[It is necessary to do psychological intervention for patients with cleft lip and palate]

Psychological intervention is one of the most important parts in cleft lip/palate team approach. However, the psychological intervention has not been taken into deep consideration until now in China, and thus practical experience has not been obtained in this field. Based on a profound analysis of the reason of psychological abnormality and the psychological characteristics of cleft patients, we suggest that the psychological healthy should be the final destination of cleft lip/palate team approach. We further suggest that, based on the practical condition and experience in China, some therapies like psychological counseling should be feasible at the present time.

Language and early reading among children with orofacial clefts

OBJECTIVE

To test the hypothesis that children with orofacial clefts score lower than controls on measures of language and reading and to examine predictors of these outcomes.

DESIGN

Longitudinal study tracking the development of children with and without orofacial clefts from infancy through age 7 years.

SUBJECTS

Children with isolated cleft lip and palate (n = 29) and cleft palate only (n = 28) were recruited from the craniofacial program in an urban medical center. Seventy-seven demographically similar, unaffected controls were recruited via advertisements placed in area pediatric clinics and community centers.

MEASURES

Infant measures assessed child development and mother-child interactions during feeding and teaching tasks. At ages 5 and 7 years, measures of language functioning and academic achievement were completed along with an interview to collect school placement data and information on speech services received.

RESULTS

There were no significant group differences in language at ages 5 and 7 years. Children with clefts scored significantly higher than controls on measures of early reading at age 7 years. Outcomes were predicted by demographic factors, the quality of mother-child interactions during teaching and feeding tasks, and cognitive development scores at age 24 months.

CONCLUSIONS

Findings do not support the hypothesis that children with clefts score lower than controls on neurocognitive and academic achievement measures. Predictive analyses revealed several dimensions that may be used in clinical practice to identify children at risk for learning and developmental concerns.

Peer harassment and satisfaction with appearance in children with and without a facial difference

This study investigated associations between perceived peer harassment and satisfaction with appearance in the presence or absence of a facial difference. A cross-sectional sample of 661 children aged 10 or 16, with a cleft lip and/or palate, completed measures of satisfaction with appearance and peer harassment. Results indicated that the presence of a visible versus a nonvisible cleft was not associated with appearance dissatisfaction or higher levels of peer harassment for children aged 10 or for adolescent boys. Peer harassment was related to dissatisfaction with appearance in both age groups. In the adolescent group, there was an interaction between cleft visibility and gender, girls with a visible cleft being least satisfied with appearance. However, the association between cleft visibility and satisfaction with appearance was fully mediated by experiences of peer harassment. The results highlight the need to further explore the role of social interactions for subjective perceptions of appearance.

Reading in children with orofacial clefts versus controls

OBJECTIVE

To examine reading and related skills in children with and without orofacial clefts.

METHODS

Forty-two children with orofacial clefts were recruited from an urban craniofacial center. A demographically similar sample of 43 children without clefts was recruited using community advertisements and a research registry. Participants completed assessments of basic reading, phonological awareness, phonological memory, reading fluency, and rapid naming. Parents completed a semi-structured interview regarding educational and medical history.

RESULTS

Children with clefts scored significantly lower than controls on measures of basic reading, phonological memory, and reading fluency.

CONCLUSIONS

This is one of the first studies of reading in children with orofacial clefts to include a control sample. The findings suggest that children with clefts are less adept readers than demographically matched peers without clefts, supporting the need to monitor academic achievement in this population.

Understanding cleft lip and palate. 4: Surgery and continuing care

The fourth paper in this series on cleft lip and palate discusses the surgery involved in the care of children and young people with clefts of the lip and/or palate, orthodontic treatment and psychological support for this group of patients and their families.

The psychosocial impact of oral conditions during transition to secondary education

AIM

Transition to secondary education is a significant life event. Little is known about the impact of oro-facial conditions during this time and how concerns may contribute as a risk factor to negative adaptation. The aim of the study was to explore experiences of young people with oro-facial conditions as they undergo the transition to secondary education.

