Dentofacial defects are characterized by abnormalities in the size, position or relationship of the maxilla, mandible and associated facial structures. In addition to producing malocclusion, these conditions may affect mastication, speech, facial aesthetics, self-confidence and interpersonal relationships [1]. Consequently, patients with dentofacial deformities may experience considerable impairment in oral health-related QoL. Orthognathic surgery is executed to correct the significant skeletal discrepancies that can’t be adequately managed with orthodontic treatment alone [2]. Although traditional assessment of treatment success has focused on skeletal correction, occlusal relationships and postoperative stability, patient-centered outcomes have become increasingly important. Improvement in QoL represents an important measure of whether treatment has produced meaningful benefits from the patient's perspective [3].

The Oral Health Impact Profile-14 (OHIP-14) is a broadly used instrument for measuring the impact of oral

conditions on daily life [4]. Psychological disability, functional limitation, bodily pain, social disability, psychological discomfort, physical disability, and handicap are the seven dimensions it assesses. Importantly, higher OHIP-14 scores indicate a greater negative impact of oral conditions and therefore poorer OHRQoL [5]. Previous prospective studies have demonstrated significant recovery in OHRQoL after orthognathic surgery. Göelzer et al. [6] evaluated 74 patients before surgery and 4–6 months afterward and reported a reduction in mean OHIP-14 scores from 13.23 to 3.26, with significant improvements across all seven OHIP-14 domains. Another prospective study of 85 patients demonstrated that OHIP-14 scores initially increased during the immediate postoperative period but subsequently declined during recovery, with continued improvement at later follow-up.

A systematic & meta-analysis conducted by Meger et al. [7] also demonstrated a positive impact of orthognathic surgery on QoL, with significant improvement measured using both OHIP-14 and the Orthognathic Quality of Life Questionnaire (OQLQ). A systematic review conducted by Zamboni et al. [8] reveals that QoL improved after orthognathic therapy, with particularly prominent improvements in social and aesthetic aspects. Class III patients also demonstrated greater improvement than Class II patients. Another systematic review by Soh et al. (2013)⁹ reported significant progress in QoL after orthognathic management and identified surgical type, malocclusion and sex as potential influencing factors.

Despite growing evidence, prospective assessment of OHRQoL using the same validated instrument at multiple postoperative time points remains valuable. Therefore, the present study evaluated changes in OHIP-14 scores before & after orthognathic surgery and examined whether improvement differed according to patient and surgical characteristics.

A prospective clinical study was conducted on 70 patients aged 20–35 years who underwent orthognathic surgery for dentofacial deformities in tertiary dental care hospital of Khyber Pakhtunkhwa, Pakistan after obtaining ethical approval from the concerned authorities vide number 1393/BKMC dated 8/8/2024. The study was conducted in compliance with the ethical guidelines outlined in the 1964 Declaration of Helsinki, which was updated in 2000. Every patient and guardian provided written consent. Sample size was calculated for a paired preoperative postoperative comparison of OHIP-14 scores. Previous research by Göelzer et al. [6] demonstrated a significant improvement in OHIP-14 following orthognathic surgery, with mean scores decreasing from 13.23 ± 6.45 preoperatively to 3.26 ± 4.19 postoperatively. Because the effect observed in the previous study was very large, a conservative standardized effect size of 0.50 was selected for the present study. With a two-sided α of 0.05 and 80% power, the minimum required sample was 34 participants. After allowing for approximately 20% follow-up, the minimum adjusted sample was 43 participants. To provide additional participants for exploratory subgroup analyses according to skeletal deformity and surgical procedure, the target sample was increased to 70 patients. Patients with congenital craniofacial syndromes, previous major facial trauma, active malignancy, severe systemic disease affecting quality of life, or inability to complete the questionnaire were excluded. Baseline demographic information including age and sex was recorded. Clinical information included skeletal classification, type of dentofacial deformity and surgical procedure. The OHIP-14 questionnaire was administered before surgery and again at three months & six months postoperatively. The questionnaire consists of 14 items covering seven domains. Each item was scored using the standard response categories. Higher scores indicate worse OHRQoL. The overall OHIP-14 score was determined by adding the item scores. The change in the overall OHIP-14 score from baseline to six months following surgery was the main result. Changes in specific OHIP-14 areas and comparisons of progress based on skeletal categorization and surgical type were secondary objectives.

Total 70 patients undergoing orthognathic surgery were included in the study. The mean age of the participants was 26.7 ± 4.2 years, with an age range of 20–35 years. There were 29 (41.4%) males and 41 (58.6%) females. Skeletal Class III deformity was present in 43 (61.4%) patients, while 27 (38.6%) had skeletal Class II deformity. Regarding the surgical procedure, 43 (61.4%) patients underwent double-jaw surgery and 27 (38.6%) underwent single-jaw surgery. All 70 participants completed the preoperative and 6-month postoperative OHIP-14 assessments (Table 1).

Table 1. Participants' clinical and demographic details

The mean total OHIP-14 score before surgery was 14.6 ± 5.8, which increased temporarily to 17.2 ± 6.1 during the early postoperative period in patients assessed at 1 week. At 3 months, the mean score had decreased to 8.4 ± 4.6, and at 6 months it decreased further to 5.8 ± 3.9. The overall difference across the assessment periods was statistically significant (p<0.001). Because lower OHIP-14 scores indicate better oral health-related quality of life, the reduction from baseline to 6 months represents a substantial improvement (Table 2). The mean reduction in OHIP-14 score from baseline to 6 months was 8.8 ± 4.7 points, corresponding to an approximately 60.3% improvement in the total score. The improvement was statistically significant (p<0.001).

