The importance of the presence of dysmorphophobic disorder in patients with jaw anomalies in the dynamic assessment of changes in quality of life during rehabilitation after orthognathic surgery

Abstract

Body dysmorphic disorder (BDD) is a mental disorder that can distort the perception of one’s own body appearance and lead to serious impairment of functioning in social, professional and other spheres, as well as distress. In addition, the presence of this mental disorder in patients can have a negative impact on the perception of the treatment outcome, especially when carried out for aesthetic purposes, which is why a more thorough examination for this syndrome is required. Objective — to analyze the dynamics of changes in the quality of life of patients with skeletal classes II and III during rehabilitation after orthognathic surgery, also taking into account the influence of BDD syndrome. Materials and methodsThe study involved 131 patients with jaw anomalies (68 with skeletal class II and 63 with skeletal class III) who had completed orthodontic preparation and were referred for surgery. Signs of dysmorphophobia were assessed preoperatively using the BDDQ-AS questionnaire. Quality of life was assessed using the OQLQ questionnaire preoperatively, 1 month postoperatively (stage 1), 3 months postoperatively (stage 2), and 6 months postoperatively (stage 3).
Results.
After orthognathic surgery, statistically significant improvement in the aesthetic and social aspects of the OQLQ questionnaire was observed in all patients at all postoperative control stages (p<0.05). In the functional aspect, statistically significant deterioration (p<0.05) was observed in patients with skeletal class II, and only at the 3rd control stage was there a statistically significant improvement (up to 2 [0; 5]; p<0.05) relative to the preoperative value (6 [2; 10]). In patients with skeletal class III, statistically significant improvement was obtained at the 2nd and 3rd control stages (3 [0; 7] and 1 [0; 3], respectively) relative to the preoperative value (8 [4; 12]). The aspect of awareness of the presence of deformity improved statistically significantly in all patients at the 2nd and 3rd control stages. Among patients with skeletal class II without signs of BDD, improvement in the aesthetic and social aspects was obtained at all control stages, in the aspect of awareness of the presence of deformity — at the 2nd and 3rd stages (p<0.05), and in the functional aspect — only at the 3rd stage with an improvement of 1 [0; 4] versus 5 [2; 10] before surgery (p<0.05). In patients with skeletal class II with signs of BDD, improvement in the aesthetic aspect was obtained at all control stages (p<0.05), in the social aspect — at the 2nd and 3rd stages (11.5 [7.5; 20] and 8.5 [5; 17], respectively) compared to the preoperative value (22 [13.5; 23]), in the functional aspect — only at the 3rd stage (5 [1.25; 9.5]) compared to the preoperative value (9 [3.5; 13]; p<0.05). Improvement in the aspect of awareness of the presence of deformity was not achieved. Among patients with skeletal class III without signs of BDD, improvement was obtained at all control stages in the aesthetic and social aspects (p<0.05), at the 2nd and 3rd stages — in the functional aspect and the aspect of awareness of the presence of deformity (p<0.05). In patients with skeletal class III with signs of BDD, improvement in indicators was achieved at all control stages in the aesthetic aspect (p<0.05), at the 2nd and 3rd stages in the social aspect (11 [5.75; 15.5] and 10 [4; 12.75], respectively) relative to the preoperative indicator (13 [11; 29]; p<0.05), and at none of the control stages in all other aspects of the OQLQ.
Conclusion.
Orthognathic surgery improves the quality of life of patients with jaw anomalies, but the presence of BDD syndrome significantly hinders the positive perception of the OQLQ aspects during the rehabilitation period. These circumstances make it necessary to diagnose patients with skeletal classes II and III for the presence of BDD syndrome and eliminate it at the preoperative stage.