STUDY DESIGN

Qualitative interview and diary study.

METHODS

Participants were children aged 11-12 years with a range of clinical conditions who attended a dental hospital. Participants completed a two-week diary during the transition and were interviewed about the diary and their experiences. The interviews were audio-taped and transcribed verbatim.

RESULTS

Seventeen participants returned the diary and were interviewed; they described both changes in school environment and social interactions. A key finding was the concerns about aspects of themselves that children developed during this time. For some young people these concerns were about their oro-facial condition. No links between gender, severity of condition and experiences of school were apparent.

CONCLUSION

Transition to secondary education affected young people to varying degrees. Timely treatment for those concerned about the condition of their teeth may improve the likelihood of positive adaptation.

[Psychosocial adjustment in children with a cleft lip and/or palate]

OBJECTIVE

To gain insight into the psychosocial health of children aged 9 to 12 years with a cleft lip and/or palate; to determine the relation between their health and the nature and severity of the cleft as well as other individual characteristics.

DESIGN

Descriptive, cross-sectional study.

METHOD

Questionnaires completed by parents, teachers and children were used to obtain information about the psychosocial health, nature and severity of the cleft lip and/or palate, and individual characteristics of 80 children. The interrelationship between these parameters was assessed using chi-square tests, single-factor analysis of variance and correlational analysis.

RESULTS

In general, the psychosocial health of children with a cleft lip and/or palate did not differ from that of the norm groups. Parents of children with a cleft lip/and or palate reported more withdrawn or depressive behaviour in their child than parents from the norm groups. Children with a cleft lip and/or palate exhibited less rule-breaking behaviour. Teachers reported relatively more social problems. One-third of the children had learning problems. A better psychosocial health was associated with fewer speech problems but not with a more or less abnormal physical appearance. Self-image showed a negative correlation with psychosocial health problems, while learning problems showed a positive correlation.

CONCLUSION

In general, the psychosocial health of children with a cleft lip and/or palate does not differ from children without this condition. However, children with a cleft lip and/or palate do exhibit more learning problems.

[A study of Rutter behavior problems in school aged children with cleft lip and/or palate]

PURPOSE

To study the difference of behavior problems in school aged children with cleft of lip and/or palate.

METHODS

The Rutter Children Behavior Parent Checklist was used in 100 school aged children with cleft lip and/or palate and 135 school aged normal children in Shanghai.The questionnaire were filled and analyzed with chi2 test and logistic regression using SPSS 10.0 software packageî

RESULTS

The positive rate of Rutter behavior problems in school aged children with cleft of lip and/or palate was significantly higher than that in normal children (P<0.05). The positive rate of behavior problems and Rutter behavior problem A in boys was significantly higher than in girls.

CONCLUSION

Primary mental health intervention is necessary to promote the psychiatric health.

Priorities for future public health research in orofacial clefts

The National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention conducted a workshop in January 2006, entitled "Prioritizing a Research Agenda for Orofacial Clefts." The goals of the meeting were to review existing research on orofacial clefts (OFCs), identify gaps in knowledge that need additional public health research, and develop a prioritized research agenda that can help guide future public health research. Experts in the field of epidemiology, public health, genetics, psychology, speech pathology, dentistry, and health economics participated to create the research agenda. Research gaps identified by the participants for additional public health research included: the roles of maternal nutrition, obesity, and diabetes in the etiology of OFCs; psychosocial outcomes for children with OFCs; the quality of life for families and children with OFCs; and the health care costs of OFCs. To create the research agenda, the participants prioritized the research gaps by public health importance, feasibility, and outcomes of interest. This report summarizes the workshop.

Patient satisfaction related to rigid external distraction osteogenesis

The aim of this study was to evaluate satisfaction with treatment among cleft lip and palate patients who underwent maxillary advancement using a rigid external distraction (RED) device. Nine patients (four boys, five girls), mean age 17.7 years (SD 4.0), were included in the study. Outcome measures included satisfaction with facial appearance and function (sensitivity/pain, discomfort during daily functioning, daily activities, speech, eating and/or drinking, expression of affection) before, during and after treatment with the RED device assessed by a self-administered questionnaire. Before treatment, the majority of patients were not satisfied with their facial appearance. Some received negative remarks about their appearance and experienced minor functional problems. Dissatisfaction with appearance, negative remarks and functional problems increased significantly during active treatment, and the majority of patients experienced pain or sensitivity. After treatment all patients but one were satisfied with their appearance and level of function. Overall patient satisfaction after treatment with a RED device is high, but the active treatment period, during which the frame is worn, significantly compromises function and may be painful. For most patients, satisfaction with the final result and appearance outweighs the negative factors they reported.

Satisfaction with treatment outcome in bilateral cleft lip and palate patients

The aim of this case-controlled study was to assess satisfaction with facial appearance and function, and health-related quality of life (HRQL) in bilateral cleft lip and palate patients (BCLP). The study sample was composed of adult BCLP subjects and controls matched for age, gender and socioeconomic status. Outcome measures included a self-administered questionnaire evaluating satisfaction with facial appearance, function and HRQL. Bivariate statistics were computed to analyse the association between BCLP status and outcome measures. Forty-three treated adult BCLP patients (mean age 28.2 years, SD 7.8) were compared to 43 controls without clefts (mean age 28.5 years, SD 8.0). Quantitative and qualitative assessment revealed that BCLP patients were significantly less satisfied with the appearance of the upper lip, the nose and nasal breathing. Additionally, satisfaction with facial appearance correlated positively with HRQL. For speech, hearing and drinking, quantitative scores did not differ between BCLP and controls, while qualitative assessment revealed that BCLP patients had considerable problems and concerns with these functions. This study underlines the importance of qualitative assessment of patient satisfaction with treatment outcome to identify individual problems and concerns not revealed by quantitative measures alone.

[Socioeconomic adjustment in young cleft lip-palate patients]

INTRODUCTION

The aim of our study was to evaluate socioeconomic adjustment of young adults after treatment for cleft lip and palate.

MATERIALS AND METHODS

A retrospective study was made including patients born from 1975 to 1986 and followed-up in our department. The investigation was based on response to a questionnaire that partly replicated a national survey of social and economic life in the population (standard of living survey Burgundy, Insee France 1999). The control group was constituted by individuals taken from a regional probability sample of households. This report covered education, employment, and marriage.

RESULTS

41 patients were enrolled in this retrospective study and compared to 972 young adults. There was a significant delay in the independence process, regarding housing and marriage. Patients remained in normal limits concerning employment. However the patients' education history showed a significant delay, and a higher rate of vocational courses.

DISCUSSION

The independence process showed a significant delay in cleft lip-palate patients, as well as education history. Nevertheless the final socioeconomic adjustment was similar to that of the general population.

Health-related quality of life among preadolescent children with oral clefts: the mother's perspective

OBJECTIVE

The purpose of this study was to evaluate the factors that affect the health-related quality of life of preadolescent children with nonsyndromic oral clefts using the Pediatric Quality of Life Inventory instrument and to evaluate whether there were any differences related to the type of cleft or other factors.

METHODS

Data for this study were derived from telephone interviews with the parents of a statewide population of children who were in the Iowa Registry for Congenital and Inherited Disorders, were aged 2 to 12 years, had nonsyndromic oral clefts, and were born in Iowa between January 1, 1990, and December 31, 2000. Twenty-minute interviews were conducted with mothers of 104 children in the spring and summer of 2003; respondents then completed and mailed back Pediatric Quality of Life Inventory surveys 2 to 3 weeks after the interviews (69% participation rate).

RESULTS

After controlling for demographic characteristics, children with less severe speech problems had higher total Pediatric Quality of Life Inventory scores as well as higher physical and psychosocial health domain scores. Age and cleft type interacted, with younger children (aged 2-7 years) with a cleft lip or cleft lip and palate having higher health-related quality of life scores than children with an isolated cleft palate; however, this pattern was reversed for older children (aged 8-12 years).

