Do Patients Detect Changes in Breathing After Orthognathic Surgery?

BACKGROUND: Orthognathic surgery addresses facial aesthetics and function in patients with dentofacial deformities. It is associated with changes in upper airway volume (UAV). If changes in UAV are perceived by asymptomatic patients is unclear. PURPOSE: The purpose was to measure associations between changes in UAV and patient-reported benefits using patient-reported outcome measures. STUDY DESIGN: A sample presenting dentofacial deformities without reported breathing problems undergoing orthognathic surgery was retrospectively studied. Patients aged 18-30 years with 12-month follow-up were included. Patients with systemic disease, drug abuse, mental health disorder, or temporomandibular joint dysfunction were excluded. PREDICTOR: The predictor variable was changes in UAV measured in 3-dimensional computed tomography. Subjects were grouped into increased or decreased UAV. MAIN OUTCOME VARIABLE: The primary outcome variable was changes in health-related quality of life measured with Oral Health Impact Profile 49 (OHIP-49). COVARIATES: Weight, height, age, sex, and sub-scaled OHIP-49 were registered. Cephalometric measurements of hard tissue movements were recorded. ANALYSES: Mean, standard deviation, and a level of statistical significance at P < .05 were used. Differences in OHIP-49 were compared using unpaired t-test. The correlation between covariates and outcomes was analyzed using the Spearman's rank test. Analysis of covariance between the predictor and outcome, adjusted for covariates (body mass index), was performed. RESULTS: Fifty-four subjects with a mean age of 20.89 years and 52% males were enrolled. The mean change in UAV was 0.12 cm3 (standard deviation [SD] 9.21, P = .93) with a mean absolute deviation of 7.28 cm3 (SD 5.54). The mean change in OHIP-49 score was 20.93 (SD 28.90). Twenty-seven (50%) subjects had increased UAV (7.4 cm3, SD 6.13) and the other had decreased (-7.17 cm3, SD 5.01) (P = .01). At follow-up, equal levels of mean OHIP-49 score were found, but because of a baseline difference (15.74, P = .048), the subjects with and without increased UAV improved in OHIP-49 score 13.04 (SD 30.53) and 28.81 (SD 25.33), respectively (P = .04). CONCLUSIONS: Because equal levels of OHIP-49 score at follow-up, changes in UAV could not be associated with patient-reported health-related quality of life. Patient-reported outcome measure evaluations of orthognathic surgical treatment for airway obstruction should be performed in patients with a perceived impairment.

Correlation of Orthognathic Surgical Movements to Perception of Facial Appearance in Patients With Cleft Lip and Palate.

STUDY DESIGN: Cephalometric scans were compared before and after surgery to assess the degree of correction. Correlations between skeletal movements and survey outcomes were determined using multivariate regression analysis. OBJECTIVE: This study aims to identify relationships between subjective observer-reported improvements in esthetics and emotional appearance with specific surgical movements. METHODS: Ten patients at a single tertiary institution (average age: 18.1 ± 0.8), 9 males and 1 female, underwent orthognathic repair and had comprehensive cephalometric records. Standardized anterior posterior and lateral pre and postoperative photographs of patients were included in a survey to clinicians to assess noncognitive domains on a Likert Scale (1-10). CLEFT-Q was administered to gauge patient satisfaction in categories of appearance, speech, and quality of life. RESULTS: Per clinicians, multiple domains increased including facial attractiveness (4.1 ± 0.7 versus 7.3 ± 0.7, P < 0.001), friendliness (4.5 ± 0.4 versus 7.3 ± 0.5, P < 0.001), confidence (4.1 ± 0.4 versus 7.1 ± 0.4, P < 0.001), and recommendation for surgery decreased (8.9 ± 0.1 versus 3.6 ± 0.5, P < 0.001). Speech distress decreased with increased SNA and convexity, whereas Psychological and Social scores decreased with an increased ANB. Functional eating and drinking scores increased with maxillary depth. CONCLUSIONS: Orthognathic surgery improves many noncognitive domains in patients with cleft lip and palate as assessed by both patients and clinicians on all aspects of facial attractiveness and perception. These findings demonstrate objective bases of skeletal adjustments for perceived improvements in facial appearance and emotion.

The change of state-trait anxiety among patients undergoing orthognathic surgery: A longitudinal study.

