Gender differences in pre-surgical motivations, expectations, and patient-reported outcomes in Class III orthognathic surgery patients: An item-level analysis

Objective To evaluate gender differences in pre-surgical motivations, expectations, functional and psychosocial evaluations, and treatment process perceptions among adult patients with skeletal Class III malocclusion undergoing orthodontic preparation for orthognathic surgery. Methods In this single-center, cross-sectional study, 81 adults (37 females, 44 males) with skeletal Class III malocclusion completed a 27-item investigator-developed questionnaire during pre-surgical orthodontic preparation, covering demographics, problem awareness, functional and psychosocial evaluations, motivation and expectations, treatment process, and patient engagement. Gender differences were analyzed item by item with Mann-Whitney U, chi-square, or Fisher’s exact tests. P-values for the 37 comparisons were adjusted with the Benjamini-Hochberg false discovery rate (FDR) procedure within questionnaire domains, and effect sizes with 95% confidence intervals were estimated. Because the a priori sample size calculation did not address between-gender comparisons, these were treated as exploratory. Results Seven differences met the unadjusted threshold (p < 0.05), of which three remained significant after within-domain FDR correction: females reported greater lack of self-confidence in social environments (q = 0.044), and males reported more adequate information from their orthodontist (q = 0.018) and higher pre-operative treatment satisfaction (q = 0.019), with moderate effect sizes (rank-biserial |r| = 0.30–0.35). The other four, all reported more often by females (eating difficulty, food avoidance, temporomandibular joint problems, and lack of confidence when photographed), were nominally significant only (unadjusted p = 0.013–0.043). No difference survived correction across all 37 comparisons. For the other items no significant differences were detected, but confidence intervals did not exclude small-to-moderate differences. Conclusions Gender differences in social self-confidence, perceived information adequacy, and pre-operative satisfaction were the strongest exploratory findings. Because the study was not powered for gender comparisons, non-significant results do not indicate that the genders are similar. These exploratory findings warrant confirmation in adequately powered multi-center, longitudinal studies.