Attitudes and practices regarding preoperative psychological evaluation in orthognathic surgery: a scenario-based national survey of Turkish oral and maxillofacial surgeons.

backgroundOrthognathic surgery is known to influence patients' psychological status and quality of life. While psychosocial outcomes have been widely investigated, limited data exist regarding oral and maxillofacial surgeons' attitudes and clinical practices related to preoperative psychological evaluation. Understanding these perspectives is important, as unrecognized psychological concerns may affect treatment adherence, outcomes, and patient satisfaction. This study aimed to assess surgeons' perspectives and reported practices regarding preoperative psychological evaluation in orthognathic surgery candidates and to identify any attitude-practice gap. Secondary aims were to evaluate variations across patient profiles using scenario-based assessments and to identify barriers influencing referral decisions.

methodsA cross-sectional, scenario-based online survey was conducted among oral and maxillofacial surgeons in Türkiye. The questionnaire included demographic items and scenario-based questions representing different clinical and psychosocial conditions, assessing both the perceived necessity and actual implementation of preoperative psychological evaluation. Descriptive statistics were used. Associations between categorical variables were analyzed using chi-square or Fisher's exact tests. Differences between perceived necessity and actual practice were evaluated using the Wilcoxon signed-rank test. Scenario-based comparisons were performed using the Friedman test with Bonferroni-adjusted post hoc analyses where appropriate. A p-value < 0.05 was considered statistically significant.

resultsFifty-nine surgeons participated. Although most respondents (81.4%) considered preoperative psychological evaluation necessary, only 35.6% reported routinely conducting evaluations or referring patients. Among specific clinical scenarios, the highest level of support for preoperative psychological evaluation was observed in patients requesting gender transition (91.5%), although the survey did not distinguish supportive psychosocial assessment from mandatory psychiatric approval or clearance processes in these cases. High levels of support were also observed for patients presenting with unrealistic expectations (91.5%) or body dysmorphic features (86.4%), whereas support was lowest for patients with obstructive sleep apnea (27.1%) and older patients (49.2%). Perceived necessity varied significantly according to medical and surgical history (p < 0.001) but not by deformity type (p = 0.708). The most common barriers were anticipated negative patient reactions (40.7%) and limited knowledge of standardized tools (16.9%).

conclusionsDespite broad recognition of its importance, routine psychological evaluation remains inconsistently implemented in orthognathic surgery practice. Surgeons appeared more likely to support psychological referral in scenarios involving prominent psychosocial or identity-related concerns, whereas psychosocial considerations were less consistently emphasized in functionally indicated cases. These findings highlight the context-dependent nature of psychological referral tendencies and underscore the importance of context-sensitive multidisciplinary approaches in preoperative orthognathic care.