Does Maxillomandibular Advancement Change the Lay Perception of Personality and Emotional Traits?

Abstract

Maxillomandibular advancement (MMA) is an effective treatment for obstructive sleep apnea (OSA); however, the esthetic outcome is a frequent source of concern. The purpose of the present study was to determine whether MMA altered the lay perception of patients' personality traits and emotional expressions. We conducted a survey of the lay public recruited through Qualtrics Research Services (available at: www.qualtrics.com). Clinical photographs were obtained from patients at our institution who had undergone MMA with advancement genioplasty for OSA. Survey respondents were randomized to either pre- or postoperative photograph sets and were asked to rate the clinical photographs on 6 personality and 6 emotional traits using 7-point Likert scales. The independent predictor was the preoperative or postoperative status. The dependent outcomes were the emotional and personality trait ratings. Multivariate analyses of variance were conducted to determine whether MMA had a significant effect on 2 or more emotional or personality traits. Significant results underwent post hoc testing with Bonferroni correction to determine which individual traits were affected. A total of 670 individuals accessed the published survey, of whom 210 (31.3%) completed the task and had their responses included in the final sample. No significant differences were found in age (P=.54), gender (P=.31), or ethnicity (P=.26) between the included and excluded respondents. Within the final sample, 110 participants were assigned to the preoperative image set and 100 to the postoperative set. After MMA, patients were observed to have significantly different emotional expressions (P<.01) but not personality traits (P=.12). Post hoc testing found patients to be significantly less sad (P<.01) and less disgusted (P<.01). MMA was accompanied by favorable changes in the lay perceptions of emotional, but not personality, traits. Patients considering surgery should recognize that their outward appearance will not be negatively affected by a large functional advancement.