An international surgical exchange program for children with cleft lip/cleft palate in Manaus, Brazil: patient and family expectations of outcome

Increasingly, surgeons are traveling from the developed to the developing world to volunteer their services. They can often make an enormous difference in the lives of patients they serve, but they must understand that these patients exist in a sociocultural matrix in which the meaning of the condition they have and the future they face are determined by a host of factors over and above the specific surgery itself. This means that programs in which teams quickly go in and out of a country must take into account and plan for longer term follow-up by colleagues within that country as well as develop and target rehabilitation services and educational messages to ensure maximum benefits from the intervention performed. This study examines the long-term implications of a short-term surgical team intervention for pediatric patients with cleft lip/cleft palate and their families in the Amazon region of Brazil.

[Clinical picture and orthodontic treatment of adult patients with cleft lip and palate]

There are represented the results of clinical investigation of 15 patients in age from 15-54 years with cleft lip and palate. There is given the detailed clinical description and the peculiarities of prosthetic rehabilitation of those patients.

Emotion self-regulation in preschool-aged children with and without orofacial clefts

Emotion self-regulation is an important developmental task in the preschool period that is related to children's emotional and behavioral adjustment in early childhood. Emotion self-regulation and its relation to later adjustment has not been studied in children born with orofacial clefts, despite their risk for externalizing and internalizing behavior problems. Eighty-three 5-year-old children with cleft lip and palate, isolated cleft palate, or no cleft condition were videotaped during a laboratory disappointment situation. Results showed that children in the cleft group expressed less disappointment than children in the comparison group. Longitudinal analyses revealed that parenting stress measured when the children were 2 years of age predicted Expressed Disappointment at age 5 years, which, in turn, predicted severity of behavior problems at age 7 years. Although tentative, results indicate that control over mild negative affect may be a protective factor for children with clefts, buffering the effects of early stress on the development of later behavioral and emotional problems. Thus, interventions that reduce parenting stress and enhance children's emotion regulation strategies may decrease the risk for later psychological problems in this population.

Assessment of facial emotion encoding and decoding skills in children with and without oral clefts

PURPOSE

Investigated the facial emotion decoding and encoding skills and perceived social acceptance in children with and without oral clefts.

PATIENTS

8-15 year-old children with surgically repaired facial clefts (n=19) and non-cleft controls (n=19).

METHODS

The children viewed photographs of facial emotions expressed by other children and identified the emotion in each photograph. They were videotaped while listening to a series of brief vignettes designed to evoke facial emotions and while posing prototypic facial expressions. They also completed a measure of their perceived social acceptance. Judges, blind to experimental group and targeted emotion, viewed systematically sampled video images, then recorded their subjective judgement of the emotion expressed in each. Trained coders also scored selected images using objective measures of the degree to which specific facial movements associated with emotion-specified expressions were present.

RESULTS

Analysis of variance procedures detected significantly different patterns of facial responses between the oral cleft and control groups, and within group. Pearson correlation analyses found significant relationships between specific facial movements and perceived social acceptance.

CONCLUSION

Systematic assessment of facial expression in children with oral clefts can identify unique differences in their encoding of facial emotion and may lead to behavioural interventions to improve social functioning by training facial expression skills.

Attitudes toward prenatal diagnosis, termination of pregnancy, and reproduction by parents of children with nonsyndromic oral clefts in Argentina

OBJECTIVE

To investigate the attitudes of Argentine parents of children with nonsyndromic oral clefts with respect to prenatal diagnosis, termination of pregnancy, and reproduction and to assess the variables that might influence their responses.

DESIGN

One hundred and sixty-five parents of children with oral clefts, ascertained from a craniofacial clinic in the suburbs of Buenos Aires, answered a 151-item semistructured questionnaire. The questionnaire included sections covering sociodemographic information, level of religiousness, characteristics of the child's cleft, parental perception of their child's cleft, pregnancy history, recurrence risk, access to health care, attitudes in regard to abortion, and family environment.

RESULTS

Most parents (60%) believe their child's cleft is not a serious condition. None of the respondents would terminate a pregnancy because the ultrasound reveals an oral cleft. Similarly, very few (6.1%) would terminate the pregnancy if there were an early diagnosis of Down syndrome. Half of the respondents believe that abortion should not be an option for any couple expecting a child.

