The impact and quality of the surgery-first approach for orthognathic treatment

Carr, Emma (2026) The impact and quality of the surgery-first approach for orthognathic treatment. MSc(R) thesis, University of Glasgow.

Abstract

Background

High-quality healthcare aims to deliver patient-centred service that adapts to the clinical needs. The aim of this study was to evaluate the impact and quality of orthognathic surgery, using validated questionnaires from patients (Patient Reported Outcome Measures -PROMs) and clinicians (Quality Outcomes in Oral and Maxillofacial Surgery -QOMS).

Materials and Method

This prospective cohort study was conducted in patients who received orthognathic treatment, according to the Surgery First Approach, between 2023 and 2025. Two questionnaires were used in the study; PROMS, which incorporated the Orthognathic Quality of Life Questionnaires (OQOL), and was completed pre-surgery, and at four to eight weeks and one-year post-surgery; and QOMS, which was completed by clinicians pre-surgery, and at six months and one-year post-surgery. It was hypothesised that a large effect would be found, and a sample of 31 patients would ensure that the study was powered appropriately at 80%. Chi-squared and Fisher’s exact tests were applied to assess associations between PROMs and QOMs.

Results

Thirty-three patients (mean age 26.6 ± 9.0 years) were included in the study. Surgery improved patients’ reported quality of life, facial aesthetics, and oral function. Pre-operatively, 25 patients reported being ‘very dissatisfied’ or ‘dissatisfied’ with facial appearance. At one-year post-surgery, all patients reported being ‘satisfied’ or ‘very satisfied’ with their facial appearance, and total OQOL scores improved substantially, reducing from 40.4 pre-treatment to 20.0, indicating significant long-term improvement in function, aesthetics, psychological status, and overall quality-of-life. Two patients required return to theatre (RTT) but, within 30 days, both patients demonstrated reductions in OQOL scores from baseline to post-operative assessments, indicating that RTT did not negatively affect overall quality of life outcomes. A statistically significant association was observed between clinicians’ and patients’ perceptions regarding facial aesthetic improvement as a primary indication for surgery (p=0.007). However, alignment of perception was less evident concerning improving function as an indication for surgery (p=0.078). Both patients and clinicians reported agreement at one year post-operatively on improved function (p=0.017), but the agreement on improved aesthetics did not reach statistical significance (p=0.069).

Conclusions

The Surgery-First Approach to orthognathic treatment yields measurable improvements in patient-reported, and clinician-assessed, outcomes. The PROMS and QOMS questionnaires are useful tools for the evaluation of the quality of orthognathic service delivery.

• Item Type: Thesis (MSc(R))
• Qualification Level: Masters
• Subjects: R Medicine > RF Otorhinolaryngology
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Supervisor's Name: Ayoub, Professor Ashraf and Benington, Mr Philip
• Date of Award: 2026
• Depositing User: Theses Team
• Unique ID: glathesis:2026-85926
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 19 May 2026 12:57
• Last Modified: 20 May 2026 11:58
• Thesis DOI: 10.5525/gla.thesis.85926
• URI: https://theses.gla.ac.uk/id/eprint/85926