Eur J Oral Sci 2017; 1–8 Ó 2017 Eur J Oral Sci

DOI: 10.1111/eos.12371 European Journal of

Printed in Singapore. All rights reserved
Oral Sciences

Dyonne L. M. Broers1,2 ,
Do patients benefit from orthognathic Geert J. M. G. van der Heijden2 ,
Frederik R. Rozema3,4 ,
surgery? A systematic review on the Ad de Jongh1,2,5,6
1
Centre for Special Care Dentistry,

effects of elective orthognathic Amsterdam; 2Department of Social Dentistry,

University of Amsterdam and Vrije
Universiteit, Amsterdam; 3Department of Oral

surgery on psychosocial functioning Medicine, Academic Centre for Dentistry

Amsterdam, University of Amsterdam and
Vrije Universiteit, Amsterdam; 4Department of

and patient satisfaction Oral and Maxillofacial Surgery, Academic

Medical Centre, University of Amsterdam,
Amsterdam, the Netherlands; 5School of
Health Sciences, Salford University,
Manchester; 6Institute of Health and Society,
Broers DLM, van der Heijden GJMG, Rozema FR, de Jongh A. Do patients benefit University of Worcester, Worcester, UK
from orthognathic surgery? A systematic review on the effects of elective orthognathic
surgery on psychosocial functioning and patient satisfaction.
Eur J Oral Sci 2017; 00: 1–8. © 2017 Eur J Oral Sci
The main purpose of this systematic review was to determine the current state of
evidence regarding patient satisfaction with, and the impact of, orthognathic sur-
gery on psychosocial functioning of patients 17 yr of age and older. A secondary
aim was to determine whether individuals with psychiatric disorders and mental
health conditions are more likely to be dissatisfied with the treatment outcome
than those without. We systematically searched PubMed, PsycInfo, and Embase
for relevant studies (up to 6 June 2016). After selection of articles we determined
Dyonne L. M. Broers, Academic Centre for
the Directness of Evidence (DoE) and Risk of Bias (RoB). We identified 3,948
Dentistry Amsterdam, Gustav Mahlerlaan
studies (1,053 studies in Pubmed, 2,023 in Embase, and 872 in PsycInfo). Of 3004, 1081 LA Amsterdam, the Netherlands
these, 87 remained after screening of title and abstract, while after full-text screen-
ing only nine remained for DoE and RoB assessment. All nine studies had a high E-mail: d.l.m.broers@acta.nl
RoB and a low or moderate DoE. The quality of the methods of studies, pub-
lished to date, on the effects of orthognathic surgery on patient satisfaction or the Key words: behavioral sciences; body
psychosocial impact carry a high RoB. Therefore, these do not allow inferences dysmorphic disorder; osteotomy;
on the effects of orthognathic surgery on patient satisfaction or their psychosocial psychopathology
functioning. Accepted for publication June 2017

