## 4 Discussion
An improvement in this domain could mean that patients are more confident about noticing teeth, and their own facial appearance and that of others, as a result of esthetic improvement. Our clinical observation showed that the OFA patients had lower self-esteem and self-confidence during the presurgical orthodontic phase, and that this continued in the long term after surgery; the awareness of facial deformities improved later, at 6 months, in the OFA patients. The SFA patients, on the other hand, had no experience of the presurgical orthodontic phase, and their awareness of facial deformities improved at 3 months after surgery. Other studies have produced varying results in regard to the awareness of the facial deformities domain: a study in South Korea showed the same results [21], while the OFA and SFA groups in the UK study both demonstrated improvement after 6 weeks [23]; by contrast, a study in Taiwan found that, from 1 month to 12 months following surgery, there was no significant improvement in this domain in SFA patients [28]. Oral function was an additional domain in the OFA group that improved significantly. This delayed improvement of domain may have been a result of limitation of function at 1 month after surgery, when soft tissue swelling had not completely resolved, and early mobilization had just started. Previous research has shown that within a month of surgery, swelling significantly decreased, and that within 3 months, the healing was almost complete [29; 30]; patients were motivated to eat a soft-to-regular diet during the second and third months after surgery; in addition, the OFA patients were in the finishing and detailing phase of orthodontic treatment, so that they could begin to function efficiently; therefore, 3 months after surgery, the oral function domain had significantly improved. A study in South Korea also showed that the oral function domain improved significantly after 3 months [21]. A study in the UK showed improvement after 6 weeks [23; 28]. In the SFA, as no dental decompensation had been performed before surgery [7], leveling and aligning were performed after surgery. Patients could still experience discomfort as a result of orthodontic treatment, which could impede their ability to function. A study in Taiwan reported worsening of the oral function domain at 1 month, and improvement after 6 months [28]. Similar to the UK's result and our result, the oral function domain improved significantly at 6 months [23]. This may be concluded to be a result of improved occlusion in postsurgical orthodontic treatment. By contrast, the South Korea study reported that the oral function domain in both the OFA and the SFA improved after 3 months [21]. At 6 months after surgery, all domains and total scores improved significantly in both groups; likewise, previous studies have demonstrated that all domains in both the OFA and SFA groups improved significantly [21; 23]. At 6 months, all postoperative sequelae had been resolved, bone healing had been completed, and occlusion was nearly completely corrected. The patients may also have become familiar with their new occlusion and appearance; therefore, quality of life improved significantly in all domains. When comparing changes in scores across groups, the results revealed that there was no significant difference in the OQLQ score change in each domain, between the OFA and the SFA groups, at any stage: these results were similar to previous studies performed in other countries [15; 16; 17]. In addition, we also calculated the effect size, to compare the magnitude of change of each domain between groups and to other published studies. We found the same results in both the OFA and the SFA groups: facial esthetics had the largest effect size, followed by social aspects of deformity, oral function and awareness of facial deformities (E > S > F > A), representing the degree of concern in Thai patients from our center.