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Design and Validation of JAW-Q: A Novel Patient Reported Outcome Measure for Orthognathic Surgery
Charbel Saad
*, Katherine Zhu, Alec Chen, Emma Yan, Jonlin Chen, Alisa Girard, Moreen Njoroge, Christopher Lopez, Robin Yang
Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
Background: By correcting jaw asymmetry, occlusion, oral function and aesthetics,
orthognathic surgery can significantly improve a patient's quality of life (QOL). For many patients, improved QOL is a significant motivator to seek surgery. To adequately understand the patient perspective for orthognathic surgery, a well-defined and valid patient reported outcome measure is needed. The aim of this study is to develop a patient reported outcomes scale for orthognathic surgery that encompasses a variety of QOL domains.
Methods: The questionnaire was developed by a literature review to encompass outcome measures related to orthognathic surgery, including jaw and nasal function, facial aesthetics, pain, and psychological wellbeing. To assess the internal validity of each question, 30 patients completed the survey twice before surgery, with a one-week interval between responses. Any questions with poor reliability were eliminated. The finalized survey was distributed to patients preoperatively and postoperatively from June 2021 to February 2025 at our institution.
Results: The final survey consisted of six domains: Appearance, Jaw Function, Nasal Function, Psychological Wellbeing, Pain and Complications, and the Epworth Sleepiness Scale (ESS). A total of 93 pre-operative and 42 postoperative responses were collected. Univariate analysis showed statistically significant improvement in appearance scores by 10.5 points (p<0.00005), jaw function by 5.5 points (p=0.004), psychological assessment by 7.5 points (p=0.006), and pain and related complications by 9 points (p=0.004). Nasal function and the ESS showed no statistically significant improvement. After adjustment for age in a multivariate regression, orthognathic surgery status persisted as the most significant predictor of the fundamental outcomes.
Conclusion: The JAW-Q is a promising novel patient-reported outcome tool for use in orthognathic surgery patients. These findings indicate its potential to assess a patients' perceived QOL across key domains including appearance, jaw function, pain, and psychological wellbeing.
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