SA2 - Epidemiology and Trends in Jaw Surgery Associated With Gender-Affirming Care in the United States

Abstract: Background: Jaw surgery is often a component of gender-affirming facial surgery.^1,2 However, the epidemiology of jaw surgery associated with gender-affirming care remains understudied. This study aimed to compare the temporal trends and treatment patterns of patients undergoing jaw surgery for gender-affirmation versus malocclusion or sleep apnea.

Methods: This was a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset from 2016-2023. Subjects were included if they 1) underwent a maxillary osteotomy, mandibular osteotomy, and/or genioplasty based on Current Procedure Terminology (CPT) codes; and 2) had an International Classification of Diseases Tenth Revision (ICD-10) diagnosis of transsexualism, malocclusion, or sleep apnea associated with the index procedure. Subjects were excluded if they underwent any concurrent temporomandibular joint procedures, neoplasm resection, or cleft palate repair. The primary predictor variable was year from 2016 to 2023. The primary outcome variable was indication for surgery based on ICD-10 coding (transsexualism versus malocclusion/sleep apnea). Secondary outcomes included concurrent facial procedures, surgical complications (yes or no), operative time, and length of stay (days). Covariates were categorized as demographic (age, sex based on medical record, race), medical (body mass index, American Society of Anesthesiologists (ASA) classification, comorbidities), and surgical (discharge pathway). Descriptive and bivariate statistics were calculated. Linear regression was used to evaluate temporal trends in the proportion of patients undergoing jaw surgery for gender affirmation.

Results: The cohort consisted of 1,371 subjects with a mean age of 30.1 ± 10.9 years, and 633 (46.3%) were male. There were 297 (21.7%) subjects who underwent surgery for gender affirmation, while 1,074 (78.3%) underwent surgery for malocclusion or sleep apnea. The percentage of patients undergoing jaw surgery for gender affirmation increased from 0% in 2016 to 22.6% in 2023, for a mean year-over-year increase of 4.8 percentage points (P = .002). Subjects undergoing surgery for gender affirmation were more likely to undergo mandibular surgery with genioplasty (53.5%, n = 159, P < .001) or isolated genioplasty (38.7%, n = 115, P < .001) compared to those undergoing surgery for malocclusion or sleep apnea. Approximately 91.9% of subjects (n = 273) in the gender affirmation cohort underwent a concurrent facial cosmetic procedure compared to 1.5% of subjects (n = 16) in the malocclusion or sleep apnea group (P < .001). The predominant concurrent procedures for the gender affirmation cohort were for surgeries of the forehead/orbit (82.2%, n = 244), brow (58.6%, n = 174), rhinoplasty (47.5%, n = 141), and rhytidectomy (46.8%, n = 139). The mean operation time was significantly greater in the gender affirmation cohort (368.4 ± 112.2 minutes vs 214.4 ± 113.1 minutes, P < .001). Subjects undergoing surgery for gender affirmation had significantly higher rates of any complication (6.1% vs 2.4%, P = .003) and surgical complications (5.7% vs 1.8%, P < .001).

Conclusions: Gender-affirming jaw surgery represents a growing proportion of facial skeletal procedures captured within orthognathic coding frameworks in the United States and is characterized by a distinct procedural profile, including a predominance of genioplasty and facial cosmetic procedures. These cases highlight the evolving role of jaw surgery in gender-affirming care and underscore the need to account for cohort heterogeneity when interpreting national orthognathic datasets and outcomes.


References:

1. Fisher EL, Morrison S, Susarla SM, Ettinger R: Planning the cut: Gender-affirming considerations in orthognathic surgery. J Oral Maxillofac Surg 82:1343, 2024.

2. Simon D, Capitan L, Bailon C, et al: Facial gender confirmation surgery: The lower jaw. Description of surgical techniques and presentation of results. Plast Reconstr Surg 149:755e, 2022.