Quality of Life Treatment Outcomes of Class III Skeletal Patients after Bimaxillary Osteotomies

Abstract

Introduction: Bimaxillary osteotomies are commonly done to correct dentofacial deformities. Osteotomy at the LeFort I level and bilateral sagittal split osteotomy (BSSO) are commonly used in combination to treat patients with Class III skeletal dentofacial deformities. However, few studies are available which assess the treatment outcome measured in terms of quality of life (QoL) of Class III skeletal patients after bimaxillary osteotomies. This study aims to evaluate the long-term benefits of bimaxillary osteotomies, measured in terms of QoL outcomes of Class III skeletal patients at two (2) years post-surgery. Methods: This study was conducted at the National Dental Centre Singapore and selected patients were given 2 questionnaires each based on Oral Health Impact Profile (OHIP-14) and Orthognathic Quality of Life Questionnaire (OQLQ). The patients were told to report each question using a Likert-type scale and their perception for each question before and after surgery. Results: A total of 41 patients were recruited in this study, of which 23 were males and 18 were females. Their age ranged from 17 to 32 years old at the time of surgery and the median age was 20 years 2 months. All the patients in this study were Chinese. All the patients underwent LeFort I maxillary procedure in addition to BSSO setback surgery. The Wilcoxon Signed Rank test was used for evaluation of the statistics. There were significant changes to both OHIP-14 and OQLQ scores (p<0.001) two-years post-operatively. All the OHIP-14 domains, functional limitation (p<0.001), physical pain (p<0.001), psychological discomfort (p<0.001), physical disability (p=0.001), social disability (p<0.001) and handicap (p<0.001), were significantly decreased when compared to pre-surgical scores. The OQLQ domain scores, social aspects of deformity (p<0.001), facial aesthetics (p<0.001), oral function (p<0.001), and awareness of facial deformity (p=0.013), were also significantly lower two-years post-operatively. Conclusion: Treatment outcomes measured in terms of QoL were significantly improved in Class III skeletal patients after bimaxillary osteotomies. The function, psychosocial and facial aesthetics improved significantly after surgery and these aspects continued well into two-years post-surgery. The inclusion of QoL as a routine treatment outcome measure in orthognathic surgery would be beneficial in clinical profiling of patients, decision making and evaluating the efficacy of the procedure. It could potentially be used to evaluate surgical complications, arising from orthognathic surgery, and its impact on QoL in patients. More studies would be required to establish its correlation in the future.