The article entitled “Surgery-first orthognathic approach vs traditional orthognathic approach: oral health-related quality of life assessed with 2 questionnaires” published in August 2017 was interesting in the light of contemporary interest in this topic (Pelo S, Gasparini G, Garagiola U, Cordaro M, Di Nardo F, Staderini E, et al. Am J Orthod Dentofacial Orthop 2017;152:250-4). The surgery-first approach reduces the number of treatment phases from 3 to 2 and hence reduces treatment time and patient discomfort. Even so, an evidence-based benefit assessment is still not clear with this new approach.

We appreciate the authors for publishing data that will initiate more studies regarding this intangible aspect of orthognathic/orthodontic treatment. Confusion persisting among clinicians regarding the application of generic or condition-specific quality of life measures for othognathic surgery is reflected here also with the use of 2 different measures, even though the use of generic measures in orthodontics is questioned by Marshman and Robinson and others. However, this article also has generated some doubts in our mind which, if clarified, will broaden its scope.

• 1.

  The study design is not clear even though test and control groups were mentioned. Ethics committee approval is not cited (although it was according to the Helsinki Declaration). This is essential in any study involving human participants, and the importance of mentioning the study design cannot be overlooked when considering this study for future systematic review or meta-analysis.

• 2.

  There is no mention regarding the outcome assessment using morphometric skeletal, occlusal, and soft tissue parameters; this causes us to conclude that the study is ongoing. Quality of life status of the surgery-first group during the postsurgical orthodontic phase is very important, and we doubt that the results were premature to publish.

• 3.

  Translation and cross-cultural adaptation of these psychometric tools were not mentioned, nor was the existence of such validated tools (OHIP-14 and OQLQ) in the geographic area of study. Administration of questionnaires 1 month before surgery and before bracket placement for the test group does not make sense when the bracket was placed just 3 days before surgery for this group.

Clarification of the above doubts will be really appreciated.