Recovery After Orthognathic Surgery: Short-term, Health-related Quality of Life Outcomes

Objective: This prospective study assessed patient perception of recovery and quality of life for 90 days following orthognathic surgery using a medical health daily diary.

Methods: 174 patients, (age 14 to 53) scheduled for orthognathic surgery (1 or 2 jaw procedure; semi-rigid internal fixation) for correction of a dentofacial disharmony, were recruited. Post-operatively, most patients wore inter-occlusal elastics and had a soft diet restriction for 6 weeks. Each patient completed a 20-item health instrument, OSPostop, each post-surgery day (PSD) for 90 days. Subjects recorded perceived time to recovery in four domains: post-surgical sequelae, discomfort/pain, daily activities, and oral function. Discomfort/pain was scored on a 7, and all other outcomes on a five point Likert-like scale.

Results: Subjects were predominately female (65%), Caucasian (84%), and young adults (median age = 19 years). 40% had osteotomies in both jaws. In general, post-surgical sequelae except for swelling resolved within the first week. At PSD 15, 25% reported some problem with swelling; of those, the problem was substantial (score of 4 or 5) for 10%. By the end of 3 weeks, over 90% of subjects had discontinued using pain medications and reported resolution of discomfort/pain. By the end of week three, 75% of subjects reported no problem with routine activities, but return to recreational activities took longer (75% by day 45). Problems with eating, chewing, and opening took the longest to resolve, approximately 6 to 8 weeks. Seventy-five percent reported no problems with mouth opening by PSD 45, but difficulties/discomfort with chewing continued until PSD 60 for the majority of subjects.

Conclusions: Patient based time to recovery estimates can assist clinicians in providing realistic post-operative expectations for patients. This allows patients to make a more informed treatment decision and improves the peri-operative experience. Supported in part by NIH R01 DE005215.