Abstract
Purpose
This study evaluated changes in patient-reported functional, aesthetic, and psychosocial outcomes before and after orthognathic surgery and assessed overall satisfaction among patients treated in the Eastern Province of Saudi Arabia.
Methods
A retrospective cross-sectional study was conducted among 100 patients who underwent orthognathic surgery at Dammam Medical Complex, Saudi Arabia. Data were collected through structured telephone interviews using a questionnaire adapted from previously published instruments and translated into Arabic. Paired multi-category outcomes were analyzed using the Stuart-Maxwell test, paired binary outcomes using the McNemar test, and p ≤ 0.05 was considered statistically significant.
Results
The sample included 53 females and 47 males, with a mean age of 29.4 ± 5.9 years. Most participants (70%) expected improvement in both aesthetics and chewing function. Overall, 65% reported postoperative improvement in both domains. Significant favorable changes were observed in chewing ability, nasal breathing, facial profile, frontal facial appearance, and smile (all p < 0.001). Self-confidence increased from 50% to 87% (p < 0.001), and 95% said they would recommend surgery to others.
Conclusion
Orthognathic surgery was associated with high patient-reported satisfaction and favorable functional, aesthetic, and psychosocial outcomes in this sample from the Eastern Province.
Keywords: Orthognathic surgery, Patient satisfaction, Oral health-related quality of life, Aesthetic outcomes, Functional outcomes, Saudi Arabia
1. Introduction
Orthognathic surgery is an established treatment option for patients with dentofacial deformities when growth has been completed and orthodontic camouflage alone is insufficient. Beyond correction of skeletal discrepancies, treatment is expected to improve facial harmony, dental function, and oral health-related quality of life 1, 2, 3, 4, 5. Because these benefits are experienced directly by patients, patient-reported outcomes are a necessary complement to clinical and cephalometric assessments.
Previous studies have shown that orthognathic surgery may improve chewing ability, facial appearance, self-confidence, and broader psychosocial well-being, although not all patients report complete satisfaction after treatment 2, 3, 4, 5, 6, 7, 8, 9. Satisfaction is influenced not only by surgical correction itself but also by preoperative expectations, postoperative recovery, and how well functional and aesthetic goals align with what patients hoped to achieve.3,4,8,10,11
Understanding patient satisfaction is particularly important in routine surgical planning because it helps clinicians identify the outcomes that matter most to patients, improve preoperative counseling, and better tailor local service delivery. In the Saudi context, patient expectations and satisfaction may also be shaped by social norms, family perceptions, and access to public-sector surgical care. However, data from the Eastern Province remain limited.
This study therefore aimed to evaluate recalled preoperative and postoperative patient-reported functional, aesthetic, and psychosocial outcomes after orthognathic surgery and to assess overall satisfaction among patients treated in the Eastern Province of Saudi Arabia. The primary focus was the preoperative-to-postoperative comparison of patient-reported functional and aesthetic outcomes. Secondary outcomes included self-confidence, perceived job opportunities, selected personal attributes, recommendation of surgery to others, and perceived family/friend satisfaction with postoperative appearance.
2. Materials and methods
2.1. Study design and reporting
This retrospective cross-sectional study evaluated patient-reported satisfaction after orthognathic surgery and was reported with reference to the STROBE recommendations for observational studies.
2.2. Study setting
The study was conducted at the Department of Oral and Maxillofacial Surgery, Specialized Dental Center, Dammam Medical Complex, Dammam, Saudi Arabia.
2.3. Sample size
The sample size was estimated using an expected satisfaction proportion of 0.50, a 95% confidence level, and a margin of error of 10%, based on previous findings reported by Duhduh et al.1 The minimum required sample was 97 participants, and the final target was rounded to 100 patients.
2.4. Participants
Eligible participants were adults who had completed growth and had undergone orthognathic surgery for skeletal Class II or Class III malocclusion. Growth completion was confirmed using cervical vertebral maturation status CS6.12 Eligible patients were aged 20-45 years, and both male and female patients were included. Patients with cleft lip and/or palate, a history of previous orthognathic surgery, or diagnosed psychological disorders were excluded.
2.5. Participant identification and sampling
Participants were selected using a pragmatic sampling approach from the orthognathic surgery population treated at the study center.
Eligible patients who met the inclusion and exclusion criteria were identified from the orthognathic surgery population treated at the study center and were contacted by telephone for participation.
Data collection was conducted in April 2025 through structured telephone interviews. The study included previously treated patients who fulfilled the eligibility criteria at the time of contact.
