Factors influencing the quality of life among orthognathic patients: a systematic review and meta-analysis

Abstract Background Orthognathic surgery enhances both oral function and aesthetic outcomes for patients with dentofacial disharmony (DFD). However, the influencing factors on oral health-related quality of life (OHRQoL) in patients with varying characteristics remain unclear. Objective This systematic review aims to comprehensively investigate the factors that influence quality of life (QoL) in patients undergoing orthognathic surgery, and address the gaps of subgroup comparisons in existing reviews, specifically focusing on country development level, type of DFD, type of surgical procedure, and sex. Search methods PubMed, Embase, Web of Science, CENTRAL, SIGLE, CNKI, CSTJ, and WANFANG Database were searched from 2000 to 2025. Selection criteria This systematic review included cohort studies that evaluated the impact of orthognathic surgery on QoL and its various influencing factors as measured by Orthognathic Quality of Life Questionnaire-22 (OQLQ-22) or the Oral Health Impact Profile-14 (OHIP-14). Data collection and analysis The Newcastle-Ottawa Scale (NOS) for Cohort Study was employed to evaluate the quality of included studies. RevMan software was used to perform the meta-analyses. Results The review included 22 articles with 1482 participants, of which 20 were included in the meta-analyses. Using OQLQ-22, an improvement was noted in the four dimensions of QoL at five months postoperatively compared to the preoperative period. Subgroup analysis indicated that patients undergoing double jaw surgery (MD 22.55, 95% CI [17.00, 28.10]), with skeletal Class III malocclusion (MD 21.91, 95% CI [16.38, 27.45]) and female patients (MD 23.72, 95% CI [11.05, 36.40]) experienced a more significant degree of improvement, suggesting a higher likelihood of achieving greater surgical satisfaction. Notably, the overall QoL improvement was more pronounced in developing countries (MD 21.63, 95% CI [13.82, 29.45]) overall compared with developed countries (MD 18.22, 95% CI [14.22, 22.22]). Similar results were observed in the use of OHIP-14. Conclusions This study highlights the factors influencing QoL in orthognathic patients, including country development level, type of DFD, surgical procedures, and sex in the QoL. The degree of improvement in patients’ QoL varied according to these characteristics. Given the limited number of studies available, further comprehensive research is warranted. Registration PROSPERO (CRD42024582409)