Effect of surgery-first approach on quality of life and mental health of orthognathic patients: A systematic review and meta-analysis

Yi Zheng; Ni Liao; Shuixue Mo; Xuanping Huang; Nuo Zhou

doi:10.1016/j.heliyon.2023.e23285

Effect of surgery-first approach on quality of life and mental health of orthognathic patients: A systematic review and meta-analysis

Heliyon. 2023 Dec 3;10(1):e23285. doi: 10.1016/j.heliyon.2023.e23285. eCollection 2024 Jan 15.

Authors

Yi Zheng¹, Ni Liao¹, Shuixue Mo¹, Xuanping Huang^{1

2}, Nuo Zhou^{1

2}

Affiliations

¹ College of Stomatology, Hospital of Stomatology, Guangxi Medical University, No.10 Shuangyong Road Nanning, Guangxi 530021, People's Republic of China.
² Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, Guangxi Key Laboratory of Oral and Maxillofacial Surgery Disease Treatment, Nanning 530021, Guangxi, People's Republic of China.

Abstract

Objectives: This study intends to explore the effects of the surgery-first approach (SFA) on quality of life and mental health of patients who undergo orthognathic surgery compared to the conventional three-stage approach (CTA).

Data: The analysis included eight studies with a total of 307 patients, of which one was randomized controlled trial (RCT), one was clinical controlled trial (CCT), and six were non-randomized studies of interventions (NRSIs).

Sources: Electronic databases such as Medline, Embase, Scopus, and Web of Science were searched for eligible trials up to April 2023.

Study selection: RCTs, CCTs, and NRSIs, which compared the quality of life or mental health of orthognathic patients treated with SFA and CTA, were included in this study. The meta-analysis showed that the standardized mean differences (SMD) of Oral Health Impact Profiles-14 (OHIP-14) scores and the Orthognathic Quality of Life Questionnaire (OQLQ) between SFA and CTA were -1.58 (P = 0.05) and -2.99 (P < 0.00001) at the termination of the first-stage treatment, which altered to -0.94 (P = 0.54) and 0.09 (P = 0.65) after total treatment. Two studies applied the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and the Beck Depression Inventory (BDI-II) to examine mental health, resulting in a trend similar to the former scales.

Conclusion: In contrast to the conventional procedure, orthognathic treatment with SFA can instantly enhance the quality of life at the end of the first-stage treatment but has similar effects after the overall treatment. Moreover, SFA has a positive impact on psychological conditions.

Clinical significance: This study first systematically reviewed the effect of SFA on patients' mental well-being. According to our findings, it is better to select SFA if possible. Otherwise, the patient's psychological condition should be monitored appropriately throughout decompensation for better well-being both physically and mentally.

Keywords: Mental health; Meta-analysis; Orthognathic surgery; Quality of life; Surgery-first.