| Correction of dentofacial deformities with orthognathic surgery: Outcome of treatment with special reference to costs, benefits and risks | ||
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The most common motive for seeking treatment was to improve occlusion (92%), followed by prevention or improvement of TMJ problems (70%), improvement of chewing ability (68%) and appearance of teeth (67%), as demonstrated in Table 5. These were also the aspects in which patients most often (91%–72%) reported improvements as a result of surgery. General health, self-esteem and improvement of facial appearance were less often mentioned as motives for seeking treatment (27%–46%) (Paper I). The results of the Papers II and III are in accordance with these findings: functional and/or pain-related problems constituted 61% and 52% of the motives, while cosmetic and functional/cosmetic motives together represented 28% and 20% of the motives. It was also shown that the patients with functional and pain-related reasons for seeking treatment were older (median 34 and 33 years, respectively) than the patients with cosmetic (median 27 years) and other reasons (Paper III).
Table 5. Motives for seeking treatment and effects of treatment (n = 100)
| Motive for seeking treatment | Classification of motive* | Percentage of patients | Percentage of patients considering improvement achieved** | |
|---|---|---|---|---|
| Improvement in chewing ability | O | 68 | 82 | |
| Improvement in appearance of teeth | A | 67 | 72 | |
| Improvement in occlusion | O | 92 | 91 | |
| Prevention of tooth and periodontal disease | D | 36 | 36 | |
| Improvement in facial appearance | A | 39 | 46 | |
| Prevention or improvement of TMJ problems | O | 70 | 74 | |
| Improvement in speaking ability | S | 19 | 19 | |
| Improvement in work performance | S | 14 | 9 | |
| Improvement in general health | S | 31 | 27 | |
| Improvement in breathing | S | 17 | 13 | |
| Improvement in self-esteem | S | 20 | 29 | |
| *Classification according to Ostler and Kiyak (1991): O = oral function; A = appearance; S = social health; D = disease prevention. **Patients could also indicate if a particular motive had played no role in their decision to undergo surgery. | ||||
Problems relating to occlusion and mastication were rated as the most significant problems before surgery, and the next highest scores were allotted to temporomandibular joint problems and headache. Perceptions of the appearance of teeth and, to a lesser degree, facial appearance were also rated high. General appearance, speech and general health, self-esteem and social interactions were not considered particularly problematic by the patients. Significant improvements were noted after surgery in relation to all aspects except work performance and general health.
The scores for satisfaction with life were uniformly high before surgery, but even higher one year after surgery. Most differences between pre- and postoperative scores were significant (work, livelihood, personal relationships, leisure, mental health, health, concept of life). Overall satisfaction correlated with low numbers of postoperative problems (p < 0.0001), especially TMJ problems (p < 0.0001), facial appearance problems (p < 0.0001), biting problems (p < 0.001), problems with general health (p < 0.001), occlusal problems (p < 0.01) and problems with teeth and general appearance (p < 0.01). Willingness to undergo surgery again was high, 8.6 (on a VAS scale from 0 to 10), and willingness to recommend surgery to others with similar problems was 9.0.
The duration of postoperative orthodontics had no effect on treatment satisfaction, but those reporting postoperative numbness of the lower lip and chin were less satisfied than those not reporting numbness (p < 0.01). Thirty-one patients (33% of patients with mandibular surgery) reported numbness.