CONCLUSIONS

Most respondents do not perceive oral clefts as a severe condition. Parents would not choose to terminate the pregnancy over delivery of such an affected newborn.

Reflections on the cleft experience by South african adults: use of qualitative methodology

OBJECTIVE

This study explored the perceptions of a group of South African adults with repaired cleft lip, cleft palate, or both regarding their quality of life by considering the domains of communication, education, employment, family and marital life, social life, and emotional issues.

DESIGN

An exploratory-descriptive, qualitative research design was employed.

SETTING

Individual, semistructured interviews were conducted in the homes of participants.

RESPONDENTS

Twenty adults with repaired cleft lip, cleft palate, or both aged between 18 and 50 years participated in the study.

RESULTS

Participants were generally satisfied with their communicative abilities and perceived their speech to be intelligible. They also felt that speech therapy had improved the quality of their lives. Although they had experienced teasing during childhood, they did not feel that their cleft had affected their relationships with teachers and were generally satisfied with their educational attainments. Socially they reported being greatly affected by negative societal perceptions and prevailing cultural myths regarding etiology of clefts. Generally employment did not appear to be affected by the presence of a cleft. With regard to family life, participants reported being treated differently by parents in comparison with their siblings. For the majority of respondents, marital relationships and dating did not seem to be adversely affected. In terms of emotional factors, both positive and negative reactions were experienced in relation to the cleft. They also felt that the competent and compassionate care received from the multidisciplinary team had definitely enhanced the quality of their lives.

CONCLUSIONS

These findings have important clinical implications for a multidisciplinary approach to treatment; counseling of patients and their families; education of the community regarding cleft lip, cleft palate, or both; and further research.

[Social orientation of parents of children with cleft lip and palate]

BACKGROUND

Cleft lip and palate are the most common malformation in the orofacial region. The type and dimension of the cleft determine the functional limitations of respiration, swallowing, speech, articulation and hearing. In addition, cosmetic and communicative restrictions influence the cognitive, social and educational progress and the wellbeing of the children affected. Their parents face a difficult and lasting task: They have to cope with their child's handicap and the current standardised treatment procedures which start in early infancy. To guarantee optimum therapeutic success parents must be included as co-therapists. Therefore more information about parents' concerns and coping strategies are required.

METHOD

To assess the strain put on parents of children with cleft lip and palate as well as the parents' coping strategies, a standardised questionnaire for the German-speaking parents was used during consultation in the out-patient clinic. RESULTS. In comparison with parents of children with other handicaps, the parents of children with cleft lip and palate feel less stressed out and adopt strategies of coping such as intensification of partnership, use of social support, as well as self-respect and fulfillment. Working mothers are less preoccupied and less at risk of being focussed on the handicapped child only. In comparison, the parents of children with Orofacial clefts focus less on the handicapped child in general than those parents whose children suffer from additional behavioural disorders.

DISCUSSION

Though several functional, behavioural and psychological disorders may occur in children with cleft lip and palate their parents feel comparatively little stress. They do use a variety of coping strategies and tend to adopt a rather positive approach. Certainly, additional disorders of the child lead to more parental stress and likewise requiring more attention to the child which may even accentuate existing behavioural disorders.

CONCLUSION

Parents of children with cleft lip and palate experience less stress in comparison with parents of children with other handicaps. Therapeutic efforts and regular check of the child's progress might support parents' coping strategies. Therapists should also ask for additional disorders such as behavioural disorders and initiate adequate support.

Characteristics of nonverbal behavior in patients with cleft lip and palate during interpersonal communication

OBJECTIVE

This study examined characteristics of nonverbal behavior that patients with cleft lip and palate (CLP) presented during interpersonal communication.

DESIGN

This was a case-control design comparing nonverbal behavior of adult women with CLP with females without CLP.

PARTICIPANTS

Subjects were 20 adult women with CLP and 20 noncleft control women matched for age and educational experience.

MAIN OUTCOME MEASURES

Subject gestures and facial expressions were videotaped during interviews and analyzed with a computer-based kinematic measurement system.

RESULTS

The clinical group displayed significantly fewer head movements and a lower smile frequency than the control group. Furthermore, head and hand movements and smiles were less coordinated or congruent for the subjects with CLP than for the comparison group.

