Orthognathic surgery in patients over 40 years of age: indications and special considerations.
OBJECTIVE
To assess indications, incidence, patient experience, and outcomes of orthognathic surgery in patients over 40 years of age.


METHODS
This was a retrospective cohort study of all patients who underwent orthognathic surgical procedures at Massachusetts General Hospital from 1995 to 2012. Demographic variables, including age, gender, indications, date, and type of operation, were documented. Patients were divided into 2 groups by date of operation: 1) 1995 to 2002 and 2) 2003 to 2012. The predictor variable was age (>40 vs <40 yr). Outcome variables included indications for treatment, date of operation, length of hospital stay, and removal of hardware.


RESULTS
During the study period, 1,420 patients underwent 2,170 procedures; 911 patients (1,343 procedures) met the inclusion criteria. Group 1 consisted of 260 subjects (346 procedures, 35 patients ≥40 yr old, 13.5%) and group 2 consisted of 651 subjects (997 procedures, 89 patients ≥40 yr old, 13.8%). Subjects over 40 had longer hospital stays (P ≤ .0001) than those under 40. Indications for men were more frequently functional problems, whereas women sought esthetic improvements (P = .0001). Subjects over 40 were 2.51, 2.44, and 2.72 times more likely to require hardware removal 6 months (P = .0245), 12 months (P = .0073), and 24 months (P = .0003) postoperatively than those younger than 40.


CONCLUSIONS
Motivation to undergo orthognathic surgery varies by age and gender. Older patients, particularly men, tend to seek treatment for functional rather than esthetic reasons. Patients older than 40 years had longer hospital stays and an increased rate of postoperative hardware removal.
Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA. Electronic address: zpeacock@partners.org.
Zachary S
ZS
Peacock
DMD Candidate, Harvard School of Dental Medicine, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA.
Cameron C Y
CC
Lee
Instructor in Orthodontics, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA.
Katherine P
KP
Klein
Walter C. Guralnick Professor and Chairman, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA.
Leonard B
LB
Kaban
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D020878:Device Removal / Q000706:statistics & numerical data; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D063172:Genioplasty / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008334:Mandible / Q000601:surgery; D008404:Massachusetts; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D009042:Motivation; D056948:Orthognathic Surgical Procedures / Q000295:instrumentation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult