Analytical study of the psychosocial impact of malocclusion and maxillofacial deformity in patients undergoing orthodontic treatment.

Patients whose with facial appearance involves dental anomalies and malocclusion face an increased prevalence of various psychosocial problems such as a high level of social anxiety, social avoidance, and low quality of life. This study investigates the patients with craniofacial anomalies and their psychological adjustment concerning the facial and dental appearance. It also evaluates the expectations of this patient group from the orthodontic treatment. Two steps were done in this study. In the first step, translation and validation of the Derriford Appearance Scale (DAS59), The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and Patient Expectation from the Orthodontic Treatment (PEOTQ) questionnaires into Maithili were done, and then the main study was conducted using these valid questionnaires. This was a cross-sectional study conducted on the patients with congenital craniofacial anomalies visiting the orthodontics department of Patna Dental College and Hospital, Patna (Bihar). All the patients received the Maithili DAS, Maithili PIDAQ and Patients' Expectation from the orthodontic treatment questionnaires. The Maithili version of DAS59, PIDAQ and PEOTQ were developed with outstanding reliability and validity. A significant difference between PIDAQ (p<0.001) and DAS59 scores (p<0.001) was found. In females, the total PIDAQ score was significantly higher as compared to males, but there was no association of DAS scores with gender. Place of residence showed no association with PIDAQ and DAS59 scores in patients. Patients and controls had significant differences between various items, and a comparison was made in terms of expectation from the orthodontic treatment. Altered facial and dental appearance in patients with craniofacial anomalies showed a significant psychological impact.

Autoestima e depressão em pacientes com anomalias dentomaxilofaciais / Autoestima y depresión en pacientes con anomalías dentomaxilofaciales

As anomalias dentomaxilofaciais são uma condição do desenvolvimento, na maioria das vezes, não se deve a processos patológicos, mas sim a uma moderada distorção do desenvolvimento normal, isso acarreta alteração da estética que influencia os níveis de autoestima e depressão nos pacientes. O objetivo foi caracterizar a autoestima e a depressão em pacientes com anomalias dentomaxilofaciais. Foi realizado um estudo transversal observacional descritivo em pacientes da Consulta de Ortodontia da Clínica Universitaria de Especialidades Estomatológicas Manuel Cedeño entre janeiro e maio de 2018. O universo era composto por 145 pacientes com anomalias dentomaxilofaciais. A amostra foi composta por 24 pacientes maiores de 15 anos aos quais foram aplicados os inventarios utilizados para autoestima e depressão. A faixa etaria de 15 a 17 anos (50,00 por cento) e o sexo feminino (62,50 por cento) foram os que apresentaram maior percentual; Ao caracterizar a população em estudo, revelouse que a autoestima era baixa em 70,83 por cento e o nível de depressão era baixo como traço (12,50 por cento) e alto como estado (45,83 por cento). Concluiuse que pacientes com anomalias dentomaxilofaciais apresentam baixa autoestima e baixo e alto nível de depressão, como traço e estado, respectivamente(AU)

Las anomalías dentomaxilofacial son una afección del desarrollo, en la mayoría de los casos, no se debe a procesos patológicos, sino a una moderada distorsión del desarrollo normal, ello provoca alteración de la estética que influye en los niveles de autoestima y depresión en los pacientes. El objetivo fue caracterizar la autoestima y depresión en pacientes con anomalías dentomaxilofaciales. Se realizó un estudio observacional descriptivo transversal, en pacientes ingresados en Consulta de Ortodoncia de la Clínica Universitaria de Especialidades Estomatológicas Manuel Cedeño entre enero y mayo de 2018. El universo fue de 145 pacientes con anomalías dentomaxilofaciales. La muestra quedó conformada por 24 pacientes mayores de 15 años a los cuales se les aplicó los inventarios empleados para la autoestima y depresión. El grupo etario de 15 a 17 años (50,00 por ciento) y el sexo femenino (62,50 por ciento) fueron los de mayor por ciento; al caracterizar la población objeto de estudio se reveló que la autoestima fue baja en el 70,83 por ciento y el nivel de depresión fue bajo como rasgo (12,50 por ciento) y alto como estado (45,83 por ciento). Se concluyó que los pacientes con anomalías dentomaxilofaciales presentan baja autoestima y niveles de depresión bajo y alto, como rasgo y estado, respectivamente(EU)

Psychology input to an orthognathic clinic: Patients' perception of service quality.