Table 2. Changes in total OHIP-14 score over time (n=70)

All seven OHIP-14 domains showed improvement in 6 months compared with baseline. The greatest improvement was observed in psychological discomfort, which decreased from 3.0 ± 1.4 to 0.9 ± 0.8, followed by psychological disability, which decreased from 2.3 ± 1.2 to 0.7 ± 0.7. Physical pain decreased from 2.5 ± 1.3 to 1.0 ± 0.9, while social disability decreased from 1.8 ± 1.0 to 0.5 ± 0.6. All domain-level improvements were statistically significant (p<0.05) (Table 3).

Table 3. OHIP-14 domain scores before and 6 months after surgery

When skeletal deformity was considered, patients with Class III deformity demonstrated a mean OHIP-14 reduction of 9.4 ± 4.6 points, compared with 7.8 ± 4.7 points among Class II patients. Although the Class III group showed a numerically great improvement, the difference between the groups was not statistically significant (p=0.145) (Table 4). Patients undergoing double-jaw surgery demonstrated a mean reduction of 9.1 ± 4.8 points, compared with 8.3 ± 4.6 points among patients undergoing single-jaw surgery. This difference was not statistically significant (p=0.461) (Table 5).

Table 4. Change in OHIP-14 according to skeletal deformity

Table 5. Change in OHIP-14 according to surgical procedure

The present study demonstrated a significant improvement in OHRQoL following orthognathic surgery, with the mean OHIP-14 score decreasing from 14.6 ± 5.8 preoperatively to 5.8 ± 3.9 at 6 months (p<0.001). This finding is consistent with broader literature. A prospective study by Göelzer et al. [6] involving 74 patients reported a reduction in mean OHIP-14 score from 13.23 before surgery to 3.26 at 4–6 months postoperatively, with significant improvement in all seven OHIP-14 domains. The magnitude of improvement in the present study was somewhat smaller, which could be attributed to variations in follow-up duration, patient characteristics, severity of deformity and surgical procedures. The progressive improvement observed between 3, and 6 months is particularly important. Orthognathic surgery involves substantial manipulation of the maxillofacial skeleton and soft tissues, and patients may experience pain, swelling, altered sensation and impaired chewing during the early postoperative period. A longitudinal prospective study carried out by Zhu et al. [10] on 85 patients demonstrated that OHIP scores increased sharply immediately after surgery before progressively declined during recovery. At 4 weeks, scores could still be higher than baseline, while longer-term assessments demonstrated substantial improvement. Therefore, evaluation of OHRQoL immediately after surgery may underestimate the long-term benefit of treatment. The significant improvement across all seven OHIP-14 domains in the present study is also consistent with previous evidence. Göelzer et al. [6] stated significant reductions in all OHIP-14 domains after orthognathic surgery. A systematic review carried out by Zheng et al. [11], 30 studies likewise concluded that orthognathic surgery improves QoL both physically and psychosocially and is related to high levels of patient satisfaction. These findings support the concept that the benefits of orthognathic surgery extend beyond correction of skeletal and occlusal relationships. The largest improvement in the present study occurred in psychological discomfort & psychological disability. This finding is clinically meaningful because facial appearance and dentofacial deformity may influence self-esteem, social confidence and psychological well-being. Once facial proportions and occlusion are improved, patients may experience greater confidence in social and interpersonal situations. A systematic review published by Lin et al. [12] found that social and aesthetic aspects demonstrated some of the major improvements following orthognathic treatment. The present study also demonstrated a significant improvement in physical pain. Patients with dentofacial deformities may experience functional difficulties associated with malocclusion, including difficulty chewing and discomfort during oral function. Surgical correction can improve occlusal relationships and masticatory function, although the early postoperative period may temporarily worsen these symptoms. A systematic review conducted by Alkaabi et al. [13] specifically examining oral function-related QoL found that mild deterioration may occur in the short term after surgery, whereas longer-term follow-up demonstrated significant improvements in chewing, speech and taste. Patients undergoing double-jaw surgery demonstrated greater improvement in OHIP-14 scores than those undergoing single-jaw surgery. This finding is constant with recent studies suggesting that surgical procedure may influence the magnitude of quality-of-life improvement [7-11]. One possible explanation is that double-jaw surgery can address more complex skeletal discrepancies and may result in greater changes in facial harmony, occlusion and function. However, this finding should be interpreted cautiously because patients selected for double-jaw surgery may have more severe baseline deformities and consequently greater potential for improvement. Patients with skeletal Class III deformities demonstrated greater improvement than Class II patients in the present study. This finding is consistent with the systematic review by Schaefer et al. [14], which stated greater QoL improvement among Class III patients compared with Class II patients. A systematic review by Lin et al. [12] found greater improvement among patients with skeletal Class III malocclusion. One possible explanation is that Class III deformities may produce particularly noticeable functional and aesthetic concerns, meaning that correction can result in a greater perceived improvement. The overall findings are also supported by a systematic review and meta-analysis of orthognathic surgery outcomes conducted by Meger et al. [7]. The review identified 12 studies for qualitative synthesis and seven for meta-analysis and demonstrated a significant positive impact of orthognathic surgery on QoL measured using both OHIP-14 and OQLQ.

Despite a brief decline in QoL during the early postoperative phase, orthognathic surgery was linked to a notable improvement in oral health-related quality of life by six months. When assessing orthognathic surgery, the results encourage the inclusion of patient-reported metrics like OHIP-14 in addition to traditional clinical outcomes.