Impact of orthognathic surgery on normal and abnormal personality dimensions: a 2-year follow-up study of 61 patients.

The psychological adjustments and self-concepts of 61 orthognathic surgery patients were evaluated before surgery and at 1 month, 6 months, 1 year, and 2 years after surgery. The impact of orthognathic surgery on self-concept and personality adjustment was assessed. Significant improvements in group scores were found with the use of a repeated measures ANOVA in the following subscales of personality disturbances: general maladjustment, psychosis, neurosis, personality disorder, and personality integration. A significantly positive effect was also observed in the following subscales of self-concept: self-esteem, self-satisfaction, self-identity, physical self, family self, social self, and total self-conflict. The improved changes in psychological profile two years after orthognathic surgery are encouraging.

The effects of orthognathic surgery on mandibular range of motion.

A prospective study of 55 orthognathic surgical patients was done to determine the effects of surgery on mandibular range of motion. None of the patients had oral physiotherapy during the course of the study. Nineteen patients had mandibular osteotomies, 21 had maxillary osteotomies, and 18 had two-jaw operations. Maximal interincisal opening (MIO), right and left lateral excursion, and protrusive measurements were obtained preoperatively and at six or more months following surgery. MIO was significantly reduced in both categories of mandibular osteotomies. A sagittal split osteotomy to advance the mandible was associated with the greatest mean reduction of 29%, while a vertical subcondylar osteotomy to set the mandible back had a mean reduction of 10%. Likewise, decreases in MIO were noted with combined surgical procedures. Le Fort I and sagittal split osteotomies were associated with a mean decrease in MIO of 28%, while Le Fort I and vertical subcondylar osteotomies had a mean decrease of 9%. Minimal change in MIO were noted with isolated maxillary osteotomies. These results are similar to the findings of other investigators and indicate the critical need for a sound postoperative rehabilitation program following orthognathic procedures to prevent hypomobility.

Patient perceptions of orthognathic surgery.

A retrospective study of ninety orthognathic surgery patients was conducted to investigate (1) their presurgical concerns and motivations, (2) their preoperative preparation for surgery, and (3) their perceptions of the postsurgical outcome. All subjects completed a twenty-three-item questionnaire and Rotter's Locus of Control Inventory. Statistical date analyses were performed by means of frequency distributions, chi-square, Spearman's r, and Fisher's exact probability tests. The results are presented as thirteen tentative conclusions categorized into three broad areas: motivations and concerns, presurgical preparation, and postsurgical outcome. In the area of motivations and concerns, those with primarily esthetic motivations have less initial reticence toward having orthognathic surgery and less difficulty adjusting to their new appearance than those with strong functional incentives. Younger patients and those patients with strong cosmetic motivations are less concerned about surgical risks. Under the category of presurgical preparation, more females than males desire to speak to a previous orthognathic surgery patient. Patients who receive inadequate explanation of the surgical procedure are more likely to be emotionally unprepared. One of the leading factors in patient dissatisfaction with surgery is the patient's experience of postoperative "surprises." In the area of postsurgical outcome, two-jaw operations precipitate more pain complaints than single-arch procedures. With time, however, patients tend to forget the degree of postoperative pain. Maxillary surgical procedures lead to less severe pain complaints than mandibular procedures, but there are more initial complaints of breathing difficulties and sinus problems following maxillary procedures. Surgical goal fulfillment does not guarantee that a patient would re-elect to have the treatment.

Stability associated with mandibular advancement treated by rigid osseous fixation.

Relapse after a mandibular sagittal ramus split osteotomy (SSO) fixed by transosseous wire has been shown to occur. Authors who use rigid screw fixation claim a lesser incidence of such relapse. Nine subjects with horizontal mandibular deficiency treated by an SSO and fixed with bone screws were prospectively studied. Serial cephalometric radiographs were traced and superimposed on the sella-nasion line and anterior cranial base structures. A markedly reduced horizontal movement during the first six weeks at both points B and Pg, followed by a slight advancement at six months, was observed. Concomitantly, the surgically increased facial height was shown to subsequently decrease during both those time intervals. The stability of this procedure warrants further investigation.

Patient responses to the orthognathic surgical experience: factors leading to dissatisfaction.

The authors surveyed 93 orthognathic surgery patients about presurgical concerns, preparation for the surgical experience, and postsurgical outcomes. Nine of the 90 respondents indicated they would not re-elect the surgical treatment. Reasons for dissatisfaction varied, although all had in common the occurrence of unanticipated postsurgical events. The importance of effective preoperative preparation of patients cannot be overestimated. The authors have written an information brochure to reinforce verbal orientation for the orthognathic surgery patient and family.