Orthognathic surgery aims to improve function and
physical appearance and therefore can also partly be
considered as cosmetic surgery. It has been estimated
that approximately 5% of the current UK and US pop-
ulation suffers from dentofacial deformities that are not
receptive to orthodontic treatment, whereby orthog-
nathic surgery can be considered (1, 2). It has been
reported that 2,718 orthognathic surgical procedures
were performed in the UK in 2012 compared with
10,345 in the USA in 2008 (3, 4). This represents
0.004% of the current UK population and 0.003% of
the current US population.
While the reasons for orthognathic surgery may vary,
the most prevalent indications (approximately 70%)
seem to be functional limitations, problems with
appearance, and temporomandibular joint dysfunction
(5–7). In cases where one has good reasons to be
dissatisfied about oneself or one’s appearance, it is
likely that surgery will lead to a positive change in
esthetic appearance and consequently may result in
improved psychosocial well-being, self-confidence, and
self-esteem. Although plastic surgeons report high levels
of satisfaction among their patients after cosmetic sur-
gery in general (almost 90%) (8–10), it is unknown
how frequently patients who seek orthognathic surgery
for cosmetic reasons are dissatisfied with their appear-
ance following surgery.
There is a lack of information regarding whether
orthognathic surgery will indeed make people happier
and more satisfied with their appearance, and whether
orthognathic surgery improves their well-being and qual-
ity of life. This may hold true particularly for individuals
suffering from psychological difficulties (such as a low
self-esteem) and mental health conditions. For example,
Body Dysmorphic Disorder (BDD) has been identified
as an important driver for seeking surgical treatment and
has been found to be associated with a tendency to be
dissatisfied with the result of cosmetic treatment (11, 12).
This may also hold true for other mental health condi-
tions or symptoms of psychopathology.
To the best of our knowledge, until now only two
systematic reviews have been published regarding the
2 Broers et al.
effects of orthognathic surgery on patient satisfaction
and the psychosocial impact of orthognathic surgery in
patients ≥17 yr of age (13, 14). Both reviews had a
somewhat different focus, and one did not apply a sys-
tematic or explicit method, such as the Preferred
Reporting Items for Systematic reviews and Meta-
Analyses (PRISMA) guideline to identify, select, and
critically appraise the studies (13). One review used
only a limited number of search terms and did not
include studies other than those written in the English
language (13), whereas the other review based its con-
clusions on eight studies, five of which had a high Risk
of Bias (RoB), and four made use of non-validated
measures (14).
In an effort to analyze the available literature and
draw reliable conclusions that could inform dentists
and oral surgeons in making decisions on individual
patients who may be eligible for orthognathic sur-
gery, we systematically reviewed the effects of orthog-
nathic surgery on patient satisfaction and
psychosocial functioning of patients ≥ 17 yr of age
using rigorous criteria. An additional aim was to
determine whether patients with psychiatric disorders
or other mental health problems would be more
likely to be dissatisfied with the treatment outcome
than those without.
Material and methods
On 6 June, 2016, we searched PubMed, PsychInfo, and
Embase for relevant publications. Relevant search terms
for orthognathic surgery, patient satisfaction, and psy-
chosocial functioning were used (Appendix S1). This sys-
tematic review is reported in accordance with the
PRISMA statement.
Inclusion and exclusion criteria
To be included, publications had to report on outcome
measures pertaining to psychosocial functioning or
specific aspects thereof (i.e. appearance and body
image, patient satisfaction, quality of life, psychological
functioning, self-esteem, depression, and anxiety) in the
follow up of orthognathic surgery in patients ≥ 17 yr
of age. The minimal follow-up period had to be
6 months. Only publications in English, German,
French, and Dutch, reporting original empirical data,
were included. Studies had to include a comparison (all
other treatments including orthodontic treatment only)
and report on follow-up with a prospective parallel
control group.
Studies only reporting effects of orthodontic treatment
were excluded, as were studies reporting on non-validated
outcome measures. Studies reporting only patient satisfac-
tion of a global generic nature (e.g. happiness with the sur-
gical result), dental factors (e.g. crowding) or physical
complaints (e.g. pain and numbness), or outcomes on
other aspects than treatment outcome (e.g. satisfaction
about hospital and staff), were also excluded. Finally, sys-
tematic reviews, studies based on (retrospective) hospital
chart data, case reports, and studies on animals were
excluded (Fig. 1).
Methods assessment
Directness of Evidence (DoE) concerns the applicability of
the study findings for answering the research question. It
concerns evaluation of:
(i) patients, notably those patients diagnosed with
dentofacial deformities who require additional treat-
ment following orthodontic treatment;
(ii) treatments, notably comparison of orthognathic sur-
gery with a control treatment (all other forms of
treatment including orthodontic treatment only); and
(iii) outcomes, notably measures pertaining to patient sat-
isfaction, psychosocial functioning, or specific aspects
thereof.
Assessment of RoB concerns evaluation of the internal
validity of a study and involves assessment of the risk of
selection bias and information bias. Assessment for risk of
selection bias concerns the following items: (i) random
allocation, (ii) concealed allocation of treatment, (iii) stan-
dardization of study procedures, and (iv) completeness of
reported data. Assessment for risk of selection of informa-
tion bias concerned: (i) blinding with respect to the nature
of treatment during outcome assessment and (ii) standard-
ization of outcome assessment (15).
All DoE or RoB items were rated as satisfied or not sat-
isfied. Criteria for assessment and rating of all RoB and
DoE items are listed in the legend of Table 1. When the
information reported allowed assessment, and the assess-
ment criteria were fulfilled, an item was rated as ‘satisfied’.
In all other cases (i.e. when no information was reported,
or when it was unclear or too ambiguous to allow assess-
ment) an item was rated as ‘not satisfied’.
Subsequently, studies were classified as having a high
DoE if they satisfied all three DoE items, moderate DoE
if they satisfied two DoE items, and low DoE if these sat-
isfied only one DoE item. Studies were classified as having
a low RoB if they satisfied all six items; as having a mod-
erate RoB if they satisfied both treatment allocation crite-
ria and at least two of the other criteria; and the
remainder were classified as having high RoB. Studies with
either or both low DoE or/and high RoB were excluded
from further review.
Retrieval and selection
The search was constructed and performed by one of the
reviewers (D.B.) with the assistance of three librarians.
After excluding duplicates, two reviewers (D.B., A.d.J.)
independently screened titles and abstracts and this led to
the retrieval of full texts for articles, which were then
assessed in toto. Reference lists of selected publications
were screened for titles not identified by our initial search.
The methods used in the selected studies were assessed by
three independent reviewers (D.B., G.v.d.H., and A.d.J.).
Initial disagreements between reviewers on selection and
assessment of methods were solved by discussion, and the
findings reported are based on their full consensus.
Results
Study selection
The initial search yielded a total of 3,948 citations
(Fig. 1); 1,053 studies were identified in Pubmed, 2,023

