| Correction of dentofacial deformities with orthognathic surgery: Outcome of treatment with special reference to costs, benefits and risks | ||
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The majority of patients in this study reported pain-related or functional problems as the reasons for seeking orthognathic surgery. This impression was confirmed by the clinical findings of a high prevalence of TMD. These issues were also best resolved by orthognathic surgery. The finding that functional and pain-related issues were of greater significance to patients than esthetic concerns differs from the findings of most previous studies. The high level of patient satisfaction with the treatment without any evident psychological adverse effects and with a low official complaint rate shows good cost-effectiveness in the psychosocial respect.
Patients with skeletal Class II non-open-bite deformities, who have TMD of mainly muscular origin with or without recurrent headache, seem to benefit most from orthognathic surgery. Those with TMD of more internal derangement type may or may not benefit from orthognathic surgery, similarly to other dentofacial deformities. Prophylactic treatment of asymptomatic dentofacial deformities cannot be recommended on the basis of the present study.
Complications in orthognathic surgery are rare, and severe complications are even less frequent. The most common complication is neurosensory deficit of the inferior alveolar nerve. Minimal soft tissue retraction of the ascending mandibular ramus in the initial phase of sagittal ramus osteotomy apparently decreases the risk of damage to this nerve. The occurrence of paresthesia in the jaw decreased satisfaction with the treatment outcome.
The treatment of patients with skeletal Class II, non-open-bite malocclusion was found to be the cheapest mode of treatment, if treatment included only BSSO in addition to orthodontics. Treatment of these patients with TMD symptomalogy of muscular origin can be regarded as cost-effective and probably also improves the quality of life. Patients with skeletal open-bite deformities must be assessed with special care before a decision to do orthognathic surgery due to the lower cost-effectiveness of the treatment.