Gender Patterns Emerge in Pre-Surgical Class III Orthognathic Care
In adults preparing for orthognathic surgery for skeletal Class III malocclusion, gender differences appeared most clearly in social confidence, information adequacy, and satisfaction with treatment before the first osteotomy ever took place. The study was designed as a single-center, cross-sectional analysis in Turkey, and it focused on item-level responses rather than broad summary scores, a choice that exposed differences a domain-level instrument can easily flatten.
The cohort included 81 adults, 37 females and 44 males, all in pre-surgical orthodontic preparation. Because these patients are already moving through a long treatment pathway, the questionnaire captured a clinically important moment: the period when expectations are forming, appearance concerns are active, and patients are deciding how much of the burden of malocclusion they are willing to tolerate before definitive surgical correction.
One of the clearest signals involved social self-confidence. Female participants reported a greater lack of confidence in social environments, a finding that fits the lived burden of dentofacial deformity, where facial profile, speech, and chewing problems can intersect with self-presentation and social ease. In orthognathic care, these concerns are not cosmetic extras; they often shape whether a patient feels ready to continue through orthodontic decompensation, operative planning, and recovery.
Social Confidence, Information Flow, and Pre-Operative Satisfaction Diverged
Three findings remained significant after within-domain false discovery rate correction. Women reported more lack of self-confidence in social settings, while men reported more adequate information from their orthodontist and higher pre-operative treatment satisfaction. Each of those differences carried moderate effect sizes, with rank-biserial |r| values between 0.30 and 0.35.
The information finding is especially relevant at the bedside. Orthognathic surgery is not a single visit or a single procedure; it is a sequence of orthodontic preparation, operative correction, and postoperative adaptation. When patients feel poorly informed, they may enter that pathway with more uncertainty, less realistic expectations, and less tolerance for temporary worsening during decompensation. Men in this cohort appeared more satisfied with treatment before surgery and more likely to feel adequately informed, while women were more likely to report social insecurity. The pattern suggests that communication style, expectation setting, and perceived readiness may not be landing equally across gender groups.
Seven differences reached the unadjusted threshold of statistical significance, but only three survived correction within their questionnaire domains. Four additional items were more often endorsed by women: eating difficulty, food avoidance, temporomandibular joint problems, and lack of confidence when photographed. Those findings were nominal rather than corrected, yet they fit the same clinical direction seen in prior orthognathic research, where women often report greater concern about appearance and function before surgery.
A single sentence captures the practical tension in these data: the most visible differences were not in anatomy, but in how anatomy was being lived.
Item-Level Questioning Exposed What Domain Scores Can Miss
The questionnaire approach matters here. Prior work often relies on domain scores from instruments such as the OQLQ, but aggregated scores can mask item-specific divergence. A patient may score similarly on an overall psychosocial scale while still struggling with a very specific problem such as avoiding photographs, feeling uneasy in social settings, or avoiding certain foods because chewing feels awkward or painful. By moving to item-level analysis, this study caught differences that a broader summary may have blurred.
That design choice also explains why the results should be read as exploratory rather than definitive. The between-gender comparisons were not the basis of the original sample size calculation. The planned sample size of 81 was derived for the study as a whole, not for gender subgroup testing, and the realized sample could only detect moderate-to-large differences with reasonable power. Smaller contrasts would be easy to miss even if they were clinically real.
No difference survived correction across all 37 comparisons. Still, the confidence intervals for the non-significant items did not rule out small-to-moderate effects. In clinical terms, absence of statistical significance here cannot be treated as evidence of equivalence between men and women. It means only that the study did not have enough power to make firm claims about the smaller signals.
Why Class III Orthognathic Patients May Experience Gendered Burden
Skeletal Class III malocclusion often affects facial profile, dental alignment, mastication, and speech. Those features are visible in social space and functional in daily life, so the psychological load can be substantial. Orthognathic surgery can improve self-esteem, social adaptation, and quality of life, but the pathway to that benefit is demanding. Patients spend months in orthodontic preparation before they reach the operating room, and during that period they may be living with a temporary appearance that feels worse than their baseline.
The social self-confidence gap observed in women likely reflects more than a simple preference difference. It may reflect the intersection of facial appearance, self-evaluation, and social exposure. Likewise, the higher satisfaction and information adequacy reported by men may point to differences in how treatment conversations are received, how expectations are built, or how concerns are voiced during consultations. Those are not trivial communication issues. They can affect adherence, anxiety, and willingness to remain engaged through a difficult pre-surgical phase.
Because orthognathic surgery changes facial appearance in a relatively short time, psychosocial response is a major part of outcome assessment. The operative result is only part of the story. Patients also evaluate whether the treatment made them feel more comfortable in public, less distressed by photographs, less burdened by chewing problems, and more confident about their appearance. This study places those experiences at the center of pre-operative care, where they can be identified before they become barriers to treatment completion.
A Single-Center Cohort Leaves Open the Larger Question
The cohort came from one orthodontic department, and all participants were Turkish adults in pre-surgical preparation for Class III correction. That creates a clean diagnostic group, but it also narrows generalizability. Cultural expectations around appearance, communication with clinicians, and willingness to report dissatisfaction may influence how these items are answered. Multi-center studies will need to test whether the same gender pattern appears in other health systems and other populations.
The next step should not be another broad survey with the same level of aggregation. The meaningful question is whether item-level differences persist when a larger sample is followed through the full treatment course, from presurgical orthodontics to surgery and recovery. Longitudinal work would also clarify whether the women who entered treatment with lower social confidence eventually gain more from surgery, or whether they require more targeted counseling and expectation management along the way.
For now, the study leaves a concrete clinical message: in Class III orthognathic surgery preparation, gender-linked differences are most visible in how patients experience their social image, how well informed they feel, and how satisfied they are before surgery begins. Those differences deserve to be assessed directly, not assumed away.