Identity change as a consequence of oral surgery.

The article stresses the need to consider the psychological significance of craniofacial deformities and their correction. The paper reviews some basic concepts of identily and self-image, particularly as they apply to the face and specifically in patients suffering facial disfigurement. The psychological problems of the repair of the disfigurement are also discussed. The continuity of body-image, self-concept and identity is presented. People with craniofacial deformities have a need to reorganize body-image and correction of the deformity requires another reorganization. A change in selfimage coincident with a change physically requires time and may require psychotherapy. The severity of the handicap of a facial disfigurement is presented. The importance of the significance of the deformity and the influence of social forces are outlined as determinates of the emotional impact. The "loss" is dealt with by such defense mechanisms as denial and undoing, both pathologic defenses which frequently break down. After reconstructive surgery, personality change does not occur simultaneous with physical change. The repair, potentially, can produce a depression related to the loss of the old identity, as well as a psychosis. Frequently, fantasied expectations of the patient can lead to much difficulty. The repair may also confront the patient with new sensory experiences. Acceptance of the change in identity is more readily accomplished by the young as opposed to the old. Problems of facial disfigurement and the work involved psychologically as a consequence of the repair of the disfigurement are illustrated in a case presentation of prognathous mandible. The need for the patient to receive proper support and help in integrating the new facial image and the need to concretize expectations for the patient, preoperatively, are stressed since these are often grossly unrealistic.