Int. J. Oral Maxillofac. Surg.

2016; 45: 1513–1519

http://dx.doi.org/10.1016/j.ijom.2016.07.003, available online at http://www.sciencedirect.com

Clinical Paper
Orthognathic Surgery

Impact of orthognathic surgery K. Kurabe1, T. Kojima1, Y. Kato1,

I. Saito2, T. Kobayashi1
1
Division of Reconstructive Surgery for Oral

on oral health-related quality of and Maxillofacial Region, Niigata University,

Graduate School of Medical and Dental
Sciences, Niigata, Japan; 2Division of
Orthodontics, Niigata University, Graduate

life in patients with jaw School of Medical and Dental Sciences,

Niigata, Japan

deformities
K. Kurabe, T. Kojima, Y. Kato, I. Saito, T. Kobayashi: Impact of orthognathic surgery
on oral health-related quality of life in patients with jaw deformities. Int. J. Oral
Maxillofac. Surg. 2016; 45: 1513–1519. # 2016 International Association of Oral and
Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Abstract. The purpose of this study was to clarify the impact of orthognathic surgery
on oral health-related quality of life (OHRQOL) in patients with jaw deformities.
The subjects were 65 patients (21 males and 44 females) who underwent
orthognathic surgery. The mean age of the patients was 23.6 years. Forty-seven
patients had skeletal class III malocclusions, eight patients had skeletal class II, and
10 patients had skeletal class I with facial asymmetry and/or open bite. OHRQOL
was assessed using the Japanese version of the Oral Health Impact Profile (OHIP-
J54) before and 6 months after surgery. While OHIP-J54 scores in the patients
before surgery were significantly higher than those in the control subjects,
OHIP-J54 scores after surgery were significantly lower than those before surgery.
OHIP-J54 scores in older patients were significantly higher than those in younger
patients. In conclusion, most patients with jaw deformities have lower OHRQOL
Key words: oral health-related quality of life;
than individuals with normal occlusion, and orthognathic surgery has a positive orthognathic surgery; jaw deformities.
impact on OHRQOL. The determination of OHRQOL in patients with jaw
deformities seems to be very useful for understanding the patients’ problems and for Accepted for publication 7 July 2016
assessing the extent of changes in terms of patient well-being. Available online 3 August 2016

Orthognathic surgery is now an established
treatment for patients with jaw deformities.
The purpose of this treatment is to correct
the functional and aesthetic problems
resulting from the underlying jaw deformi-
ties. This treatment might also contribute
to improvements in the patient’s psycho-
logical and social problems, because
they often experience difficulties in, for
example, social interactions and interper-
sonal relationships.1 Therefore, it is impor-
tant to understand the patient’s problems
and offer an appropriate treatment for each
individual patient.
There have been many reports on psy-
chological status and satisfaction following
orthognathic surgery determined using
qualitative and quantitative methods.1–22
It has become clear that orthognathic sur-
gery has various effects on patients with
jaw deformities. However, there have been
few investigations in Japanese subjects
on the patient’s subjective evaluation, in-
cluding mental disability, psychological
responses, social aspects, and functionality.
In recent years, assessments of quality of
life (QOL) have been used throughout

0901-5027/01201513 + 07 # 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Descargado de ClinicalKey.es desde Universidad de Valparaiso abril 04, 2017.

Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2017. Elsevier Inc. Todos los derechos reservados.
1514 Kurabe et al.
healthcare, and QOL has become one of the
important outcomes in medical evaluation
research. Patients can now compare various
treatments and select a treatment for them-
selves. Information on the effects of treat-
ments on QOL would be helpful for
patients when choosing an appropriate
treatment and would also help to close
the gap between patients and medical prac-
titioners regarding recognition of the treat-
ment for better health care. The increasing
use of condition-specific QOL measures in
orthognathic surgery highlights the impor-
tance of a patient-centred approach3 and a
shared decision-making process.4
The purpose of this study was to clarify
the impacts of orthognathic surgery on
oral health-related quality of life (OHR-
QOL) in patients with jaw deformities by
conducting investigations before and after
surgery.
Materials and methods
Subjects
The subjects were 65 orthognathic surgery
patients (21 males and 44 females) for
whom jaw deformities were corrected sur-
gically in a clinic of oral and maxillofacial
surgery in Niigata, Japan, between Decem-
ber 2013 and June 2015 (Table 1). The
mean age of the patients ( SD) at surgery
was 23.6  8.1 years (range 15–43 years).
Exclusion criteria were the presence of a
congenital disease or syndrome with max-
illofacial deformities such as cleft lip and
palate, a mental disease, and maxillofacial
transformation caused by an injury.
The chief complaint was classified
into three categories. Forty-two patients
Table 1. Characteristics of the subjects.
Chief complaint
Facial deformity
Occlusal disharmony
Functional disturbance
Anteroposterior skeletal pattern
Class III
Class II
Class I
Operative procedures
BSSO
LFI + BSSO
Postoperative symptoms
Paresthesia of the lip or chin
Temporomandibular joint symptoms
Limited mouth opening (MMO <35 mm)
BSSO, bilateral sagittal split osteotomy; LFI, Le Fort I osteotomy; MMO, maximum mouth
opening.
Descargado de ClinicalKey.es desde Universidad de Valparaiso abril 04, 2017.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2017. Elsevier Inc. Todos los derechos reservados.
complained of a facial deformity, 20 Assessment of oral health-related quality
patients complained of occlusal dishar- of life (OHRQOL)
mony, and three patients complained of
OHRQOL was assessed using the Japa-
functional disturbances. The anteropos-
nese version of the Oral Health Impact
terior relationships between the facial
Profile (OHIP-J54) (Table 2)23 before sur-
skeletal structures were assessed on later-
gery and at 6 months after surgery. The
al cephalograms, and the patients were
original OHIP was developed by Slade
divided into three groups according to the
and Spencer in 1994 to assess geriatric
type of anteroposterior skeletal pattern.
OHRQOL24 and consists of 49 items or-
Forty-seven patients had skeletal class III
ganized into seven domains: functional
malocclusions, eight patients had skeletal
limitation, physical pain, psychological
class II malocclusions, and 10 patients
discomfort, physical disability, psycho-
had skeletal class I malocclusions with
logical disability, social disability, and
facial asymmetry and/or open bite. A
handicap. These domains were based on
bilateral sagittal split osteotomy (BSSO)
Locker’s model of oral health.25 The
was performed in 19 patients, and a com-
OHIP-J54 is the Japanese version of the
bination of Le Fort I osteotomy (LFI) and
OHIP with an additional domain consist-
BSSO was used in 46 patients. All of the
ing of five items on TMJ symptoms.23 The
patients received pre- and postoperative
questions are rated using a five-point
orthodontic treatment, and osteosynthesis
Likert scale: never 0, hardly ever 1, occa-
was achieved using titanium miniplates
sionally 2, fairly often 3, very often 4. The
and/or resorbable fixation devices. Max-
total OHIP-J54 score ranges from 0 to 216,
illomandibular fixation was performed 1
and the subscale scores of the eight
day after surgery and was maintained for
domains are 0–36 for functional limita-
14 days. Postoperative symptoms were
tion, 0–36 for physical pain, 0–20 for
assessed clinically at 6 months after sur-
psychological discomfort, 0–36 for physi-
gery, including paresthesia of the lip or
cal disability, 0–24 for psychological dis-
chin, temporomandibular joint (TMJ)
ability, 0–20 for social disability, 0–24 for
symptoms, and limitations in mouth open-
handicap, and 0–20 for the additional
ing. In this study, limited mouth opening
items in the Japanese version. OHRQOL
was defined as a maximum inter-incisal
is estimated using the eight subscale
distance of less than 35 mm. Postopera-
scores and the total score; a high score
tively, paresthesia of the lip or chin was
means a low OHRQOL level.
identified in 17 patients (26.2%), TMJ
symptoms in 24 patients (36.9%), and
limited mouth opening in seven patients Ethical considerations
(10.8%).
The study protocol was approved by the
Control subjects were 14 young female
necessary ethics committee and informed
students at the university who had a nor-
consent was obtained from the subjects.
mal occlusion, no TMJ symptoms, and
little knowledge of dentistry.
Statistical analyses
The Wilcoxon signed-rank sum test was
used to compare scores before and after
surgery. The Mann–Whitney U-test was
n (%) used to compare scores in the patient group
and control group. The Mann–Whitney
42 (64.6) U-test, Kruskal–Wallis one-way analysis
20 (30.8) of variance, and pairwise comparison were
3 (4.6) used to assess the relationships between
OHIP-J54 scores and contributing factors.
47 (72.3) Probabilities of less than 0.05 were accept-
8 (12.3) ed as significant. Data were analyzed
10 (15.4) using IBM SPSS Statistics 20 for Windows
(IBM Japan, Ltd, Tokyo, Japan).
19 (29.2)
46 (70.8) Results
17 (26.2) All of the subscale scores of the patients
24 (36.9) before surgery were significantly higher
7 (10.8) than those of the control subjects, and
all of the subscale scores after surgery
were significantly lower than those before
 Impact of orthognathic surgery on OHRQOL 1515

