Copyright © 2019 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. Assessing Quality of Life After Orthognathic Surgery in Disabled Patients Alexandra Promerat, MD,  Sandrine Touzet-Roumazeille, MD, MSc,  Matthias Schlund, MD, MSc, y and Joel Ferri, MD, PhD y Introduction: Orthognathic surgery is a common procedure in facial deformities treatment but requires a high level of compliance from the patient. Performing this treatment for mentally disabled patients is a subject of discussion. The aim of this study was to evaluate the quality of life (QOL) after orthognathic surgery in disabled patients. Material and methods: Eight patients with mental disability who underwent orthognathic surgery between 2007 and 2017 participated in this study. Their family or guardian completed a questionnaire to assess modification in aesthetic, functional, and social abilities after orthognathic surgery. Complications, difficulties in maintaining postoperative cares were also recorded. Results: All patients had improvement in global facial aesthetic. 62.5% of the patients had improvement in self-esteem and confidence in social events. Regarding functional aspect, the main improvement was found in chewing (75%) and ability to move the jaw (75%). Two patients (25%) found that jaw noises and pain were worse after surgery. No major complication occurred. Postoperative care was hard to follow but no patient had to stop maxillomandibular fixation. Conclusion: On well selected cases, orthognathic surgery is a safe procedure which provides improvement in QOL in disabled patients. Key Words: Disabled patients, orthognathic surgery, quality of life (J Craniofac Surg 2019;30: 2404–2407) O rthognathic surgery has become a routine procedure in the management of facial deformities over the past decades. This surgery can provide improvement both from the functional as well as the aesthetic point of view with low morbidity and complication rates. Several studies have shown an improvement in quality of life after orthognathic surgery. 1–3 However, it requires a high level of compliance both before surgery, in order to achieve a proper orthodontic treatment, and after surgery, to maintain postoperative instructions (maxillomandibular fixation [MMF], diet, sport restric- tion, postoperative orthodontic treatment, physiotherapy). The mental handicap is defined by the World Health Organiza- tion (WHO) as the reduction in intelligence of a person below the variation regarded as normal and the lack of social abilities, which are necessary to lead an independent life. For these patients, compliance to the treatment can be restricted, particularly for orthodontic treatments. It can be considered as an obstacle to perform orthognathic surgery in this population. However, facial dysmorphia with huge malocclusions is very frequent in this population, and can induce functional disturbances such as mastication and speech impairment, drooling, and psycho- logical disturbances. Stigmatizing facial features may exaggerate the mental state and lead to greater social isolation of mentally disabled patients. Patient aware of their deformity or functional difficulties ask for surgical correction. Few studies have been done to assess the effects of orthognathic surgery on disabled patients. 4,5 The WHO defines QOL as an individual’s perception of their position in life in the context of culture and value systems in which they live and about their goals, expectations, standard and concerns. Different questionnaires have been created to evaluate QOL such as OHIP 14 (Oral Health Impact Questionnaire) 6 or OQLQ (Orthognathic Quality of Life Questionnaire), which is more specific to orthognathic surgery. 7,8 The aim of this study was to evaluate the improvement in quality of life (QOL) after orthognathic surgery in disabled patients. The complications rate, treatment difficulties before and after surgery were also studied. MATERIAL AND METHODS This retrospective study involved disabled patients undergoing orthognathic surgery in the Oral and Maxillofacial Surgery Depart- ment of Lille University Hospital between 2007 and 2017. The surgical procedures included maxillary and mandibular osteotomies with or without associated genioplasty. MMF was maintained for 2 weeks postoperatively. The diet was liquid during MMF and soft for 6 weeks afterwards. Primary Outcome We used a modified Orthognathic Quality of Life Questionnaire to assess the improvement of quality of life after orthognathic surgery. It consisted of 20 questions with answers ranking from much better than before surgery to much worse than before surgery. This questionnaire focused on 3 aspects: functional, aesthetic and social. The questionnaire was filled by the patient’s entourage (family or guardian). From the  University Lille, Oral and Maxillofacial Surgery Department, CHU Lille; and y University Lille, Oral and Maxillofacial Surgery Department, CHU Lille; INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, Lille, France. Received March 17, 2019. Accepted for publication April 19, 2019. Address correspondence and reprint requests to Alexandra Promerat, MD, Service de Chirurgie Maxillo-Faciale et Stomatologie, Ho ˆpital Roger Salengro, Rue Emile Laine, 59037-Lille-Cedex, France; E-mail: alexandra.promerat@gmail.com The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jcraniofa- cialsurgery.com). Copyright # 2019 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000005698 CLINICAL STUDY 2404 The Journal of Craniofacial Surgery  Volume 30, Number 8, November/December 2019