INTRODUCTION: This study aimed to assess state-trait anxiety level changes in Chinese patients with dentofacial discrepancies before and after orthognathic surgery and to explore the feasibility of developing a reference index for the preoperative screening of postoperative patients with high anxiety. METHODS: A total of 96 Chinese patients with dentofacial discrepancies who underwent orthognathic surgery were included in this study. Data were collected before orthognathic surgery and at 2 weeks (T2), 3 months, and 6 months (T4) after surgery using the State-Trait Anxiety Inventory. Receiver operating characteristic and linear regression analyses were performed to screen for preoperative indicators of postoperative high-state anxiety. RESULTS: State-trait anxiety levels in patients with dentofacial discrepancies decreased after surgery (F = 18.95, P <0.01; F = 6.90, P <0.01). Trait Anxiety Inventory can be used to screen patients with high-state anxiety from T2 to T4 (area under cover 95% confidence interval: T2, 0.74 [0.62-0.86]; 3 months, 0.79 [0.69-0.90]; T4, 0.77 [0.66-0.87], P <0.01), corresponding to cutoff values of 48.5, 46.5, and 45.5, respectively. CONCLUSIONS: All participants' state-trait anxiety levels improved after surgery compared with their preoperative levels. Preoperative trait anxiety levels can be used as a reference indicator to screen patients who may have high-state anxiety levels after orthognathic surgery. The creation of a screening scale will assist health care professionals to more pertinently help patients with high anxiety.

Genetic polymorphisms are involved in oral health-related quality of life in skeletal class III patients submitted to orthognathic surgery.

OBJECTIVE: This study aimed to evaluate whether sex and genetic polymorphisms impact the oral health-related quality of life (OHRQoL) preoperatively and the difference between preoperative and postoperative OHRQoL in skeletal Class III patients submitted to orthognathic surgery. MATERIALS AND METHODS: This longitudinal study consisted of ninety-nine patients with skeletal Class III malocclusion who required orthognathic surgery. The Oral Health Impact Profile-14 (OHIP-14) is a questionnaire used to assess the OHRQoL with a 5-point Likert-type scale, covering seven domains related to physical and psychosocial factors. The questionnaire was applied in the preoperative and postoperative periods, and the difference scores were calculated to assess the OHRQoL after orthognathic surgery. The DNA was extracted from oral mucosa cells to evaluate genetic polymorphisms in ANKK1, DRD2, ESR1, and ESR2 through real-time PCR. RESULTS: There was an improvement in all OHRQoL domains following orthognathic surgery (p < 0.05). In the preoperative evaluation, women presented worse OHRQoL (p < 0.05) than men. There was no statistical difference between sex and the OHRQoL after surgery (p > 0.05). When evaluating the polymorphisms and preoperative OHIP-14 scores, CT genotype patients for rs1800497 (ANKK1) had a worse perception of the physical pain domain than CC genotype (p = 0.026), and CC genotype patients for rs1256049 (ESR2) had a worse perception of the functional limitation domain than CT genotype (p = 0.002). In the analysis between polymorphisms and postoperative and preoperative difference scores, CT genotype patients for rs1256049 (ESR2) had a greater improvement in the perception of the physical pain domain than the CC genotype (p = 0.031). In rs6275 and rs6276 (DRD2), patients with the CC genotype worsened the perception of the functional limitation domain than the TT genotype (p = 0.045), and AA genotype patients worsened the perception of the functional limitation domain than GG genotype (p = 0.048) after surgery, respectively. In addition, patients with the CT genotype for rs1800497 (ANKK1) had a greater improvement of OHRQoL perception in the total scale than the TT genotype (p = 0.018), and CT genotype patients had a greater improvement in the perception of function limitation domain than TT genotype (p = 0.017). CONCLUSION: Women have a worse perception of OHRQoL in the preoperative period of orthognathic surgery. Furthermore, polymorphisms in the ANKK1, DRD2, and ESR2 genes could be involved with OHRQoL in the preoperative period and following orthognathic surgery. CLINICAL RELEVANCE: The knowledge of the genetic background concerning OHRQoL in skeletal class III patients would aid in clinical practice to screen for associated genetic factors and prevent OHRQoL deterioration, especially after orthognathic surgery, considering that patients' genetic profiles would soon be available.

Measurement of quality of life in orthognathic surgery using an original questionnaire: About a series of 123 cases.

