Qualitative study to identify issues affecting quality of life in adults with craniofacial anomalies

Adult Cleft Patients: An Exploration of Functional Needs and Treatment Barriers

BACKGROUND

Management of cleft lip and palate has been well characterized in pediatric patients, but limited data exist regarding the long-term functional outcomes of cleft patients once they reach adulthood.

MATERIALS AND METHODS

An institutional, cross-sectional survey of adult patients with a history of cleft lip and/or palate was performed. The survey recorded patient characteristics, concerns, and barriers to care. Patient-reported outcome measures were assessed using the Nasal Obstruction Symptom Evaluation Scale, Epworth Sleepiness Scale, Mandibular Function Impairment Questionnaire, and the CLEFT-Q Speech Modules.

RESULTS

A total of 63 patients (18.2%) participated in the survey. The mean patient age was 43.7 years (median: 41 y, range: 19-93 y), and the most common diagnosis was cleft lip and palate (51%) followed by isolated cleft palate (35%) and isolated cleft lip (14%). A subset of patients scored with moderate to severe dysfunction on each outcome measure including the Nasal Obstruction Symptom Evaluation Instrument (59%), Epworth Sleepiness Scale (7%), and Mandibular Function Impairment Questionnaire (13%). Respondent scores on the CLEFT-Q Speech modules demonstrated a bimodal distribution with lower scores in a significant subset of patients with cleft palate and cleft lip and palate. Many respondents (41%) were interested in clinical evaluation but cited barriers to seeking treatment including financial barriers (35%) or lack awareness of clinical options (27%).

CONCLUSIONS

Many cleft patients have persistent needs or concerns in adulthood, especially regarding speech and nasal breathing. Systemic barriers pose challenges to these patients undergoing clinical evaluation.

Towards a better understanding of the social stigma of facial difference

Facial difference (FD) is not only an individual experience; it is inherently social, reflecting interactions between social norms and individual attitudes. Often FD is stigmatized. In this paper, we employ a widely used stigma framework, namely the social stigma framework put forth by Pryor and Reeder (2011), to unpack the stigma of FD. This framework posits that there are four forms of stigma: public stigma, self-stigma, stigma by association, and structural stigma. We first discuss the social and psychological literature on FD as it pertains to these various forms of stigma. We then describe coping approaches for FD stigma. Lastly, we delineate evidence-based methods for addressing the various forms of FD stigma, such that future efforts can more effectively tackle the stigma of facial difference.

The psychosocial burden of visible disfigurement following traumatic injury

Hundreds of thousands of individuals experience traumatic injuries each year. Some are mild to moderate in nature and patients experience full functional recovery and little change to their physical appearance. Others result in enduring, if not permanent, changes in physical functioning and appearance. Reconstructive plastic surgical procedures are viable treatments options for many patients who have experienced the spectrum of traumatic injuries. The goal of these procedures is to restore physical functioning and reduce the psychosocial burden of living with an appearance that may be viewed negatively by the patient or by others. Even after receipt of reconstructive procedures, many patients are left with residual disfigurement. In some, disability and disfigurement may be so profound that individuals are candidates for vascularized composite allotransplantation (VCA) procedures, i.e., the transplantation of a vascularized human body part containing multiple tissue types (skin, muscle, bone, nerves, and blood vessels) as an anatomical and/or structural unit. This narrative review paper summarizes the literature on the psychosocial burden experienced by those who have visible disfigurement. While many of these individuals experience stigma and discrimination, relatively few studies have employed a stigma framework to understand the psychosocial sequelea. This paper briefly addresses this framework. Last, particular focus is given to the psychosocial issues of individuals with particularly severe injuries who are potential candidates for VCA procedures.

Do Specific Craniomaxillofacial Features Correlate with Psychological Distress in Adult Pretreatment Orthodontic Patients? A Cephalometric Study

Purpose

To explore the relationship between craniomaxillofacial features and psychological distress among adult pretreatment orthodontic patients.

Methods

A group of 190 patients (95 males and 95 females) was included. Questionnaires including the Kessler psychological distress scale (K10) were sent to patients, and cephalograms were collected. Patients were divided into two groups according to K10 score: psychological distress group (score ≥ 20) and no psychological distress group (score < 20). Nineteen hard tissue and thirteen soft tissue parameters were traced on cephalograms to characterize the craniomaxillofacial features.

