The Benefits of a Surgery-First Approach in Promoting the Psychological Well-Being of Patients with Skeletal Anomalies and Temporomandibular Disorder.

Orthognathic surgery using the Surgery-First approach (SFA) has gained increasing attention not only for its functional and aesthetic benefits but also for its potential psychological impact. This study aimed to evaluate the effects of SFA on the psychological well-being of patients with dentofacial anomalies and temporomandibular disorders (TMD), using validated tools for assessing anxiety (GAD-7), depression (PHQ-9), and pain catastrophizing (PCS). A longitudinal observational study was conducted on 27 patients treated between 2022 and 2025. TMD was assessed using the DC/TMD clinical criteria. Psychological status was evaluated preoperatively and 6 months postoperatively using the GAD-7, PHQ-9, and PCS standardized questionnaires. Significant reductions were observed in all three domains: GAD-7 scores dropped from 13.8 to 4.1 ( < 0.001), PHQ-9 from 15.5 to 5.3 ( < 0.001), and PCS from 26.2 to 12.7 ( < 0.001). These are raw total scores; corresponding normalized mean scores (per item) decreased from 2.78 to 1.08 for GAD-7, from 3.00 to 0.36 for PHQ-9, and from 1.22 to 1.06 for PCS. The greatest improvements were seen in Class III patients with TMD. Psychological scores did not significantly predict persistent TMD. These findings support the psychological benefits of SFA and underline the importance of integrating psychological screening into orthognathic treatment planning.