INTRODUCTION: The aim of this study was to measure changes in the quality of life of patients who had orthognathic surgery using an original questionnaire, designed for this purpose. MATERIAL AND METHOD: This single-center retrospective study included all patients who had orthognathic surgery in our center between 2014 and 2019. An original questionnaire comprising 13 items in 4 domains was sent to patients postoperatively by email after telephone contact and obtaining their consent. Items were scored on a 5-point scale ranging from (-1), worse than before surgery, to (+3), better than before surgery. RESULTS: All data were collected in a standardized way. In total, 123 patients responded. The mean score for all surgeries combined was +1.14, indicating an improvement in QOL considered to be "low to moderate". A total of 118 patients (95.9%) reported an improvement following surgery, including 18 patients (14.6%) who reported a marked improvement. The greatest improvement was observed for psychosocial aspects and morphology. CONCLUSION: This study shows a positive effect of orthognathic surgery on patients' QOL, including self-perception, relationships with others, or functional aspects as mastication and breathing. We propose an original tool that is easy to use by patients to measure quality of life following orthognathic surgery.

Psychosocial changes in patients submitted to orthodontic surgery treatment: a systematic review and meta-analysis.

OBJECTIVE: This systematic review aims to answer the following question: What is the psychological impact of orthognathic surgery on patients with dentofacial deformities undergoing orthodontic-surgical treatment? MATERIAL AND METHODS: The search was adapted for each of the following databases: American and Caribbean Center on Health Sciences (LILACS), Cochrane Library, Embase, Psychinfo, PubMed/Medline, Scopus and Web of Science, and gray literature using Google Scholar, OpenGrey, and ProQuest. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. This study performed estimates of interest, random-effects meta-analyses, and calculated heterogeneity using Higgins inconsistency index (I2). RESULTS: A total of 6751 references were found in all searches. After applying the eligibility criteria after full-text reading, 37 studies comprised the final qualitative synthesis. Thirteen studies were included in quantitative synthesis, and it was possible to meta-analyze data from the following questionnaires: GHQ-28, MMPI, RSES, and SCL-90-R. There was an improvement in psychological aspects related to depression, hysteria, self-esteem, anxiety, obsessive-compulsiveness, interpersonal sensitivity, paranoid ideas, and psychoticism (p < 0.05). CONCLUSIONS: Correction of dentofacial deformity through orthodontic-surgical treatment is associated with improvements observed in several psychological domains, especially in relation to depressive states. CLINICAL RELEVANCE: This result highlights the importance of surgeons and orthodontists in promoting adequate control of patients' expectations and treatment goals taking into account the individual's psychological aspects.

Influence of Orthognathic Surgery on Oral Health and Quality of Life.

ABSTRACT: Orthognathic surgery is a common treatment modality for moderate to severe dentofacial deformities. This study aimed to determine the early postoperative changes in quality of life (QoL) after orthognathic surgery.Twenty patients were evaluated preoperatively (T0), postoperatively after 1 month (T1), and postoperatively after 3 months (T2). Short Form Oral Health Impact Profile and Orthognathic Quality of life Questionnaire were used as generic oral health-related and condition-specific QoL measures.Oral Health Impact Profile -14 and Orthognathic Quality of life Questionnaire scores significantly decreased from T0-T2. Physical pain, psychological disability, social disability, and handicap scores significantly decreased during this interval. Facial esthetic, function, awareness of facial deformity, and social aspects of deformity were also found to significantly improve. No significant difference was found between age groups; female patients had significantly greater preoperative Oral Health Impact Profil-14 scores than did male patients.Orthognathic surgery not only enhances the skeletal and facial relations, but also has significant positive effects on the patients' QoL, oral health, and psychological status.

Does orthognathic treatment improve patients' psychosocial well-being?

OBJECTIVE: To analyse changes in patients' psychosocial well-being from before treatment until post-surgical orthodontic treatment (including retention) is completed. MATERIALS AND METHODS: Data was collected six times: before treatment (T0), 6-8 weeks after the placement of orthodontic appliances (T2), 3-4 weeks before surgery (T3), six weeks after surgery (T4), one year after surgery (T5) and after completing orthodontic treatment (T6; 20-57 months after surgery). At T0, 60 patients participated while at T6, data was available for 15 patients. All patients completed the Orthognathic Quality of Life Questionnaire (OQLQ), Rosenberg Self-Esteem Questionnaire (RSES), Acceptance and Action Questionnaire II (AAQ-II) and the Symptom Checklist 90 (SCL-90). All pairwise comparisons between variables were conducted with the Wilcoxon signed-rank test. RESULTS: OQLQ function, RSES, AAQ-II and SCL GSI worsened from T0 to T2. At T5, improvements compared to T0 were found in all aspects of OQLQ and SCL GSI. When comparing results at T6 to T0, improvements where only found in OQLQ sum, OQLQ facial aesthetics and OQLQ function. CONCLUSIONS: Although well-being of orthognathic patients seems to improve during treatment, many improvements cannot be verified anymore at the completion of the retention period. Most stable changes are found in the oral function component and in the facial aesthetics component of the OQLQ.