Fig. 1. Flow of information through the different phases of the systematic literature search.
in Embase, and 872 in PsycInfo. After excluding dupli-
cates and subsequent title and abstract screening, 245
publications remained. Of these, 163 were excluded fol-
lowing full-text reading, leaving 82 studies for inclusion
After screening of reference lists another four studies
were identified. Moreover, KIYAK (16) reported two
separate studies in her paper. Hence, 87 studies fulfilled
all eligibility criteria for further assessment of methods
and outcomes. The reference lists of these studies were
also checked for relevant articles and unpublished
manuscripts. During assessment of the methods, 39
studies were excluded because they reported on retro-
spective data from hospital charts or failed to include a
prospective parallel-control group. Another 39 studies
were excluded owing to inappropriate outcome mea-
sures (nine for no psychosocial functioning measure
and another 30 for no validated measure). Therefore,
we eventually report the DoE and the RoB for nine
studies.
Study characteristics
A summary of the characteristics of the trials
included is provided in Table 2. These trials differed
Effects of orthognathic surgery 3
considerably in their approach to the outcome
measure. Remarkably, the response rate was not
reported in four studies (16, 17–19); in one study
the reported response rate was low (34%) (20); in
another study the reported response rate was rather
high (89% of the surgery patients, 96% of the
orthodontic patients, 93% in the no-treatment
group) (21). Furthermore, the sample size was small
(n = 15) in one study (17), the follow-up period was
unknown in one study (18), and no exclusion criteria
were mentioned in one study (16). All studies were
prospective follow-up studies.
Directness of Evidence
Studies failed to satisfy DoE criteria when they
included syndromal patients, patients ≤16 yr of age,
or reported on orthognathic surgery for defects result-
ing from trauma or cancer. Studies satisfied DoE cri-
teria when the Peer Assessment Rating Index (PAR),
the index of orthodontic treatment need (IOTN), the
index of orthognathic functional treatment need
(IOFTN), or the index of complexity, outcome and
need (ICON) were reported as the outcome measure
4 Broers et al.

Table 1
Characteristics of the nine studies analyzed with respect to their fulfillment of the criteria for Directness of Evidence (DoE)* and
their Risk of Bias (RoB)†

Directness of Evidence Risk of bias

DoE Randomization/ Completeness RoB
Authors Patients Intervention Outcome score concealment Blinding of data score

ALVES E SILVA
et al. (17)
BAHERIMOGHADDAM
et al. (33)
KIYAK et al. (21)
KIYAK (Study II) (16)
LOVIUS et al. (18)
ØLAND et al. (20)
RUSTEMEYER &
GREGERSEN (19)
SCOTT et al. (30)
SILVOLA et al. (32)
? L H
+ L H
+ L H
? L H
+ L + H
+ + M + H
+ L NA H
+ L H
+ + M H

*Directness of Evidence is assessed by evaluation of: (i) Patients: are all patients with orthognathic surgery 17 yr of age or older, excluding
syndromal patients or patients treated with orthognathic surgery as a result of trauma or because of oncological defects? (ii) Intervention:
is orthognathic surgery carried out according to the Peer Assessment Rating Index (PAR Index), the index of orthodontic treatment need
(IOTN), the index of orthognathic functional treatment need (IOFTN), or the index of complexity, outcome and need (ICON)? (iii) Out-
come: is patient satisfaction measured with PSPSQ or PSQ?
†
Risk of Bias is assessed by evaluation of: (i) selection bias (randomization, concealment); (ii) information bias (blinding); and (iii) com-
pleteness of data (complete description of data of all patients included).
+, satisfied; , not satisfied; ?, insufficient information/unclear; H, high; L, low; M, moderate; NA, not available.