AIMS: The aim of this study was to assess patient satisfaction with a clinical psychology service, integrated within an inter-disciplinary orthognathic planning clinic. METHOD: A self-report, custom-designed questionnaire was sent to patients who had completed orthognathic treatment within the last three years. Of the 60 patients approached, 49 responded. RESULTS: The great majority of patients agreed that there was a need for a psychological assessment and that its purpose was adequately explained. Most patients were happy with the information given during their appointment and found the experience helpful. A number of patients felt that additional appointments would have been helpful shortly before, and after, surgery. CONCLUSIONS: The group of orthognathic patients studied found the pre-treatment psychology assessment, provided for them through the combined clinic, to be very acceptable and beneficial. Some suggested that further appointments, throughout the treatment journey, as well as supportive literature, might also have been helpful.

Qualidade de vida, capacidade para o trabalho e deformidades faciais / Quality of life, work ability, and facial deformities

Introdução: A face exerce papel central nas relações interpessoais. Pessoas com deformidades faciais adquiridas ou congênitas tendem a apresentar dificuldades nas relações interpessoais. O tratamento desses pacientes deve visar à melhoria de sua qualidade de vida e da capacidade para o trabalho. Objetivo: Avaliar a qualidade de vida relacionada à saúde e a capacidade para o trabalho de pessoas com deformidades faciais. Método: Estudo misto de abordagem qualitativa e quantitativa. Entrevistas semiestruturadas sobre qualidade de vida em saúde e implicações no trabalho foram realizadas com 16 pessoas com deformidades faciais, oito congênitas e oito adquiridas, procedentes de serviços de atenção especializada de Salvador, Bahia. Aplicaram-se os questionários Índice de Capacidade para o Trabalho (ICT) e 36-Item Short-Form Health Survey. Resultados: A análise temática permitiu identificar duas categorias associadas às deformidades faciais: relações interpessoais e capacidade para o trabalho; e qualidade de vida e acesso a tratamento. Indivíduos com deformidades faciais adquiridas apresentaram menor escolaridade, renda e índices mais baixos nos indicadores de qualidade de vida e ICT, quando comparados aos do grupo com deformidades congênitas. Todos com deformidades congênitas receberam algum tipo de reabilitação e apresentaram menor comprometimento das relações sociais. Conclusões: Pessoas com deformidades faciais adquiridas apresentam maior comprometimento da sua capacidade para o trabalho e qualidade de vida do que aquelas com deformidades faciais congênitas. A reabilitação precoce das anormalidades congênitas parece exercer papel importante na melhora dos índices de ICT e de qualidade de vida em saúde

Background: The face plays a central role in interpersonal relationships. Individuals with congenital or acquired facial deformities might experience difficulties with interpersonal relationships. Treatment should seek to improve their quality of life and work ability. Objective: To analyze the health-related quality of life and work ability of individuals with facial deformities. Method: Study with mixed, quantitative and qualitative methods. We conducted semi-structured interviews on health-related quality of life and its implications for work with 16 individuals with facial deformities, eight cases of congenital and eight of acquired deformities, cared at specialized services in Salvador, Bahia, Brazil. The Work Ability Index (WAI) and 36-Item Short-Form Health Survey were administered. Results: Thematic analysis led us to detect two categories of themes associated with facial deformities: interpersonal relationships and work ability; and quality of life and access to treatment. The participants with acquired facial deformities exhibited lower educational level and income, and lower quality of life and WAI scores compared to the ones with congenital deformities. All the participants with congenital deformities had received some form of rehabilitation and their social relationships were less impaired. Conclusions: Individuals with acquired facial deformities exhibited poorer work ability and quality of life compared to the ones with congenital deformities. Early rehabilitation of congenital deformities seems to considerably improve work ability and health-related quality of life

Orthognathic surgery improves quality of life and depression, but not anxiety, and patients with higher preoperative depression scores improve less.