Can orthognathic surgery be expected to improve patients' psychological well-being? The challenge of hedonic adaptation.

In addition to improved oral health and function, many people are motivated to undergo orthognathic surgery to improve their facial aesthetics and overall psychological well-being (daily affect and satisfaction with life). This article explains the phenomenon of hedonic adaptation, which challenges the notion that patients treated with orthognathic surgery can expect to experience improvements in psychological well-being following surgery. We review evidence for hedonic adaptation across a variety of life circumstances and explain the psychological processes which account for the relative stability of people's well-being over their life course despite significant positive (and negative) changes in their circumstances. We examine the conditions that assist and inhibit hedonic adaptation to positive life events, and argue that if patients are made aware of these processes, they are more likely to achieve sustained improvements in psychological well-being following orthognathic surgery. Based on our narrative review of evidence for hedonic adaptation, we conclude that orthognathic surgery should not be expected to improve patients' psychological well-being in the long term and suggest that patients be advised to take intentional steps to preserve any improvements in their day-to-day affect and satisfaction with life that arise as a result of their surgery.

Quality of Life Assessment for Elderly Patients Treated With Orthognathic Surgery.

AIM: The purpose of the present study was to evaluate the impact of orthognathic surgery on quality of life (QoL) in elderly patients. METHODS: Twenty patients who underwent orthognathic surgery to correct Angle Class I, II e, III relations were evaluated. Condition-specific QoL through a 22-item Orthognathic Quality of Life Questionnaire (OQLQ) and generic oral health-related QoL through a 14-item short-form Oral Health Impact Profile (OHIP-14) were assessed. RESULTS: A statistically significant reduction (P < 0.001) in the average overall score was detected between the presurgical and postsurgical assessments. Male group showed significant improvement in physical pain (P = 0.047) and psychological discomfort (P = 0.039). No difference was found between the OHIP-14 (P = 0.582) and OQLQ (P = 0.525) total scores for the type of surgery (mono-maxillary or bimaxillary). CONCLUSIONS: Orthognathic surgical treatment had a positive impact on oral health-related QoL in the patients evaluated. The results of this study emphasize the concept that dental esthetics influence patients' oral health-related QoL.

Orthognathic Surgery Has a Significant Positive Effect on Perceived Personality Traits and Perceived Emotional Facial Expressions in Subjects With Primary Mandibular Deficiency.

This study tested the hypothesis that a layperson's social perceptions of a dentofacial deformity (DFD) patient with primary mandibular deficiency (PMD) are more positive after bimaxillary orthognathic surgery.A survey was implemented comparing layperson's social perceptions of emotional expressions and personality traits before and >6 months after orthognathic surgery when viewing standardized facial photographs. The study sample comprised 20 patients selected randomly from a larger primary mandibular deficiency database, treated by 1 surgeon after orthognathic surgery. The outcome variable was change in 6 perceived emotional expressions and 6 personality traits studied. Descriptive and bivariate statistics were computed (P < .05).Five hundred respondents (raters) completed the survey. The respondents were 52% male with 44% aging from 25 to 34. After bimaxillary and chin orthognathic surgery, primary mandibular deficiency patients were perceived to be significantly more dominant, trustworthy, friendly, intelligent, attractive, and less threatening (P < .05). They were also perceived as happier and less angry, surprised, sad, afraid, or disgusted than before surgery (P < .05).Laypeople consistently report improved social traits in primary mandibular deficiency patient's perceived emotional expressions and perceived personality traits after bimaxillary and chin orthognathic surgery.

The changes of self-esteem, sensitivity to criticism, and social appearance anxiety in orthognathic surgery patients: A controlled study.