CONCLUSIONS

Speech and aesthetic concerns seem to have been important factors affecting the health-related quality of life for children with oral clefts. These factors seem to be more important as children get closer to adolescence (ages 8-12 years) when acceptance by peers becomes more critical.

A developmental approach to mental health for children and adolescents with orofacial clefts

The mental health of children, adolescents, and adults with orofacial clefts has been studied extensively. Outcomes of interest have included parental adaptation, parent-child attachment, child development, intellectual and academic outcomes, behavioral adaptation, and quality of life. The literature sheds light on mental health needs and opportunities in each of these domains at various stages of development. However, this research has been limited in several respects and methodologically rigorous studies are needed to clarify the role of mental health in craniofacial team care. In particular, randomized controlled trials investigating the efficacy of psychosocial interventions tailored for this population are long overdue. Such studies have the potential to advance routine mental health care for individuals with orofacial clefts to the level of 'evidence-based care.'

Evaluation of patient satisfaction after therapy of unilateral clefts of lip, alveolus and palate

INTRODUCTION

Cleft lip, alveolus and palate (CLAP) is a craniofacial abnormality and is one of the most frequent human developmental anomalies. Therapy of clefts does not only comprise surgical closure of the cleft, but rather aims at an aesthetically and functionally optimal result at adult age.

MATERIAL AND METHODS

Thirty-three cleft patients with total clefts of lip, alveolus and palate were enrolled in this study. Osseous bridging of the alveolar cleft (osteoplasty) was performed in all patients followed by different types of subsequent treatment. All patients answered a questionnaire to assess their satisfaction with the treatment result and their facial appearance. Patient satisfaction was correlated to the type of alveolar cleft repair.

RESULTS

The returned questionnaires revealed varying patient satisfaction with their appearance, occlusal conditions, and dental aesthetics depending on the type of dental treatment in the alveolar cleft area. Questionnaire analysis by gender revealed clear gender-dependent differences in self-rated satisfaction.

CONCLUSION

Aesthetics gain increasing importance for self-perception. Therefore, patient satisfaction with her facial appearance should move even more into focus of therapy of clefts.

Social function in boys with cleft lip and palate: relationship to ventral frontal cortex morphology

Isolated clefts of the lip and/or palate (ICLP) are developmental craniofacial abnormalities that have consistently been linked to increased social inhibition or shyness. Two explanations have been proposed: (1) psychosocial factors related to differences in facial appearance may lead to low self-concept and subsequent shyness, or (2) abnormal development of brain structures involved in social function, such as the ventral frontal cortex (VFC), may underlie the difference. To investigate these two possibilities this study was designed to evaluate measures of social function in relation to measures of self-concept and VFC morphology. Subjects included 30 boys (age 7-12) with ICLP and a comparison group of 43 boys without cleft in the same age category. Social function and self-concept were assessed using questionnaires with standardized scoring filled out by subjects and one of their parents. The cortical volume and surface area of the VFC, composed of the orbitofrontal cortex (OFC) and straight gyrus (SG), were evaluated using structural magnetic resonance imaging. The ICLP subjects had significantly impaired social function relative to the comparison group. No difference in self-concept was identified. VFC morphology revealed significant differences between groups, particularly decreased volume and surface area in the left SG of the ICLP group. Moreover, abnormal VFC measures were correlated with social dysfunction but measures of self-concept were not. These results are consistent with the possibility that aberrant VFC development may partially underlie social dysfunction in boys with ICLP.

Type of oral cleft and mothers' perceptions of care, health status, and outcomes for preadolescent children

OBJECTIVE

To evaluate the outcomes of care for children by type of oral cleft.

DESIGN

Data were collected through structured telephone interviews during 2003 in Iowa with mothers of 2- to 12-year-old children with oral clefts. Interviews with mothers of children with clubfoot and statewide data on Iowa children were used for comparison.

PARTICIPANTS

Participants included mothers of children in Iowa born between 1990 and 2000 with nonsyndromic oral clefts. Children were identified by the statewide Iowa Registry for Congenital and Inherited Disorders.

