Correction of dentofacial deformities with orthognathic surgery

Abstract

Considerable amounts of research have been done on various aspects of orthognathic surgery during its short history. Nevertheless, there are no comprehensive publications on the cost-risk-benefit analysis of the entire process of orthognathic surgery. The purpose of the present study was to evaluate the psychosocial and biophysiological outcomes of orthognathic surgery with special reference to complications and financial costs.

The study series consisted of patients referred for consultations and treatment of dentofacial deformities and involved a total of 953 patients and 20 controls. Both prospective clinical follow-up examinations with measurements of various clinical parameters and retrospective assessments of radiographs and patient records were included.

Functional and pain-related reasons were found to motivate patients to seek orthognathic surgery, and this impression was confirmed by the clinical findings. The great majority of the subjects examined had signs and symptoms of temporomandibular disorders (TMD). The significance of facial appearance for the motivation to seek treatments seemed to play a lesser role compared to most earlier studies. Most of the patients felt that their expectations had been fulfilled by the treatment, and despite the potential risks involved, the overall complication rate in orthognathic surgery was very low. The most usual problem was neurosensory deficit of the inferior alveolar nerve.

TMD patients with skeletal Class II non-open bite dentofacial deformity seem to have the greatest probability to benefit from orthognathic surgery, especially if their TMD is mostly of muscular origin. Pain in the face and headache improved significantly. The outcomes were more variable when the TMD mainly originated from internal derangements. In these cases, the individual outcome of treatment is more difficult to predict, and conservative treatment methods should probably be tried first. The orthognathic surgery of patients with non-open bite skeletal Class II dentofacial deformity is also cost-effective due to the low complication rate and the low cost, since sagittal ramus osteotomy is often sufficient treatment. However, there must be weighty grounds for orthognathic surgery of skeletal open-bite deformities due to their greater risk for relapse and condylar resorption. The high expenses of their treatment also result in a poor cost-effectiveness ratio.