Improving dental appearance and preventing future dental problems are major motivators for orthognathic patients. Although patients felt well informed about what to expect from their orthodontic treatment, a significant proportion, particularly younger patients and males, were surprised at the length of treatment and the need to wear retainers. This suggests that orthognathic patients might benefit from better information regarding the orthodontic aspects of their care.

A patient-based measure of the process and outcome of combined orthodontic and orthognathic treatment has been developed. This has sufficient validity and reliability for use in inter-center audit projects.

This qualitative research has identified issues that are important to adolescent orthodontic patients. These issues will be used to form the basis of a patient-centred measure for auditing patients' perceptions of orthodontic treatment under the NHS.

INTRODUCTION The aim of this study was to evaluate, within an NHS region, the process of care and the standard of record for orthognathic patients. PATIENTS AND METHODS A retrospective analysis of the medical records of 372 patients who underwent orthognathic surgery 1 January 1995 and 31 April 2000 in the South West Region of the UK. RESULTS Most patients underwent joint orthodontic and maxillofacial planning and had third molars extracted under general anaesthesia prior to orthognathic surgery. There was a significant difference in the median operation times and length of stay for bimaxillary surgery (4 h/4 days) compared with single jaw surgery (2 h/3 days; P < 0.001). Just over 15% of patients required removal of internal fixation plates after surgery, with nearly 90% of these requiring a further episode of general anaesthesia. The level of record keeping and patient review was variable with no regional standardisation. CONCLUSIONS This study is evidence of a generally acceptable standard in the process of care, which was found to follow international and national practices. However, at the time of the study there was no regional protocol for patient records or patient review, highlighting the need for the establishment of a regional database.

The aim of this study was to determine which of two occlusal indices were the most appropriate for use in the assessment of orthognathic outcome. The indices used were the Peer Assessment Rating (PAR) Index and the Index of Treatment Complexity, Outcome, and Need (ICON). These indices were validated against the subjective assessments of treatment outcome and treatment improvement obtained from a panel of experienced orthodontic consultants. For the subjective assessment, intraexaminer agreement for ranking treatment outcome, from patient study models (30 models), was good. Interexaminer agreement for ranking treatment outcome, in the same way, was good or moderate. Intraexaminer agreement for ranking treatment improvement (30 start and finish pairs of models) was very good or good. Interexaminer agreement for ranking treatment improvement ranged from good to fair. All the patient study models were scored using PAR and ICON. The level of correlation between PAR and ICON scores of treatment outcome and the subjective ranking of treatment outcome was significant (P < 0.001). The level of correlation between PAR and ICON scores of treatment improvement and the subjective ranking of treatment improvement was also significant (P < 0.001). It is concluded that both PAR and ICON are suitable indices for assessing the clinical outcome of combined orthodontic treatment and orthognathic surgery.