CONCLUSIONS

Even slight facial disfigurement could have a harmful effect on communication behavior in female patients with CLP.

An investigation of the relationship between associated congenital malformations and the mental and psychomotor development of children with clefts

OBJECTIVE

This research studied the relationship between associated congenital malformations and the mental and psychomotor development of children with clefts.

DESIGN

The study was cross-sectional.

SETTING

The study was conducted in a university hospital for children.

PARTICIPANTS

The sample consisted of 148 children with cleft lip, cleft palate, or both.

MAIN OUTCOME MEASURES

The children were assessed by a clinical geneticist at the age of 18 months. The children's level of development was determined by means of the Dutch version of the Bayley Scales of Infant Development.

RESULTS

One-third of the total sample had associated malformations. Children with an isolated cleft lip showed the least. Children with an isolated cleft palate showed the highest percentage of minor malformations that are minor yet possibly worrisome. The total group achieved a mean developmental index (DI) on the mental scale of 98.9 with SD of 20.9. The motor scale showed a mean DI of 104.9 and SD of 24.7. Analysis of variance (ANOVA) showed that on the mental scale, the three main effects (diagnosis, evaluation, and sex) were significant at the 5% level. On the motor scale, only the main effect "evaluation" was significant.

CONCLUSIONS

This study demonstrated that children with associated congenital malformations might be disadvantaged with respect to their development. These malformations occurred most frequently with the cleft lip and palate and cleft palate only subgroups. More research, especially concerning the cleft palate only subgroup is needed because they are most at risk.

Feeding behaviour of infants with cleft lip and palate

AIM

To determine whether the feeding behaviour of infants with cleft lip and palate is improved with a type-P teat, which is widely used in Japan by such infants, compared with a standard teat. The difference in intra-oral movements between the type-P teat, modified for the evaluation of feeding behaviour, and an unmodified type-P teat was also compared using ultrasonography.

METHODS

In part 1 of the study, 15 infants aged 2 to 3 mo and 7 infants aged 2 wk were evaluated for sucking pressure, expression pressure, frequency and duration of sucking. All the infants had a complete unilateral cleft lip and palate without any other abnormalities. In part 2, an ultrasonographic analysis of intra-oral movement was done for 5 infants enrolled in part 1 of the study.

RESULTS

Sucking pressure did not occur in all infants. It was found that feeding efficiency improved with the type-P teat compared with the standard teat. The expression pressure with the type-P teat was significantly higher than that with the standard teat, and the feeding frequency with the type-P teat was lower than that with the standard teat.

CONCLUSION

A type-P teat is suitable for infants with cleft lip and palate who have sucking difficulties. However, a type-P nipple with a squeezable bottle does not fully solve the feeding problems of infants with cleft lip and palate. New artificial teats that allow a higher expression pressure are desirable, and the measurement of the expression pressure may be helpful in the evaluation of artificial nipples.

Perceived social support of mothers of children with clefts

OBJECTIVE

To identify factors that may predict perceived social support in mothers of children with clefts.

DESIGN

A comparison was conducted from a sample of mothers of children with oral clefts identified from a single institution (multidisciplinary craniofacial clinic). The Interpersonal Support Evaluation List and Beck Depression Inventory were completed by all participants.

RESULTS

Mothers of children with visible clefts were more likely to report higher perceived social support than mothers of children with clefts that were not visible (p =.005). Mothers of female children reported higher levels of perceived social support than mothers of male children (p =.02). Mothers who had completed more years of education reported significantly higher levels of perceived social support than mothers who had completed fewer years of school (p =.03). Mothers with more children were more likely to report lower levels of perceived social support (p =.009). Maternal depression was highly correlated with perceived social support (p <.0001).

CONCLUSIONS

Cleft visibility, family size, child sex, and maternal education level were important factors in predicting perceived social support in mothers of children with clefts. Child age, syndrome status, and cleft family history were not significant predictors.

