similar scoring. However, internal device patients had superior FACE-Q scores for Quality of Life: Social Function (80.9 versus 68.9), Early Life Impact (92.9 versus 62.4), Dental Anxiety (70.2 versus 48.3), Psychological Well-being (87.8 versus 68.6); and Decision Satisfaction (81.2 versus 56.9) and Outcome Satisfaction (91.0 versus 84.7). CONCLUSIONS: Internal and external midface distraction patients had similar patient-reported outcomes for appearance and functional improvement; however, internal device patients were more satisfied with their quality of life and their decision to undergo the procedure.

[Unfavorable outcomes in orthognathic surgery]. / Chirurgie orthognathique : les cas défavorables∗.

Successful completion of an orthodontic-surgical protocol requires faultless involvement of all the parties concerned, both the practitioners and the patient. When the result achieved does not match esthetic and/or functional expectations, the outcome may be seen as a failure by the patient, the practitioners or even both. Two situations comprising a potential for failure will be analyzed here: unfavorable outcomes and the psychological difficulties involved in accepting a new face.

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.

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.

The comparison of psychological adjustment of patients with cleft lip and palate after maxillary distraction osteogenesis and conventional orthognathic surgery.

OBJECTIVE: The objective of this study was to compare the psychological changes of patients with cleft lip and palate (CLP) undergoing maxillary Le Fort I advancement by distraction osteogenesis (DO) and conventional orthognathic surgery (CO). STUDY DESIGN: Prospective randomized controlled study. Participants completed a set of questionnaires to measure their psychological states preoperatively and postoperatively. RESULT: When compared with CO, CLP patients treated with DO had lower social self-esteem and higher social avoidance and distress levels during the first 3 postoperative months. Their self-esteem, social avoidance, and distress levels improved after the distractors were removed. Both CO and DO patients had similar levels of self-esteem, social avoidance, and distress levels 2 years postoperatively. The CLP patients treated with DO were more satisfied with their lives after 2 years. CONCLUSIONS: DO may induce short-term distress to patients up to 3 months but CLP patients who received DO were more satisfied with their lives in the long term.

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.

Perception of improvement after orthognathic surgery: the important variables affecting patient satisfaction.

PURPOSE: We evaluated which factors affect patient satisfaction and if patient expectations were fulfilled after orthognathic surgery. METHODS: Questionnaires consisting of 14 questions were given 1 year after bimaxillary osteotomy for class-III correction to subjects. Six questions were answered using an 11-point rating scale based on a visual analog scale (VAS; 0 = poor; 10 = excellent). Also included were seven closed-form questions with yes/no answers, as well as one open question for 'further remarks'. Sagittal and vertical cephalometric parameters were determined on postoperative cephalograms. RESULTS: Seventy-seven patients (37 females, 40 males; mean age, 23.4 +/- 4.9 (SD) years) responded. The intention to undergo surgery only for aesthetic improvement was noted in 11.9% of patients; only improvement of chewing function in 15.5%; both in 71.4%; and none/don't know in 2.6%. Postoperative satisfaction was rated (in means) with 8.13 +/- 1.97 on VAS and correlated significantly with the opinions of friends and relatives. Facial aesthetics was rated 5.6 +/- 1.2 before surgery and 8.1 +/- 1.5 after surgery (p = 0.04). Preoperative chewing function was rated 5.65 +/- 1.8 and 8.03 +/- 1.51 after surgery (p = 0.014). TMJ disorders or hypoesthesia had no negative impacts. Cephalometric analyses revealed a significantly lower SNB (75.3 degrees +/- 2.7 degrees ; p = 0.033) in patients rating lower than grade 7 for overall satisfaction. For SNA and ArGoMe, no significant differences were observed. CONCLUSION: The most distinctive factors for patient satisfaction after orthognathic surgery were chewing function and facial aesthetics with respect to the lower face. Function, aesthetics, and even psychological aspects should be considered equally when planning surgery.

Quality of life evaluation of maxillomandibular advancement surgery for treatment of obstructive sleep apnea.

