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.

Subjective assessment of facial aesthetics after maxillofacial orthognathic surgery for obstructive sleep apnoea.

We aimed to evaluate the subjective perception of facial appearance by patients after maxillofacial surgery for obstructive sleep apnoea (OSA), and explored the possible correlation between satisfaction and surgical outcome. A total of 26 patients, 24 men and 2 women (mean (SD) age 45 (7) years), subjectively assessed their facial appearance before and after operation using a visual analogue scale (VAS). To investigate a possible association between postoperative facial appearance and surgical outcome, we analysed postoperative scores for the apnoea/hypopnoea index (AHI) and Epworth sleepiness scale (ESS). Postoperatively, 14 (54%) indicated that their facial appearance had improved, 4 (15%) recorded a neutral score, and 8 (31%) a lower score. The rating of facial appearance did not correlate with changes in the AHI or ESS following surgery. This study supports the view that most patients are satisfied with their appearance after maxillofacial orthognathic surgery for OSA. The subjective perception of facial aesthetics was independent of the surgical outcome.

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.

A randomized crossover study comparing two mandibular repositioning appliances for treatment of obstructive sleep apnea.

PURPOSE: The purpose of this study was to determine whether treatment outcomes vary according to the design of the mandibular repositioning appliance (MRA). Two titratable MRA's were compared. The designs differ in advancement hardware and configuration of acrylic both in bulk and interocclusal contact. MATERIALS AND METHODS: The primary treatment outcome was the Respiratory Disturbance Index (RDI). Other outcomes that were compared included Sleep Apnea Quality of Life Index (SAQLI), Epworth Sleepiness Scale, oxygen saturation, and subjective feedback regarding experiences with the appliances. Twenty-four subjects were recruited from consecutive referrals for MRA therapy following diagnosis of obstructive sleep apnea (OSA) by polysomnography. Subjects were randomly assigned to a treatment arm of the crossover study. Each subject underwent an initial sleep study with a type III home monitor to establish a baseline RDI. Subjects were then treated with one of the two MRAs determined by random assignment. The MRA self-titration phase was monitored until a treatment position was determined, and the home sleep study was repeated. After a 2-week period without any OSA treatment, subjects received the second MRA and the self-titration treatment protocol was repeated. At completion of treatment with each appliance, subjects answered questionnaires and underwent a sleep study with the type III monitor. The outcome data for each appliance were compared using analysis of variance. RESULTS: Eighteen subjects completed the treatment protocol. There were no significant statistical differences in treatment outcomes between the two appliances. There was a statistically significant (p ≤ 0.05) preference for a MRA design with minimal coverage of teeth and palate. The subjects' appliance selection was consistent with a corresponding reduction in SAQLI score for the selected appliance. CONCLUSION: Although no statistically significant difference was observed between the two appliances in the outcomes measured, there was a trend toward greater improvement with the appliance with less acrylic resin bulk and less interocclusal contact. MRA selection should favor titratable, unobtrusive designs with appropriate construction to promote acceptance and adherence to MRA therapy.

Impact of type D personality on adherence to oral appliance therapy for sleep-disordered breathing.

PURPOSE: Type D personality, defined as a combination of social inhibition and negative affectivity, has been associated with poor medication adherence and lower adherence to continuous positive airway pressure in patients with sleep-disordered breathing. Up to this date, the association of patient's personality with adherence with a mandibular advancement device (MAD) has not been studied. The purposes of this study were to examine the association between type D personality and poor adherence to MAD treatment and to examine the impact of type D personality on perceived side effects during this treatment. METHODS: Eighty-two patients out of 113 patients with a known baseline type D scale who have started MAD treatment between June 2006 and December 2009 were included. Information about side effects and adherence were collected via a postal questionnaire. Thirty-three patients were using a monobloc MAD and 49 patients were using a duobloc MAD. RESULTS: Forty-five percent of type D patients discontinued MAD treatment, whereas only 15 % of non-type D patients reported treatment discontinuation. The odds ratio for treatment discontinuation was 6.03 (95 % confidence interval 1.22-29.81; p = 0.027) for type D personality, adjusted for age, gender, MAD type (monobloc or duobloc), and decrease in apnea severity. In continuing MAD users, no significant difference in perceived side effects was reported between the personality types. CONCLUSION: This is the first study to examine the relationship between type D personality and adherence to MAD treatment. Type D patients reported a significantly higher discontinuation rate when compared to patients without type D personality.

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.

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.

Response of patients and families to lengthening of the facial bones by extraoral distraction osteogenesis: a review of 14 patients.