Table 2. Items of the Japanese version of the Oral Health Impact Profile (OHIP-J54).
How often in the last month have you had problems with your teeth, mouth, dentures, or restorations?
Have you experienced the following problems in the last month?
Please put a circle around the most appropriate choice (never [0], hardly ever [1], occasionally [2], fairly often [3], very often [4]).
Functional limitation
1. Have you had difficulty chewing any foods because of problems with your teeth, mouth, or dentures?
2. Have you had trouble pronouncing any words because of problems with your teeth, mouth, or dentures?
3. Have you noticed a tooth that doesn’t look right?
4. Have you felt that your appearance has been affected because of problems with your teeth, mouth, or dentures?
5. Have you felt that your breath has been stale because of problems with your teeth, mouth, or dentures?
6. Have you felt that your sense of taste has worsened because of problems with your teeth, mouth, or dentures?
7. Have you had food catching in your teeth or dentures?
8. Have your felt that your digestion has worsened because of problems with your teeth, mouth, or dentures?
9. Have you felt that your dentures have not been fitting properly?
Physical pain
10. Have you had painful aching in your mouth?
11. Have you had a sore jaw?
12. Have you had headaches because of problems with your teeth, mouth, or dentures?
13. Have you had sensitive teeth, for example, due to hot or cold foods or drinks?
14. Have you had toothache?
15. Have you had painful gums?
16. Have you found it uncomfortable to eat any foods because of problems with your teeth, mouth, or dentures?
17. Have you had sore spots in your mouth?
18. Have you had uncomfortable dentures?
Psychological discomfort
19. Have you been worried by dental problems?
20. Have you been self-conscious because of your teeth, mouth, or dentures?
21. Have dental problems made you miserable?
22. Have you felt uncomfortable about the appearance of your teeth, mouth, or dentures?
23. Have you felt tense because of problems with your teeth, mouth, or dentures?
Physical disability
24. Has your speech been unclear because of problems with your teeth, mouth, or dentures?
25. Have people misunderstood some of your words because of problems with your teeth, mouth, or dentures?
26. Have you felt that there has been less flavour in your food because of problems with your teeth, mouth, or dentures?
27. Have you been unable to brush your teeth properly because of problems with your teeth, mouth, or dentures?
28. Have you had to avoid eating some foods because of problems with your teeth, mouth, or dentures?
29. Has your diet been unsatisfactory because of problems with your teeth, mouth, or dentures?
30. Have you been unable to eat with your dentures because of problems with them?
31. Have you avoided smiling because of problems with your teeth, mouth, or dentures?
32. Have you had to interrupt meals because of problems with your teeth, mouth, or dentures?
Psychological disability
33. Has your sleep been interrupted because of problems with your teeth, mouth, or dentures?
34. Have you been upset because of problems with your teeth, mouth, or dentures?
35. Have you found it difficult to relax because of problems with your teeth, mouth, or dentures?
36. Have you felt depressed because of problems with your teeth, mouth, or dentures?
37. Has your concentration been affected because of problems with your teeth, mouth, or dentures?
38. Have you been a bit embarrassed because of problems with your teeth, mouth, or dentures?
Social disability
39. Have you avoided going out because of problems with your teeth, mouth, or dentures?
40. Have you been less tolerant of your spouse or family because of problems with your teeth, mouth, or dentures?
41. Have you had trouble getting on with other people because of problems with your teeth, mouth, or dentures?
42. Have you been a bit irritable with other people because of problems with your teeth, mouth, or dentures?
43. Have you had difficulty doing your usual jobs because of problems with your teeth, mouth, or dentures?
Handicap
44. Have you felt that your general health has worsened because of problems with your teeth, mouth, or dentures?
45. Have you suffered any financial loss because of problems with your teeth, mouth, or dentures?
46. Have you been unable to enjoy other people’s company as much because of problems with your teeth, mouth, or dentures?
47. Have you felt that life in general was less satisfying because of problems with your teeth, mouth, or dentures?
48. Have you been totally unable to function because of problems with your teeth, mouth, or dentures?
49. Have you been unable to work to your full capacity because of problems with your teeth, mouth, or dentures?
Additional items in Japanese version
50. Have you bitten your buccal mucosa because of problems with your teeth, mouth, or dentures?
51. Have you had difficulty swallowing any foods because of problems with your teeth, mouth, or dentures?
52. Have you been afflicted by temporomandibular joint noises?
53. Have you experienced dryness of the mouth?
54. Have you felt that your sense of food texture was worsened because of problems with your teeth, mouth, or dentures?

Descargado de ClinicalKey.es desde Universidad de Valparaiso abril 04, 2017.

Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2017. Elsevier Inc. Todos los derechos reservados.
1516 Kurabe et al.
Table 3. OHIP-J54 scores before and after surgery compared with those of control subjects; results are reported as the median (interquartile
range).
Domain
Functional limitation
Physical pain
Psychological discomfort
Physical disability
Psychological disability
Social disability
Handicap
Additional items in Japanese version
Total
OHIP-J54, Japanese version of the Oral Health Impact Profile; NS, not significant.
a
Wilcoxon’s signed-rank sum test.
b
Mann–Whitney U-test.
surgery (Table 3). The total score and
subscale scores after surgery, except
scores for the functional limitation and
psychological discomfort domains, were
significantly higher than those of the con-
trol subjects (Table 3).
The relationships between the OHIP-
J54 scores and contributing factors includ-
ing age, sex, chief complaint, anteropos-
terior skeletal pattern, operative
procedures, and postoperative symptoms
were examined (Table 4).
The patients were divided into two
groups based on average age. Pre- and
postoperative total scores in the older
patients were significantly higher than
those in the younger patients. There was
no relationship between the total score
and sex or between the total score and
the chief complaint. Pre- and postopera-
tive total scores in patients with skeletal
class III were significantly lower than
those in patients with skeletal class I or
II (Table 4), and there were significant
differences among the types of anteropos-
terior skeletal pattern in many subscale
scores, including scores for physical pain,
psychological discomfort, psychological
disability, social disability, and handicap
before surgery, and functional limitation,
physical pain, psychological discomfort,
physical disability, psychological disabil-
ity, social disability, and handicap after
surgery (Table 5). Postoperative total
scores in patients who underwent BSSO
were significantly lower than those in
patients who underwent LFI and BSSO
(Table 4).
There were no significant differences in
total scores between patients with postop-
erative paresthesia of the lip or chin and
patients without this paresthesia. Postop-
erative total scores in patients with TMJ
symptoms and/or limited mouth opening
were significantly higher than those in
patients without symptoms.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2017. Elsevier Inc. Todos los derechos reservados.
Before surgery (1) After surgery (2) Controls (3)
13.0 (9.0–16.0) 8.0 (5.0–12.0) 5.0
7.0 (4.0–14.0) 7.0 (3.0–9.0) 2.5
8.0 (10.0–14.0) 5.0 (2.0–7.0) 2.0
11.0 (6.0–14.0) 6.0 (3.0–11.0) 2.0
4.0 (1.0–7.0) 1.0 (0.0–5.0) 0.0
1.0 (0.0–5.0) 0.0 (0.0–2.0) 0.0
3.0 (0.0–7.0) 0.0 (0.0–4.0) 0.0
5.0 (2.0–7.0) 4.0 (2.0–5.0) 2.0
52.0 (31.0–78.0) 35.0 (16.0–52.0) 13.0 (7.5–21.8)
Discussion
There is growing interest in how orthog-
nathic surgery affects patient lives. The
World Health Organization (WHO) has
defined QOL as an individual’s perception
of their position in life in the context of the
culture and value systems in which they
live and in relation to their goals, expec-
tations, standards, and concerns.26 It is a
comprehensive concept that is affected
by the individual’s physical health, psy-
chological state, social relationships, and
environment.
Various OHRQOL scales, including
Oral Impacts on Daily Performance
(OIDP),27 Dental Impacts on Daily Living
(DIDL),28 Oral Health Impact Profile
(OHIP),24 General Oral Health Assess-
ment Index (GOHAI),29 and Orthognathic
Quality of Life Questionnaire (OQLQ),4
have been developed since the 1990s.
These scales provide numerical scores that
can be used to compare groups with or
without disease in the oral and maxillofa-
cial regions, and the scores can also be
compared before and after treatment to
determine the extent of change in terms
of patient well-being and QOL. Some of
these scales have been used for the assess-
ment of OHRQOL in patients with jaw
deformities.1–16
In this study, the OHIP-J54 was selected
to assess OHRQOL for three reasons. The
first reason is its reliability for the assess-
ment of oral health, because OHIP-J54 has
been verified in various institutions and its
validity is similar to that determined for
the original OHIP.23,30,31 The second rea-
son is that OHIP translated into various
languages has already been used to inves-
tigate OHRQOL in patients with jaw
deformities.2,7–15 The third reason is that
pain, discomfort, and psychological and
social factors are included in this scale.
The OHIP was originally developed as an
Descargado de ClinicalKey.es desde Universidad de Valparaiso abril 04, 2017.
P-value P-value P-value
(1) vs. (2)a (1) vs. (3)b (2) vs. (3)b
(2.3–7.8) <0.05 <0.05 NS
(2.0–6.8) <0.05 <0.05 <0.05
(0.0–5.0) <0.05 <0.05 NS
(0.0–2.0) <0.05 <0.05 <0.05
(0.0–0.0) <0.05 <0.05 <0.05
(0.0–0.0) <0.05 <0.05 <0.05
(0.0–0.0) <0.05 <0.05 <0.05
(1.0–2.0) <0.05 <0.05 <0.05
<0.05 <0.05 <0.05
indicator of perceived need in order to
enhance understanding of oral health-re-
lated behaviours by measuring discomfort,
dysfunction, and the self-perceived impact
of oral diseases on daily activities of adults
and seniors.24 Thereafter, some authors
concluded that the OHIP may be a sensi-
tive screening tool to identify people with
high levels of oral health impacts, includ-
ing younger individuals.32,33
Some authors have reported that
patients with jaw deformities have
lower OHRQOL than subjects without
jaw deformities in many aspects as
assessed using the OHIP-14 (short form
of OHIP),8,13,14 and also lower OQLQ
scores.8,13,14,16 Similarly, in this study,
patients with jaw deformities had low
OHRQOL because their OHIP-J54 total
score and all of the subscale scores were
significantly higher than those in control
subjects. Moreover, many subscale scores
in patients with skeletal class III were
significantly lower than those in patients
with skeletal class I or II. There are some
indications that differences might exist in
the OHRQOL of patients with different
types of jaw deformity. A comparative
study of skeletal class II and skeletal class
III patients showed that skeletal class III
patients had stronger feelings of insecuri-
ty regarding their facial appearance.17 In a
previous study by the present research
group using the Minnesota Multiphasic
Personality Inventory, which is the most
widely used psychological test, the de-
pression scale score for skeletal class III
group patients was higher than the scores
in the other skeletal groups.34 In this
study, however, the scores for psycholog-
ical discomfort, psychological disability,
social disability, and handicap were sig-
nificantly lower than those of skeletal
class II patients. One reason for this might
be that patients with skeletal class III
malocclusion exhibit lower levels of
 Impact of orthognathic surgery on OHRQOL 1517