Participants were interviewed at least 6 months after surgery to allow postoperative stabilization before outcome assessment.
2.6. Surgical characteristics
The surgical procedures included maxillary osteotomy, bilateral sagittal split osteotomy, and mandibular osteotomy.
2.7. Questionnaire and interview procedure
The questionnaire was adapted from the World Health Organization quality-of-life framework and from previously published studies on patient satisfaction and quality of life after orthognathic surgery 1,13, 14, 15. The questionnaire used for data collection is provided as Supplementary File 1. It included items on chewing function, nasal breathing, facial appearance from frontal and profile views, smile, and selected psychosocial and social outcomes.
To improve cultural appropriateness, the questionnaire was translated into Arabic by three bilingual native Arabic speakers. Structured telephone interviews were used to collect responses. Participants were asked to report their current postoperative perceptions and to recall their preoperative status for the same outcome domains.
The interviews were conducted by 2 orthodontists at Dammam Medical Complex, Dammam, Saudi Arabia.
Pilot testing was used to assess face validity, clarity, readability, and the overall length of the questionnaire. Participants were invited to provide structured feedback on question wording, ease of understanding, response options, and survey flow.
2.8. Ethical considerations
Ethical approval was obtained from the Institutional Review Board of Dammam Medical Complex, Saudi Arabia (Approval No. H-05-D-107). The study followed the principles of the Declaration of Helsinki. Eligible participants were contacted by telephone, the study objectives were explained, and verbal informed consent was obtained from all participants prior to conducting the interview.
2.9. Statistical analysis
Data were analyzed using SPSS version 29 (IBM Corp., Armonk, NY, USA). Continuous variables are presented as mean ± standard deviation, and categorical variables are presented as frequencies and percentages.
For paired multi-category outcomes in Table 2, Table 3, the Stuart-Maxwell test of marginal homogeneity was used because these outcomes were paired and had more than two response categories. For paired binary outcomes in Table 4, the McNemar test was used. A two-sided p-value of ≤0.05 was considered statistically significant. In addition, 95% confidence intervals were calculated for selected key proportions to improve interpretability of the findings.
Table 2.
Postoperative overall improvement in relation to the primary intention for undergoing orthognathic surgery.
| Primary intention | n | Both aesthetic and chewing | Aesthetic only | Chewing only | Don't know |
|---|---|---|---|---|---|
| Both aesthetic and chewing | 70 | 59 (84.3) | 4 (5.7) | 2 (2.9) | 5 (7.1) |
| Aesthetic only | 21 | 3 (14.3) | 18 (85.7) | 0 (0.0) | 0 (0.0) |
| Chewing only | 7 | 2 (28.6) | 0 (0.0) | 3 (42.9) | 2 (28.6) |
| Don't know | 2 | 1 (50.0) | 0 (0.0) | 1 (50.0) | 0 (0.0) |
| Overall | 100 | 65 | 22 | 6 | 7 |
Paired multi-category comparison by Stuart-Maxwell test of marginal homogeneity: p = 0.392.
Table 3.
Preoperative and postoperative paired distributions of patient-reported outcomes.
| Chewing function (Stuart-Maxwell test: p < 0.001) | |||||
|---|---|---|---|---|---|
| Before surgery | n | Excellent after | Good after | Acceptable after | Poor after |
| Excellent | 28 | 22 (78.6) | 4 (14.3) | 0 (0.0) | 2 (7.1) |
| Good | 33 | 26 (78.8) | 5 (15.2) | 2 (6.1) | 0 (0.0) |
| Acceptable | 26 | 12 (46.2) | 12 (46.2) | 2 (7.7) | 0 (0.0) |
| Poor | 13 | 9 (69.2) | 2 (15.4) | 1 (7.7) | 1 (7.7) |
| Breathing from nose capacity (Stuart-Maxwell test: p < 0.001) | |||||
|---|---|---|---|---|---|
| Before surgery | n | Excellent after | Good after | Acceptable after | Poor after |