This study assessed quality of life (QoL), depression, and anxiety before and after orthognathic surgery and identified risk factors for poorer postoperative outcome. This multicentre prospective study included 140 patients from five French medical centres. We assessed patients before surgery (T1), 3 months after surgery (T2), and 12 months after surgery (T3). We assessed the severity of the orofacial deformity, physical, psychological, social, and environmental QoL (WHOQOL-BREF), and depression and anxiety (GHQ-28). Risk factors for poorer outcome were identified using linear mixed models. Between baseline and 12 months, there was significant improvement in psychological and social QoL and in depression (although below the norms reported in the general population), but not in anxiety. Physical QoL was poorer in patients who were younger, who had a mild orofacial deformity, and who were depressed. Psychological QoL was poorer in younger patients and in depressed patients. Social QoL was poorer in patients who were single, who had a mild orofacial deformity, and who were depressed. Although orthognathic surgery provides a moderate improvement in psychological and social QoL, the systematic screening and treatment of depression could further improve QoL after surgery because it is a major predictor of poor QoL in this population.

Social anxiety in orthognathic patients.

There is evidence that patients seeking orthognathic treatment may be motivated by social anxiety disorder (SAD). The aim of this study was to investigate SAD in orthognathic patients using the Brief Fear of Negative Evaluation Scale (BFNES) and to compare these findings with those of the general population. This was a cross-sectional, questionnaire study conducted in two parts. Firstly, a national survey was conducted to yield data for the BFNES from a large, random sample of the UK general population. Secondly, orthognathic patients completed the BFNES. The BFNES scores are reported in two formats: the original 12-item scale (O-BFNES) and a shorter eight-item version (S-BFNES). With regards to the national survey, 1196 individuals participated. The mean O-BFNES score was 29.72 (standard deviation (SD) 9.39) and S-BFNES score was 15.59 (SD 7.67). With regards to the orthognathic sample, 61 patients participated. The mean O-BFNES score was 39.56 (SD 10.35) and the mean S-BFNES score was 24.21 (SD 8.41). Orthognathic patients had significantly higher scores than the general UK population (P<0.001), and multiple linear regression revealed that age, gender, and patient status were all independent predictors of BFNES scores. From the results of this study, orthognathic patients experience significantly higher levels of social anxiety than the general population.

Psychologic health status of patients undergoing orthognathic surgery.

BACKGROUND: The appearance and dysfunction of deformities may cause psychologic disorders in patients. The aim of this study was to assess the psychologic health status of patients undergoing orthognathic surgery and its relationship with demographic characteristics, social activityof the individuals, and severity of maxillofacial deformity. METHODS: As a tool for assessing the psychologic health status, the Symptom Checklist-90 (SCL-90) questionnaire was used on 318 patients undergoing orthognathic surgery at the Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, China from January 2006 to November 2012. t-Test was used to compare the psychologic health status between the 318 patients and 200 healthy volunteers. Variance analysis (analysis of variance) was applied for assessing the relationship between the psychologic health status and the variables of the study. RESULTS: The SCL-90 total score of the patients undergoing orthognathic surgery was higher than that of the healthy volunteers (P < 0.05). Results of the t-test revealed statistically significant difference (P < 0.05) in the symptom dimensions of obsessive-compulsive, interpersonal sensitivity, depression, and paranoid ideation. An association between sex and the SCL-90 total score was observed (F = 11.293; P = 0.001 and P <0.05). The patients who had regular work presented better psychological health status than did the patients who had no regular work (F = 8.008; P = 0.005 and P < 0.05). The patients who received comfort from family and relatives presented better psychological health status than did the patients who did not receive such help (F = 10.064; P = 0.002 and P < 0.05). The patients who received economic help from family and relatives presented better psychological health status than did the patients who did not receive such help (F = 9.789; P = 0.002 and P < 0.05). An association was found between severity of deformity and psychologic health (F = 6.394; P = 0.002 and P < 0.05). CONCLUSIONS: Patients with jaw deformity have significant psychologic problems and their psychologic health is affected by demographic characteristics, social activity of individuals, and severity of maxillofacial deformity.