Speech characteristics in the Kabuki syndrome

Six children with Kabuki syndrome were studied to investigate speech patterns associated with the syndrome. Each child's speech was characterized with regard to articulation (types of errors and intelligibility), pitch (high or low), loudness (volume of speech), and prosody (general quality of speech that combines rate and inflection). All six children had a history of delayed speech and language acquisition and were receiving speech services. All individuals had articulation errors and abnormal oral resonance, which appeared to be due to poor oral-motor coordination and hypotonia and were not felt to be due to structural abnormalities such as velopharyngeal insufficiency, dental malocclusion, or cleft palate. An intriguing finding, noted in the two individuals followed from childhood into adolescence with serial speech evaluations, was that pitch, loudness, and prosody did not mature over time and what was age appropriate performance at younger ages became inappropriate in adolescence. This raises a challenge for speech services, as by adolescence, while articulation had improved, the pitch and loudness of these individuals' speech had not and so was noticeably different from peers. Distinctive speech characteristics with a lack of normal maturation during childhood can be added to the extensive list of clinical features associated with the Kabuki syndrome and hopefully will lead to improved speech/language treatment for individuals with this syndrome.

Cognitive dysfunction in adult males with non-syndromic clefts of the lip and/or palate

Cognitive deficits have been well-documented in children with non-syndromic clefts of the lip and/or palate. However, no study to date has formally assessed cognition in adults with oral clefts. This study was designed to evaluate neuropsychological functioning in adult males with non-syndromic clefts of the lip and/or palate (n=50) compared to age and sex-matched controls. Subjects with oral clefts were found to have significantly lower full scale IQ, performance IQ and verbal IQ scores compared to their matched controls. After controlling for IQ, patients showed specific deficits in verbal fluency. Adult males with oral clefts manifest a specific pattern of cognitive deficits. As the development of the face is highly interdependent with the development of the brain, it is theorized that the etiology of these cognitive deficits is a primary problem with abnormal brain development.

Self-concept and introversion in adolescents with cleft lip and palate

The purpose of this study was to investigate if adolescents with cleft lip, or palate, or both (CLP), have an altered self-concept, and to assess their degree of introversion, compared with a control group. The CLP group consisted of 55 adolescents (aged 17-20 years) and the control group consisted of 31 adolescents (16-19 years). The Tennessee Self Concept Scale (TSCS) was used to measure the subjects' self-concept, while the Eysenck Personality Questionnaire Inventory (EPQ-I) was used to measure introversion. The results indicate that those with CLP have a normal or even a high self-concept, and no signs of introversion.

Phoniatric aspects in cleft lip patients

Multidisciplinary care for patients with clefts includes surgical correction of the facial disfigurement and optimizing the quality of speech to improve the social integration of the affected patient. This work summarizes the knowledge of communicational aspects of cleft lip (CL) patients. Cleft-type speech characteristics can be described as "passive" obligatory errors resulting from the anatomical defect and "active" compensation efforts. Long-lasting phonological deficits in patients with clefts may be due to the fact that their development is affected by abnormal learned neuromotor patterns as a consequence of these two mechanisms. Surgery alone will not modify active cleft-type characteristics whereas speech therapy should lead to an improvement. Passive characteristics are usually assessed by speech therapy but surgery may facilitate the progress. From the phoniatrician's point of view, rhinophonia in (secondary lip and septo-) rhinoplasty (and surgery of the nasal sinuses) in CL patients has to be assessed in no other way than in patients without a cleft. Pragmatic skills, that is, using verbal speech in a social context, cognition, and the acquisition of emotional, behavioral, and social interaction patterns may be affected in patients with isolated CLs. As a consequence these individuals are at high risk to develop emotional disorders. So speech developmental disorders in a narrow sense are of minor importance in individuals with an isolated CL when comparing them with patients with CL and palate. Communication disorders in these patients seem not to result from phonological defects but from psychological problems that may influence the entire development of an affected child. The literature shows that there is a need to collect more data on the issue of psychological and social problems in patients with an isolated CL for clinical and scientific purposes.

