Oral Health and Dental Management

Quality of Life of Patients with Dentofacial Deformities Undergoing Orthognathic Surgery

Kassio Vieira Macedo^1*, Maria Candida de Almeida Lopes¹, Raimundo Rosendo Prado Junior² and Francisco Antonio de Jesus Costa Silva^{3 1}Department of Pathology and Dental Clinic, Federal University of Piauí, Teresina, Brazil
²Department of Restorative Dentistry, Federal University of Piauí, Teresina, Brazil
³Department of Dentistry, Federal University of Piauí, Teresina, Brazil
^*Correspondence: Kassio Vieira Macedo, Department of Pathology and Dental Clinic, Federal University of Piauí, Teresina, Brazil, Tel: (86) 3233-9557, Email:

Received: 09-Nov-2020, Manuscript No. OHDM-20-001-PreQc-22; Editor assigned: 13-Nov-2020, Pre QC No. OHDM-20-001-PreQc-22; Reviewed: 27-Nov-2020, QC No. OHDM-20-001-PreQc-22; Revised: 27-Nov-2022, Manuscript No. OHDM-20-001-PreQc-22; Published: 26-Aug-2022, DOI: 10.35248/2247-2452.22.21.1011

Introduction

Orthognathic surgery has an increasing demand in situations where orthodontic correction, which is increasingly accessible, presents limitations [1]. Facial deformities and congenital or acquired skeletal problems, associated or not to malocclusions, cause disturbances to physiological functions, aesthetic dissatisfaction and difficulties in the social sphere, which leads many patients to seek such treatment [2].

Although most studies on the subject demonstrate the positive effect of orthognathic surgery, it requires the patient to adapt almost immediately due to a rapid change in his facial appearance [3]. Due to the psychological condition of the patient (who may or may not be favorable to treatment), and its probable change, given the impact on quality of life [4], it needs a comprehensive and adequate assessment, as it involves objective and subjective, environmental and personal elements, and also their interactions [5].

It is important to compare preoperative and postoperative perceptions, including to guide future patients [6]. Among the results observed after the end of the treatment process is a level of quality of life similar to that of individuals without dentofacial deformity [1,7,8].

In addition to measuring the magnitude of the effect, this study investigated the correlation between the quality of life before and after orthognathic surgery and demographic aspects (age, sex, income and schooling), clinical aspects (main complaint, type of deformity and type of surgery) and the degree of satisfaction with the facial appearance obtained after the procedure.

Materials and Methods

Ethical Principles

The volunteers were given clarifications about the study and they signed the Informed Consent Form. The research followed the bioethical norms related to human studies and its project was submitted and previously approved by the Research Ethics Committee (CEP) of the Federal University of Piauí (UFPI) through the number of opinion 1.431.207.

Sample

The study is of the longitudinal observational type. The sample calculation was made considering the following factors: impact prevalence of 35%, estimation error of 5, 95% confidence level and test power of 80% [9]. The population (N) of individuals who underwent orthognathic surgery in Teresina-PI in 2014 was 28 individuals, according to a survey conducted by this study in all hospitals and public and private healthcare plans. An adjustment was made for finite populations. The minimum sample number required for the study was 27 individuals.

We included all patients with dentofacial deformities (regardless of sex, age, social class, level of education, main complaint, type of surgery and type of deformity) who underwent orthognathic surgery, attended in a private office located in Teresina-PI, in 2015. Those who refused to participate in the study or who for any reason did not complete the form or questionnaire before and/or after the surgical procedure were excluded. The sample obtained consisted of 17 individuals (10 men and 07 women) between 20 and 57 years (mean age 31.83 years). All participants had started orthodontic treatment before surgery and continued it after a recovery period of 6 weeks.

Data Collection

An identification and socio-demographic form and the Brazilian Orthognathic Quality of Life Questionaire (B-OQLQ) were completed by the participants one week before and six weeks after the orthognathic surgery. The form contained the question Regarding</b> his facial appearance, o (a)</b> Mr. (Mrs) is he?, followed by</b> alternatives and answered only</b> in the post-operative phase-represented in this study by the term facial aspect.

Data Analysis

Statistical analysis was performed using the Graphpad Prism software (Graphpad Software). The Sperman correlation test was applied at a significance level of 0.01 (99.9%) (p<0.01). The size of the effect was calculated by subtracting the mean of the post-treatment score by the mean of the pre-treatment score and then dividing by the Standard Deviation (SD) of the pre-treatment score.

