Patient satisfaction among subjects with facial skeletal discrepancies is a fundamental issue for orthognathic surgery. The primary factor in determining the level of patient satisfaction after orthognathic surgery is the perception of the changes and therefore the patient’s opinion of the esthetics. For the majority of these patients, the objective is to obtain a significant improvement in both the esthetics of their faces and oral functionality. At a psychological level, the surgeon’s job is to prepare patients for the results of the operation before the surgery, so that the results can meet their expectations.

In longitudinal investigations by Cunningham et al, orthognathic patients were reported to have some psychological characteristics: high level of anxiety, and low satisfaction of body image and facial image, although this had borderline significance. These negative repercussions on the patient’s psychological state are probably related to the long orthodontic treatment and decompensation of the dental elements causing temporary worsening of the facial esthetics, transitory worsening of mastication, and improvement of oral discomfort.

Another important issue is the discomfort that the patient will initially suffer in the postsurgery period (problems related to oral functionality, pain, neurosensory deficit, bleeding, swelling, and scarring). Furthermore, some patients may experience reactive depression as a consequence of surgical treatment and require social support in the postoperative phase. Other disadvantages perceived by the patient and connected to this procedure are the duration of the therapy and its possible negative effect on the patient’s compliance. Another negative factor reported by patients is the inability to predict the date for the surgery; this often causes protracted anxiety and uncertainty throughout the waiting period. These factors can discourage the patient from undergoing the therapy.

Surgery first is an orthognathic surgical procedure that is in constant evolution and diffusion. Its success has been defined by the number of advantages offered and is definitively determined by the satisfaction of the patients themselves. The approach of surgery first differs from the traditional approach used in orthognathic surgery because it consists of only 2 phases: the surgery and the postsurgery orthognathic therapy.

The main advantages of this method, with regard to the level of satisfaction with the treatment, are the possibility of eliminating or reducing the presurgery orthodontic treatment, surgically repositioning the jaws immediately into the desired position, and a short orthodontic therapy afterward. This new approach is also frequently requested by patients because it is possible to see improvements in facial esthetics immediately and the duration of the therapy is significantly shortened.

Patient-assessed health outcome measures were introduced to examine the relationship between oral health and the sense of well-being and the patient’s perceived quality of life. The definition of life quality was introduced in 1993 by the World Health Organization as “the perception of people with regard to their situation in life, within the cultural context and values with which they live, in relation to their objectives, expectations, patterns and concerns.” Although the quality of life is a subjective concept, several questionnaires were created to assess it. Among those, the most widely used is the Oral Health Impact Profile (OHIP) that evaluates the person’s perception about quality of living in relation to oral conditions. The OHIP includes 49 items, divided into 7 sections: functional limitation, physical pain, psychological discomfort, physical incapacity, psychological incapacity, social incapacity, and difficulty doing usual jobs. Its short version, the OHIP-14, was published in 1997; it includes 14 questions divided into the same 7 sections.

The Orthognathic Quality of Life Questionnaire (OQLQ-22) was developed and validated by Cunningham et al, whose objective was to assess the impact of dentofacial deformities and the benefits of orthognathic surgical treatment on patients’ quality of life.

In this article, we aimed to investigate and evaluate the differences detected by the patients between the traditional orthognathic procedure and the surgery-first approach.