No difference in quality of life between rigid and non-rigid fixation used in BOSS osteotomy

Abstract

Objective To compare the effects of rigid and wire fixation on health-related quality of life following surgical mandibular advancement in patients with Class II malocclusions. Design A multi-site randomised controlled trial. Intervention One hundred and forty patients aged at least 13 (referred for surgical correction of a class II dentofacial malocclusion by orthodontists) were randomised to receive wire (n=63) or rigid (n= 64) fixation. Strict exclusion criteria were used. Age, overjet, EPI Neuroticsm score, gender and ethnicity were analysed. Outcome measures Quality of life was measured using the Sickness Impact Profile, a generic measure of health-related quality of life, and the Oral Health Status Questionnaire, a specific measure of oral health and function designed for use with orthognathic surgery patients. Patients were evaluated before application of orthodontic appliances, approximately 2 weeks before surgery; and 1 week, 8 weeks, 6 months, 1 year, and 2 years after surgery. Results Neither the Sickness Impact profile or the Oral Health Status Questionnaire revealed a statistically significant difference in quality of life between wire and rigid fixation at any time period. Conclusion The authors point out that the implicit assumption in orthognathic surgery, as in all surgery, is that patients accept short-term risks and discomforts in return for long-term benefits in terms of length or quality of their lives. They conclude the health-related disability associated with Class II malocclusion is modest compared with many other medical conditions. Nonetheless, orthognathic surgery patients exhibit progressive and statistically significant improvement in health-related quality of life across a wide variety of functional domains, regardless of the fixation method used. This study did not involve an untreated control group so the quality of life observed in the study subjects cannot be compared with that which might occur in untreated patients.