Results

Sociodemographic Characteristics

The sample consisted predominantly of men (58.82%), aged 20 to 29 years (64.70%), white race (47.06%), 11 years of formal study (29.41%), and Household income between 1000 and 2000 reais (35.29%).

The most frequent dentofacial deformity was class III (82.35%) and three were the main complaints: facial appearance, difficulty chewing and irregular dentition (each 23.53%).

The predominant type of surgery was combined (70.59%) and when asked about how satisfied they were with the facial appearance obtained after surgery, most stated very satisfied (76.47%) (Table 1).

Table 1: Sociodemographic characteristics of the sample.

Pre and Post-Operative Quality of Life

In the comparison between the total scores and each of the OQLQ domains obtained in the pre and postoperative periods, no statistically significant differences were found (p<0.01) (Table 2).

Table 2: Correlations between preoperative and postoperative OQLQ scores (p<0.01).

Quality of Life and Socio-Demographic Characteristics

The social aspects domain did not find a significant correlation with any of the socio-demographic factors. However, there was a correlation in the preoperative period with satisfaction with facial appearance (p<0.01) (Table 3).

Table 3: Correlations between the socioeconomic form scores and the social aspects.

The type of deformity was the socio-demographic factor that, before surgery, presented significant correlation with the deformity awareness domain (p<0.001) (Table 4).

Table 4: Correlations between the scores of the socioeconomic form and the awareness domain score of the dentofacial aesthetics of the OQLQ, applied in the preoperative period (p<0.01).

There was a significant correlation of the postoperative facial aesthetic domain only with the type of deformity (p<0.01) (Table 5).

Table 5: Correlations between socioeconomic form scores and OQLQ facial aesthetic domain scores, applied in the postoperative period (p<0.01).

The oral function domain demonstrated, after surgery, a significant correlation with sex, as well as satisfaction with facial appearance (p<0.01) (Table 6).

Table 6: Correlations between the socioeconomic questionnaire scores and the oral function domain score, applied in the postoperative period (p<0.01).

A significant correlation was found in the preoperative period between education level and the total OQLQ score (p<0.01) (Table 7).

Table 7: Correlations between the socio-demographic form scores and the total score of the OQLQ questionnaire, applied in the preoperative period (p<0.01).

Effect Size

Regarding the size of the effect (total: 1.57), a positive effect was obtained in all domains: facial aesthetics (1.44) followed by social aspects (1.26), oral function (1.26) and deformity awareness (0.78), the latter being the only one not to have wide difference (>0.8) and therefore significance (p<0.01) (Table 8).

Table 8: Effect size obtained in all domains (p < 0.01).

Discussion

The Orthognathic Quality of Life Questionnaire (OQLQ), used in this study in its validated version in Portuguese (B-OQLQ), has proved to be an instrument of outstanding ability to evaluate quality of life related to the specific condition [3,7,9-16]. However, we consider it pertinent to add to our identification and socio-demographic form a specific question about satisfaction with the facial aspect and oriented to the postoperative moment, using scores similar to those of the OQLQ. Our results revealed that the sample had a degree of satisfaction similar to that previously reported in other studies, which also reconciles its correlation with the social function domain and the preoperative moment (Table 3) [4,13,17-20].

The present study verified the need to investigate the difference in quality of life not only between the operative times, but also its correlation with variables that, with the exception of satisfaction with post-operative facial appearancesurgical, were little or never before explored in the literature. Thus, in common with other research we had the following factors: sex, type of deformity, type of surgery and age [6,8,16,19, 21-23]. Nicodemo et al. and Stagles et al., as well as this study, found a correlation between sex and postoperative time (Table 6), however due to different domains (facial aesthetics, deformity awareness and oral function, respectively) [16,21]. The same result was observed by Corso et al. and Yu et al., who used OHIP-14, however, respectively in all domains of quality of life and only in that of self-esteem [8,22]. All these studies showed a greater impact on the female group, however our sample was predominantly male.

The type of dentofacial deformity had an influence on the domain of deformity awareness before surgery and on facial aesthetics after surgery. These results corroborate those of Baherimoghaddam et al., who showed that in class II patients the greatest positive impact on quality of life is due to increased facial, mentolabial and convexity angles; and that in class III patients, due to the decrease of the same angles as well as the increase of the protrusion of the upper lip [19]. However, other studies have shown greater impact, especially in the short term, among class III patients, especially attributed by their abrupt aesthetic transformation compared to greater psychological discomfort before surgery and functional limitation after surgerySurgical class II [6,23].