MAIN OUTCOME MEASURES

Rating of cleft care, severity of condition, health status, esthetic outcome, speech, and school performance were evaluated by type of oral cleft.

RESULTS

Children with cleft lip and palate were most likely to have their clefts rated as very severe. Children with palatal involvement were reported to have a lower health status and were almost twice as likely to be identified as having a special health care need compared with either children with cleft lip or children statewide. Children with cleft lip had more esthetic concerns; children with palatal involvement had the most speech concerns.

CONCLUSIONS

Although mothers generally believed their children had received high-quality care, ratings of the children's current health status and outcomes of care varied significantly by type of cleft (cleft lip, cleft palate, and cleft lip and palate). Differences observed in this population-based study support the proposition that cleft type should be considered when examining outcomes of care for children with oral clefts.

[Long-term effects of cleft lip repair taking into account of life lot of operated patients]

AIM

The purpose of the study was the estimation of late aesthetic and functional results after the treatment of the primary or primary and secondary cleft palate. We also analysed the cleft impact upon the patients' social lives.

MATERIAL AND METHODS

The research was conducted on 50 individuals in the ages of 17 to 54, including 29 patients with complete primary and secondary cleft palate and 21 patients with primary cleft palate only. The following parameters were evaluated in the patients: general appearance of the face and detailed states of the lip, nose and occlusion. The self-assessment of the examined individuals and the facial cleft impact upon their social lives was taken under consideration.

RESULTS

The facial aesthetics was judged as positive in 80% of the cases and the correlation between the authors' assessment and self-assessment of the patients was similar. Patients with an unilateral cleft lip achieved better aesthetic and functional results of the lip. However, individuals with a bilateral cleft lip achieved the better nasal shape. Occlusion was incorrect in 64% of the examined patients. Almost all of them continue their secondary level education and university studies. Some of them work in the professions they have been trained in. 38% of them are married or have constant partners and 32% of them have children.

CONCLUSION

The plan of multidisciplinary treatment of a cleft lip and palate allows to obtain positive late results. Early psychological and pedagogical care procedures towards patients and their families facilitate proper mutual social relations, improves their self-assessment and prevent social troubles.

The Early Psychological Adjustment of Cleft Patients After Maxillary Distraction Osteogenesis and Conventional Orthognathic Surgery: A Preliminary Study

PURPOSE

To compare the early psychological changes of cleft lip and palate (CLP) and noncleft patients after maxillofacial corrective surgery, including maxillary distraction osteogenesis and conventional orthognathic surgery.

MATERIALS AND METHODS

Nine CLP patients were compared with a group of 9 non-CLP patients having similar dentofacial deformities in a prospective longitudinal cohort study. Five of the CLP patients underwent maxillary distraction osteogenesis and 4 underwent conventional orthognathic surgery. A control group of 9 noncleft patients received conventional orthognathic surgery. All patients completed a set of questionnaires to enable their psychological profile to be assessed. The data were collected immediately before surgery (T1), and at 3 weeks (T2) and 12 weeks (T3) after surgery.

RESULTS

The CLP patients treated with distraction osteogenesis were happier, but had a higher level of social anxiety and distress than the CLP patients receiving conventional orthognathic surgery. On the other hand, the CLP patients overall were happier, with lower social anxiety and distress, than the noncleft control group. The CLP patients showed a higher level of parental self-esteem than the noncleft patients.

CONCLUSION

This preliminary study shows that CLP patients were generally happier, and had a higher level of parental support, than normal patients suffering from dentofacial deformities. Maxillary distraction osteogenesis seemed to induce a higher level of anxiety and distress in CLP patients than conventional orthognathic surgery in both cleft and noncleft patients.

Health professionals' assessment of health-related quality of life values for oral clefting by age using a visual analogue scale method

OBJECTIVE

To elicit health-related quality of life (HRQL) values associated with oral clefting by age using a visual analogue scale, and to explore the appropriateness of using health professionals as evaluators.

