Do Patients Detect Changes in Breathing After Orthognathic Surgery?

Abstract

Orthognathic surgery addresses facial aesthetics and function in patients with dentofacial deformities. It is associated with changes in upper airway volume (UAV). If changes in UAV are perceived by asymptomatic patients is unclear. The purpose was to measure associations between changes in UAV and patient-reported benefits using patient-reported outcome measures. A sample presenting dentofacial deformities without reported breathing problems undergoing orthognathic surgery was retrospectively studied. Patients aged 18-30years with 12-month follow-up were included. Patients with systemic disease, drug abuse, mental health disorder, or temporomandibular joint dysfunction were excluded. The predictor variable was changes in UAV measured in 3-dimensional computed tomography. Subjects were grouped into increased or decreased UAV. The primary outcome variable was changes in health-related quality of life measured with Oral Health Impact Profile 49 (OHIP-49). Weight, height, age, sex, and sub-scaled OHIP-49 were registered. Cephalometric measurements of hard tissue movements were recorded. Mean, standard deviation, and a level of statistical significance at P<.05 were used. Differences in OHIP-49 were compared using unpaired t-test. The correlation between covariates and outcomes was analyzed using the Spearman's rank test. Analysis of covariance between the predictor and outcome, adjusted for covariates (body mass index), was performed. Fifty-four subjects with a mean age of 20.89years and 52% males were enrolled. The mean change in UAV was 0.12cm3 (standard deviation [SD] 9.21, P=.93) with a mean absolute deviation of 7.28cm3 (SD 5.54). The mean change in OHIP-49 score was 20.93 (SD 28.90). Twenty-seven (50%) subjects had increased UAV (7.4cm3, SD 6.13) and the other had decreased (-7.17cm3, SD 5.01) (P=.01). At follow-up, equal levels of mean OHIP-49 score were found, but because of a baseline difference (15.74, P=.048), the subjects with and without increased UAV improved in OHIP-49 score 13.04 (SD 30.53) and 28.81 (SD 25.33), respectively (P=.04). Because equal levels of OHIP-49 score at follow-up, changes in UAV could not be associated with patient-reported health-related quality of life. Patient-reported outcome measure evaluations of orthognathic surgical treatment for airway obstruction should be performed in patients with a perceived impairment.