Dentoskeletal malformations are anomalies in the proportion and anatomical position of facial bones that can alter chewing, temporomandibular joint (TMJ) function, facial esthetics, and breathing (Proffit et al., 2004). Altered facial esthetics secondary to malocclusions influences self-confidence, self-esteem, and overall quality of life (Proothi et al., 2010). Orthognathic surgery (bone movement, usually bimaxillary surgery) is indicated when orthodontic treatment (tooth movement) is incapable of successful correction of the face, airway, and bite.

Patient satisfaction after orthognathic surgery depends on the facial, airway, and bite outcome but is influenced by unknown patient expectations and motivations. Moreover, preexisting psychological factors such as the patient's social context, self-esteem, and mental health (Phillips et al., 2004), may significantly impact the degree of satisfaction with treatment outcomes. Further, Rustemeyer et al. (Rustemeyer et al., 2010) stated that patient dissatisfaction not only depends on poor surgical outcomes, but frequently poor communication between surgeon and patient.

Orthognathic surgery patients may have unrealistic facial expectations. To offset unrealistic facial expectations, the surgeon must educate the patient regarding what facial change is realistically feasible. Many studies fail to distinguish between patient motivating factors for orthognathic surgery and surgical result expectations (G. W. Arnett and Worley, 1999). Motivation for treatment derives from preexisting patient problems (e.g., malocclusion, facial asymmetry), whereas patient expectations arise largely from communication with the surgeon performing the operation. To enhance communications, Arnett has suggested using a patient motivation questionnaire (Fig. 1) to reveal the patients’ motivation and expectations for the face, airway, and bite prior to surgery. The patient motivation questionnaire educates the patient to possible outcomes and educates the surgeon to what the patient expects all prior to treatment (G. W. Arnett and Worley, 1999).

With the present study, we examine patients' motivation for and satisfaction after combined orthodontic and surgical treatment planned according to Face-Airway-Bite principles (FAB) as described by Arnett (G. W. Arnett and Bergman, 1993a, 1993b; G. W. Arnett et al., 1999; G. William Arnett et al., 2022; G. William Arnett, D'Agostino et al., 2022; G. William Arnett and Gunson, 2004). We were interested to verify whether the FAB diagnosis and treatment planning approach results in high patient satisfaction with treatment outcomes.