Patients' own reasons and patient-perceived recommendations far orthognathic surgery

In an attempt to learn more about patients' decision-making processes, an a nalysis was performed to examine patients' reasons for undergoing orthognat hic surgery and their understanding of the reasons surgery was recommended. Before surgery, 105 females and 38 males completed an open-ended questionn aire in which they listed their reasons for choosing orthognathic surgery a nd their perceptions of their orthodontists' recommendations. Three raters classified the responses into 7 categories: esthetics, psychosocial, functi onal, TMJ/pain, authority, prevention, and other. Rater agreement ranged fr om a kappa of .55 to 1.00. Patients reported undergoing orthognathic surger y primarily for esthetic, functional, and TMJ improvements, 71%, 47%, and 2 8%, respectively. Females reported more TMJ-related reasons than males (P < .05). Patients reporting function (P < .05), TMJ (P < .05), and prevention of future problems (P < .05) were older than patients not reporting these reasons. Mexican American patients indicated more psychosocial reasons (P < .05) than European Americans. Patients understood that orthognathic surger y was recommended primarily for esthetic, functional, and TMJ improvements, 52%, 44%, and 18%, respectively. Males reported receiving more preventativ e recommendations (23%) than females (10%), Mexican American patients repor ted receiving more psychosocial recommendations (P < .05) than European Ame ricans. Agreement between each paired patient/patient-perceived reason was highest for TMJ problems (kappa = 0.588). In conclusion, patients underwent orthognathic surgery to improve esthetic, functional and TMJ problems and interpreted orthodontists' recommendations for similar reasons. On a case-t o-case basis, agreement between patient and orthodontist-represented reason s was modest, suggesting differences between patients' own reasons and thei r perceptions of orthodontists' recommendations.