PURPOSE: The purpose of this study was to investigate the quality of life (QOL) for patients who underwent maxillomandibular advancement (MMA) surgery for obstructive sleep apnea (OSA) treatment using the Functional Outcomes of Sleep Questionnaire (FOSQ). Correlation of the findings with parameters from the polysomnograph (PSG) and physical examination were also performed. No QOL studies have been carried out for MMA in OSA, and the FOSQ is the most appropriate method. PATIENTS AND METHODS: The FOSQ instrument is a survey designed to evaluate QOL in OSA and proven to be effective. All patients followed a standard prospective protocol of pre- and 6 months postoperative data collection. Clinical radiographs, PSG, FOSQ, endoscopy, and computed tomography scans were analyzed. RESULTS: Fifteen patients with complete data were included in the study. There was minimal change in the BMI from a preoperation mean of 32.10 to 31.50 at 6 months postoperation. The operation was 86.7% (13 of 15) successful (postoperative apnea and hypopnea index [AHI] decreased by 50% and was <20), with a significant decrease of the mean preoperation apnea-hypopnea index (AHI) of 69.12 to 13.87 postoperation (P < .0001). The minimum oxygen saturation (Lsat) correspondingly increased from a mean of 76.49 to 84.96 (P = .0001). A total of 93.3% of our patients achieved a successful QOL change based on a FOSQ score of greater than or equal to 18. There was statistically significant changes in all domains; general productivity (P = .0003), social outcome (P = .0020), activity level (P = .0008), vigilance (P = .0028), intimacy and sex (P = .0039), and the total score (P = .0002) postoperatively. Changes of Lsat and AHI were highly correlated (r = -0.728, P = .002). The magnitude of the Le Fort advancement was also found to be negatively correlated to the change in AHI (r = -0.544, P =.036). There was no correlation between the FOSQ scores and all other parameters, including both the PSG parameters (AHI and Lsat). CONCLUSION: MMA remains the most effective operation for the treatment of OSA and yet no QOL studies have been carried out. The disease-specific QOL instrument (FOSQ) showed the subjective functional improvement in MMA patients. QOL instruments should be used for all surgical based treatment as they add a new dimension to the assessment of the patient and procedures.

The early psychological adjustment of cleft patients after maxillary distraction osteogenesis and conventional orthognathic surgery: a preliminary study.

PURPOSE: To compare the early psychological changes of cleft lip and palate (CLP) and noncleft patients after maxillofacial corrective surgery, including maxillary distraction osteogenesis and conventional orthognathic surgery. MATERIALS AND METHODS: Nine CLP patients were compared with a group of 9 non-CLP patients having similar dentofacial deformities in a prospective longitudinal cohort study. Five of the CLP patients underwent maxillary distraction osteogenesis and 4 underwent conventional orthognathic surgery. A control group of 9 noncleft patients received conventional orthognathic surgery. All patients completed a set of questionnaires to enable their psychological profile to be assessed. The data were collected immediately before surgery (T1), and at 3 weeks (T2) and 12 weeks (T3) after surgery. RESULTS: The CLP patients treated with distraction osteogenesis were happier, but had a higher level of social anxiety and distress than the CLP patients receiving conventional orthognathic surgery. On the other hand, the CLP patients overall were happier, with lower social anxiety and distress, than the noncleft control group. The CLP patients showed a higher level of parental self-esteem than the noncleft patients. CONCLUSION: This preliminary study shows that CLP patients were generally happier, and had a higher level of parental support, than normal patients suffering from dentofacial deformities. Maxillary distraction osteogenesis seemed to induce a higher level of anxiety and distress in CLP patients than conventional orthognathic surgery in both cleft and noncleft patients.

Preparation, perceptions, and problems: a long-term follow-up study of orthognathic surgery.

Follow-up of patients who have undergone orthognathic surgery is well documented in the literature, usually in the form of questionnaire-based studies or clinical interviews. However, there have been few long-term follow-up investigations. This study aimed to look at the long-term outcomes of such operative procedures. Questionnaires were sent to 68 patients who had undergone joint orthodontic and orthognathic surgery procedures 5 to 16 years previously, after the patients were contacted by telephone to learn the nature of the study. The 49 responses were compared with a previously analyzed preoperative group and a short-term postoperative group (1 to 3 years following surgery) from the same institution. Respondents showed high levels of satisfaction overall, with the majority believing they had made the correct decision to undergo surgery. The main problem areas identified were those concerning presurgical explanations and lack of advice regarding side-effects. This area requires improvement as postsurgical dissatisfaction can be minimized by accurate descriptions of the treatment. A number of respondents reported persistent lip paresthesia and continued limitation of mouth opening. However, the majority of patients commented that these persistent symptoms had no effect on their daily life.