Nicodemo et al., were the only ones to attempt to correlate quality of life to the type of surgery without, as in our study, finding statistically significant difference in this factor in any of the operative times [21]. And as in the evaluation of Corso et al., we found no significant correlation between age and total scores of the quality of life questionnaire used before and after surgery [8].

Among the other variables studied, our results indicated possible influence of the patient’s level of education on the quality of life related to the specific pre-surgical condition. On the other hand, the factors that were not evaluated in previous studies (color/ race, income and main complaint) did not present correlation in our study, which suggests that new research be performed using them.

The size of the effect, based on the Cohen scale, was also evaluated in previous studies [24]. Our results showed a wide difference (>0.8) in all domains (with the exception of deformity awareness) as well as in the total OQLQ score, in the comparison between before and after surgery. This corroborates the studies of Soh & Narayanan and Park et al., except that in the first study the domain with no large effect was that of the oral function and in the second, all domains had an effect size greater than 0.8 [3,15]. However, in the study by Murphy et al., the only significant effect found was in the domain of facial aesthetics [12]. In all cases, upper postoperative moments (beyond 12 weeks) were evaluated than the one used (6 weeks), which may explain such differences.

As this is a convenience sample (patients from a private practice), the number of orthognathic surgeries performed during data collection was not sufficient to reach the n of the sample calculation. However, other studies were performed with sample size similar to the [4,7,8,13-15,25].

Conclusion

Despite not finding significant difference in quality of life related to the specific condition between the preoperative and postoperative moments (which may be attributed to the short postoperative period). The present study concludes that the impact of orthognathic surgery is positive, which can be confirmed by the size of the effect and the level of satisfaction of patients with the post-surgical facial aspect. Such impact may be conditioned to the individual’s level of education and type of deformity. More studies are needed to assess the influence of clinical and sociodemographic factors on the quality of life of ortho-surgical patients.

REFERENCES

1. Sar C, Soydan SS, Ozcirpici AA, Uckan S. Psychosocial and functional outcomes of orthognathic surgery: Comparison with untreated controls. J Oral Maxillofac Surg Med Pathol. 2015;27(4):451-457.

   [Crossref], [Googlescholar]

2. Costa KLD, Martins LD, Gonçalves RCG, Zardo M, De Sá ACD. Avaliação da qualidade de vida de pacientes submetidos à cirurgia ortognática. Rev. cir. traumatol. buco-maxillo-fac. 2012;12(2):81-92.

   [Googlescholar]

3. Soh CL, Narayanan V. The impact of surgical correction on the quality of life in patients with dentofacial deformity-A prospective study. J Oral Maxillofac Surg Med Pathol. 2015;27(3):323-327.

   [Crossref], [Googlescholar]

4. Alves e Silva AC, Carvalho RAS, Santos T de S, Rocha NS, Gomes ACA, de Oliveira e Silva ED. Evaluation of life quality of patients submitted to orthognathic surgery. Dental Press J Orthod. 2013;18(5):107-114.

   [Crossref], [Googlescholar], [Pubmed]

5. Cummins RA. Moving from the quality of life concept to a theory. J Intellect Disabil Res, 2005;49(10):699-706.

   [Crossref], [Googlescholar], [Pubmed]

6. Baherimoghaddam T, Tabrizi R, Naseri N, Pouzesh A, Oshagh M, Torkan S. Assessment of the changes in quality of life of patients with class II and III deformities during and after orthodontic-surgical treatment. Int J Oral Maxillofac Surg. 2015;45(4):476-485.

   [Crossref], [Googlescholar], [Pubmed]

7. Kilinc A, Ertas U. An assessment of the quality of life of patients with class III deformities treated with orthognathic surgery. J Oral Maxillofac Surg. 2015;73(7):1394.e1-e5.

   [Crossref], [Googlescholar], [Pubmed]

8. Corso PFC de L, Oliveira FAC de, Costa DJ da, Kluppel LE, Rebellato NLB, Scariot R. Evaluation of the impact of orthognathic surgery on quality of life. Braz Oral Res. 2016;30(1).

   [Crossref], [Googlescholar], [Pubmed]

9. Bock JJ, Odemar F, Fuhrmann RAW. Assessment of quality of life in patients undergoing orthognathic surgery. J Orofac Orthop. 2009;70(5):407-419.

