The Psychosocial Effects of Cleft Lip and Palate in Non-Anglo Populations: A Cross-Cultural Meta-Analysis

A Retrospective and Prospective Cohort Study Comparing Pediatric Patients With Cleft Lip and Palate From the United States and Guatemala

Orofacial clefts (OFC) remain among the most prevalent congenital abnormalities worldwide. In the United States in 2010 to 2014, 16.2 of 10,000 live births are born with OFC compared with 23.6 of 10,000 in Alta Verapaz, Guatemala in 2012. Demographics and cleft severity scores were retrospectively gathered from 514 patients with isolated OFC at the Children's Hospital of Philadelphia scheduled for surgery from 2012 to 2019 and from 115 patients seen during surgical mission trips to Guatemala City from 2017 to 2020. Risk factors were also gathered prospectively from Guatemalan families. The Guatemalan cohort had a significantly lower prevalence of cleft palate only compared with the US cohort, which may be a result of greater cleft severity in the population or poor screening and subsequent increased mortality of untreated cleft palate. Of those with lip involvement, Guatemalan patients were significantly more likely to have complete cleft lip, associated cleft palate, and right-sided and bilateral clefts, demonstrating an increased severity of Guatemalan cleft phenotype. Primary palate and lip repair for the Guatemalan cohort occurred at a significantly older age than that of the US cohort, placing Guatemalan patients at increased risk for long-term complications such as communication difficulties. Potential OFC risk factors identified in the Guatemalan cohort included maternal cooking-fire and agricultural chemical exposure, poor prenatal vitamin intake, poverty, and risk factors related to primarily corn-based diets. OFC patients who primarily rely on surgical missions for cleft care would likely benefit from more comprehensive screening and investigation into risk factors for more severe OFC phenotypes.

Development and validation of the Brazilian Version of Lay Persons' Social Judgements about Cleft-lip Scale (B-LSojCleft-S)

The aim of this study was to develop and analyze the psychometric properties of the Brazilian Version of Lay Person's Social Judgement about Cleft-lip Scale (B-LSojCleft-S). A standardized photograph of a 16-year-old girl was manipulated by using photo editing software, to simulate different cleft-lip situations. The cleft-free image was used as a control. The researchers structured an initial questionnaire that was evaluated by experts and a sample of the target population to evaluate the construct. After analysis by the researchers, a final version of the B-LSojCleft-S containing 14 items was generated. Each answer was awarded score from 1 to 3 points, yielding a total score of 14 to 42 points. Higher scores represented better social judgements. The B-LSojCleft-S was applied online to 103 test participants and 73 retest participants with an interval of 20 days between application. Aspects of acceptability, discriminant property, internal consistency, reliability and construct validity were evaluated. Construct validity was assessed using the Friedman test (p < 0.05). Reliability was determined using an intraclass correlation coefficient > 0.70, and internal consistency using Cronbach's alpha > 0.81. The B-LSojCleft-S showed high acceptability, strong discriminant property, excellent internal consistency and reliability, but had a floor and ceiling effect. The instrument reached valid and reliable scores and had acceptable psychometric properties to evaluate the social judgments of lay persons about different cleft lip situations in a Brazilian population.

Study of myths and beliefs among the parents of a child with cleft lip and palate

Aim

The aim of the study was the identification of predictors of psychology and beliefs among parents of children affected by cleft lip and cleft palate.

Methods

The study included a sample of 157 parents of children having cleft lips and cleft palates. Parents were given a questionnaire related to their beliefs and reasons behind deformity.

Results

Out of 157 participants, 90 were fathers, and 67 were mothers. The children with deformities included 105 boys and 52 girls. The majority of parents (43) believed that the eclipse was one of the reasons for the deformity and the other was God's wrath for the mother's sins. The time of birth was considered a factor for cleft lip and palate by 27 parents. The study revealed that the self-esteem of fathers was higher than mothers and they were more concerned of being undesirably judged by others due to deformity of their children than the mothers.

Conclusion

It can be inferred that the parents of a child with cleft lip and palate differ in their psychosocial adjustments. Also, mothers experience more psychosocial problems than fathers. The superstitious beliefs still prevail in rural areas despite advanced medical facilities and awareness.

