Impact of orthognathic surgery on quality of life: a comparison between orthodontics-first and surgery-first approaches.

The aim of this study was to compare the impact that the orthodontics-first approach and the surgery-first approach have on quality of life, anxiety, and depression in patients treated for dentofacial deformities. Data were collected on 32 patients (aged 17-47 years) who were all treated at a single multidisciplinary orthognathic clinic. They completed a 22-item Orthognathic Quality of Life Questionnaire (OQLQ), a seven-item Generalised Anxiety Disorder (GAD-7) questionnaire, and a nine-item Patient Health Questionnaire (PHQ-9), at one week preoperatively (T1), and at six weeks (T2) and six months (T3) postoperatively. Quality of life was significantly better in the surgery-first group preoperatively (p=0.010, ES=0.96). The mean score and the individual domain scores of the OQLQ showed significant improvements at six weeks and six months postoperatively. The facial aesthetic domain showed the largest improvement (orthodontics-first group: ES=2.5; surgery-first group: ES=2.2). Patients in the orthodontics-first group had a poorer quality of life and greater deterioration in social life immediately before surgery. Postoperatively, the scores for anxiety and depression did not reduce significantly in either group. Our results do not support the assumption that all psychological aspects of a patient's life improve after orthognathic surgery. The surgery-first approach eliminates the deterioration in social activities that is associated with preoperative orthodontic decompensation.