134 A patient’s decision to undergo orthognathic surgery is based on multiple needs and motives. Social and psychological concerns, cultural values, cost of treat- ment, recovery time, and perceived benefits (ie, improved function, appearance, and/or self-esteem) can encourage a patient to pursue surgery or discourage him or her. Orthodontists are often the first to introduce patients to the concept of orthognathic surgery. Ortho- dontists are also one of patients’ primary providers of information concerning the goals, benefits, and risks of surgical treatment. Yet relatively little is known about patients’ use and interpretation of the treatment recom- mendations communicated by their orthodontists. Although orthodontists’ recommendations form the foundation for presurgical consultation, patients’ rea- sons for and expectations about orthognathic surgery may differ from those they attribute to their referring orthodontist. Previous studies have examined patients’ and clinicians’ opinions in several areas, including the treatment of diabetes mellitus, 1,2 communication between cancer patients and their physicians, 3 and problem identification. 4,5 The majority of these studies report differences in the opinions of patients and clini- cians concerning patients’ decision-making processes, 3 the most appropriate time to inform patients about unpleasant events, 3 the identification of principal health problems for scheduled visits, 4 and agreement about problems requiring follow-up examinations. 5 The relationship between patients’ own reasons for desiring orthognathic surgery and their understanding of the treatment benefits communicated by the ortho- dontist has yet to be examined. This assessment may be This research was supported by NIDR grant DE09630. These findings were pre- sented in part at the 76th annual IADR meeting in Nice, France, June 1998. a Research Assistant, Department of Orthodontics, The University of Texas Health Science Center at San Antonio. b Associate Professor, Department of Psychiatry and Orthodontics, The Univer- sity of Texas Health Science Center at San Antonio. c Assistant Professor, Department of Orthodontics, The University of Florida. d Professor and Chief, Department of Oral and Maxillofacial Surgery, Emory University. e Professor and Senior Surgeon, Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at San Antonio. f Professor and Interim Chair, Department of Orthodontics, The University of Texas Health Science Center at San Antonio. Reprint requests to: John D. Rugh, PhD, Department of Orthodontics, The Uni- versity of Texas, Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7910. Submitted, April 1999; Revised and accepted, February 2000. Copyright © 2000 by the American Association of Orthodontists 0889-5406/2000/$12.00 + 0 8/1/107010 doi.10.1067/mod.2000.107010 ORIGINAL ARTICLE Patients’own reasons and patient-perceived recommendations for orthognathic surgery Semilla M. Rivera, BA, a John P. Hatch, PhD, b Calogero Dolce, DDS, PhD, c Robert A. Bays, DDS, d Joseph E. Van Sickels, DDS, e and John D. Rugh, PhD f San Antonio, Tex, Gainesville, Fla, and Atlanta, Ga In an attempt to learn more about patients’ decision-making processes, an analysis was performed to examine patients’ reasons for undergoing orthognathic surgery and their understanding of the reasons surgery was recommended. Before surgery, 105 females and 38 males completed an open-ended questionnaire in which they listed their reasons for choosing orthognathic surgery and their perceptions of their orthodontists’ recommendations. Three raters classified the responses into 7 categories: esthetics, psychosocial, functional, TMJ/pain, authority, prevention, and other. Rater agreement ranged from a κ of .55 to 1.00. Patients reported undergoing orthognathic surgery primarily for esthetic, functional, and TMJ improvements, 71%, 47%, and 28%, 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 surgery was recommended primarily for esthetic, functional, and TMJ improvements, 52%, 44%, and 18%, respectively. Males reported receiving more preventative recommendations (23%) than females (10%). Mexican American patients reported receiving more psychosocial recommendations (P <.05) than European Americans. Agreement between each paired patient/patient-perceived reason was highest for TMJ problems (κ = 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-to-case basis, agreement between patient and orthodontist- represented reasons was modest, suggesting differences between patients’ own reasons and their perceptions of orthodontists’ recommendations. (Am J Orthod Dentofacial Orthop 2000;118:134-40)