for orthognathic surgery. The PAR is a suitable and
validated clinical outcome measure for the deviation
of a normal occlusion and alignment for the combined
orthodontic treatment and orthognathic surgery (22,
23). The IOFTN is a reliable tool for measuring
patient need for orthognathic surgery (2, 24) and has
good content validity, and good inter-rater and mod-
erate-to-good intra-rater reliability (25). The ICON is
also a valid index for measuring orthodontic treatment
need and complexity (26) and may be used instead of
PAR or IOTN (27). The IOTN is a valid and reliable
index also for measuring the severity of malocclusion
(28).
Furthermore, studies satisfied DoE when the following
validated outcome measures for measuring patient satis-
faction were used: the Post-Surgical Patient Satisfaction
Questionnaire (PSPSQ) and the Patient Satisfaction
Questionnaire (PSQ) (29–31). Except for the studies by
ØLAND et al. (20) and SILVOLA et al. (32), which had a
moderate DoE, the DoE was found to be low for the
remaining seven studies (Table 1).
Risk of bias
All studies failed randomized and concealed allocation
of treatment, making them vulnerable to selection bias.
Outcomes of orthognathic surgery were compared with
outcomes in one or two control groups undergoing dif-
ferent treatments, sometimes non-surgical treatment.
Most studies reported the completeness of data poorly.
Because patients were involved in evaluating the effect
of orthognathic surgery, in which placebo surgery is
not feasible, they could not be blinded for the nature
of treatment. For all studies included it is therefore, by
definition, impossible to satisfy the item of blinded out-
come measurement. For all nine studies the RoB was
found to be high (Table 1).
Relationship between psychiatric conditions and
(dis)satisfaction with treatment outcome
Given that no evidence was found for the effect of elec-
tive orthognathic surgery on patient satisfaction and
psychosocial functioning, we were not able to evaluate
the effects of orthognathic surgery in patients with psy-
chiatric disorders and mental health conditions.
Discussion
The purpose of this systematic review was to examine
the benefits of elective orthognathic surgery for adults,
in terms of patient satisfaction and psychosocial func-
tioning. There appear to be no valid studies to support
claims for such an effect. Among the rather limited
number of studies available, only a few qualified for
inclusion in this systematic review when rigorous crite-
ria were applied. At best, the available evidence consists
of a few cohort studies with rather small sample sizes,
a low DoE, and a particularly high RoB. In other
words, the evidence for a benefit of elective orthog-
nathic surgery for adults in terms of having a positive
impact on patients’ psychosocial functioning or their
satisfaction with treatment (irrespective of their mental
condition) is lacking.
Based on the many articles and meta-analyses (13,
14) that have been published on this topic it is tempting
to conclude that there is some evidence to suggest that
 Table 2
Characteristics of the nine studies analyzed
Results concerning patient
Measure points/follow-up satisfaction and psychosocial
Authors Design Participants Measures period Response rate impact