Aesthetic and psychosocial impact of dentofacial appearance after primary rhinoplasty for cleft lip and palate

The primary aim of this study was to demonstrate whether primary rhinoplasty shows aesthetic and psychosocial advantages for children with a complete unilateral cleft lip and palate. The second aim was to determine the satisfaction levels concerning the dentofacial appearance. Group A corresponded to patients from a center specialised in primary cheilo-rhinoplasty with 20 years' experience and Group B to patients who did not benefit from primary rhinoplasty. Children and their parents filled in a custom-designed satisfaction questionnaire on dentofacial appearance and its psychosocial impact. The variables studied were the main criterion (the nose) and secondary criteria (the upper lip, the smile, the profile and the face as a whole). 56 families consented to be involved in the study. The children did not rate statistically differently their social relationships if they had primary rhinoplasty or not. Parents however expressed very different views. They considered the nasal appearance of the children who had primary rhinoplasty as statistically more attractive and evaluated their psychosocial experience as significantly better. For the other parts of the face, in both groups, satisfaction levels of dentofacial appearance and psychosocial comfort were good (scores above 80/100). Yet, 44% of the families would go for further interventions, especially concerning the nose (13% of whom were in Group A and 42% in Group B). Within the limitations of this study, primary rhinoplasty seems to improve the patient's well-being and social life and, therefore, should be considered whenever appropriate.

Awareness of Orofacial Clefts in the Sultanate of Oman

INTRODUCTION

Cleft lip and/or palate (CL/P) is the most common craniofacial anomaly. In Oman, the incidence of CL/P is estimated to be 1.5 per 1000 live births per year. Knowledge, awareness, and attitude toward CL/P help to optimize the management of the condition and reduce social and emotional stress among this group of children and their family. In this survey, we assessed the public awareness, knowledge, and attitude toward this deformity in the Sultanate of Oman.

METHOD

A cross-sectional study was conducted using validated questionnaire that was distributed using Google forms.

RESULT

A total of 739 participants completed the survey. The majority is aware of cleft lip (86.7%) and palate (63.2%). In general, attitude toward patients with CL/P was positive. Females had higher knowledge compared to males, 54.4% and 32.9%, respectively. Online resources were the main source of information.

CONCLUSION

There are variations in knowledge, awareness, and attitude toward CL/P among participants. Omani population needs to be educated more about CL/P, its complications if not treated, and the available treatment.

Psychological Variables in Children and Adolescents with Cleft Lip and/or Palate

Objective: This review analyzes the psychological variables most frequently studied over the last 10 years in children and adolescents with cleft lip/palate (CL/P). Such variables are assumed to be the keys to these patients' psychosocial adjustment. Study design: Articles published from January 2007 to February 2017 were retrieved from PubMed to identify the psychological variables most commonly studied in children and adolescents with CL/P, irrespective of gender or type of cleft. The search terms were "cleft palate" and "psychology", with the operator AND. Results: Of the 324 articles retrieved, 26 met the criteria for inclusion in the review. The psychological variables most extensively studied over the years were children's social functioning, quality of life and ability to cope. Conclusion: While CL/P patients' quality of life was unanimously agreed to be affected, no consensus was found in the literature on social functioning or coping. In addition to the cleft, patient adjustment was reported to be governed by individual variables and mediators. The range of ages most frequently studied was 7 to 16.

A Sustainable Model for Patient follow-up following an International Cleft Mission

Purpose:

Patient follow-up after cleft missions is imperative if we are to critically assess the quality of care provided in these settings. The adoption of mobile telephones among disadvantaged families abroad may enable such an undertaking in a cost-effective manner. This project aimed to assess the efficacy of cellular phone-based follow-up in a developing country following a cleft mission to Thailand.

Methods:

Changing Children's Lives Inc. performed a cleft surgical mission to Udon Thani, Thailand, in January 2013. Telephone numbers collected at that time were used to survey the patients or their parents 1.5 years postoperatively.

Results:

Of the 56 patients who underwent cleft lip and/or palate surgery during the mission, more than 50% ( n = 30, 54%) were reachable by telephone; all chose to participate in the study. The cost for families was U.S. $124.92 (56.15); 26 families (87%) believed their money was well spent. Follow-up care was received by 22 (73%) patients, and all but one family ( n = 29, 97%) felt that their child received all of the medical care and support required. All families ( N = 30) would recommend similar cleft care to a friend. Of the patients younger than 18 years of age ( n = 24, 80%), 20 (80%) families found their child more comfortable interacting with peers, more comfortable interacting with adults, and more confident postoperatively.

Conclusion:

In one month, a survey response rate of more than 50% was obtained by leveraging the increased adoption of mobile phones in rural settings. Nearly all patients/families treated during the cleft mission were satisfied with the care that they received.