Cross-cultural adaptation of the orthognathic quality of life questionnaire(OQLQ) in a Brazilian sample of patients with dentofacial deformities

Objectives: The aim of this study is to translate into Portuguese-Brazilian language and adapt cross-culturally tothe Brazilian population the Orthognathic Quality of Life Questionnaire (OQLQ).Study Design: The cross-cultural adaptation process followed six stages which are; (I) initial translation, (II)synthesis of the translation, (III) back translation, (IV) expert committee and (V) test of the prefinal version. Forvalidation process, the OQLQ results were compared with Oral Health Impact Profile Questionnaire (OHIP-49),with the generic SF-36 Quality of Life Questionnaire and a visual analogue scale. A convenience sample of 25patients was selected in two Southern Brazilian states of Santa Catarina and Rio Grande do Sul.Results: Internal consistency analysis of the OQLQ-Brazilian showed good correlation for items or domains andthe test-retest reliability also presented excellent intra-class correlation coefficients. OQLQ-Brazilian exhibited aweak and negative correlation with SF-36, and good correlation with OHIP-49.Conclusion: The OQLQ-Brazilian preserved and reached equivalence with its original source and the findingsalso corroborate that there is good evidence for the construct validity. The demonstration of its reproducibility,reliability and validity makes this instrument an additional useful parameter for evaluation of the impact of dentofacialdeformity over the quality of life for Brazilians (AU)

Oral health-related quality of life in orthognathic surgery patients.

INTRODUCTION: In the last decade, an increasing number of studies focusing on the impact of oral deformities and illnesses on quality of life have been published. Our goal was to evaluate the impact of oral problems on quality of life in 3 groups of adult patients in need of orthognathic-surgical treatment. METHODS: A total of 117 patients were recruited from the Clinic of Oral and Maxillofacial Surgery of the State University of Rio de Janeiro in Brazil: 20 in the initial phase, 70 in the presurgical phase (presurgical orthodontic preparation), and 27 in the postsurgical phase. The impact of treatment phase on oral health-related quality of life was evaluated with the oral health impact profile (OHIP-14). OHIP-14 scores were calculated by an additive method, and the participants were divided on the basis of level of impact into 2 groups: high impact (scores, >11) and low impact (scores, < or =11). RESULTS: Compared with patients in the postsurgical phase, those who needed orthognathic surgical treatment but had not yet begun it and those who were in the presurgical phase of treatment were 6.48 and 3.14 times more likely, respectively, to experience a negative impact of their oral condition. CONCLUSIONS: Among those undergoing or anticipating orthognathic-surgical treatment, orthognathic surgery positively affects the patients' quality of life.

Motivating factors for patients undergoing orthognathic surgery evaluation.

PURPOSE: Orthognathic surgery is generally performed to correct facial abnormalities related to the maxilla and/or mandible, and there are a variety of reasons for which patients choose to be evaluated for this procedure. We surveyed 637 cases to determine the patients' motivating factors for seeking surgical consultation. PATIENTS AND METHODS: We reviewed 637 cases from 1990 to 2006 in this study, and data were extracted from 501 appropriately completed surveys to determine why patients seek corrective maxillofacial surgery. Patients aged under 12 years and those with an identified syndrome were not included in the final data set. RESULTS: The results indicate that patients with dentofacial deformities have multiple complaints related to their poor maxillomandibular relationships. However, their primary motivation for undergoing surgical evaluation is not appearance; it is their bite/function. Of the 501 patients reviewed in this study, 216 (43%) were male and 285 (57%) were female. Age ranged from 12 to 45 years. Of the patients, 76% stated that their appearance was affected by their condition, but only 15% stated it was their primary motivation for undergoing surgical evaluation. Thirty-six percent stated that their bite was their primary motivation for seeking treatment. CONCLUSION: The most common reason for surgical evaluation was correction of bite or functional disability, not improvement of appearance. Most previously published studies on this subject included smaller sample sizes and showed appearance to be the primary motivating factor.

Quality of life in patients with severe malocclusion before treatment.

The aim of this study was to determine the occurrence of oral health impacts among patients with severe malocclusions and dentofacial deformities before treatment. A further aim was to evaluate the effect of gender or the type of malocclusion on the oral impacts. The study comprised 151 adult patients who were referred for orthodontic or surgical-orthodontic treatment to the Oral and Maxillofacial Department, Oulu University Hospital, Finland during the years 2001-2004. The study group consisted of 92 females and 59 males with a mean age of 35.5 years [standard deviation (SD) 11.5 years, range 16-64 years]. A self-completed Oral Health Impact Profile (OHIP)-14 questionnaire was used to measure oral impacts during a 1 month reference period. The prevalence, extent, and severity scores were calculated from the OHIP-14. Malocclusions were registered at clinical examination. The prevalence and mean extent and severity scores were compared among malocclusion groups and between genders. Statistical significance was evaluated with Mann-Whitney, Kruskall-Wallis, Chi-squared, and Fisher's exact tests. The prevalence of oral impacts perceived fairly or very often was 70.2 per cent. The mean severity and extent scores were 17.2 (SD 10.5, range 0-45) and 2.5 (SD 2.6, range 0-10), respectively. Physical pain as well as psychological discomfort and disability were the most commonly perceived oral impacts. Being self-conscious, feeling tense, having difficulties in relaxing, and being somewhat irritable with other people were more common in females than in males. No differences were observed in oral impacts among the malocclusion groups. Compared with a 'normal' population, patients with severe malocclusions report high levels of oral impacts. Females reported oral impacts more often than males.