METHODS

A representative group of health professionals working on craniofacial and/or cleft palate teams in the United States was sampled. Values (between 0 and 1) representing the HRQL associated with isolated and nonisolated oral clefting for infants, children, adolescents, and adults were obtained. The relationships between selected evaluator characteristics and values were also assessed.

RESULTS

Of 330 professionals surveyed, 133 (40%) completed and returned reliable evaluations. Overall, HRQL values were clustered toward the right tail of the scale, indicating modest decreases in HRQL. Most evaluators reported feeling confident in completing the evaluations. HRQL values seemed to vary by team type (cleft palate only versus cleft palate/craniofacial care) and geographic location, but no major differences were found overall for any selected evaluator characteristics.

CONCLUSIONS

This study provides HRQL values for oral clefting based on preferences of health professionals that may be useful in evaluating the effectiveness and cost-effectiveness of prevention and treatment strategies, including those carried out in clinical trial studies. The clustered pattern of HRQL values suggests either a consensus among evaluators of a limited burden of oral clefting or an overall lack of understanding of the evaluation task.

The self-concept of adolescents with cleft lip and palate: a pilot study using a multidimensional/hierarchical measurement instrument

OBJECTIVE

To pilot the use of a multidimensional/hierarchical measurement instrument called the self-description questionnaire II to determine whether specific areas of self-concept in a group of adolescents with cleft lip and palate would be affected by their condition when compared with a normative sample.

PARTICIPANTS AND DESIGN

The self-concept of 23 adolescents with a cleft of the lip and palate was compared to an Australian normative sample. Adolescents attending the dental department of a paediatric hospital in Australia.

MAIN OUTCOME MEASURE

The main outcome measure was a self-report questionnaire (102 items) with 10 domain-specific scales and a global measure of general self-concept.

RESULTS

When compared to the normative data the study group showed significant differences in 4 of the 11 domain-specific scales: Parent Relations (P < 0.001), Physical Abilities (P < 0.001), Opposite-Sex Relations (P < 0.01) and Physical Appearance (P < 0.01) self-concepts. These differences were in a positive direction. Global self-concept as measured by the General Self scale was not significantly different from the normative sample.

CONCLUSION

These results suggest that adolescents with clefts of the lip and palate have normative if not better self-concept than their peers. The study also suggests that having a cleft of the lip and palate has specific rather than broad associations with psychosocial adjustment. This justifies the use of instruments designed to assess specific areas of self-concept rather than more global measures.

Prosthodontic and psychological factors in treating patients with congenital and craniofacial defects

This article addresses treatment of patients with various types of congenital defects, including partial and total anodontia, hypohydrotic ectodermal dysplasia, dentinogenesis imperfecta, and cleft lip and palate. The psychosocial aspects of these patients and rehabilitation with removable, fixed, and implant-supported prostheses are discussed. The factors to be considered are altered anatomy, lack of teeth or malformed teeth, teeth in abnormal positions, lack of facial growth, and altered arch development. The short- and long-term treatment of patients in these categories is discussed.

'Outlook': A psychological service for children with a different appearance

'Outlook' is a unit within North Bristol Trust which has been developing a psychosocial service for children, young people and adults with a different appearance resulting from congenital abnormalities such as cleft lip and palate and also burns and other forms of trauma. This study presents data collected from 29 children aged between 5 and 16 who received individual therapeutic interventions. The baseline assessment included a semistructured interview schedule, visual analogue scales and the CBCL (Achenbach, 1991) to provide the parents' view of their children's behaviour profile. Measures were repeated post intervention and at 6 months follow-up. The intervention consisted of four sessions of cognitive-behavioural therapy (CBT) including social skills and problem-solving components. Statistical analyses revealed significant outcomes on a range of measures. At 6 months follow-up children reported a reduction in the frequency of teasing and in the degree of distress it caused both in the classroom and in the playground. Parents reported reductions in their children's' somatizing behaviour and levels of anxiety. These outcomes suggest that this approach represents an effective therapy for children with appearance-related psychological problems.