title: The use of clinical photographs to determine clinician’s perception of the need for orthognathic surgery in patients of different racial backgrounds presenting with class 3 skeletal discrepancy
Creators: name: Vesey, JA
Publisher: name: University of Liverpool Repository
Year: 2019

description: Aim: To investigate the impact of patients’ race on clinician’s perception of the need for orthognathic surgery in patients with class 3 profiles. Design: Prospective cross-sectional questionnaire. Method: A questionnaire was distributed to consultant and specialist orthodontists and oral and maxillofacial surgeons in the United Kingdom and Hong Kong. It contained average composite profile images of adult male and female patients from two different racial backgrounds (Caucasian and Chinese) which had been manipulated to produce increasingly severe class 3 skeletal discrepancies in 2mm increments from baseline (0mm) in both the mandible; (+2mm, +4mm, +6mm), and maxilla; (-2mm, -4mm, -6mm). Respondents were asked whether they felt that ‘a patient presenting with this skeletal pattern would benefit from orthognathic surgery’ and ‘how do you rate the level of attractiveness of the profile?’ on a 7- point Likert scale. Multi-level logistic regression and multi-level linear regression were used to investigate factors influencing decision to recommend surgery and perception of attractiveness. Results: The response rate was 62% (N=306). Significantly more clinicians felt that the manipulated class 3 profiles would benefit from surgery compared with baseline (p=&lt;0.006, p&lt;0.001). Oral and maxillofacial surgeons were 3.94 times more likely to recommend surgery than orthodontists (p=&lt;0.001). The image’s race and gender, clinician’s years since becoming a specialist, specialty and the number of orthognathic patients treated per year were statistically significant factors for predicting perceived benefit from surgery (p&lt;0.001). Attractiveness ratings for all manipulated class 3 profiles were statistically significantly different to baseline (p&lt;0.001). Attractiveness ratings reduced with increasing severity of class 3 manipulation with -6mm maxilla being rated least attractive (p=&lt;0.001). Maxillary manipulations were on average rated as less attractive than the mandibular manipulation with the same degree of discrepancy. Ethnicity was a statistically significant factor associated with attractiveness rating with Caucasian profiles rated more attractive than Chinese profiles for the same degree of manipulation (p=&lt;0.001). Conclusion: Oral and maxillofacial surgeons are more likely to perceive benefit from surgery in patients with class 3 skeletal profiles than orthodontists. Ethnicity significantly impacts decision making with Chinese profiles more likely to be perceived as having benefit from surgery than Caucasian profiles, and Caucasian profiles rated as more attractive than Chinese, for the same degree of discrepancy. Mild class 3 skeletal profiles are rated as significantly more attractive than baseline with attractiveness decreasing with increasing severity of the class 3 profile. Keywords: Orthognathic surgery, class 3 profile, Chinese, Caucasian, facial attractiveness, need for surgery