Clinical Paper
Orthognathic Surgery
A longitudinal study of changes in psychosocial well-being during orthognathic treatment

https://doi.org/10.1016/j.ijom.2017.05.004Get rights and content

Abstract

The aim was to evaluate changes in the psychosocial well-being of orthognathic surgery patients (n = 22) during treatment and to compare results with those of adults not requiring orthognathic treatment (n = 22). Patient data were collected before treatment (T0), after the first orthodontic examination (T1), three times during treatment (T2–T4), and 1 year after surgery (T5). In this article, only data corresponding to patient stage T5 are reported for the control subjects. Participants filled in a structured diary and the modified version of the Secord and Jourard body image questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem Scale, and the Acceptance and Action Questionnaire II. Moreover, patients filled in the Symptom Checklist-90. After the placement of orthodontic appliances (T2), orthognathic quality of life, self-esteem, and psychological flexibility were lower and psychiatric symptoms increased. Improvements were observed from T2 to T5 in orthognathic quality of life, body image, self-esteem, psychological flexibility, and psychiatric symptoms. Treatment resulted in improvements from T0 to T5 in orthognathic quality of life, body image, and psychiatric symptoms. At T5, patient psychosocial well-being was comparable to or even better than that of control subjects. Orthognathic treatment seems to support psychological well-being, but the range of individual variation is wide.

Section snippets

Materials and methods

This prospective study recruited patients referred to two university hospitals for the evaluation of orthognathic treatment needs. Patients with cleft lip or palate, syndromes affecting the craniofacial anatomy, and those whose Finnish language skills did not allow them to complete the questionnaires were excluded from the study. The sample sizes at the different time points are presented in Fig. 1. Sixty patients participated at T0. Thirty-eight patients did not complete every stage of the

Changes in patient well-being during treatment

Patient scores in all OQLQ subscales, body image, facial body image, RSES, AAQII, and most subscales of the SCL-90 changed during treatment (T2–T4) (Table 2). Only in the hostility, phobic anxiety, and psychoticism subscales of the SCL-90 did scores remain stable.

Changes from pre-treatment (T0) to placement of fixed orthodontic appliances (T2)

The patient OQLQ total scores and oral function subscale scores rose from baseline values, indicating a decrease in orthognathic quality of life (Table 3). Other aspects of the OQLQ remained stable, as did body image and facial body

Discussion

The aim of this prospective study was to analyze changes in psychosocial well-being of orthognathic patients from the pre-treatment stage to at least 1 year after surgery. The findings were also compared to those of controls not needing orthognathic treatment. In the current study, patient psychosocial well-being decreased in many respects after the placement of fixed orthodontic appliances, which is in line with the findings of Johal et al.18. In general, the results suggest that treatment

Funding

This study was supported by grants from the Finnish Dental Society Apollonia, the Orthodontic Division of the Finnish Dental Society, Finnish Women Dentists’ Association, the University of Tampere and the Hospital District of Southwest Finland, and the Pirkanmaa Hospital District.

Competing interests

None to declare.

Ethical approval

Ethical approval given by the Ethics Committee of the Hospital District of Southwest Finland 22.9.2009, completed 16.3.2010 and 15.3.2011.

Patient consent

Not required.

Acknowledgements

The authors wish to thank the personnel of the Turku unit of the Finnish Student Health Service for their kind help in organizing this study.

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