OBJECTIVES: To evaluate the changes of psychologic parameters, such as self-esteem, sensitivity to criticism, and social appearance anxiety, in skeletal Class III patients undergoing orthognathic surgery and to compare the psychologic status of skeletal Class III patients with control subjects. METHODS: The first group consisted of 60 patients with a mean age of 22.07 ± 1.30 years who did not need orthognathic surgery. The second group comprised 45 patients with skeletal Class III malocclusion (mean age 21.40 ± 2.02 years) who were evaluated in terms of psychologic changes from before to after surgery. A third group consisted of 50 Class III patients (mean age 20.09 ± 2.59 years) who were evaluated before surgery and a different 50 Class III patients (mean age 22.15 ± 2.03 years) who were investigated after surgery. The Rosenberg Self-Esteem Scale and the Social Appearance Anxiety Scale were used to evaluate psychologic parameters both before and after surgery. Analysis was carried out with the use of independent- and dependent-sample t tests, 1-way analysis of variance, and post hoc Tukey test. RESULTS: Self-esteem of the patients with skeletal Class III malocclusion increased, and sensitivity to criticism and social appearance anxiety decreased significantly after the surgery (P <0.001). In the patients with Class III malocclusion, self-esteem was significantly lower and social appearance anxiety significantly higher before orthognathic surgery than in the control group, and at the postoperative evaluation Class III patients had significantly higher self-esteem than the control group (P <0.001). CONCLUSIONS: Through the improvement in facial appearance after surgery, patients' self-esteem increases and their sensitivity to criticism and social appearance anxiety decrease.

Improvement of Esthetic, Functional, and Social Well-Being After Orthognathic Surgical Intervention: A Sampling of Postsurgical Patients Over a 10-Year Period From 2007 to 2017.

PURPOSE: The objectives of this study were to evaluate the effect of orthognathic surgery on the long-term quality of life of patients who received this treatment and to delineate the common reasons for dissatisfaction. MATERIALS AND METHODS: In this retrospective cohort study, patients who underwent orthognathic surgery were studied. One hundred thirty-two patients who had undergone orthognathic surgery from 2007 to 2017 in the oral and maxillofacial surgery department participated in this study. They were divided based on their dentofacial deformity into those with Class II malocclusion and those with Class III malocclusion. Each participant completed a modified questionnaire used to assess the patient's esthetic, social, and functional abilities after orthognathic surgery. RESULTS: The rate of esthetic improvement in orthognathic surgery patients was 91.7%. No significant difference between male and female patients was found regarding the changes in social, esthetic, and functional aspects before and after orthognathic surgery. Both genders recommended orthognathic surgery for patients with similar problems. One in four patients was dissatisfied with the nasal appearance after the surgical procedure (25.8%). CONCLUSIONS: In this study the patients' satisfaction from the orthognathic surgical procedure was mostly a result of improvements in facial esthetics, followed by psychological well-being and then functional abilities. Most dissatisfaction after the orthognathic surgical procedure was related to nasal appearance.

Young Adults' Experience of Appearance-Altering Orthognathic Surgery: A Longitudinal Interpretative Phenomenologic Analysis.

OBJECTIVE: To gain an experiential account of the processes of change associated specifically with orthognathic surgery. DESIGN: A qualitative design was used. Semistructured interviews were carried out with 7 participants approximately 1 week before and 6-8 weeks after surgery. The data were analyzed using interpretative phenomenologic analysis (IPA). SETTING: Participants were recruited from a NHS Dental Hospital. PARTICIPANTS: Patients aged 16 to 25 years scheduled to undergo orthognathic surgery on both the upper and lower jaws were purposively sought to participate. Seven participants aged between 18 and 25 years and who had undergone a bimaxillary osteotomy completed interviews (5 females and 2 males). RESULTS: Themes were identified in connection with the overall journey of treatment being a rite of passage; the treatment's role in raising awareness about the anomalies in appearance; the initial shock at the changes that followed surgery; the uncertainty about treatment; the impact of actual negative reactions of others; and the role of significant others in the decision-making process. CONCLUSIONS: Participants described undergoing a much more complex process of adjustment to change in appearance than has been identified elsewhere within the literature, and the study highlights the nuanced fashion in which both medical and parental communication influence patient expectation and experience of surgery. There is a need to improve communication between clinicians, families, and young adults seeking orthognathic surgery. Further studies are needed to investigate the processes associated with seeking to change facial appearance resulting from other forms of dentofacial condition.

Long-term changes in oral health-related quality of life of standard, cleft, and surgery patients after orthodontic treatment: A longitudinal study.