Results

There was no significant difference in gender or age distribution between the two groups. Male patients with psychological distress showed statistically significantly larger anterior facial height (AFH) (126.62 mm vs. 120.97 mm), upper lip length (25.11 mm vs. 23.26 mm), and smaller overbite (1.21 mm vs. 2.75 mm) than patients without psychological distress. Male patients with hyperdivergent pattern and open bite were more likely to have psychological distress. None of the parameters showed statistical differences across groups in females. Frankfort-mandibular plane angle (r = 0.235), Bjork's sum (r = 0.311), AFH (r = 0.322), overbite (r = −0.238), AFH/posterior facial height (r = 0.251), and upper anterior facial height (UAFH)/lower anterior facial height (LAFH) (r = −0.230) were correlated with K10 score in males. After adjusting gender and age, the AFH (B = 0.147) and UAFH/LAFH (B = −14.923) were significantly related with the K10 score.

Conclusion

Psychological distress was mainly correlated with hyperdivergent pattern, open bite, and larger lower anterior facial height proportion in pretreatment orthodontic patients. Orthodontists should be aware of the possible underlying psychological distress in patients with specific craniomaxillofacial features. Clinical assessment of psychological distress may need to take into account gender differences in patients.

Quality of life in patients with craniosynostosis and deformational plagiocephaly: A Systematic Review

BACKGROUND

Craniosynostosis is a bony dysmorphism of the calvarium due to premature suture fusion and is classified as syndromic (part of congenital syndrome) or nonsyndromic (isolated). Deformational plagiocephaly (DP) is due to external positional forces on the skull after birth. This review aims to investigate the various quality of life (QoL) metrics across syndromic, nonsyndromic and DP patients.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search was done through EMBASE, MEDLINE, PubMed and Web of Science. After two stages of screening by two authors, seventeen articles met inclusion criteria; 11 on syndromic, 4 nonsyndromic, and 2 DP.

RESULTS

The literature suggests syndromic patients have more severe consequences on QoL, especially on psychological well-being, social functioning, and obstructive sleep apnea (OSA), leading to behavioral difficulties. Nonsyndromic patients show a less clear trend across QoL measures, but a majority stated QoL is comparable to the general population. DP patients noted motor development and QoL improvement as well as improved subjective aesthetic outcomes after orthotic helmet molding therapy (HMT).

CONCLUSIONS

While a majority of literature classifies QoL in syndromic craniosynostosis alone, this review highlights the importance of these factors in nonsyndromic craniosynostosis and plagiocephaly patients. Psychological well-being, social functioning, and secondary health impacts such as OSA are important to consider in comprehensive craniofacial care in all calvaria deformities.

Social Media as a Platform for Cyberbullying of Individuals With Craniofacial Anomalies: A Preliminary Survey

Purpose The primary aim of this study was to investigate the extent to which individuals with facial and/or speech differences secondary to a craniofacial anomaly experienced bullying through social media platforms during late school age and adolescence. Method Using an online survey platform, a questionnaire was distributed via several public and private social media groups designated for individuals with craniofacial anomaly and their caregivers. Results The majority of participants (n = 38; 88.4%) indicated they had been bullied during late school-age and adolescence and that they believed this was due to their facial difference and/or speech disorder (n = 27; 71.1%). Almost one third indicated they had been victims of cyberbullying during this time (n = 12; 31.6%) with the most common venues being texting and Facebook. Despite the large percentage of participants who reported being bullied through social media, half (n = 6) indicated they did not often report these instances of cyberbullying. Conclusions As social media use continues to increase, it appears inevitable that cyberbullying will occur. Particularly vulnerable to both traditional and cyberbullying are individuals with craniofacial anomalies. Because of the specialized training of speech-language pathologists, school-based speech-language pathologists are in a unique position to play a key role in school-wide antibullying efforts and to educate school personnel on ways in which to support the needs of children with craniofacial anomalies both inside and outside of the classroom.

Establishing a clinical psychology team within the orthognathic service: A triad model of orthodontic, maxillofacial and psychological care

The importance of psychological support for orthognathic patients has taken an increasing precedence over recent years and is embedded in orthognathic commissioning guidelines. Furthermore, attention towards mental health-related conditions and their management is of prime importance and continues to be a key area of focus within healthcare settings. With this in mind, this paper aims to outline our experience of establishing a need for and subsequently securing funding to establish a clinical psychology service within an existing orthognathic service in the NHS. The information outlined may be of benefit to orthognathic teams seeking to secure such psychological support within their respective units.