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Unlabelled: The aim of the study was to analyze the results of patients' subjective self-assessment of surgical treatment of prognathism., Materials and Methods: The study included 35 patients who underwent extraoral vertical ramus osteotomy. Each patient responded to 12 questions contained in the questionnaire created by the authors., Results: All respondents positively assessed their appearance after surgery. In most cases they pointed out the positive impact of treatment on their self-confidence (82.9% of responses). The vast majority of respondents felt improvement in biting off food (91.4%)., Conclusions: Patients positively evaluate the outcome of surgical treatment with extraoral vertical ramus osteotomy. The subjective improvement of the facial appearance, as well as chewing and articulation functions took place after the treatment.

Orthognathic intervention has not only profound implications on the individual's function and esthetics, but also on the perception of his surrounding environment. In this study, frontal and profile photographs of 3 groups of men (a control group with normal profile and prognathic and retrognathic profiles, before and after orthognathic surgery) were shown in random order to a group of 83 women, who were asked to rate the pictures according to attractiveness and several personality traits on an analog scale. Results show that men with normal profiles got the most positive scores on all categories. Men with prognathic profiles were perceived as more aggressive and assertive, while men with retrognathic profiles were perceived as less intelligent and reliable. After orthognathic intervention both retrognathic and prognathic groups had a significant improvement in their scores, which were closer to the normal profile group.

The structure of the chin determines facial attractiveness and is directly linked to quality of life (QoL). In patients with prognathism and maxillary hypoplasia, bimaxillary osteotomy (BIMAX) with mandibular setback does not always lead to a more slender chin or improved aesthetics. The aim of the present study was to evaluate whether QoL differed between females undergoing BIMAX alone (group I; n=30) and those undergoing BIMAX combined with reduction genioplasty (group II; n=30). Presurgical and postsurgical evaluations included cephalography, photogrammetry, and the Oral Health Impact Profile with one additional domain (aesthetics). Setback of the hard tissue pogonion was significantly greater (P=0.006) in group II (7.1mm) than in group I (2.7mm). Only in group II were soft tissue pogonion changes highly significant (P<0.001), amounting to a mean of 5mm. In both groups, the QoL domains 'social disability', 'psychological discomfort', and 'dissatisfied with aesthetics' changed significantly towards lower impact scores. Changes in the latter two domains were significantly greater in group II patients than in group I patients (P=0.021; P<0.001) and were correlated with changes in the soft tissue pogonion in the horizontal (P=0.024; P=0.022) and vertical directions (P=0.037; P=0.042). Genioplasty addresses both psychological and aesthetic concerns, and therefore significantly enhances postsurgical QoL., (Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The purpose of this investigation was to undertake an objective and quantitative evaluation of how the degree of chin prominence influences perceived attractiveness. The chin prominence of an idealized profile image was altered in 2 mm increments from -24 to 12 mm, in order to represent retrusion and protrusion of the chin, respectively. These images were rated on a 7-point Likert scale by a pre-selected group of pre-treatment orthognathic patients, clinicians and laypeople. In treatment planning to alter the sagittal prominence of the chin in an individual with an otherwise normal soft tissue facial profile, an 'ideal' sagittal position with soft tissue pogonion on or just behind a true vertical line through subnasale may be used. Chin retrusion or protrusion up to 4mm is essentially unnoticeable. Surgery is desired for chin protrusions greater than 6mm and retrusions greater than 10mm. The overall direction of aesthetic opinion appears to be the same for all the observer groups; the greater the retrusion or prominence of the chin, the less the rating of the perceived attractiveness and the greater the desire for surgical correction., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate correlations between presurgical and postsurgical changes in quality of life (QoL) and cephalometric hard and soft tissue changes in patients undergoing orthognathic surgery., Materials and Methods: The study sample consisted of 30 patients (mean age 24.3 ± 4.5 years) with Class III malocclusion undergoing orthognathic surgery for mandibular setback with a median follow-up of 8.3 ± 1.2 months. Presurgical and postsurgical cephalograms were traced and Oral Health Impact Profile (OHIP) questionnaires were completed. Each questionnaire consisted of 14 items designed to evaluate functional, physical, psychological, and social impacts., Results: Significant correlations between significant presurgical-to-postsurgical changes in individual items and OHIP parameters were found between labiomental angle (LA) and question 5 ("feeling self-conscious"; correlation coefficient [r]  =  0.530), between LA and question 6 ("feeling tense"; r  =  0.598), between nasion-pogonion and question 5 (r  =  0.523), and between facial convexity and question 5 (r  =  -0.540). Hence, reduction of both LA and nasion-pogonion led to a significant decrease in the impact scores of items covering psychological discomfort, while reduced facial convexity led to increased impact scores., Conclusions: Although the associations were moderate, changes in QoL following cephalometric modifications should be considered as a major concern when planning orthognathic surgery. Postsurgical changes to a more convex profile after mandibular setback should be emphasized before surgery to help patients become accustomed to their new appearance more easily without negatively affecting QoL.

