Relationship Between Patients’ Perceptions of Postsurgical Sequelae and Altered Sensations After Bilateral Sagittal Split Osteotomy

Abstract

Following orthognathic surgery, patients use qualitatively different words to describe altered sensation on their face. These words indicate normal, hypoesthetic, paresthetic, or dysesthetic sensations and so reflect the intrusiveness of the altered sensation. The objective of this study was to examine the relationship between the intrusiveness of the altered sensation and the extent to which it and the associated impairment in facial function were perceived to be a problem in the lives of the patients. One hundred forty-six patients who had a mandibular osteotomy with or without a maxillary procedure were included. Word choice data were obtained during patients' assessment of spontaneous and evoked facial sensations before surgery and at 1 week, 1, 3, and 6 months after surgery and the difficulty or problem levels associated with the altered sensation itself (PAS) and facial functions or oral behaviors in every day life (PAF) were obtained from validated questionnaires. Stratified-by-subject repeated measures Mantel Haenszel correlation statistics were calculated to assess the associations between the intrusiveness of the altered sensation and the problem levels associated with the altered sensation and with the facial functions. On average, the perception of the difficulty with each of the PAS and PAF items decreased from 1 week to 6 months after surgery (all P values < .0001). Patients reported more difficulty in every day life related to the effect of the altered sensations than they did related to the effect on facial functions. The correlations of the intrusiveness of the altered sensation and problems with altered sensations (PAS) were stronger overall and at each visit than the correlations with problems of altered facial function (PAF). Although the correlation coefficients tended to increase in value from 1 week to 6 months postsurgery for the PAF items, the increase was proportionately greater for the PAS items. The difficulties in everyday life perceived by patients following orthognathic surgery caused by altered sensations and, to a lesser extent, altered facial function are positively related to the type of altered sensation experienced. The extent of the difficulty follows the intrusiveness level: patients whose sensations are uncomfortable or painful report the most difficulty followed by those who experience nonpainful sensations that are not normally present (ie, positive symptoms), then those who experience only a simple loss in sensation (ie, negative symptoms). Subjective difficulty with altered sensation reflects, in part, its qualitative nature; whereas subjective difficulty with function may reflect the extent of loss in sensory innervation.