Patient narratives of orthognathic treatment for facial asymmetry: a qualitative study

To explore patient experiences of orthognathic treatment for facial asymmetry and adaptation to facial changes post-surgery. Design: Qualitative, cross-sectional. Setting: Two UK sites. Participants: Patients after treatment for non-cleft asymmetry. Methods: Patients were identified using patient databases and clinical notes and approached. Individual interviews and photo elicitation were conducted with fifteen patients (aged 19-40 years). These covered experiences prior to treatment, during treatment and post-surgery. Interviews were transcribed and thematic narrative analysis was undertaken. Results: Participants were largely positive about their orthognathic treatment. The following themes were identified: preoperative (becoming aware, negative impacts of asymmetry, committing to treatment, establishing expectations); pre-surgery orthodontics and inpatient experiences (challenges and coping strategies, preparedness, support and shared experiences); postoperative (surgery as ‘worth it’, positive impacts of treatment, adapting to facial change). Undergoing orthognathic surgery was portrayed as a journey, involving recognisable narratives (treatment unfinished, threat of liminality, treatment as resolution, treatment as transformation). Conclusions: Patient experience of facial asymmetry is associated with feeling ‘abnormal’ and has negative impacts. Undergoing orthognathic treatment for facial asymmetry was worthwhile. Having the feeling that something is ‘wrong’ legitimised by clinicians allows patients access to a recognisable treatment narrative (resolution). Orthognathic treatment is also narrated as transformation from ‘normal abnormality’ to being ‘normal’. Nevertheless, challenges associated with treatment can be frustrating, particularly if resolution is hard to envisage. Further psychological input could help to support patients cope with these challenges and the complex process of adapting to facial change.