Introduction: Improved facial esthetics can be fully achievable only if facial preferences of the treated group are known. We hypothesized that facial profile perception and preferences could be influenced by orthodontic treatment., Methods: Differences in facial profile preferences between children with and without an orthodontic history were investigated in a sample of 1626 children aged 12 to 19 years (mean age, 14.8 ± 2.2 years) from 24 public schools in Zagreb, Croatia, randomly selected by using a cluster sampling procedure. Eight profile distortions for each sex, morphed by a digital imaging technique, were used for estimation. Analysis of variance (ANOVA), Bonferroni, and 2 independent sample t tests were used to compare the preferences of the groups., Results: A straight profile was the most favored in both sexes, regardless of previous orthodontic history. A bimaxillary alveolar protrusive profile with thicker lips was preferred among the female profiles, and a bimaxillary retrusive profile with flat lips and a prominent chin was preferred among the male profiles. Orthodontic history and personal facial profile had little effect, and sex had a slightly greater influence on personal facial profile preferences., Conclusions: It seems that orthodontic therapy has no clinically relevant influence on facial profile preferences. Depending on the patient's sex, orthodontists should have different criteria for treating borderline patients with bimaxillary dentoalveolar protrusion and mandibular prognathism., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Purpose: This study investigated the association between the anteroposterior position of the mandible and the perceived need for orthognathic surgery., Materials and Methods: Profiles of 2 men, 1 black and 1 white, and 2 women, 1 black and 1 white, were photographed and altered to produce photos with a straight profile and 6 simulations of mandibular discrepancies, 3 by retrusion and 3 by protusion from each original face. The 28 faces were evaluated by orthodontists, maxillofacial surgeons, artists, and laypersons., Results: The greatest numbers of indications for surgery were made for male convex profiles and for female concave profiles. Laypersons were more tolerant to profile changes, whereas maxillofacial surgeons indicated surgery and stated that they would seek facial surgery if profiles were their own in a greater number of cases., Conclusion: The angle of facial convexity has a strong effect on the perceived need for orthognathic surgery.

Introduction: Our aims in this study were to determine the anteroposterior facial relationship that is regarded as most attractive by Japanese laypersons in a questionnaire survey and to evaluate which analysis of the soft-tissue profile is most suitable for Japanese people., Methods: We showed 262 Japanese laypersons (121 male, 141 female) 9 morphed profile images with Point B and menton anteriorly or distally moved by software and asked them to number them sequentially according to their attractiveness. To examine which analysis best reflects facial attractiveness as judged by laypersons, we made 5 types of analyses of the facial profile with 11 variables in the 9 images., Results: The normal face was judged favorably; however, an attractive profile might be different for each subject. The 3 highest ranking profiles (normal face and moderate mandibular retrusions) were often favorites, and 2 profiles (severe mandibular protrusions) were liked the least for most subjects. However, the other images showed a wide range of distribution. Mandibular retrusion was generally more favored than mandibular protrusion and bimaxillary protrusion (severe chin retrusion) had a high attractiveness ranking and was well accepted in the Japanese population., Conclusions: To evaluate the profiles of Japanese subjects, it is important to evaluate not only the esthetic line defined by the nose and chin, but also the balance of the upper and lower lips defined by the posterior reference line--ie, Burstone's Sn-Pog' line.

Purpose: The aim of the study was the comparison of the cephalometric results occurring during orthodontic and surgical treatment of patients with mandibular prognathism. Results of patients treated surgically and of patients who underwent complex orthodontic and orthognathic treatment were compared. Additionally, the purpose of the research was to evaluate the psychical state of the prognathic patient: the affect the physical "difference" may have had on his life as well as his own opinion concerning the treatment and its outcome., Material and Method: Cephalometric results using the Segner-Hasund method of two groups of patients were compared: group I (12 patients undergoing surgical treatment), group II (11 patients treated orthodonically and surgically). The X-rays in group I were taken just before the surgical treatment and at least 3 months after the treatment, and in group II, before orthodontic treatment and at least 3 months after surgery was preformed. Additionally patients were asked to answer a questionnaire concerning their self-esteem and approach to the treatment and its results., Conclusions: The comparison ofcephalometric results of the prognathic patient prior and post treatment gives a good insight on changes which take place. The study showed that better cephalometric results were obtained in group II i.e., in patients undergoing orthodontic--orthognathic treatment. Patients of both groups were pleased with the outcomes of the treatment (with a slight emphasis on group II), which lead to the conclusion that treatment of the prognathic patient has a positive influence on his self-esteem and way of life.