Fourteen patients or their immediate family were interviewed about their experiences of having either unilateral or bilateral external distraction osteogenesis of the mandible. The patients showed a high level of co-operation with treatment. Six of the 14 patients required repeat distractions, and had been informed and accepted that this was a possibility before the initial distraction. However, patients or their parents expressed some reservations about the extraoral distractors, which prevented them from practising their favourite sport and made them vulnerable to bullying by their friends and colleagues. Patients had moderate pain when the appliances were removed. They all expressed their satisfaction with the results and would recommend this treatment to others. Problems, including speech, eating, pain, and sleeping difficulties, were encountered by patients at all stages of treatment. Of considerable concern was the disruption of education when the child was treated during the school term.

Esthetic aspects of orthodontic-surgical treatment of sagittal-vertical anomalies: the example of the short face syndrome.

BACKGROUND: Psycho-esthetic aspects play an important role in motivating patients to undergo combined orthodontic-surgical treatment as well as in the subjective appraisal of treatment outcome. The facial soft tissues are the crucial interlink between the underlying skeletal and dental structures and their perception by the patient and his social environment. TREATMENT OF SHORT FACE SYNDROME: In the therapy of Class II malocclusions with skeletal deep bite and short lower face (short face syndrome), the soft tissues and the psycho-esthetic treatment expectations of the patient are taken systematically and appropriately into account during treatment planning and evaluation. PATIENTS AND METHOD: The respective elements of the treatment concept are outlined and explained in this article. Based on the empirical evaluation of 15 patients treated according to this concept, the soft tissue changes in patients with short face syndrome and the changes in esthetic and psychosocial self-perception are reported. RESULTS: The results demonstrate the efficiency of the treatment concept in improving facial soft tissues, especially in the vertical dimension, and the resulting psycho-esthetic benefit to the patient.

Concerns and motivations of skeletal Class III patients receiving orthodontic-surgical correction.

The objective of this research was to study the impact of skeletal Class III malocclusion on patients' emotional status, as well as patients' motivations for seeking surgical correction of Class III malocclusion. The sample comprised 140 consecutive Chinese patients with skeletal Class III malocclusion who had been treated with a combined orthodontic-surgical approach. A retrospective analysis was performed, based on questionnaires with answers ranked on a numeric scale (O = not at all; 1 = a little; 2 = moderately; 3 = quite a bit; 4 = extremely). Sixty-seven percent of subjects (40 males and 54 females) returned completed questionnaires. Fifty-four percent had bimaxillary deformities, 32% had mandibular hyperplasia, and 14% had maxillary hypoplasia. Seventy-seven percent received bimaxillary surgery, 15% received maxillary advancement, and 8% received mandibular setback. The results showed that nearly half of the patients had a nickname related to their dentofacial problems, and 8 of 10 of these felt embarrassed or angry about their nickname. Ninety-three percent sought improvement of their facial appearance, 85% wanted an improvement in their dental appearance, and 73% desired an improvement in chewing ability. Seventy-six percent were concerned about surgical risks and 63% about possible pain. The vast majority of Class III patients undergoing orthognathic surgery suffered psychologic and functional problems related to their appearance prior to treatment. Esthetic improvement was the driving force behind seeking treatment.

Evaluation of profile esthetic change with mandibular advancement surgery.

Our purpose was to investigate the impact of mandibular advancement surgery on profile esthetics and to attempt to define guidelines that could be of value to the clinician in predicting profile esthetic change. The sample consisted of 34 patients who had been treated with a combination of orthodontics and mandibular advancement surgery without genioplasty. Initial (pretreatment) and final (posttreatment) cephalometric radiographs of each patient were used to produce silhouette images and to quantify skeletal changes that occurred with surgery. The images were displayed randomly to lay persons and orthodontic residents who were asked to score the esthetics of each profile. On average, after mandibular advancement surgery, B point moved forward 5.0 mm (SD = 2.6 mm) and downward 4.7 mm (SD = 3.1 mm), and the ANB angle decreased 3.0 degrees (SD = 1.6 degrees ) Graphical analysis and results of paired t tests revealed that for patients with an initial ANB angle >/= 6 degrees, a consistent improvement in profile esthetics was seen following surgery (P

Psychological function in orthognathic surgical patients before and after bilateral sagittal split osteotomy with rigid and wire fixation.

A multisite randomized controlled trial was conducted to compare the psychological function of patients who undergo surgical correction of a Class II malrelation with bilateral sagittal split osteotomy with either wire or rigid fixation. Subjects were 31 male and 86 female patients referred by orthodontists. Psychopathological symptoms and psychological distress were measured with the Symptom Checklist-90 Revised at the following times: before placement of orthodontic appliances, 1 to 2 weeks presurgery, and 1 week, 8 weeks, 6 months, and 2 years postsurgery. Patients' satisfaction with their surgical outcome was measured with a 3-item questionnaire. Results showed no statistically significant differences in psychological function or satisfaction between patients treated with wire or rigid fixation. Psychological function was within normal limits immediately before surgery. Psychological parameters did not determine patient satisfaction, even among patients who met an operational definition of "psychopathological caseness." Psychological symptoms and general distress increased modestly immediately after surgery for both groups and then progressively declined over the succeeding 2 years, eventually reaching levels that were significantly lower than presurgical levels. It was concluded that (1) rigid and wire fixation do not differ in their effects on psychological function and satisfaction; (2) patients who seek orthognathic surgery for a Class II malocclusion are psychologically healthy, ie, comparable to normal populations, immediately before surgery; (3) presurgical psychological function does not determine satisfaction with surgical outcome; and (4) psychological function tends to improve during the 2 years after surgery.

Psychosocial predictors of high-risk patients undergoing orthognathic surgery.

The purpose of this analysis was to identify a set of predictor variables that are prospectively related to postsurgical outcomes. Specifically, psychosocial characteristics were sought to predict postsurgical outcomes. The 5 Revised Symptom Checklist-90 (SCL-90-R) scales, the neuroticism score of the Eysenck Personality Inventory (EPI), the psychosocial domain score from the Sickness Impact Profile (SIP), and 4 scales from the Oral Health Status Questionnaire (OHSQ) were used as the predictors. A total of 31 male and 86 female subjects participated in this multicenter randomized trial, which compared rigid and wire fixation. Data were collected prior to placement of orthodontic appliances, 1 to 2 weeks presurgery, and at 1 week, 8 weeks, 6 months, and 2 years after surgery. Baseline oral health was used as an indicator of postsurgical oral health functioning. A path analytic model of influences on presurgical oral health was estimated (R2 = 0.43). The results suggest that presurgical screening of demographic characteristics (age, sex, and ethnicity), oral health (the OHSQ), quality of life issues (SIP), and personality features (SCL-90-R), accounts for 23% to 39% of the variance in postsurgical oral health outcomes. The path analysis conducted suggests that a patient's age, ethnicity, gender, and elevated scores on the EPI have indirect effects on postsurgical health. As determined by a 2-stage least squares regression model, 3 variables--the patient's presurgical oral health (per the OHSQ), pre- and postsurgical Global Severity Index (GSI) score from the SCL-90-R, and the psychosocial scale score from the SIP--were found to have a statistically significant impact on postsurgical outcomes. Additionally, the GSI, SIP, and OHSQ are reliable measures in predicting oral health outcomes.

Patients' evaluation of the final result of sagittal split osteotomy: is it influenced by impaired sensitivity of the lower lip and chin?

The purpose of this article was to evaluate whether neurosensory disturbances such as impaired sensitivity of the lower lip and chin influence patients' final evaluation of the treatment result. Information about the patients' degree of satisfaction and about lip and chin sensitivity were obtained from final follow-up documents of 215 patients. All patients had undergone sagittal split ramus osteotomy for mandibular advancement. In patients with normal sensitivity on both sides of the lower lip and chin, the degree of satisfaction was equally distributed at a very high level through all age groups. Among those with some degree of numbness on either or both sides of the lower lip and chin, patients in the younger quarter and middle half of the group were as satisfied as those with normal sensitivity, while those in the oldest quarter with impaired sensitivity demonstrated a lower degree of satisfaction than the rest of the patients. Although the difference was not statistically significant, the finding strongly indicates that older patients seem to suffer more from neurosensory disturbances than do younger patients with similar conditions.

Health-related quality of life following orthognathic surgery.

A randomized controlled trial was conducted to compare the effects of rigid and wire fixation on health-related quality of life following surgical mandibular advancement in patients with Class II malocclusions. Sixty-four patients randomly selected to receive rigid fixation with bicortical position screws were compared with 63 patients randomly selected to receive nonrigid fixation with inferior border wires. Quality of life was measured using the Sickness Impact Profile, a generic measure of health-related quality of life, and the Oral Health Status Questionnaire, a specific measure of oral health and function designed for use with orthognathic surgery patients. Patients were evaluated prior to application of orthodontic appliances, approximately 2 weeks before surgery, and 1 week, 8 weeks, 6 months, 1 year, and 2 years following surgery. Neither instrument revealed a statistically significant difference in quality of life between wire and rigid fixation at any time period. The health-related disability associated with Class II malocclusion is modest compared to many other medical conditions. Nonetheless, orthognathic surgery patients exhibit progressive and statistically significant improvement in health-related quality of life across a wide variety of functional domains, regardless of the fixation method used.

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.