Table 4. Relationships between OHIP-J54 scores and contributing factors; results are reported as the median (interquartile range).
P-valuea
Factors n Preoperative total score Postoperative total score Preop. vs. Postop.
Age, years
23 25 74.0 (58.0–87.0) 47.0 (36.0–62.0) <0.05
<23 40 40.5 (27.8–63.0) 24.0 (12.0–41.8) <0.05
P < 0.05b P < 0.05b
Sex
Male 21 51.0 (31.0–78.0) 35.0 (26.3–45.0) <0.05
Female 44 56.0 (30.0–77.3) 35.0 (14.0–55.3) <0.05
NS NS
Chief complaint
Facial deformity 42 59.0 (37.8–78.0) 38.5 (19.8–53.5) <0.05
Occlusal disharmony 20 51.5 (30.0–78.5) 34.5 (14.0–52.5) <0.05
Functional disturbance 3 29.0 (16.5–51.0) 24.0 (24.0–30.0) NS
NS NS
Anteroposterior skeletal pattern
Class III 47 46.0 (28.0–73.0) 24.0 (14.0–45.5) <0.05
Class II 8 76.0 (64.5–80.5) 52.0 (40.0–86.5) NS
Class I 10 80.0 (51.5–89.0) 45.0 (32.0–59.0) <0.05
Class III vs. II, P < 0.05c Class III vs. II, P < 0.05c
Class III vs. I, P < 0.05c Class III vs. I, P < 0.05c
Operative procedures
BSSO 19 41.0 (29.5–69.5) 24.0 (8.5–40.0) <0.05
LFI + BSSO 46 59.0 (37.0–82.5) 41.0 (23.3–56.8) <0.05
NS P < 0.05b
Symptoms 6 months after surgery
Paresthesia of the lip or chin
Symptoms 17 54.0 (34.0–78.0) 41.0 (15.0–61.0) <0.05
No symptoms 48 51.5 (29.8–77.3) 31.5 (16.8–49.8) <0.05
NS NS
Temporomandibular joint
Symptoms 24 73.5 (47.0–87.8) 52.0 (28.0–62.0) <0.05
No symptoms 41 46.0 (29.0–72.0) 27.0 (14.0–44.0) <0.05
NS P < 0.05b
Limited mouth opening (MMO <35 mm)
Yes 7 73.0 (57.5–79.5) 56.0 (53.0–59.0) NS
No 58 51.0 (31.0–77.8) 28.5 (16.0–46.5) <0.05
NS P < 0.05b
OHIP-J54, Japanese version of the Oral Health Impact Profile; NS, not significant; BSSO, bilateral sagittal split osteotomy; LFI, Le Fort I
osteotomy; MMO, maximum mouth opening.
a
Wilcoxon’s signed-rank sum test.
b
Mann–Whitney U-test.
c
Kruskal–Wallis one-way analysis of variance and pairwise comparison.

psychological stress in social situations
than do those with skeletal class II mal-
occlusion, but there is no clear evidence of
this, because there have been only a few
comparative studies on QOL and psycho-
logical status in patients with different
types of jaw deformity.
Older patients had lower OHRQOL
than younger patients in this study. This
difference might be related to the age at
which the patient obtains information on
orthognathic surgery. The most important
process of identity development takes
place during adolescence. Many older
patients obtain information about orthog-
nathic surgery after the establishment of
their identity as an individual. On the other
hand, younger patients know about the
possible resolution of their problems by
orthognathic surgery before establishment
of their identity, and the information might
have a positive impact on their psycholog-
ical status and identity development.
It has been reported that a greater per-
centage of females suffer a psychosocial
disadvantage as a result of their dental or
facial appearance than males,35 and fe-
male patients have been found to be twice
as likely to report negative impacts on
OHRQOL as male patients.11 However,
there was no significant difference in
OHRQOL between females and males in
this study.
In this study, all of the subscale scores
after surgery were significantly lower
than those before surgery, indicating that
OHRQOL in patients with jaw deformities
had improved significantly after surgery.
Similarly, several studies have shown im-
proved self-confidence and QOL following
orthognathic surgery,1–15 and review arti-
cles on the benefits of orthognathic surgery
on QOL by Hunt et al.1 (29 articles pub-
lished from 1966 to December 2000) and
by Soh et al.7 (21 articles published from
2001 to June 2012) concluded that patients
with jaw deformities experience an
improvement in QOL after orthognathic
surgery and that a positive effect of orthog-
nathic surgery on psychosocial status has
generally been accepted. On the other
hand, it has been reported that the
OHIP-14 score was slightly increased at
6 weeks after surgery but was significantly
decreased at 6 and 12 months after sur-
gery,10 that the level of QOL is projected to
reach the same level as that in subjects

Descargado de ClinicalKey.es desde Universidad de Valparaiso abril 04, 2017.

Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2017. Elsevier Inc. Todos los derechos reservados.
1518 Kurabe et al.

Table 5. Comparison of pre- and postoperative subscale scores among types of anteroposterior skeletal pattern; results are reported as the median
(interquartile range).
P-valuea P-valuea
Domains Class I Class II Class III Class III vs. I Class III vs. II
Functional limitation Before surgery 14.0 (12.5–17.0) 14.0 (12.5–15.5) 12.0 (8.0–16.0) NS NS
After surgery 10.0 (8.0–13.0) 12.0 (7.0–14.5) 7.0 (4.0–10.5) <0.05 NS
Physical pain Before surgery 16.0 (10.5–17.0) 9.0 (5.5–10.0) 6.0 (3.0–10.5) <0.05 NS
After surgery 10.0 (6.0–12.5) 9.0 (4.5–16.0) 5.0 (2.0–8.0) <0.05 <0.05
Psychological discomfort Before surgery 10.0 (6.0–12.0) 10.0 (8.0–12.0) 6.0 (4.0–8.5) NS <0.05
After surgery 6.0 (4.5–8.0) 6.0 (5.0–11.0) 3.0 (0.5–6.0) NS <0.05
Physical disability Before surgery 12.0 (9.5–15.5) 15.0 (11.5–16.0) 10.0 (5.5–12.5) NS NS
After surgery 10.0 (5.5–12.5) 9.0 (8.0–12.5) 5.0 (2.0–9.0) <0.05 <0.05
Psychological disability Before surgery 6.0 (4.0–9.0) 7.0 (6.0–8.0) 2.0 (0.0–6.0) <0.05 <0.05
After surgery 2.0 (0.5–5.5) 7.0 (1.5–8.5) 0.0 (0.0–3.0) NS <0.05
Social disability Before surgery 1.0 (1.0–4.5) 6.0 (2.0–8.0) 0.0 (0.0–5.0) NS <0.05
After surgery 1.0 (0.5–3.0) 6.0 (2.5–8.5) 0.0 (0.0–1.5) <0.05 <0.05
Handicap Before surgery 4.0 (1.5–8.0) 7.0 (7.0–7.5) 1.0 (0.0–5.5) NS <0.05
After surgery 3.0 (0.5–4.5) 6.0 (3.5–7.5) 0.0 (0.0–3.0) NS <0.05
Additional items in Before surgery 7.0 (5.0–9.0) 5.0 (3.0–6.5) 4.0 (1.5–6.5) NS NS
Japanese version After surgery 5.0 (4.0–7.0) 4.0 (3.5–5.5) 3.0 (2.0–5.0) NS NS
Total Before surgery 80.0 (51.5–89.0) 76.0 (64.5–80.5) 46.0 (28.0–73.0) <0.05 <0.05
After surgery 45.0 (32.0–59.0) 52.0 (40.0–86.5) 24.0 (14.0–45.5) <0.05 <0.05
NS, not significant.
a
Kruskal–Wallis one-way analysis of variance and pairwise comparison.