| Excellent | 47 | 40 (85.1) | 3 (6.4) | 0 (0.0) | 4 (8.5) |
| Good | 19 | 13 (68.4) | 4 (21.1) | 2 (10.5) | 0 (0.0) |
| Acceptable | 19 | 7 (36.8) | 9 (47.4) | 2 (10.5) | 1 (5.3) |
| Poor | 15 | 5 (33.3) | 7 (46.7) | 2 (13.3) | 1 (6.7) |
| Face side view (Stuart-Maxwell test: p < 0.001) | |||||
|---|---|---|---|---|---|
| Before surgery | n | Excellent after | Good after | Acceptable after | Poor after |
| Excellent | 17 | 14 (82.4) | 2 (11.8) | 1 (5.9) | 0 (0.0) |
| Good | 33 | 19 (57.6) | 10 (30.3) | 4 (12.1) | 0 (0.0) |
| Acceptable | 36 | 21 (58.3) | 12 (33.3) | 2 (5.6) | 1 (2.8) |
| Poor | 14 | 6 (42.9) | 4 (28.6) | 2 (14.3) | 2 (14.3) |
| Face front view (Stuart-Maxwell test: p < 0.001) | |||||
|---|---|---|---|---|---|
| Before surgery | n | Excellent after | Good after | Acceptable after | Poor after |
| Excellent | 17 | 17 (100.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
| Good | 44 | 30 (68.2) | 11 (25.0) | 3 (6.8) | 0 (0.0) |
| Acceptable | 32 | 18 (56.2) | 12 (37.5) | 1 (3.1) | 1 (3.1) |
| Poor | 7 | 2 (28.6) | 3 (42.9) | 1 (14.3) | 1 (14.3) |
| Smile (Stuart-Maxwell test: p < 0.001) | |||||
|---|---|---|---|---|---|
| Before surgery | n | Excellent after | Good after | Acceptable after | Poor after |
| Excellent | 6 | 5 (83.3) | 0 (0.0) | 1 (16.7) | 0 (0.0) |
| Good | 34 | 24 (70.6) | 9 (26.5) | 0 (0.0) | 1 (2.9) |
| Acceptable | 35 | 21 (60.0) | 11 (31.4) | 3 (8.6) | 0 (0.0) |
| Poor | 25 | 19 (76.0) | 4 (16.0) | 2 (8.0) | 0 (0.0) |
Table 4.
Paired preoperative and postoperative comparisons of selected personal attributes.
| Outcome | Before surgery | After surgery | p-value |
|---|---|---|---|
| Pronunciation difficulty | 34% | 23% | 0.086 |
| Pain in the temporomandibular joint area | 19% | 22% | 0.832 |
| Snoring | 23% | 16% | 0.214 |
| Perceived job opportunities | 12% | 30% | 0.002 |
| More self-confidence | 50% | 87% | <0.001 |
Binary paired comparisons were analyzed using the McNemar test based on the original before/after paired responses.
3. Results
A total of 100 patients who had undergone orthognathic surgery were included in the analysis. The study population comprised 53 females and 47 males, with a mean age of 29.39 ± 5.95 years. Most participants (84%) were between 20 and 35 years of age. Seventy-four participants were university graduates, and 86 participants were categorized as having moderate socioeconomic status (Table 1).
Table 1.
Demographic characteristics of the study participants (n = 100).
| Characteristic | Category | n | % |
|---|---|---|---|
| Gender | Male | 47 | 47 |
| Gender | Female | 53 | 53 |
| Age group (years) | 20-25 | 30 | 30 |
| Age group (years) | 26-30 | 36 | 36 |
| Age group (years) | 31-35 | 18 | 18 |
| Age group (years) | 36-40 | 10 | 10 |
| Age group (years) | 41-45 | 6 | 6 |
| Education | University | 74 | 74 |
| Education | High school | 25 | 25 |
| Education | Secondary | 1 | 1 |
| Socioeconomic status | Low | 8 | 8 |
| Socioeconomic status | Moderate | 86 | 86 |
| Socioeconomic status | High | 6 | 6 |
Most participants (70%) reported that their primary motivation for undergoing orthognathic surgery was improvement in both aesthetic appearance and chewing function. Twenty-one patients reported aesthetic improvement only, 7 reported chewing improvement only, and 2 were uncertain about what impact to expect before surgery.
Overall, 80 participants reported that the main outcome they experienced matched their primary preoperative expectation. In postoperative overall evaluation, 65 patients reported improvement in both aesthetic appearance and chewing function, 22 reported improvement mainly in aesthetics, 6 reported improvement mainly in chewing function, and 7 remained uncertain about the overall impact. There was no statistically significant shift between primary preoperative intention and postoperative overall improvement pattern (Stuart-Maxwell test, p = 0.392; Table 2).