Evaluation on the psychosocial status of orthognathic surgery patients.

OBJECTIVE: This study was performed to evaluate the psychosocial status of orthognathic surgery patients through the Minnesota Multiphasic Personality Inventory (MMPI) and the Symptom Checklist 90-Revision (SCL-90-R). STUDY DESIGN: A total of 34 patients were enrolled in the study. They were assessed with the MMPI and the SCL-90-R before surgery and followed-up for 6 months after the operation with the MMPI. Comparisons between the personality characteristics of preoperative and postoperative patients and a total of 30 dental students with class I occlusion were made with the t test. RESULTS: The majority of patients showed no abnormal findings in the MMPI psychologic status. Significant differences in personality characteristics were noticed after orthognathic surgery. CONCLUSIONS: The results of this study suggest that surgical treatment of dentofacial deformities may induce psychologic changes, such as depression, and that the improvement in facial deformities and enhanced sense of esthetic satisfaction may have a positive influence on psychosocial aspects.

Atratividade facial e cirurgia ortognática: aspectos físicos e emocionais / Facial attractiveness and orthognatic surgery: emotional and physical aspects

Pessoas que apresentam grandes deformidades dentofaciais podem ter prejuízos sociais, pessoais e emocionais. A cirurgia ortognática é utilizada para correções dessas deformidades, que conseqüentemente afeta as aparências das faces dos pacientes. Este estudo teve como objetivos: 1) Avaliar amostras de faces da população de Ribeirão Preto, SP e as faces prototípicas provenientes delas, consideradas sem deformidades; 2) Analisar a atratividade facial de dez pacientes submetidos a cirurgias ortognáticas nas fases pré e pós-cirúrgicas; ao relacionar suas atratividades aos parâmetros físicos alterados pela cirurgia; e também avaliar as conseqüências na qualidade de vida, ansiedade e auto-estima destes pacientes. As análises faciais foram frontais e obedeceram aos critérios preconizados na literatura de meios, terços e quintos faciais. A coleta de dados com os pacientes foi feita no CEDEFACE (Centro de Pesquisa e Tratamento das Deformidades Buco-Faciais). Foram obtidas fotografias nas fases pré e pós-cirúrgicas; momentos em que também foram aplicadas escalas de qualidade de vida (WHOQOL bref), de ansiedade (IDATE e Escala Analógica de Humor) e autoestima (Escala de Autoestima de Rosenberg). Dois experimentos foram realizados. Um com as fotos das faces pré e pós-cirúrgicas a fim de avaliar a atratividade facial dos pacientes antes e depois das cirurgias e outro para comparar a atratividade facial dos pacientes com a atratividade de faces prototípicas relativas ao sexo e etnia correspondentes. Nesses experimentos os julgamentos de atratividade foram provenientes de uma amostra de 40 participantes leigos. Os resultados apontaram que: 1) As análises do banco de faces e protótipos apresentaram parâmetros físicos faciais diferentes daqueles apontados na literatura, principalmente na análise dos terços e quintos; 2) A cirurgia ortognática contribuiu para o aumento da atratividade dos pacientes, embora estes ainda...(AU)

