Is the Index of Orthognathic Functional Treatment Need Able to Successfully Prioritise Patients for Orthognathic Surgery Within the NHS?

IS THE ‘INDEX OF ORTHOGNATHIC FUNCTIONAL TREATMENT NEED’ ABLE TO SUCCESSFULLY PRIORITISE PATIENTS FOR ORTHOGNATHIC SURGERY WITHIN THE NHS?

 

M. Chand, R.Shah, J. Breeze, P. Stockton

 University Hospital Coventry and Warwickshire, Coventry, UK

 

The Index of Orthognathic Functional Treatment Need (IOFTN) is a newly proposed system for prioritising patients for orthognathic surgery in an NHS system which in recent years has been experiencing a drive to reduce costs. The five category structure is similar to the system used in orthodontics, but includes additional parameters such as sleep apnoea and facial asymmetry. The index also stipulates patients should be assigned a score once they have completed facial growth, with 18 years generally being the accepted average age.

The aim of this study was to provide early validation for the IOFTN and ascertain the potential future implications for our service.

 

The IOFTN category of 100 consecutive patients accepted for orthognathic surgery between 2010-2014 was determined using clinical notes, photographs, study models and radiographs. The percentage of patients falling into categories 4 or 5 (‘great’ and ‘very great’ need for treatment) was determined, analogous to the current indications for orthodontic treatment within the NHS which were developed by Brook and Shaw in 1989.

 

Sufficient clinical information was available to categorise 59/100 patients, with 95% (56/59) falling into either category 4 or 5. Of the remaining 3 patients that were selected for surgery with categories 1-3, all 3 patients were treated due to the anticipated psychological advantages for that particular individual.

Although majority of patients had their initial consultation post completion of growth, 34% of patients were seen prior to the age of 18. 91% of patients were aged 18 or above at the date of their first surgical procedure however out of the 8 patients who were operated on prior to being 18, 7 were female, thus they may have completed facial growth by this time.

The IOFTN is likely to become an important tool in future commissioning of orthognathic services within the NHS and this study has confirmed its accuracy in accurately prioritising treatment, with 95% of our patients previously selected for surgery correctly categorised. With waiting list times in some centres as large as 36 months, its common practice to commence pre surgical orthodontics prior to completion of facial growth, therefore we may see IOFTN scores being assigned to patients earlier than what the index stipulates.  We would recommend that the IOFTN be adapted to include an additional objective psychological assessment so that patients who fall into categories 1 to 3 are not automatically excluded from this potentially life changing surgery.

References

Ireland AJ, Cunningham SJ, Petrie A, Cobourne MT, Acharya P, Sandy JR, Hunt NP. An Index of Orthognathic Functional Treatment Need (IOFTN). Journal of Orthodontics 2014; 41: 77-83

Cunningham SJ, Garratt AM, Hunt NP. Development of a condition-specific quality of life measure for patients with dentofacial deformity: II. Validity and responsiveness testing. Community Dent Oral Epidemiol 2002; 30: 81–90