Orthognathic surgery in class II patients: a longitudinal study on quality of life, TMD, and psychological aspects.

Abstract

To evaluate, longitudinally, the impacts of orthognathic surgery in patients with skeletal class II malocclusion on oral health-related quality of life (OHRQoL), temporomandibular disorders (TMD) and psychological symptoms. Forty-three patients with skeletal class II malocclusion who were submitted to orthognathic surgery were evaluated during their preoperative and postoperative periods. They answered the short version of the Oral Health Impact Profile (OHIP-14) and were also diagnosed according to Axes I and II of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The evolution of OHRQoL and TMD before and after surgery was verified, and the relationships among these variables were found through statistical analysis using Wilcoxon, McNemar, chi-square, and Mann-Whitney tests, with a 5% significance level. The median of the overall OHIP-14 score and five domains decreased after orthognathic surgery (p< 0.05), the functional limitation domain increased (p= 0.014), and the physical disability domain did not show an association (p= 0.133). There were improvements in articular pain (p= 0.016), chronic pain (p= 0.019), and nonspecific physical symptoms excluding pain (p= 0.013). In addition, an association was found between poorer OHRQoL (overall scale and domains) and the Axis II variables of the RDC/TMD (p< 0.05). Orthognathic surgery improved perceived OHRQoL, articular pain, and chronic pain. The conditions of Axis II of the RDC/TMD interfered with OHRQoL postoperatively. Although orthognathic surgery improves QoL and some TMD conditions in skeletal class II patients, poorer postoperative outcomes are observed when psychological conditions are present.