Introduction: The purpose of this study was to determine the influence of chin prominence on preferred lip position in profile., Methods: Five "male" and 5 "female" silhouette profiles differing only in the degree of mandibular retrognathism or prognathism (-25 degrees, -18 degrees, -11 degrees, -4 degrees , and +3 degrees facial contour angles) were created. Using a computer animation program, the evaluators moved the upper and lower lips independently into the positions they deemed to be the most esthetic for each profile. The evaluators included white male and female adolescent orthodontic patients, parents of patients, and orthodontists., Results: In general, no differences in preferred lip position were found between the -11 degrees and -4 degrees profiles or between the -18 degrees and +3 degrees profiles, but preferences for each of the 3 profile groupings (-11 degrees and -4 degrees, -18 degrees and +3 degrees, and -25 degrees) were different. Fuller lip positions were preferred for the more extreme retrognathic and prognathic profiles, whereas more retrusive lip positions were preferred for the more average profiles. No differences were found among the 3 evaluator groups or between male and female evaluators. Scattered differences were found among lip preferences for male and female profiles.

Aim: To assess the facial profile preferences of laypersons in an Asian community and the influence of age, ethnic and gender on profile selection., Methods: A sample of 149 laypersons (65.1% Chinese, 21.5% Malays and 13.4% Indians), comprising of 112 females (75.2%) participated in the study. The mean age was 24.6 years (SD 4.4). A facial profile photograph and a lateral cephalometric radiograph of a Chinese male and female adult with a normal profile and a class I incisor and skeletal relationship were digitized to create a baseline template. Computerized digital photographic image modification was carried out on the template to obtain seven facial profiles [bimaxillary protrusion, protrusive mandible, retrusive mandible, normal profile (incisor and skeletal class I pattern), retrusive maxilla, protrusive maxilla and bimaxillary retrusion] for each gender. The laypersons were asked to rank the profiles of each gender on a scale of 1 (very attractive) to 7 (least attractive)., Results: Orthognathic Chinese male and female profiles were perceived to be the most attractive. A male orthognathic profile with normative Chinese cephalometric values was perceived to be more attractive than a 'flatter' bimaxillary retrusive profile. Bimaxillary retrusion and normal Chinese female profiles were perceived to be the most attractive. A male or female profile with a protrusive mandible was judged to be the least attractive. Age, gender and ethnicity were nonsignificant predictors for the most attractive female profile., Conclusions: Orthognathic Chinese male and female profiles were judged to be the most attractive by Asian adult laypersons. Male and female profiles with mandibular protrusion were judged to be the least attractive.

Introduction: Facial profile disharmonies in the anteroposterior (AP) position of the mandible are among the most frequent reasons that patients seek orthodontic treatment. Various methods are available for assessing profile preferences, and differences between them could affect treatment decisions. The purposes of this study were to compare and contrast 3 methods of evaluating profile preferences for the AP position of the mandible., Methods: Facial profile preferences of white orthodontists (n = 28) and white (n = 56) and Japanese-American (n = 55) laypeople were evaluated. The esthetic significance of variations in the AP position of the mandible was investigated by using 3 methods: a traditional semantic differential scale, the Perceptometrics method (Health Programs Intl, Wellesley, Mass), and the implicit association test (IAT)., Results: Findings from the semantic differential scale show that, overall, there is a general preference among orthodontists and laypeople for an orthognathic profile (P <.001). Findings from the Perceptometrics method indicate that orthodontists consider the most pleasing profile to be more forward than do lay subjects (P <.001). The IAT results show a positive bias among all 3 groups toward orthognathic profiles and a negative bias toward profiles with mandibular retrognathism or prognathism. The IAT suggested that laypeople were more tolerant of mandibular prognathism in men than in women (P <.01), and more tolerant of mandibular retrognathia in white women than in men (P = .03)., Conclusions: These results support the benefits of using both implicit and explicit methods to assess facial profile preferences.