without jaw deformities when the postop-
erative orthodontic treatment had been
completed,8 and that OHRQOL continued
to increase until 2 years after surgery.5
Similarly, in the present study subscale
scores after surgery, except scores for
the functional limitation and psychological
discomfort domains, were significantly
higher than those in control subjects, be-
cause postoperative orthodontic treatment
was still ongoing in most patients and they
were in recovery and adapting to their new
occlusion at the examination 6 months
after surgery. Therefore, OHRQOL in
patients with jaw deformities should be
investigated continuously from the time
of the initial visit to the goal of postopera-
tive orthodontic treatment.
It has been reported that sex has a
significant influence on expectations and
surgical outcomes. More males than
females wanted a functional improve-
ment, whereas more females than
males hoped for an improvement in self-
confidence.22 In this study, however, no
relationship was found between sex and
OHRQOL before or after surgery.
In this study, many postoperative sub-
scale scores in patients with skeletal class
III were significantly lower than those in
patients with skeletal class I or II, and
some postoperative subscale scores in
skeletal class III patients, such as scores
for psychological disability, social disabil-
ity, and handicap, were comparable to
those in control subjects. Similarly, some
investigators have reported that patients
with mandibular setback are more
pleased with the outcome than those with
mandibular advancement.12,21 Further-
more, postoperative OHRQOL in patients
who underwent a BSSO was significantly
lower than that in patients who underwent
LFI and BSSO, although both scores
were significantly decreased compared
with preoperative scores. This seems to
be causally related to the severity of the
jaw deformity, because patients who have
a LFI and BSSO have more complex and
severe jaw deformities.
Previous studies have shown that pa-
tient satisfaction shortly after surgery is
affected by the presence or absence of
paresthesia and postoperative pain.18 In
this study, postoperative paresthesia had
no significant negative impact on OHR-
QOL, because the symptoms were slight
in most patients with paresthesia at
6 months after surgery; however, postop-
erative TMJ symptoms and limited mouth
opening had significant negative impacts.
Moreover, dissatisfaction after orthog-
nathic surgery is not only caused by the
skill of the operator, but is also due to the
patient’s psychological problems. With
regard to the psychological impact of
dentofacial disharmony, previous studies
have shown that patients with jaw defor-
mities do not appear to be more psycho-
logically distressed or depressed than
normal subjects.18,19 On the other hand,
it has been reported that patients who are
psychologically distressed before orthog-
nathic surgery tend to experience more
difficulties and more discomfort with
symptoms and greater social and general
health concerns.20 Self-concept and social
interaction before and after surgery seem
to be associated with patient satisfaction
and improvements in OHRQOL.
In conclusion, most patients with jaw
deformities had lower OHRQOL than
subjects with normal occlusion, but
orthognathic surgery had a positive im-
pact on OHRQOL, especially in younger
patients. The determination of OHRQOL
in patients with jaw deformities seems to
be very useful for understanding the
patients’ problems and for providing
appropriate treatment and assessing the
extent of changes in terms of patient
well-being.
Funding
None.
Competing interests
None declared.
Ethical approval
The study protocol was approved by the
Ethics Committee of Niigata University
(receipt number 25-R29-11-12).
Patient consent
Not required.
References
1. Hunt OT, Johnston CD, Hepper PG, Burden
DJ. The psychosocial impact of orthognathic
surgery: a systematic review. Am J Orthod
Dentofacial Orthop 2001;120:490–7.

Descargado de ClinicalKey.es desde Universidad de Valparaiso abril 04, 2017.

Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2017. Elsevier Inc. Todos los derechos reservados.

