The Benefits of a Surgery-First Approach in Promoting the Psychological Well-Being of Patients with Skeletal Anomalies and Temporomandibular Disorder

Background: Orthognathic surgery using the Surgery-First approach (SFA) has gained increasing attention not only for its functional and aesthetic benefits but also for its potential psychological impact. Aim: This study aimed to evaluate the effects of SFA on the psychological well-being of patients with dentofacial anomalies and temporomandibular disorders (TMD), using validated tools for assessing anxiety (GAD-7), depression (PHQ-9), and pain catastrophizing (PCS). Materials and methods: A longitudinal observational study was conducted on 27 patients treated between 2022 and 2025. TMD was assessed using the DC/TMD clinical criteria. Psychological status was evaluated preoperatively and 6 months postoperatively using the GAD-7, PHQ-9, and PCS standardized questionnaires. Results: Significant reductions were observed in all three domains: GAD-7 scores dropped from 13.8 to 4.1 (p < 0.001), PHQ-9 from 15.5 to 5.3 (p < 0.001), and PCS from 26.2 to 12.7 (p < 0.001). These are raw total scores; corresponding normalized mean scores (per item) decreased from 2.78 to 1.08 for GAD-7, from 3.00 to 0.36 for PHQ-9, and from 1.22 to 1.06 for PCS. The greatest improvements were seen in Class III patients with TMD. Psychological scores did not significantly predict persistent TMD. Conclusions: These findings support the psychological benefits of SFA and underline the importance of integrating psychological screening into orthognathic treatment planning.