ALVES E SILVA Prospective N = 15 11 multiple-choice and/or Follow up: 6 months ? Self-esteem improvement was
et al. (17) Age: mean  SD = 25  5.70 open-ended questions (i.e. 13.3%, especially in relation to
yr; range = 17–35 yr appearance satisfaction, and appearance satisfaction
M/F (%): ? social relationships); Improvements were also noted
WHO QoL-Bref (postsurgical regarding social, occupational,
only) and family relationships
Note: the questionnaire did not
contain answer options capable
of identifying possible worsening
of symptoms
BAHERIMOGHADDAM Prospective N = 58 OHIP-14 T0: after referral 77.3% Although the results suggest an
et al. (33) (28 Class II, T1: at the presurgical increase in QoL score from T1 to
30 Class III) stageT2: postsurgery (at T2, in their analyses the authors
Age: least 6 months after did not tease out the effects of
Class II, mean  SD = 25.1  3.4 yr surgery) orthodontic and surgical
Class III, mean  SD = 21.3  2.7 yr T3, post-treatment treatments
M/F (%): Class II, 42.9/57.1 (12 months after removal
Class III, 63.3/36.7 of orthodontic
appliances)
KIYAK (16) Prospective Study I (N = 74) Open-ended questions to Follow up: 3 yr ? 3 wk following surgery, body
(two studies) Age: mean  SD = 22  7.5 yr determine patients’ attitude to image, including facial image,
M/F (%): 39.2/60.8 measures developed in an improved over the 24-month
Study II earlier pilot study; TSCS; follow-up period
(N = 188: 122 S, 33 OT, 33 NT) body image with an Neuroticism did not affect
Age: S: mean  SD = 26  8.5 yr instrument modified from the satisfaction with outcome in the
OT mean  SD = 24.5  5.2 yr, work of SECORD & JOURARD long term (9–24 months)
NT: mean  SD = 30  4.3 yr (34);
KIYAK et al. (21) Prospective, N = 156 EPI POMS; T1: 6–12 months before S T1: 100% Tension and fatigue increased
case–control N = 90 (S patients) EPI; T2: 5–10 d before S T2: 79% significantly among surgical
Age: mean = 26 yr TSCS; questionnaire with T3: 1 d after S T3: 89% (S), patients from before surgery to
M/F (%): 35.4/64.6 satisfaction questions T4: 4–6 wk after S 96% (OT), 93% immediately after surgery, and
N = 33 (OT patients) T5: 6 months after S (NT) dropped to presurgical levels
Age: mean = 24.5 yr Follow-up: 3 yr T4: 89% (S) when fixation was removed.
M/F (%): 33.3/66.7 T5: 90% (S), Anger-hostility increased at
N = 33 (NT patients) 90% (OT), 88% fixation removal but declined
Age: mean = 30.3 yr; (NT) within 5 months
range = 14–43 yr Postsurgical discomfort, pain and
M/F (%): 28.0/72.0 paresthesia, and oral function
problems were correlated with
postsurgical emotional state
Effects of orthognathic surgery
5
Table 2 Continued 6
Results concerning patient
Measure points/follow-up satisfaction and psychosocial
Authors Design Participants Measures period Response rate impact

LOVIUS et al. Prospective, N = 41 (longitudinal sample) BSS, SAD, FNE, GHQ ? ? In the longitudinal sample
(18) cross-sectional Age: mean  SD = following surgery body
Broers et al.

20.6  5.2 yr satisfaction improved and social

M/F (%): 14.6/85.4 anxiety decreased significantly
N = 54 (cross-sectional No consistent and reliable effect on
sample, preoperative) symptoms of psychopathology
Age: mean  SD = 22.0  5.6 yr occurred
M/F (%): 46.3/53.7
N = 58 (cross-sectional sample,
postoperative)
Age: mean  SD = 22.6  8.7 yr
M/F (%): 40.3/59.7
ØLAND et al. (20) Prospective N = 118 (study group) Questionnaire ‘Problems With T0: presurgery 33.8% Of all patients, at postsurgery
Age: mean  SD = 28.8  8.2 yr Oral Function’, interview T1: after termination of 87.4% indicated that they were
M/F (%): 43.2/56.8 based on Anamnestic and postsurgical OT (up to satisfied or very satisfied with the
N = 47 (controls) Clinical Dysfunction Index, 36 months) treatment, 8.5% were indifferent,
Age: mean  SD = 31.5  8.8 yr PSPSQ whereas 4.1% were unsatisfied or
M/F (%): 38.3/61.6 very unsatisfied
Patients without signs of clinical
dysfunction were all satisfied with
the treatment at T1 as were 60%
of those with severe clinical
dysfunction
RUSTEMEYEr & Prospective N = 50 OHIP (items OH-1 to OH-14) T1: ? The scores on the scales pertaining
GREGERSEN (19) Age: mean  SD = 26.9  9.9 yr; and three additional average 9.1  2.4 months to unsatisfactory esthetics,
range = 18–52 yr questions (items AD-1 to before S; T2: psychological discomfort, and
N = 21 (Class II S) AD-3) average social disability significantly
N = 29 (Class III S) 12.1  1.4 months after S decreased after surgery
M/F (%): 40/60
SCOTT et al. Prospective N = 117 SCL-90-R, EPI, SIP, OHSQ, T1: prior to OT 54.4% The proportion of patients who
(30) N = 59 (wire fixation) PSPSQ T2: 1–2 wk before S were satisfied, or not satisfied,
Age: mean  SD = 29.7  10.4 yr T3: 1 wk after S after treatment was not reported,
M/F (%): 25.4/74.6 T4: 8 wk after S albeit esthetic improvement was
N = 58 (rigid fixation) T5: 6 months after S the most reported positive
Age: mean  SD = 28.6  10.0yr T6: 12 months after S outcome (68%)
M/F (%): 27.6/72.4 T7: 24 months after S
Follow-up: 2 yr
SILVOLA Prospective N = 51 PAR index, Follow up: 68% There were no statistically
et al. (32) (36 combined OT+S, OHIP-14 mean = 5.0 (range = 2.2– significant differences in oral
15 OT) 6.7) yr health-related quality of life
Age: between the surgical and non-
male, mean = 33.8 surgical groups
(range = 18.2–54.9) yr
female, mean = 37.5
(range = 20.1–61.6) yr
M/F (%): 31.4/68.6

