Knowledge, Attitude, and Awareness of Orthognathic Surgery among Orthodontic Patient-Prospective Study.

AIM: The aim of the current survey was conducted to assess the knowledge, attitude, and awareness regarding orthognathic surgery among orthodontic patients.
MATERIALS AND METHODS: This is cross-sectional web-based questionnaire survey conducted among orthodontic patients in Tamil Nadu. The self-administered questions related to awareness of orthognathic surgery were collected from 500 subjects. The statistical analysis was done using the Statistical Package for the Social Sciences (V 22.0). The frequency distribution was computed.
RESULTS: This survey revealed that 466 (93.2%) respondents had awareness about the role of orthognathic surgery. 332 (66.4%) had given the correct responses related to differentiating skeletal and dental malocclusion, 454 (90.6%) had the awareness of risk factors associated with orthognathic surgery and 40 (7.0%) were experienced regarding the procedure.
CONCLUSION: The result of the current study showed that it clearly implies that the population was aware of orthognathic surgery as a treatment modality for correcting skeletal deformities. Copyright:

INTRODUCTION

To understand and evaluate patient perceptions about malocclusion in orthodontics is more vital for successful orthodontic treatment, for the reason that they are innermost to the assessment of patient needs and satisfaction regarding treatment. Due to this alarm, the consequence of malocclusion on patient quality of life (QOL) has been developed.[1] Numerous treatment strategies have been recommended to correct dentofacial deformities. Orthognathic surgery coupled with orthodontic treatment is the gold standard combination for the correction of moderate-to-severe deformities.[2]

The objective of the treatment is to attain functional occlusion, facial and dental symmetry, healthy orofacial structures, and stability between the dental arches.[3] In addition, a few studies have found that dentofacial deformities not only affect the occlusal and functional aspects of the stomatognathic system but it also make worse psychosocial and esthetic well-being of patients.[4] Numerous studies have done to investigate the psychological status of the sample and they compared two groups, group of the population requires orthognathic treatment compared with those of a control group with normal population and the outcome on this subject has been contradictory. Few studies have shown that individuals looking for orthognathic treatment options have more psychological problems compared to other set of population.[5678] However, other sets of data suggest no difference in the psychological profile of the patients needed orthognathic surgery.[910]

The earlier study compared both group skeletal II and skeletal III orthognathic patients and concluded that the skeletal III patients had lack of self-confidence about their facial appearance.[11] The need for improvement in aesthetics and alleviation of functional problems are the two most significant motives of patients who ask for orthognathic surgery. The enhancement of facial appearance brought about by orthognathic surgery results in enhancement in psychosocial benefit. Orthognathic surgery outcome in subjective judgment of function, appearance, health, and interpersonal relations that was beyond than untreated control groups.[1213]

There is no literature found to describe about knowledge of orthognathic surgery among patients undergoing orthodontic patient in Tamil Nadu. The purpose of the study was to evaluate the knowledge of orthognathic surgery among patients undergoing orthodontic treatment.

MATERIALS AND METHODS

A cross-sectional descriptive questionnaire survey was conducted among the patient undergoing orthodontic treatment using an online questionnaire form. A web-based questionnaire form was developed with the help of Google form from the Google site. Pretesting of the questionnaire was done randomly on 10 orthodontic patients. The questionnaire was finalized after equivocal and inappropriate questions were altered. A pilot study was conducted to determine the sample size. After, conducting pilot study, the final sample size arrived was 500 subjects. Pretesting and pilot study sample was not included in the main sample size. A structured questionnaire was framed related to the knowledge of orthognathic surgery and online questionnaire link was forwarded to orthodontic patients. A convenient sampling technique was used. All participants completed questionnaires with the duration of 3 months from October to December 2020. The questionnaires were completed by 500 participants and their responses were recorded in Google form, of which 500 were decided after eliminating the inaccuracies. After a brief introduction on the purpose and intent of the study, an informed consent form was obtained from every participant involved in the survey. Confidentially of the information provided was assured and participation was purely voluntary. The inclusion criteria for present study includes those who undergoing orthodontic patient with dentofacial deformity. The patient who were not willing to participate in the study and unable to give informed consent were excluded. The data collected were entered into Microsoft Office Excel and analyzed by using the Statistical Package for Social Sciences (SPSS) (V 22.0) (SPSS Inc., Chicago, Illinois, USA). The frequency distribution was computed.

RESULTS

Among the 500 study subjects, 285 (57%) were males and 215 (43%) were females [Table 1].

Table 1

Distribution of study participantsaccording to gender

Gender	Frequency (%)
Male	285 (57.0)
Female	215 (43.0)
Total	500 (100.0)

Among the 500 study participants, 182 (36.4%) were included in the age group of 15–20 years, 216 (43.2%) were 20–25 years and 102 (20.4%) were 25–30 years [Table 2]. Among the 500 study subjects, 466 (93.2%) had knowledge about orthognathic surgery, whereas 34 (6.8%) had don't know about [Table 3].

