PSYCHOSOCIAL VS CLINICAL RESPONSES--ORTHOGNATHIC SURGERY

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The goals of this project are to assess psychosocial outcomes of orthognathic surgery, clarify the relationship of outcome to both pretreatment patient characteristics and patient management during treatment, and evaluate the impact of presurgical exposure of patients to video image predictions of the treatment result. The basic objective is to improve the management of patients undergoing orthognathic surgery and to identify patients who are "at risk" for a poor adjustment to either the treatment experience or the functional and/or esthetic changes following tr tment. The project is based on a collaborative effect between the University of North Carolina (UNC) and the university of Washington (UW). Essentially all patients having orthognathic surgery at both centers will be included to achieve an adequate sample size for planned comparisons that will subset the sample. Two control groups, a presurgery orthodontic patient control and an acquaintance control group, are included to minimize the effect of potential biases and confounders in the longitudinal psychological and self-concept assessment. Two control groups were selected since each group serves a different purpose and provides control for different types of potential confounders. Data collection will include two major aspects: (1) patient questionnaires to evaluate psychological adjustment and personality characteristics, expectations from treatment and patient perception of experiences during treatment; and (2) clinical examination to evaluate neurosensory status and changes; facial esthetic appearance, expectation and changes; dental appearance and changes; and functional status and changes. In addition, a randomized clinical trial of ht effects of exposing patients to video predictions of treatment outcomes will be carried out, to evaluate whether and when video image presentations are advantageous to patients. Although video predictions can improve communication with patients by helping them visualize possible treatment results, it may be that for some individuals, exposure to the video predictions can increase anxiety or create desires for unrealistic and unobtainable appearance changes. The trial should clarify whether and when, for best management, video predictions should be shared with patients.