AD-1, ‘Have you felt discomfort during chewing?’; AD-2, ‘Have you been dissatisfied with your facial aesthetics?’; AD-3, ‘Do you have a loss of sensitivity in your lips, tongue or other facial area?’; BSS, Body Satisfac-
tion Scale; EPI, Eysenck Personality Inventory; FNE, Fear of Negative Evaluation; GHQ, General Health Questionnaire; M/F, male:female ratio; NT, no treatment; OHIP-14 (OH-1 – OH-14: OHIP items 1-14), Oral
Health Impact Profile; OHSQ, Oral Health Status Questionnaire; OT, Orthodontic Treatment; PAR index, Peer Assessment Rating Index; POMS, Profile of Mood States; PSPSQ, Post-Surgical Patient Satisfaction Ques-
tionnaire; QoL, Quality of Life; S, Surgery; SAD, Social Avoidance and Distress; SCL-90-R, Revised Symptom Checklist-90; SIP, Sickness Impact Profile; TSCS, Tennessee Self-Concept Scale; WHOQoL-Bref, abbrevi-
ated version of WHOQoL-100, World Health Organization Quality of Life.
some form of functional improvement (i.e. occlusion) is
likely to enhance peoples’ oral health-related quality of
life and make them satisfied with the results. However,
when applying more rigorous criteria, the available
study findings do not allow for valid inference on the
size, direction, and consistency of an effect of orthog-
nathic surgery. The poor quality of the evidence avail-
able means that we need to be cautious about
developing recommendations for delivering care to cer-
tain target groups that are considered to be vulnerable
to invasive procedures. For example, in an earlier study
we found evidence that patients with characteristics of
BDD are more likely to remain chronically dissatisfied
with the results of any previous treatment (12). The
present findings compel us to conclude that excluding
these patients from orthognathic surgery is not
warranted (35).
In interpreting the findings of this systematic review
it should be noted that we searched in an all-inclusive
manner, selected studies using a detailed approach, and
adopted a thorough contemporary methodology to
assess RoB and DoE that is fully in line with the
methodology proposed by the Cochrane Collaboration.
Yet, it is still possible that we missed some studies that
were not included in the bibliographic databases
searched.
In conclusion, this systematic review shows that, to
date, there is no evidence from published research to
support claims on the effect of orthognathic surgery
on psychosocial functioning and patient satisfaction.
Until findings from proper research are available, we
would recommend for practitioners to explain to
patients ≥17 yr of age, who consider elective orthog-
nathic surgery, that there is no evidence for a benefit
of this surgical intervention for adults, in terms of
psychosocial functioning and patient satisfaction.
Moreover, as there is no research of sufficient quality
available, it is not clear whether patients will gain
sufficient and sustainable benefit from this rather
invasive procedure. Conversely, it is also important
to realize that the findings of our review do not con-
tradict or ignore the existence of possible benefits of
orthognathic surgery. Orthognathic surgery aimed to
correct functional deficits as a result of skeletal
misalignment of the jaws is likely to contribute to
better speech and to better chewing, breathing, and
swallowing. However, the quality of the studies that
investigated the psychosocial consequences of these
improvements is simply insufficient to draw any firm
conclusion. Clearly, given the potential societal and
economic burden, and the emotional impact of dento-
facial disorders, future research is warranted. Given
that there are already too many publications report-
ing studies of low methodological quality, the
research community should avoid spending resources
on any such studies in future. Therefore, to obtain
valid estimates of the benefit of elective orthognathic
surgery for adults, in terms of patient satisfaction
and psychosocial functioning, high-quality studies
with close monitoring and adequate reporting of
proper outcome measures in parallel treatment groups
need to be performed. In other words, there is an
urgent need for new consistent knowledge on this
topic.
Acknowledgements – This work was not funded.
Conflicts of interest – The authors declare no potential conflicts of
interest with respect to the authorship and/or publication of this
article.
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Supporting Information
Additional Supporting Information may be found in the online
version of this article:
Appendix S1. Search methods: databases searched, and search
strings used for each database.