“It Doesn't All Just Stop at 18”: Psychological Adjustment and Support Needs of Adults Born with Cleft Lip and/or Palate

Background

Cleft in the lip and/or the palate (CL/P) is considered to be a lifelong condition, yet relatively little is known about the long-term outcomes for patients. Existing literature is largely outdated and conflicted, with an almost exclusive focus on medical aspects and deficits.

Objective

To explore the psychological adjustment and possible support needs of a large number of adults born with CL/P from their own perspective.

Design

Fifty-two individual telephone interviews eliciting qualitative data.

Results

Qualitative analysis identified five themes. Participants reported a range of challenges in relation to discharge from the service, additional surgery as an adult, social and romantic relationships, higher education, vocational achievement, and access to psychological support. The findings imply that most adults with a cleft adjust well to these challenges and report many positive outcomes. For a minority of patients, issues attributed to the cleft may continue to cause distress in adulthood.

Conclusions

Adults with CL/P may require psychological support, information about the heritability of cleft, signposting and referrals from nonspecialists, support regarding further treatment, and opportunities to take part in research and activities. New issues arising in adulthood, such as entering the workplace, forming long-term relationships, and starting a family, may warrant both further investigation and additional support. Further work is needed to identify the factors that contribute to psychological distress and resilience, as well as the timing of particular points of risk and opportunity for personal growth.

Self-Esteem, Coping Styles, and Quality of Life in Polish Adolescents and Young Adults with Unilateral Cleft Lip and Palate

Objectives

To evaluate self-esteem, coping styles, and health-related quality of life and their relationships in Polish adolescents and young adults with unilateral complete cleft lip and palate and related sex differences.

Design and Participants

Self-report questionnaires measuring self-esteem (Multidimensional Self-Esteem Inventory), coping styles (Coping Inventory for Stressful Situations), and health-related quality of life (WHOQOL-BREF) were completed by 48 participants with cleft lip and palate (age, 16 to 23 years; 31 males, 17 females) and 48 controls without cleft lip and palate (age, 16 to 23 years; 28 males, 20 females) matched for age, place of residence, and socioeconomic status.

Results

Regarding self-esteem, individuals with cleft lip and palate scored higher on body functioning ( P < .01) and defensive self-enhancement ( P < .05). Self-control showed an interaction effect: Females with cleft lip and palate scored higher than controls, but males did not differ between groups ( P < .05). Males with cleft lip and palate scored lower than controls in personal power but higher in body functioning ( P < .05); females showed no differences between groups. The groups did not differ with regard to coping styles or quality of life, but several correlations were found between self-esteem and coping styles, and quality of life ( P < .01).

Conclusions

Late adolescents and young adults with and without cleft lip and palate differed little in terms of psychological adjustment measures. The higher scores in defensive self-enhancement of individuals with cleft lip and palate suggest the need for instruments measuring social approval in psychosocial adjustment research involving this group.

Social Interactions of School-Aged Children With CFA: Mothers' Perspectives and Advice

Objective : To learn about (1) mothers' perspectives on their children's social experiences and (2) how mothers interpret social situations and provide guidance to their children in challenging situations. Design : This was a qualitative study analyzing narratives. Mothers participated in a semistructured interview; mothers and their children participated in a social coaching task involving responses to hypothetical situations. Transcripts of audio recordings were used to create thematic coding categories, and transcripts were reviewed and coded. Setting : Children were patients at a reconstructive plastic surgery center in an urban hospital and medical school; families were recruited from a regional support group associated with the hospital. Participants : Mothers of nine children with congenital craniofacial anomalies, aged 9 to 14 years. Main Outcome Measures : Thematic narrative coding categories, focusing on mothers' perspectives on children's actual social experiences (from the interview) and mothers' advice and interpretations regarding challenging hypothetical social tasks (from the coaching task). Results : In the interviews, mothers reported positive and negative social experiences for their children. Multiple approaches were used by mothers to interpret social interactions experienced by children (interview) and hypothetical social situations (coaching task). These included consideration of situational factors, motivations of others, and factors within own child. Mothers' hypothetical advice was often prosocial, including concrete strategies to resolve conflict, to plan ways to avoid problems, to foster self-reliance, and to avoid hurtful situations. Conclusions : Mothers showed active interest and concern in their children's peer relationships and were thoughtful in devising strategies to successfully manage potential social challenges.