People with salient dentofacial deformities can have social, personal and emotional injury. The orthognathic surgery is used to correct these deformities, and consequently, it affects the racial appearances of the patients. The general aims of this study were: 1) Evaluate samples of faces from a population of Ribeirão Preto, SP and their prototypical faces considered as without deformities; 2) Analyze the facial attractiveness of ten patients before and after being submitted to orthognathic surgery; searching the relationship between the attractiveness and physical parameters modified on the faces by the surgery; and also assessing the effects of this surgery on the quality of life, the anxiety and the self-esteem of these patients. The facial analyses were frontal and from the halves, the thirds and the fifths of the faces. The pictures of faces before and after the orthognathic surgery were from voluntary patients from CEDEFACE (Centro de Pesquisa e Tratamento das Deformidades Buco-Faciais) at Araraquara, SP. Before and after the surgery, these patients also had their quality of life (by WHOQOL bref scale), the anxiety (by IDATE and Escala Analógica de Humor) and the self- esteem (by Escala de Auto-Estima de Rosenberg) evaluated. There were two experiments. From an experiment, forty volunteers judged the attractiveness of the faces pictured before and after the surgery. From the other experiment, the volunteers compared the attractiveness of the patient faces with the attractiveness of the prototypical faces, respectively to their sex and race. The results showed that: 1) The facial analyses of the faces from population sample of Ribeirão Preto, SP, and their prototypical faces indicated physical parameters that differ from the literature, mainly for the facial analyses of the thirds and the fifths 2) The orthognathic surgery contributed to increase the facial attractiveness of the patients, although they...(AU)

Body dysmorphic disorder screening in maxillofacial outpatients presenting for orthognathic surgery.

Body dysmorphic disorder (BDD) is a severe psychiatric disease with delusions about defects in appearance for which patients seek surgical help. This is the first European study to determine the half-year prevalence of BDD in a maxillofacial outpatient clinic. A total of 160 patients with maxillofacial problems completed a validated self-report questionnaire, while a staff member scored maxillofacial defects on a severity scale. Twenty-eight (17%) patients had excessive concerns about their appearance, which negatively influenced their psychosocial functioning; 16 patients (10%; 95%CI 5-15%) screened positive for BDD. The high prevalence of problems related to psychosocial functioning and the occurrence of BDD in maxillofacial patients means that maxillofacial surgeons should take psychological concerns about physical defects into account.

Perceptions of preoperative expectations and postoperative outcomes from orthognathic surgery: part I: Turkish female patients.

This study was conducted in Turkish female patients to investigate their preoperative concerns, motivation, expectations, preoperative preparation for surgery and perception of outcomes concerning orthognathic surgery. Thirty women, with an age range of 18 to 31 years (mean age 21.8+/-3.8 years), participated in the study. The expectations and the results of orthognathic treatment were assessed based on the patients' subjective appraisal. Patients completed questionnaires before and after the operations, designed to investigate the preoperative and postoperative psychological impact of the surgery, the perception of problems with physical and psychological functioning, self-image, body image and satisfaction with surgical outcome. The questionnaires were evaluated statistically with SPSS 11.5 for Windows. The patients' perception of their psychological improvement, faith in the surgical team, physical functioning, self-esteem, social confidence, body image and satisfaction after dentofacial correction were higher than the preoperative levels. The conclusions of the study support the theory that enhancement of facial appearance by orthognathic surgery improves the psychological status of females with growth disturbances of the jaw.

Complex orthognathic surgery: assessment of patient satisfaction.

PURPOSE: The purpose of our survey study was to determine if bimaxillary orthognathic surgery with simultaneous intranasal surgery and other procedures carried out primarily for the correction of a developmental dentofacial deformity can be completed with a high level of patient satisfaction and minimal complications. PATIENTS AND METHODS: A consecutive series of 42 patients entered in the study from senior surgeon's (J.P.) patients at a single institution who underwent the minimum designated simultaneous procedures (Le Fort I, sagittal osteotomies of the mandible, septoplasty, inferior turbinate reduction) during a 1-year period. Patient satisfaction was assessed through analysis of data gathered from a postsurgical patient satisfaction questionnaire. The questionnaire is used to assess overall postsurgical/orthodontic patient satisfaction and patient assessment of head and neck function. The questionnaire was independently completed by each subject at least 6 months after surgery and only after removal of all orthodontic appliances and planned dental rehabilitation. RESULTS: The results of our study clarify that bimaxillary orthognathic surgery including simultaneous intranasal (septoplasty and turbinate reduction) and other procedures (genioplasty, liposuction, and removal of third molars) can be carried out with a high level of patient satisfaction (89% of our study patients). Nevertheless, 2 of 42 patients (5%) in our study group were dissatisfied despite the absence of surgical or orthodontic complications and the clinicians' feelings that the results achieved were an improvement. CONCLUSIONS: The results of our study clarify that complex bimaxillary orthognathic surgery including simultaneous intranasal and other procedures can be carried out with a high level of patient satisfaction.