Table 2

Distribution of study participantsaccording to age of the patient

Years of experience	Frequency (%)
15-20	182 (36.4)
20-25	216 (43.2)
25-30	102 (20.4)
Total	500 (100.0)

Table 3

Distribution of study participantsaccording to correct response for the knowledge of orthognathic surgery

Responses	Frequency (%)
Yes	466 (93.2)
No	34 (6.8)
Total	500 (100.0)

Among the 500 study participants, 332 (66.4%) had given the correct responses related to differentiating skeletal and dental malocclusion whereas 168 (33.6%) had given the incorrect responses of differentiating skeletal and dental malocclusion [Table 4].

Table 4

Distribution of study participantscorrect response for differentiating skeletal and dental malocclusion

Responses	Frequency (%)
Yes	452 (90.4)
No	48 (9.6)
Total	500 (100.0)

Among the 500 study participants, 454 (90.6%) had the awareness of risk factors associated with orthognathic surgery, whereas 46 (9.4%) had do not know about [Table 5].

Table 5

Distribution of study participantsregarding the awareness of risk factors associated with orthognathic surgery

Responses	Frequency (%)
Yes	454 (90.6)
No	46 (9.4)
Total	500 (100.0)

Among the 500 study participants, 33 (6.6%) reported hemorrhage, 84 (16.8%) reported unpleasant esthetics, 367 (73.4%) of population responded to bone fracture and 16 (3.2%) suggested relapse as common risk factor [Table 6 and Figure 1].

Table 6

Distribution of study participantsregarding the major risk factors associated with orthognathic surgery

Major risk factor	Frequency (%)
Hemorrhage	33 (6.6)
Unpleasant esthetics	84 (16.8)
Bone fracture	367 (73.4)
Relapse	16 (3.2)
Total	500 (100.0)

Figure 1

Distribution of study participantsregarding the major risk factors associated with orthognathic surgery

Among the 500 study participants, 460 (93%) were anxious when heard about the procedure of orthognathic surgery, whereas 40 (7.0%) were not anxious regarding the procedure [Table 7].

Table 7

Distribution of study participantsregarding anxious

Responses	Frequency (%)
Yes	460 (93)
No	40 (7.0)
Total	500 (100.0)

Among the 500 study subjects, 40 (7.0%) were experienced regarding the procedure, whereas 466 (93%) never had previous history of orthognathic surgery [Table 8].

Table 8

Distribution of study participantsregarding previous experience of orthognathic surgery

Responses	Frequency (%)
No	466 (93.2)
Yes	34 (6.8)
Total	500 (100.0)

DISCUSSION

The current study was designed to assess the knowledge, attitude, and perception regarding orthognathic surgery among 500 patients undergoing orthodontic patients. Initially demographic and experience data was focused. Among the 500 patients, who participated 57% (285) were male and 215 (43%) were females. Min-Ho Jung in 2016 evaluated the self-esteem and QOL of female adult patients with severe malocclusion undergoing orthognathic surgery and the result showed that female adult orthognathic patients proved significant impairments in QOL and SE compared with those with mild malocclusion.[14] Among the 500 study subjects, 43.2% were 20–25 years of age. Previous study by Garvill and colleagues used data of the clinical interview and concluded that 63% of their patients with a median age of 27 had been unconstructively affected by their facial deformity and 44% declared that their appearance had weakened their social relationships.[15]

Among 500 study participants, 332 (66.4%) had given the correct responses related to differentiating skeletal and dental malocclusion. The sample of 454 (90.6%) had the awareness of risk factors related to orthognathic surgery. Distribution of study subjects regarding the major risk factors related to orthognathic surgery. Among the 500 study subjects, 33 (6.6%) reported hemorrhage, 84 (16.8%) reported unpleasant esthetics, 367 (73.4%) of population responded to bone fracture and 16 (3.2%) suggested relapse as common risk factor. Orthognathic surgery possess risk factors similar to any other type of surgical procedure are nerve injuries with altered sensitivity, postoperative malocclusion, infection, unwanted fracture or bad split, non-union of bone segments, temporomandibular joint disorders, hemorrhage, condylar resorption, relapse, nasal abnormalities, bone necrosis, soft tissue or periodontal injuries, dental injuries, unsatisfactory esthetic result, suture dehiscence, and fixation material failure.[1617]

Maximum number of population 460 (93%) were anxious when heard about the procedure of orthognathic surgery, whereas 40 (7.0%) were not anxious regarding the procedure. Anxiety is measured as normal part of the preoperative experience.[18] It is mandatory to maintain a bare minimum anxiety level in the preoperative period, for the reason that if patients are anxious, they may be incapable to retain significant home-care instructions, experiencing an unknown environment, loss of control, results of redundant diagnoses, failure of identity, indecision about postoperative recovery.[19] Among the 500 study subjects, 40 (7.0%) were experienced regarding the procedure, whereas 466 (93%) never had previous history of orthognathic surgery. Jan Rustemeyer et al. conducted study on observation of improvement after orthognathic surgery and concluded that treated orthognathic surgery patients gladly appreciated the change in their improved appearance and were extremely happy with the outcome.[20]

CONCLUSION

The management of dentofacial abnormalities by orthodontists and oral and maxillofacial surgeons has knowledgeable and play a vital role for tremendous growth in recent years. Based on the current study, showed that it clearly implies that the population was aware of orthognathic surgery as a treatment modality for correcting skeletal deformities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.