   [Crossref], [Googlescholar], [Pubmed]

10. Choi WS, Lee S, McGrath C, Samman N. Change in quality of life after combined orthodontic-surgical treatment of dentofacial deformities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(1):46-51.

    [Crossref], [Googlescholar], [Pubmed]

11. Khadka A, Liu Y, Li J, Zhu S, Luo E, Feng G, et al. Changes in quality of life after orthognathic surgery: a comparison based on the involvement of the occlusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(6):719-725.

    [Crossref], [Googlescholar], [Pubmed]

12. Murphy C, Kearns G, Sleeman D, Cronin M, Allen PF. The clinical relevance of orthognathic surgery on quality of life. Int J Oral Maxillofac Surg. 2011;40(9):926-930.

    [Crossref], [Googlescholar], [Pubmed]

13. Kavin T, Jagadesan AGP, Venkataraman SS. Changes in quality of life and impact on patients‘ perception of esthetics after orthognathic surgery. J Pharm Bioallied Sci. 2012;4(6):S290-293.

    [Crossref], [Googlescholar], [Pubmed]

14. Abdullah WA. Changes in quality of life after orthognathic surgery in Saudi patients. Saudi Dent J. 2015;27(3):161-164.

    [Crossref], [Googlescholar], [Pubmed]

15. Park J-K, Choi J-Y, Yang I-H, Baek S-H. Patient‘s satisfaction in skeletal class III cases treated with two-jaw surgery using orthognathic quality of life questionnaire: conventional three-stage method versus surgery-First approach. J Craniofac Surg. 2015;26(7):2086-2093.

    [Crossref], [Googlescholar], [Pubmed]

16. Stagles C, Popat H, Rogers S. Factors influencing patient-reported quality of life in pretreatment orthognathic surgery patients. Angle Orthod. 2015;86(2):331-336.

    [Crossref], [Googlescholar], [Pubmed]

17. Khattak ZG, Benington PCM, Khambay BS, Green L, Walker F, Ayoub AF. An assessment of the quality of care provided to orthognathic surgery patients through a multidisciplinary clinic. J Craniomaxillofac Surg. 2012;40(3):243-247.

    [Crossref], [Googlescholar], [Pubmed]

18. Rustemeyer J, Gregersen J. Quality of Life in orthognathic surgery patients: post-surgical improvements in aesthetics and self-confidence. J Craniomaxillofac Surg. 2012;40(5):400-404.

    [Crossref], [Googlescholar], [Pubmed]

19. Baherimoghaddam T, Oshagh M, Naseri N, Nasrbadi NI, Torkan S. Changes in cephalometric variables after orthognathic surgery and their relationship to patients‘ quality of life and satisfaction. J Oral Maxillofac Res. 2014;5(4):e6.

    [Crossref], [Googlescholar], [Pubmed]

20. Huang S, Chen W, Ni Z, Zhou Y. The changes of oral health-related quality of life and satisfaction after surgery-first orthognathic approach: A longitudinal prospective study. Head Face Med. 2016;12(1):2.

    [Crossref], [Googlescholar], [Pubmed]

21. Nicodemo D, Pereira MD, Ferreira LM. Effect of orthognathic surgery for class III correction on quality of life as measured by SF-36. Int J Oral Maxillofac Surg. 2008;37(2):131-134.

    [Crossref], [Googlescholar], [Pubmed]

22. Yu D, Wang F, Wang X, Fang B, Shen SG. Presurgical motivations, self- esteem, and oral health of orthognathic surgery patients. J Craniofac Surg. 2013;24(3):743-747.

    [Crossref], [Googlescholar]

23. Göelzer JG, Becker OE, Haas Junior OL, Scolari N, Santos Melo MF, Heitz C, et al. Assessing change in quality of life using the Oral Health Impact Profile (OHIP) in patients with different dentofacial deformities undergoing orthognathic surgery: A before and after comparison. Int J Oral Maxillofac Surg. 2014;43(11):1352-1359.

    [Crossref], [Googlescholar]. [Pubmed]

24. Cohen J. A power primer. Psychol Bull. 1992 ;112(1):155-159.

    [Crossref], [Googlescholar]. [Pubmed]

25. Tabrizi R, Rezaii A, Golkari A, Ahrari F. The impact of orthognathic surgery on oral health-related quality of life. J Dent Mater Tech. 2014; 3(1): 23-27.

    [Googlescholar]