Introduction: The aim of this study was to compare the perception of male and female Chinese facial profile esthetics between dental professionals, dental students, and laypersons., Material: The sample comprised 31 dental professionals (20 orthodontists, 11 oral surgeons), 92 dental students, and 152 laypersons in an Asian community. The facial profile photographs and lateral cephalometric radiographs of a Chinese man and a woman, each with a normal profile, a Class I incisor relationship, and a Class I skeletal pattern, were digitized. The digital images were modified to obtain 7 facial profiles for each sex. The images were constructed by altering cephalometric skeletal and dental hard tissue Chinese normative values by 2 standard deviations in the anteroposterior plane only. The 7 profiles were (1) bimaxillary protrusion, (2) protrusive mandible, (3) retrusive mandible, (4) normal profile (Class I incisor with Class I skeletal pattern), (5) retrusive maxilla, (6) protrusive maxilla, and (7) bimaxillary retrusion., Results: Normal and bimaxillary retrusion Chinese male and female profiles were perceived to be highly attractive by all 3 groups. Profiles with a protrusive mandible were perceived to be the least attractive. Dental professionals, dental students, and laypersons were highly correlated for the perception of male (r > 0.67) and female (r > 0.93) profile esthetics. All correlation coefficients were found to be significant for the perception of female profiles, but, for male profiles, only the correlation coefficient between dental students and laypersons was significant., Conclusions: Chinese male and female profiles that were normal or had bimaxillary retrusion were perceived to be highly attractive by dental professionals, dental students, and laypersons, and profiles with a protrusive mandible were perceived to be the least attractive. Dental students and laypersons were more tolerant of a male profile with a retrusive mandible than were dental professionals, and all groups were more tolerant of bimaxillary protrusion in women than in men. Dental professionals, dental students, and laypersons had a similar trend in male and female esthetic preferences. The perception of female profiles by all 3 groups was highly and significantly correlated. Only the perception of male esthetics by dental students and laypersons was not significantly correlated with dental professionals.

The purpose of this study was to determine the facial profile preferences in a sample of 2651 randomly selected panelists (mean age, 29.3 +/- 10.1 years) from Japanese cultural and educational backgrounds. Five facial profile types were computer-generated by an orthodontist to represent distinct facial types. Subjects were asked to rank the profiles in descending order of attractiveness. The ranking was as follows: orthognathic profile, bimaxillary retrusive profile, bimaxillary protrusive profile, mandibular retrognathic profile, and mandibular prognathic profile. The differences in rank scores between all the profile types were statistically significant (p < 0.05).

Authors present the essence of psychosomatics with particular emphasis on the impact of dento-occlusal and cranio-facial anomalies on the mental constitution. In their representation--after giving a historical review--they show the main features of the present state of knowledge in this branch of science based on literary publications by completing it with their own clinical experience.

A group of 20 patients (12 females and 8 males) who underwent orthognathic surgery during the previous three years were surveyed. The reasons which determined the decision to undergo surgery are discussed. Patient satisfaction and the effect of surgery on psychological and social attitudes are explored.

A postoperative survey was conducted to evaluate the motivation of twenty three patients following surgical correction of mandibular prognathism. The operative technique of bimaxillary surgery was applied to all patients. The major reason for surgery was esthetics. Majority of patients were informed about surgery by their family dentists, and almost all of them were satisfied and stated that their expectations were fulfilled.

The purpose of this study was to determine the facial profile preferences in a sample of 1,189 Asian teenagers (aged 15.3 +/- 3.2 years). Five facial profile types were computer-generated by trained personnel (orthodontists and oral maxillofacial surgeons) to represent distinct facial types. Subjects were asked to rank the profiles in descending order of attractiveness. The ranking was as follows: orthognathic profile, bimaxillary retrusive profile, bimaxillary protrusive profile, mandibular retrognathic profile, and mandibular prognathic profile. The differences in rank scores between all the profile types were statistically significant (p < 0.05). Assessment of profile types among lay personnel could provide clinicians an indication into the relative attractiveness among profile types and health care workers in treatment prioritization among dysmorphic facial types.

Within this study patients with mandibular prognathism were studied as to their psychological situation pre- and postoperatively with the help of the Freiburg Personality Evaluation Sheet. Since it was our special interest, whether psychologically it makes a big difference whether the patients were operated during the time of adolescence or after the age of twenty, the postoperative investigation was carried out with special reference to this point. Without any doubt, the correction of prognathism improved the psychological situation of the patients. It was obvious that for those patients in between fourteen and seventeen the improvement was more helpful than for those patients after the age of twenty. On the other hand the rate of recurrence was much higher within the group of those patients operated in between fourteen and seventeen (29.8%) than for those patients which were operated later than at age twenty (8%). The ideal age for the correction of mandibular prognathism must be found individually. While the operation at an early time is more helpful for the psychological situation of the patients, it must on the other hand be seen that for this age-group the danger of recurrence is higher.

