Associations of orthognathic surgery with body image perception, facial appearance, and quality of life

Background Body dysmorphic disorder (BDD) affects approximately 15% of individuals seeking orthognathic surgery and may compromise postoperative satisfaction. Purpose To evaluate the association between orthognathic surgery and changes in body image dissatisfaction, facial appearance perception, and oral health-related quality of life, and the correlations among these outcomes. Study design, setting, and sample Prospective cohort study at the Oral and Maxillofacial Surgery Service, Federal University of Paraná, Brazil, of subjects aged 18 years or older with skeletal Class II or Class III malocclusion scheduled for orthognathic surgery between 2022 and 2024. Predictor variable Surgical status (preoperative [T0] and six months postoperative [T1]). Main outcome variables Primary outcomes: body image dissatisfaction, measured by the Body Dysmorphic Disorder Examination (BDDE; range 0 to 168, higher scores indicating greater dissatisfaction), and possible BDD status (BDDE score > 66). Secondary outcomes: Psychosocial Impact of Facial Aesthetics Scale (EPAF; range 0 to 88) and Oral Health Impact Profile short form (OHIP-14; range 0 to 56). Covariates Age, biological sex at birth (male/female), self-reported race, and skeletal classification (Class II versus Class III). Data analyses Wilcoxon signed-rank test, McNemar's test, and Spearman's rank correlation coefficient (rho); statistical significance at P < 0.05. Results Of 50 subjects assessed, 45 (23 [51%] female; median age 27 years, interquartile range [IQR] = 12) were included. Possible BDD was identified in 5 subjects (11%) at T0 and 2 (4%) at T1 (P = 0.3). Median BDDE score decreased from 28 (IQR = 42.5) to 21 (IQR = 18.5), EPAF from 9 (IQR = 12) to 4 (IQR = 6), and OHIP-14 from 12 (IQR = 13.5) to 3 (IQR = 8.5) (all P < 0.001). BDDE correlated with EPAF (rho = 0.68 at T0 and 0.56 at T1; both P < 0.001) and with OHIP-14 (rho = 0.34, P=0.022 at T0; rho=0.39, P=0.008 at T1). Conclusions and clinical relevance Orthognathic surgery was associated with statistically significant improvements in body image dissatisfaction, facial appearance perception, and oral health-related quality of life, and with fewer subjects screening positive for possible BDD.