2. Rustemeyer J, Eke Z, Bremerich A. Percep-
tion of improvement after orthognathic sur-
gery: the important variables affecting
patient satisfaction. Oral Maxillofac Surg
2010;14:155–62.
3. Ballon A, Laudemann K, Sader R, Landes
CA. Patients’ preoperative expectations and
postoperative satisfaction of dysgnathic
patients operated on with resorbable osteo-
syntheses. J Craniofac Surg 2011;22:730–4.
4. Cunningham SJ, Garratt AM, Hunt NP. De-
velopment of a condition-specific quality of
life measure for patients with dentofacial
deformity: I. Reliability of the instrument.
Community Dent Oral Epidemiol 2000;28:
195–201.
5. Motegi E, Hatch JP, Rugh JD, Yamaguchi H.
Health-related quality of life and psychoso-
cial function 5 years after orthognathic sur-
gery. Am J Orthod Dentofacial Orthop
2003;124:138–43.
6. Alanko OM, Svedstrom-Oristo AL, Tuo-
misto MT. Patients’ perceptions of orthog-
nathic treatment, well-being, and
psychological or psychiatric status: a sys-
tematic review. Acta Odontol Scand 2010;
68:249–60.
7. Soh CL, Narayanan V. Quality of life assess-
ment in patients with dentofacial deformity
undergoing orthognathic surgery – a system-
atic review. Int J Oral Maxillofac Surg
2013;42:974–80.
8. Kilinc A, Ertas U. An assessment of the
quality of life of patients with class III
deformities treated with orthognathic sur-
gery. J Oral Maxillofac Surg 2015;73.
1394.e1–1394.e5.
9. Rustemeyer J, Gregersen J. Quality of life in
orthognathic surgery patients: post-surgical
improvements in aesthetics and self-confi-
dence. J Craniomaxillofac Surg 2012;40:
400–4.
10. Choi WS, Lee S, McGrath C, Samman N.
Change in quality of life after combined
orthodontic–surgical treatment of dentofa-
cial deformities. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2010;109:46–51.
11. Esperão PT, de Oliveira BH, Almeida MA,
Kiyak HA, Miguel JA. Oral health-related
quality of life in orthognathic surgery
patients. Am J Orthod Dentofacial Orthop
2010;137:790–5.
12. 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 deformi-
ties undergoing orthognathic surgery: a
Descargado de ClinicalKey.es desde Universidad de Valparaiso abril 04, 2017.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2017. Elsevier Inc. Todos los derechos reservados.
Impact of orthognathic surgery on OHRQOL
before and after comparison. Int J Oral
Maxillofac Surg 2014;43:1352–9.
13. Lee S, McGrath C, Samman N. Impact of
orthognathic surgery on quality of life. J
Oral Maxillofac Surg 2008;66:1194–9.
14. Lee S, McGrath C, Samman N. Quality of
life in patients with dentofacial deformity: a
comparison of measurement approaches. Int
J Oral Maxillofac Surg 2007;36:488–92.
15. Hassan AH, Amin Hel S.. Association of
orthodontic treatment needs and oral health-
related quality of life in young adults. Am J
Orthod Dentofacial Orthop 2010;137:42–7.
16. Al-Ahmad HT, Al-Sa’di WS, Al-Omari IK,
Al-Bitar ZB. Condition-specific quality of
life in Jordanian patients with dentofacial
deformities: a comparison of generic and
disease-specific measures. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod
2009;107:49–55.
17. Gerzanic L, Jagsch R, Watzke IM. Psycho-
logic implications of orthognathic surgery in
patients with skeletal class II or class III
malocclusion. Int J Adult Orthodon Orthog-
nath Surg 2002;17:75–81.
18. Kiyak HA, McNeil RW, West RA, Hohl T,
Bucher F, Sherrick P. Predicting psychologic
responses to orthognathic surgery. J Oral
Maxillofac Surg 1982;40:150–5.
19. Kim SJ, Kim MR, Shin SW, Chun YS, Kim
EJ. Evaluation on the psychosocial status of
orthognathic surgery patients. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod
2009;108:828–32.
20. Phillips C, Kiyak HA, Bloomquist D, Turvey
TA. Perceptions of recovery and satisfaction
in the short term after orthognathic surgery. J
Oral Maxillofac Surg 2004;62:535–44.
21. Pahkala RH, Kellokoski JK. Surgical ortho-
dontic treatment and patients’ functional and
psychosocial well-being. Am J Orthod Den-
tofacial Orthop 2007;132:158–64.
22. Siow KK, Ong ST, Lian CB, Ngeow WC.
Satisfaction of orthognathic surgical patients
in a Malaysian population. J Oral Sci
2002;44:165–71.
23. Yamazaki M, Inukai M, Baba K, John MT.
Japanese version of the Oral Health Impact
Profile (OHIP-J). J Oral Rehabil 2007;34:
159–68.
24. Slade GD, Spencer AJ. Development and
evaluation of the Oral Health Impact Profile.
Community Dent Health 1994;11:3–11.
25. Locker D. Measuring oral health: a concep-
tual framework. Community Dent Health
1988;5:3–18.
26. Study protocol for the World Health Orga-
nization project to develop a quality of life
1519
assessment instrument (WHOQOL). Qual
Life Res 1993;2:153–9.
27. Adulyanon S, Vourapukjaru J, Sheiham A.
Oral impacts affecting daily performance in
a low dental disease Thai population. Com-
munity Dent Oral Epidemiol 1996;24:385–9.
28. Leão A, Sheiham A. Relation between clini-
cal dental status and subjective impacts on
daily living. J Dent Res 1995;74:1408–13.
29. Atchison KA, Dolan TA. Development of the
Geriatric Oral Health Assessment Index. J
Dent Educ 1990;54:680–7.
30. Ide R, Tsutsui A, Yamaoto R, Ueno K,
Tsuneoka M, Mizoue T, et al. Evaluation
of dental health-related quality of life – the
reliability of the Japanese edition of Oral
Health Impact Profile. J Dent Health
2002;52:36–42. [in Japanese].
31. Kuboki T, Ichikawa T, Baba K, Hideshima
M, Sato Y, Wake H, et al. A multi-centered
epidemiological study evaluating the reli-
ability of the treatment difficulty indices
developed by the Japan Prosthodontic Soci-
ety. J Prosthodont Res 2012;56:71–86.
32. Broder HL, Slade G, Caine R, Reisine S.
Perceived impact of oral health conditions
among minority adolescents. J Public Health
Dent 2000;60:189–92.
33. Oliveira CM, Sheiham A. Orthodontic treat-
ment and its impact in oral health-related
quality of life in Brazilian adolescents. J
Orthod 2004;31:20–7.
34. Takatsuji H, Kobayashi T, Kojima T, Hasebe
D, Izumi N, Saito I, et al. Effects of orthog-
nathic surgery on psychological status of
patients with jaw deformities. Int J Oral
Maxillofac Surg 2015;44:1125–30.
35. Stagles C, Popat H, Rogers S. Factors influ-
encing patient-reported quality of life in
pretreatment orthognathic surgery patients.
Angle Orthod 2016;86:331–6.
Address:
Kana Kurabe
Division of Reconstructive Surgery for Oral
and Maxillofacial Region
Department of Tissue Regeneration and
Reconstruction
Niigata University
Graduate School of Medical and Dental
Sciences
2-5274 Gakkocho-Dori
Niigata 951-8514
Japan
Tel: +81 025 227 2880
Fax: +81 025 223 6516
E-mail: k-kurabe@dent.niigata-u.ac.jp