Satisfaction with Facial Appearance following Bimaxillary Orthognathic Surgery

Abstract

Patient-reported outcomes (PRO) questionnaires allow clinicians to collect data reflecting the healthcare experience directly from the patient's perspective. PRO can be used to collect information about outcomes that matter to patients such as quality of life or satisfaction with appearance after a cosmetic procedure. That information is relevant to patients with dentofacial deformities treated with orthognathic surgery because primary outcomes for such procedures include improved occlusion and facial harmony. However, the literature is scarce regarding patient-reported cosmetic outcomes after orthognathic surgery. The aim of this study was to assess satisfaction with facial appearance following bimaxillary orthognathic surgery using the FACE-Q, a PRO instrument developed for patients undergoing facial esthetic surgery. Thirty patients presenting with Class II skeletal deformities were recruited at CHU de Quebec - Université Laval and asked to answer a French version of the FACE-Q questionnaire focusing on orthognathic surgery relevant scales including “Satisfaction with Facial Appearance,” “Satisfaction with Lower Face and Jawline,” and “Satisfaction with Chin." Statistical analysis included Bowker's test of symmetry for the evolution of individual items and a mixed linear regression adjusting for the following covariates: difference between pre- and postoperative FACE-Q scores for each scale, age, sex, procedure, and vertical diagnosis. Results showed significantly improved FACE-Q scores for satisfaction with facial appearance (+17.42, P < .0001), nose (+6.13, P < .017), lower face and jawline (+34.58, P < .0001), and chin (+27.94, P < .0001) after surgery. Scores for satisfaction with cheekbones (+4.26, P = .1868) and nostrils (+6.25, P = .248) did not differ significantly. Patients were divided in 2 groups according to the procedure performed (bimaxillary surgery only or bimaxillary surgery in combination with genioplasty), but this did not significantly influence patient's satisfaction for facial appearance, lower face and jawline, or chin. Patients with hyperdivergent profiles were less satisfied with their chin appearance than normodivergent patients both before and after surgery (P = .024). Covariates such as age and sex did not have a significant effect on satisfaction scores. Overall, 86% of patients reported an improvement regarding their facial profile. Alar base widening was not an issue after Le Fort I osteotomies, as postoperative scores for alar base width were not statistically significant (P = .8312). A majority of patients (64%) thought their jawline was more defined after surgery, and most (81%) considered their chin suited their face better. In conclusion, bimaxillary orthognathic surgery for Class II positively affected patient satisfaction with facial appearance as demonstrated with higher postoperative FACE-Q scores. Patient-reported outcome measures such as the FACE-Q offer valuable information to the clinician wishing to have a better outlook from the patient's perspective in order to offer more patient-centered care. This type of tool can facilitate communication with the patient and help increase the surgeon's understanding of the impact of bimaxillary surgery on the patient's life.