Comparison of the quality of life changes of patients receiving sagittal split ramus osteotomy or intraoral vertical subsigmoid osteotomy for mandibular prognathism

Abstract

Objective: To investigate and compare the effect of two orthognathic procedures for mandibular setback, namely, sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO), on oral health, mental- and physical health-related quality of life across time.

Materials and methods: Patients with mandibular prognathism and planned for orthognathic surgery were recruited in this study. Patients were randomized into two groups (IVRO and SSRO groups). Quality of life (QoL) was assessed with the 14-item Short-Form Oral Health Impact Profile (OHIP-14) and the 36-item Short-Form Health Survey (SF-36) preoperatively (T₀), postoperative 2 weeks (T₁), 6 weeks (T₂), 3 months (T₃), 6 months (T₄), 12 months (T₅), and 24 months (T₆). A comparison of OHIP-14 and SF-36 scores between two groups was conducted.

Results: Ninety-eight patients (49 SSRO group, 49 IVRO group) participated in this study. There was no significant difference in OHIP-14 scores between SSRO and IVRO throughout the treatment process. SSRO group had significant reduction of OHIP-14 score (i.e., improving oral health-related QoL) since postoperative 2 weeks, whereas IVRO group had significant reduction since postoperative 6 weeks. Starting from postoperative 3 months, the oral health-related QoL of both groups was already significantly better than the baseline level and continued to steadily improve afterwards. For SF-36, both groups had increased physical health summary score starting from postoperative 2 weeks, indicating an early and gradual recovery of physical health-related QoL. The mental health summary score of the SSRO group began to increase from postoperative 2 weeks, but that of the IVRO group only began to increase from postoperative 6 weeks. Patient age at the time of surgery was positively correlated with OHIP scores in the postoperative period.

Conclusions: The study concludes that both SSRO and IVRO contributed to the improvement of QoL in the long term, but oral health- and mental health-related QoL of SSRO groups showed earlier improvement.

Clinical relevance: Undergoing orthognathic surgery at early ages is advised, as older age of patients appeared to have worse QoL.

Trial registration: Clinical trial registration number: HKUCTR-1985. Date of Registration: 14 Apr 2015.

Keywords: Dentofacial deformity; Intraoral vertical ramus osteotomy; Orthognathic surgery; Quality of life; Sagittal split ramus osteotomy.