Questionnaires and psychological tests were used to assess the psychosocial impact of mandibular prognathism. Patients with mandibular prognathism were asked to assess the impediments caused by their dentofacial deformity. In addition, they were asked to rate their appearance and to report the effect that it had on their social contacts. The self-assessment revealed that patients felt esthetically impaired, but that they had a fairly positive autostereotype, as revealed by their self-descriptive choices on a personality scale. These results were compared with the assessments made by two different control groups composed of persons with no esthetic impairment. The attitudes of the control groups toward the patients were more negative than perceived by the patients, indicating that mandibular prognathism does result in a social handicap.

The psychological adjustments and self-concepts of 61 orthognathic surgery patients were evaluated before surgery and at 1 month, 6 months, 1 year, and 2 years after surgery. The impact of orthognathic surgery on self-concept and personality adjustment was assessed. Significant improvements in group scores were found with the use of a repeated measures ANOVA in the following subscales of personality disturbances: general maladjustment, psychosis, neurosis, personality disorder, and personality integration. A significantly positive effect was also observed in the following subscales of self-concept: self-esteem, self-satisfaction, self-identity, physical self, family self, social self, and total self-conflict. The improved changes in psychological profile two years after orthognathic surgery are encouraging.

In a prospective study of 54 prognathic patients the psychological effects of this condition, which occurs typically at puberty, were investigated in postoperative follow-up examinations and the psychological effect of a corrective operation investigated. For this purpose standardized questionnaires and a semistructured psychiatric interview were used. The hypothetically expected personality disturbance of a "dysmorphophobia" was found in only some of our patients. With an inconspicuous premorbid personality they reacted to the psychological trauma of their facial deformity with depressive crises of self-assessment in the occupational and private spheres. Here, convincing postoperative improvements occur beside which the "psychological scars" are still recognizable owing to the earlier deformity.

Ninety patients undergoing surgery at two major university hospitals completed self-ratings of their profile, perceived deviations from the ideal profile, and a measure of body image. Identical measures were obtained presurgically and two years following surgery. Patients diagnosed with mandibular hypoplasia perceived themselves significantly more prognathic on the maxillary dimension and most retrognathic on the mandibular dimension; their self-drawings reflected a shorter vertical dimension. These perceptions approached the normal range at the postsurgical assessment. Patients treated for maxillary hypoplasia, however, rated themselves in the mandibular prognathic range both before and after surgery. These patients were also more likely to perceive other deviations from the ideal in their facial features 2 years after surgical correction. Body image did not differentiate among diagnostic categories, but showed overall improvements for all patients from presurgery to postsurgery. Profile drawings appear to be the most statistically and clinically useful method of determining patients' self-assessments of deviations from normal, and their perceptions of treatment needs.

Acquired maxillo-facial deformities and in particular those related to problems of facial expression are nevertheless influenced by certain hereditary factors, amongst which the constitutional type or the temperament of the individual play a major role. Morpho-psychology (L. Corman), or the art of relating physical details (especially the shape and characteristics of the face) with psychological state demonstrates correlations between the type of deformity and that of the temperament and explains them. After a brief review of the essential principles of morpho-psychology, the authors study a number of special morpho-psychological types presenting with a significant frequency maxillo-facial deformities, themselves special, and which for this reason they call "morpho-psychological types with a high orthodontic risk". They conclude that it would appear that insufficient importance is attributed at present to psychological factors in the aetiopathogenesis of dysmorphoses and feel that an overall approach to the deformed child is indispensable to progress in the specialty.

A case report of a patient with a severe skeletal Class III malocclusion has been presented. The patient's marked anteroposterior discrepancy was complicated by the fact that his buccolingual occlusion was normal. The solution to this case thus involved a correction of the transverse discrepancy in addition to the anteroposterior discrepancy, which required orthodontic and surgical solutions. A discussion of mandibular prognathism has also been presented.

The morphological organisation of the face reflects the individual's social context and heredity and also reveal certain personality traits. Emotional facial expression is a very special form of communication. This functional and behavioural dynamic leads to the formation of a certain anatomical structure as a result of repetitive functions. The psychological examination of nineteen retrognathic patients and seven prognathic patients revealed the timid, inhibited of even anxious personality of the first group of patients in contrast with the extraverted and frequently aggressive personality of prognathic patients.