INTRODUCTION: The aim of this study was to assess long-term changes and describe the trajectories of oral health-related quality of life (OHRQoL) in a cohort of cleft, surgery, and standard patients who received orthodontic treatment. METHODS: Standard (n = 16), cleft (n = 19), and orthognathic surgery (n = 22) patients completed the short-form of the Oral Health Impact Profile (OHIP-14) before treatment, immediately posttreatment, and approximately 5 years posttreatment. RESULTS: An overall reduction in OHIP-14 scores (improvement in OHRQoL) occurred after orthodontic treatment; however, this was only significant for the surgery and standard groups (P <0.05). The total OHIP-14 score increased significantly from posttreatment to 5 years follow-up for all 3 study groups (P <0.05). Relative to pretreatment, however, there were significant reductions in total OHIP-14 scores at 5 years posttreatment in the surgery group (-57.4%; P <0.05), but not in the standard sample (-24.2%; P >0.05). By contrast, the OHIP-14 score in the cleft group increased but not significantly (40.2%; P >0.05). Using a mixed model analysis, a significant interaction was detected between patient group and time (ie, study time point) (F = 6.0; P <0.0001), after adjusting for age and sex. CONCLUSIONS: Distinct patient groups showed different OHRQoL trajectories after orthodontic treatment. Treatment-related improvements in OHRQoL are maintained over time for surgery patients, but not for those with standard malocclusions and orofacial clefts.

Experiences Of Individuals Concerning Combined Orthodontic and Orthognathic Surgical Treatment: A Qualitative Twitter Analysis.

OBJECTIVE: The aim of this qualitative study was to analyze the content of posts on Twitter in order to gain an in-depth understanding of patients' thoughts and experiences surrounding orthognathic surgical treatment. MATERIALS AND METHODS: Using the Twitter search function, with the keywords "jaw surgery," the 1,000 most recent posts on Twitter with relevance to a combined orthodontic and orthognathic surgical treatment were extracted. After applying relevant inclusion and exclusion criteria, the selected posts were analyzed using thematic analysis by 2 independent investigators. Distinct themes and subthemes were developed. RESULTS: A total of 689 posts were analyzed; the 3 main themes identified in relation to orthognathic surgery were preoperative engagement, postoperative difficulties, and posttreatment satisfaction. Twelve subthemes were also identified, expressing issues such as anticipation or apprehension of the surgical procedure, postoperative pain and edema, dietary restrictions and weight loss, paresthesia, depression, and satisfaction with improvements in appearance and self-confidence. The 6 terms most frequently used in tweets were "recovery," "braces," "swollen," "eat," "liquid diet," and "pain." CONCLUSIONS: The findings from the present study can increase the awareness of clinicians involved in the combined orthodontic and orthognathic surgical treatment of patients with dentofacial deformities, allowing them to better educate and counsel their patients throughout the entire treatment process.

Do patients benefit from orthognathic surgery? A systematic review on the effects of elective orthognathic surgery on psychosocial functioning and patient satisfaction.

The main purpose of this systematic review was to determine the current state of evidence regarding patient satisfaction with, and the impact of, orthognathic surgery on psychosocial functioning of patients 17 yr of age and older. A secondary aim was to determine whether individuals with psychiatric disorders and mental health conditions are more likely to be dissatisfied with the treatment outcome than those without. We systematically searched PubMed, PsycInfo, and Embase for relevant studies (up to 6 June 2016). After selection of articles we determined the Directness of Evidence (DoE) and Risk of Bias (RoB). We identified 3,948 studies (1,053 studies in Pubmed, 2,023 in Embase, and 872 in PsycInfo). Of these, 87 remained after screening of title and abstract, while after full-text screening only nine remained for DoE and RoB assessment. All nine studies had a high RoB and a low or moderate DoE. The quality of the methods of studies, published to date, on the effects of orthognathic surgery on patient satisfaction or the psychosocial impact carry a high RoB. Therefore, these do not allow inferences on the effects of orthognathic surgery on patient satisfaction or their psychosocial functioning.

Evaluation of the Changes in the Quality of Life in Patients Undergoing Orthognathic Surgery: A Multicenter Study.