Health-related quality of life in children with craniofacial anomalies

The purpose of this study was to examine parents' perceptions of the health and health-related quality of life in a series of children and adolescents with cleft and other craniofacial anomalies. The subjects for this prospective study were a consecutive series of 54 children and adolescents presenting to an outpatient craniofacial anomalies surgery clinic, ages 5 to 18 years (mean, 8.9 +/- 4.2 years), 50 percent with cleft lip and/or palate, 9 percent synostotic (two coronal, two bicoronal, and one sagittal), 17 percent syndromic (two Apert, one Crouzon, one Noonan, two Goldenhar, two Smith-Lemli-Opitz, and one brachio-oto-renal), and 24 percent with other diagnoses. Subjects were divided into two groups, those with primary cleft lip and/or palate and those with other craniofacial anomalies. Health and health-related quality of life were assessed with the Child Health Questionnaire version PF28, a reliable and valid 28-Likert-item questionnaire completed by parents and yielding physical and psychosocial status scale scores. Physical and psychosocial scale scores largely fell within normal limits for the subset of children with cleft lip and/or palate. There were significant group differences in parents' ratings of global health status, with greater health concerns noted in the non-cleft lip and/or palate group. There were no significant associations between either age or sex and physical or psychosocial health. Physical health, behavior, and psychological status were highly correlated. Using a health status and quality-of-life assessment instrument, findings indicate perceived health differences between groups with and without primary cleft lip and/or palate. In contrast to normative data with the Child Health Questionnaire, findings suggest that there is a significant association between perceived physical health and psychosocial adjustment in the population of children with craniofacial anomalies. The significant perceived health needs of the non-cleft lip and/or palate group and the association between physical health and psychological adjustment highlight the importance of the interdisciplinary nature of craniofacial teams.

Validity and reliability of a questionnaire for measuring child oral-health-related quality of life

Oral-health-related quality of life measures that exist are designed for adults. This study aimed to develop and evaluate the CPQ(11-14), a self-report measure of the impact of oral and oro-facial conditions on 11- to 14-year-old children. An item pool was generated with the use of a literature review and interviews with health professionals, parents, and child patients. The 36 items rated the most frequent and bothersome by 83 children were selected for the CPQ(11-14). Validity testing involved a new sample of 123 children. Test-retest reliability was assessed in a subgroup of these children (n = 65). Mean CPQ(11-14) scores were highest for oro-facial (31.4), lower for orthodontic (24.3), and lowest for pedodontic (23.3) patients. There were significant associations between the CPQ(11-14) score and global ratings of oral health (p < 0.05) and overall well-being (p < 0.01). The Cronbach's alpha and intraclass correlation coefficient for the CPQ(11-14) were 0.91 and 0.90, respectively. These results suggest that the CPQ(11-14) is valid and reliable.

[Orthodontic awareness of the parents whose children suffer from cleft palate and are treated at orthodontic clinics--preliminary communication]

Cleft palate or lip constitutes circa 65% of congenital developmental anomalies in facial skeleton. This defect requires a long, complicated and team treatment, which calls for the parents' sufficient knowledge and awareness. We checked what opinions and knowledge concerning the treated defect of their children the parents have. The children were treated in the Orthodontic Clinic in Zabrze. The survey was conducted in 230 families. Beside answering the typical demographic questions the people were asked to describe the type of defect, give the reasons for its appearance and its influence on the child's life. In all cases the parents correctly defined the type of defect. Most of their knowledge came from conversations/consultations with doctors, only a small percentage gained knowledge from other sources (books, brochures, etc.). When analysing the parents' answers one can notice that there's little knowledge concerning the cause of the cleft. Whereas they seem to have more knowledge regarding the treatment, complications and the child's functioning within the society. The fact that the people directly affected by this problem have such a small knowledge of the causes of cleft indicates a need for broader education. It seems that a possible preventive educational action concerning the factors increasing the risk of cleft occurrence, the possibilities to eliminate the danger and necessity of treatment should concentrate on small towns and villages.

Facial appearance and attachment in infants with orofacial clefts: a replication

OBJECTIVE

The current study sought to replicate an unexpected finding reported by: relatively unattractive infants at age 3 months were more likely than attractive infants to show secure maternal attachment at age 12 months, a finding unaffected by the diagnosis of cleft lip and palate (CLP), cleft palate only (CPO), or the absence of a cleft condition.

DESIGN

We evaluated the effects of diagnosis (CLP, CPO, or no diagnosis) and age (3, 12, and 24 months) on facial attractiveness ratings derived from a modified Q-sort method.

SETTING

Craniofacial clinic in an urban children's hospital.