From the patients' perspective, orthognathic surgery was associated with statistically significant favorable shifts in chewing function, nasal breathing, facial side view, frontal facial appearance, and smile (all p < 0.001; Table 3). For example, among the 13 participants who had rated chewing as poor before surgery, 9 (69.2%) rated their postoperative chewing as excellent. Likewise, among the 25 participants who had rated their smile as poor before surgery, 19 (76.0%) rated their postoperative smile as excellent.
Paired binary comparisons showed a significant increase in self-confidence after surgery (from 50% to 87%, p < 0.001) and in the proportion of participants who perceived improved job opportunities (from 12% to 30%, p = 0.002). Changes in pronunciation difficulty, temporomandibular joint pain, and snoring were not statistically significant (Table 4).
Overall, 95 participants stated that they would recommend orthognathic surgery to others (95% CI: 88.8%-97.8%), 90 felt that their family members and friends were satisfied with their postoperative facial appearance, and 51 reported starting new hobbies or sports after surgery.
4. Discussion
This study evaluated patient-reported outcomes after orthognathic surgery in a sample from the Eastern Province of Saudi Arabia and found generally favorable perceptions across functional, aesthetic, and psychosocial domains. Most participants underwent surgery with combined functional and aesthetic expectations, and most reported that the overall outcome aligned with what they had hoped to achieve.
The strongest postoperative shifts were observed in chewing, nasal breathing, facial appearance, and smile. These findings are consistent with previous reports indicating that orthognathic surgery is associated with improved oral health-related quality of life, particularly in domains that matter directly to patients in daily life.3,4,7,8,14,16 The marked increase in self-confidence in the present study also aligns with literature describing psychosocial benefits after orthognathic treatment.8,14,16
The focus on the Eastern Province is clinically relevant because local patient-reported data can support service planning, counseling, and expectation management within the regional public healthcare setting. In settings where family perception, social visibility, and cultural expectations around facial appearance may influence care-seeking and treatment satisfaction, locally generated evidence is particularly valuable for patient-centered practice.
Our findings should be interpreted cautiously because the study design does not support causal inference. Rather than proving that surgery caused every reported improvement, the results indicate that patients reported more favorable postoperative than preoperative status across several domains. This distinction is important given the retrospective, cross-sectional nature of the study.
The study also has several strengths. It included a relatively large sample for a single-center orthognathic satisfaction study, assessed multiple domains of patient-reported outcomes, and focused on outcomes that are often underrepresented in purely clinical evaluations. By examining functional, aesthetic, and psychosocial dimensions together, the study provides a broader view of how patients perceived treatment benefit.
Several limitations should be acknowledged more explicitly. First, because the study was retrospective and cross-sectional, preoperative outcomes were recalled after surgery rather than recorded prospectively, which introduces recall bias. Second, selection bias cannot be excluded because sampling was pragmatic and depended on the availability and participation of previously treated patients. Third, the questionnaire was adapted for the local context, but formal psychometric validation of the modified version was not clearly documented. Fourth, the postoperative assessment interval was not standardized in the original manuscript, and variation in time since surgery may have influenced patient responses. Fifth, interviewer-related bias is possible in telephone-based self-report data collection. Finally, some analyses relied on patient-reported outcomes without linkage to objective clinical measurements.
Future research should use prospective longitudinal designs with standardized assessment intervals, baseline preoperative measurements, and a fully validated Arabic instrument. Multicenter recruitment may also help improve generalizability across different Saudi regions.
5. Conclusion
In this sample from the Eastern Province of Saudi Arabia, orthognathic surgery was associated with high patient-reported satisfaction and favorable functional, aesthetic, and psychosocial outcomes. The findings support the importance of integrating patient-reported outcomes into orthognathic treatment planning and postoperative evaluation. Careful preoperative counseling, expectation management, and context-specific assessment tools may further improve patient-centered care.
Human subjects statement
This study involved human participants. Ethical approval was obtained from the Institutional Review Board of Dammam Medical Complex, Saudi Arabia (Approval No.: H-05-D-107). Eligible participants were contacted by telephone, the study objectives were explained, and verbal informed consent was obtained from all participants prior to conducting the interview. The study was conducted in accordance with the Declaration of Helsinki.
Ethical statement
This study was approved by the Dammam Medical Complex Institutional Review Board (IRB Protocol No. DEN-13; National Registration Number: H-05-D-107). The study was conducted in accordance with the approved study protocol and applicable ethical guidelines.
Funding statement
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgement
The authors would like to thank Dammam Medical Complex for their support and assistance in conducting this study.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.jobcr.2026.101496.
Appendix A. Supplementary data
The following is the Supplementary data to this article:
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