Orthognathic surgery can affect patients' quality of life. The aim of the present study was to assess changes in quality of life during combined orthodontics-surgery treatment and effect of orthodontist-surgeon teamwork on final patient's satisfaction. Twenty-six orthognathic patients who were referred to oral and maxillofacial department of 3 hospitals in Tehran were included in the study. Orthognathic quality of life questionnaire (OQLQ) was given to patients 1 week before, 4 weeks and 4 months after surgery. Two self-designed forms were used for evaluating mood and comfort of patients 1 week before surgery and 4 days after surgery. Self-designed forms were given to the orthodontists and the maxillofacial surgeons to assess quality of teamwork and difficulty of the procedure. Twenty-four patients (15 females and 9 males) with the mean age of 22.62 ±â€Š3.57 completed the study. Quality of life increased from 1 week before surgery to 4 months after surgery (P < 0.013) and the difference was statistically significant between OQLQ score at 1 week before surgery and that of 4 months postoperative. Esthetic and social domain showed significant changes during the studied period. Orthognathic quality of life questionnaire at 4 months postoperative was correlated with surgery difficulty and duration. It can be concluded that orthognathic surgery can improve quality of life, especially in esthetic and social aspects.

Cleft Lip and Palate Repair.

INTRODUCTION: Cleft lip and palate is the most frequent congenital craniofacial deformity. In this article, the authors describe their experience with cleft lip and palate repair. METHODS: Data regarding patients presenting with primary diagnosis of cleft lip and/or palate, between 2009 and 2015, were reviewed. Details including demographics, type of cleft, presence of known risk factors, surgical details, and follow-up visits were collected. Documented complications were reported. Caregivers' satisfaction was assessed with a survey. The survey used to assess satisfaction with cleft-related features was based on the cleft evaluation profile (CEP). In addition, 4 assessors used visual analog scale (VAS) to assess the aesthetic satisfaction. RESULTS: Seven hundred fifty-two patients with primary diagnosis of cleft lip and/or palate underwent surgical correction at "S. Chiara" Hospital, 432 (57.45%) male and 320 (42.55%) female. The most common cleft types in our study were incomplete cleft palate (152 patients) and left unilateral complete cleft lip and palate (152 patients). Associated syndromes were found in 46 patients (6.12%). Cleft lip was repaired using a modified Tennison-Randall technique when the defect was unilateral, whereas a modified Mulliken technique was used for bilateral cleft lip. Cleft palate was repaired using the Bardach technique or Von Langenbeck technique at 5 to 6 months of age. Cleft lip and palate was repaired in several surgical steps. In total, complications were reported in 81 of 752 patients (14.16%). Average fathers' satisfaction score assessed using CEP was 4.5 (lip), 4.8 (nose), 4.7 (teeth), 4.8 (bite), 4.2 (breathing), 4.6 (profile). Average mothers' satisfaction score assessed using CEP was 4.3 (lip), 4.6 (nose), 4.4 (teeth), 4.5 (bite), 4.1 (breathing), 4.4 (profile). Average level of aesthetic satisfaction, assessed using VAS, was 8.7 (fathers), 8.1 (mothers), 7.9 (lay person), and 8.0 (senior cleft surgeon). CONCLUSION: The multidisciplinary management of children with oral cleft determinated good results, in terms of satisfaction and aesthetic appearance. From our experience, periosteoplasty and lip-adhesion are key surgical techniques.

Symptoms in the masticatory system and related quality of life in prospective orthognathic patients.

OBJECTIVE: The aim of this study was to investigate the relation between orthognathic patients' self-reported symptoms in the head and neck region and their quality of life (QoL). MATERIAL AND METHODS: Participants included were consecutive patients (n = 50) referred to the assessment of orthognathic treatment need and voluntary first-year university students (n = 29). All participants filled in the Orthognathic Quality of Life Questionnaire (OQLQ) and a structured diary created by the authors. The median values of Orthognathic Quality of Life (OQOL) sum and subscores, satisfaction with oral function and number of awakenings were compared between patients and controls. Further, correlations between the OQOL sum and subscores, satisfaction with oral function and number of awakenings were analyzed. RESULTS: Patients reported significantly more symptoms (p = .013) and woke up significantly more often than the controls (p = .032). Their OQOL sum scores were significantly higher (indicating a lower OQOL) (p = .001), and they were significantly less satisfied with their oral function than the controls (p < .001). Among the awakened and not-rested patients, the most commonly reported symptoms were pain in the head and/or neck region and fatigue and/or stiffness in the jaws. CONCLUSIONS: Experiences of pain and discomfort have a significant impact on patients' OQOL and well-being.