PARTICIPANTS

Infants with CLP and CPO and typically developing infants without clefts (n = 126) and their mothers. Ratings were made by 13 adults unfamiliar with cleft conditions.

MAIN OUTCOME MEASURES

Facial attractiveness ratings.

RESULTS

Infants with CLP were rated as the least attractive at all time points. At ages 12 and 24 months, infants in the CPO group were rated as less attractive than typical infants but more attractive than infants in the CLP group. Typical infants and those with CLP-but not CPO-received higher attractiveness ratings with age. As hypothesized, less attractive infants, regardless of diagnosis, were more likely to show secure attachment than were more attractive infants.

CONCLUSIONS

We tentatively conclude that the perceived vulnerability of young infants, as indexed by atypical or unattractive facial characteristics, engenders extraordinary protectiveness and responsiveness in some mothers, leading to a higher probability of secure attachment. A test of this hypothesis with a new sample of infants is recommended.

Developing a behavior rating scale for comparing teachers' ratings of children with and without craniofacial anomalies

OBJECTIVE

Published psychometric tools are often insensitive to the experience of children with craniofacial anomalies (CFAs). The purposes of this study were to develop a valid and reliable assessment of behavior among children with and without CFAs and to compare teacher ratings of these two groups of children.

METHODS

Teachers were asked prospectively to assess social competence and peer acceptance among 99 consecutively evaluated school-aged patients with CFAs and 99 "controls" (classmates without CFA matched by race, gender, intellectual status, general socioeconomic status, and grade). Sixth grade was the median grade of the subjects.

OUTCOME MEASURE

Child Behavior Rating Scale (CBRS).

RESULTS

Using oblique promax rotation, four factors emerged from the CBRS with the CFA patient group and controls. The factors explained 67% of the total variance and 69% of the variance of the two groups, respectively. The four factors were: (1) self-maintenance, (2) social adjustment, (3) independence, and (4) teasing. Cronbach alpha results averaged 0.77 for the CFA group and 0.83 for the controls; test-retest reliability estimates were .93. Results demonstrate the consistency of the factors and high level of interrelationship among the items across subject groups. Expected differences (p <.05) were found among subject groups on the total score and factor 4.

CONCLUSIONS

The CBRS demonstrates psychometric worthiness. The findings indicated that patients with CFA had lower total scores on the CBRS, and they were rated as experiencing more teasing than their matched peers.

[Self-esteem in adolescents with and without cleft-lip and/or palate]

Self-image is an important determinant of self-esteem among men and women, which makes us reflect about the process of rehabilitation of people with facial malformations. In order to measure self-esteem, the Janis and Field Scale was used. The sample consisted of 608 adolescents aged 17 to 20 years including males and females. Two hundred and thirty-five had a cleft lip and/or palate and 373 did not. The analysis of the self-esteem levels obtained enabled to conclude that the adolescents with a cleft lip and/or palate behave differently from those without it, that is, they present lower self-esteem scores.

Adult patients with treated complete cleft lip and palate. Methodological and clinical studies

The purpose of the present thesis was to investigate the quality of life, satisfaction with treatment, prevalence of temporomandibular disorders, psychosocial distress, and occlusal stability in a treated group of adults with complete cleft lip and palate (CLP). Sixty-eight adults (44 men and 24 women) with a mean age of 24.2 years (range 19.5-29.2) with treated CLP were compared with a gender- and age-matched group with no clefts. The CLP subjects were born between 1968 and 1977 and had undergone standardised plastic surgery at the Department of Plastic Surgery, University Hospital, Linköping, Sweden. Logopaedic, phoniatric, otological, and orthodontic examinations and treatment had been provided locally, supervised by the Cleft Plate Team. The subjects answered a multidimensional, self-report, standardised questionnaire regarding psychological and somatic conditions. The subjects underwent a clinical TMD examination and an evaluation of the occlusion. The reliability of the multidimensional questionnaire was analysed for the CLP group by a test-retest study within a 2-3 week interval and most questions showed an overall good reliability. A panel of professionals judged the outcome of the surgical treatment on colour slides of the CLP subjects. The dental plaster casts of 39 subjects born with complete unilateral cleft lip and palate (UCLP) were analysed (mean age 24.7 years, range 20.2-29.3) and compared with the dental plaster casts taken at mean age of 19.1 years (range 16.0-20.6). The overall level of quality of life was rather high in both groups. The CLP group rated some detached aspects, such as life meaning, family life, and private economy, significantly lower than did the group without clefts. Overall aspects such as well-being and social life were affected by having a treated cleft but not the more practical and tangible aspects of their daily living. There was an overall high level of satisfaction with all the different part of the body in both groups, but the CLP group reported significantly more dissatisfaction with their nose, lips, mouth, profile, and overall facial appearance than the group without clefts. The professionals and the subjects with CLP were generally not very satisfied with the results of surgical treatment. Thirty of the subjects with CLP (47%) wished to have more operations. The professional group recommended further operations in 38 of the subjects (59%) in particular, rhinoplasties. The CLP group had significantly higher frequencies of cross-bite than the group without clefts, but no differences regarding TMD pain were found between the two groups. In the subjects with treated UCLP, there was a significant deterioration in the occlusal score and the maxillary arch dimensions between 19 and 25 years. This was irrespective of the type of retention. The persisting morphological malocclusion with a low frequency of interferences has had no influence on TMD symptoms in the group of CLP patients studied. The conclusion is that the CLP subjects in the present study seemed to be psychosocially well adjusted to their disability. However, 47 per cent wished to have further surgical treatment. The persisting malocclusions did not provoke TMD symptoms.

Reliability of a multidimensional questionnaire for adults with treated complete cleft lip and palate

The purpose of this study was to evaluate the reliability of a multidimensional questionnaire for Swedish adults with treated complete unilateral or bilateral cleft lip and palate (CLP). The questionnaire was designed to be used in the evaluation of adults with treated CLP after treatment. Before any conclusions were drawn from the results of the study we assessed the test-retest reliability of the questionnaire. The questionnaire included 168 questions and assessed the following domains: aesthetics, functions associated with CLP, satisfaction with treatment and perceived need for treatment, quality of life, depression and non-specific physical symptoms, body image, and jaw function. The subjects answered the questionnaire twice at a 2-3-week interval. Sixty-one adults (38 men, 23 women) mean age 24 years (range 20-29) participated in the study. The response rate for the questionnaire was acceptable at 75%. The test-retest reliability varied among the different domains. The reliability of questions regarding aesthetics, functions associated with CLP, and treatment satisfaction was good to excellent (intraclass correlation coefficient (ICC) = 0.51 to 0.89). Good to excellent (ICC = 0.61 to 1.0) reliability was also found for the quality of life in various life domains and the wellbeing scales. The reliability of the body image scale was moderate (kappa = 0.43-0.60) for most items and lower than that of other scales used in this study. The reliability of the mean depression symptom score (ICC = 0.93) and the mean non-specific physical symptoms score (ICC = 0.85) were excellent. The reliability of the mandibular function impairment was good (ICC = 0.67). The conclusion of the study is that an overall reliability was good for the multidimensional questionnaire.

Quality of life in adults with repaired complete cleft lip and palate

OBJECTIVE

This study evaluated the quality of life in adult Swedish subjects with repaired complete cleft lip and palate (CLP).

DESIGN/PATIENTS

Sixty-eight adults with repaired CLP were compared with a group of 66 adults without cleft matched by gender and age.

OUTCOME MEASURES

The outcome measures included a self-report questionnaire concerning quality of life in general, well-being, and health-related quality of life.

RESULTS

The CLP group rated their quality of life significantly lower than did the control group in the areas of life meaning (p <.05), family life (p <.0001), and private economy (p <.01). There were no significant differences between the groups concerning well-being. In the CLP group, the health-related quality of life was significantly lower concerning global life (p <.0001), disturbance to life (p <.01), well-being (p <.0001), social contacts (p <.0001), and family life (p <.05) but significantly higher concerning ability to make the most of leisure time (p <.001) and to be active (p <.001).

CONCLUSIONS

The CLP group perceived a marked impact of the handicap on their lives concerning global aspects, well-being, and social life. More practical and tangible aspects of their daily living, however, were not affected, and only some minor aspects of their quality of life in general were poor in comparison with the control group, which indicates a fairly good life adjustment in spite of the handicap.