Population-based study of birth prevalence and factors associated with cleft lip and/or palate in Taiwan 2002-2009

Background

Facial cleft deformities, including cleft lip with or without cleft palate (CL/P) and cleft palate (CP), are common congenital birth anomalies, especially in Asia. This study aimed to analyze the prevalence of CL/P and CP and to identify associated factors in Taiwan.

Methods

This population-based epidemiological study retrospectively analyzed birth data obtained from the Department of Health in Taiwan for years 2002–2009. Frequency distribution, percentages and related predictors were investigated, and findings were presented by types of cleft deformities. Logistic regression analysis was performed to identify factors associated with cleft deformities.

Results

Overall prevalence of cleft deformities among 1,705,192 births was 0.1% for CL/P and 0.04% for CP over the 8-year study period. Higher prevalence of CL/P or CP was observed with multiple pregnancies, being male for CL/P, being female for CP, gestational age ≤37 weeks and lower birth weight (<1.5 kg). Both CL/P and CP were significantly associated with gestational age <37 weeks and birth weight<1.5 kg (all P <0.0001). CL/P was significantly associated with multiple parities (P = 0.0004–0.002). Male newborns and female newborns were significantly associated with CL/P and CP, respectively (both P<0.0001).

Conclusions

Overall prevalence for congenital cleft deformities in study subjects was 0.1%, in keeping with high rates in Asia. Results suggest the need for awareness and early identification of those at high risk for cleft deformities, including newborns with gestational age <37 weeks, weighing <1.5 kg at birth and women with multiple parities, as a potential strategy to counter long-term adverse effects on speech and language in this population.

Recovering the personal identity of an elderly patient with cleft lip: a case report

Instances of unoperated cleft lip and/or palate (CLP) in adult or elderly patients are still seen in developing countries. This paper presents the multidisciplinary management and the personal identity revival of a 72-year-old patient with unoperated unilateral complete cleft lip. The facial deformity was characterized by a protrusion of the excess of orbicularis oris muscle, irregularities of the upper lip, nose distortion, and septum deviation to the cleft side. The patient was edentulous with the maxillary alveolar ridge collapsed and an associated fistula. The cleft lip was repaired using the Tennison-Randall technique and complete dentures were delivered after the oroantral fistula had been closed. The patient was very pleased with the improvement in speech and eating and she approved of her facial esthetics. The existence of unoperated oral clefts in the elderly population highlights the need to improve policies in treating patients with CLP, mainly in developing countries.

Causal attributions of cleft lip and palate across cultures

Objective : To describe and compare the causal beliefs associated with cleft lips and/or palates across several different countries. Design : Cross-sectional survey. Setting : Operation Smile surgery screenings in six developing countries. Participants : Two hundred seventy-nine adult patients and parents of children with cleft lips and/or palates in Kenya, Russia, Cambodia, India, Egypt, and Peru. Interventions : In person interviews were conducted with interpreters. Main Outcome Measure : As part of a larger study, a semistructured questionnaire was created to explore cleft perceptions, belief systems that affect these perceptions, and social reactions to individuals with clefts. Results : Causal attributions were grouped by category (environment, self-blame, supernatural, chance, unknown, or other) and type of locus of control (external, internal, or unknown). Results indicate significant difference by country for both causal attribution category (P < .001) and type (P < .001). This difference was maintained in multivariate analyses, which controlled for differences by demographic variables between countries. Conclusions : This study provides evidence that causal attributions for clefts are influenced by culture. As harmful beliefs about cause may continue to impact affected individuals and their families even after a repair, it is insufficient to provide surgical care alone. Care of the entire person must include attempts to change misinformed cultural beliefs through educating the broader community.

Application of the International Classification of Functioning, Disability, and Health–Children and Youth Version (ICF-CY) to Cleft Lip and Palate

Objective

In recent health policy discussions, the World Health Organization has urged member states to implement the International Classification of Functioning, Disability, and Health: Children and Youth Version in their clinical practice and research. The purpose of this study was to identify codes from the International Classification of Functioning, Disability, and Health: Children and Youth Version relevant for use among children with cleft lip and/or palate, thereby highlighting the potential value of these codes for interprofessional cleft palate-craniofacial teams.

Design

The scope of recent published research in the area of cleft lip and/or palate was reviewed and compared with meaningful terms identified from the International Classification of Functioning, Disability, and Health: Children and Youth Version. In a five-step procedure, a consensus-based list of terms was developed that was linked separately to International Classification of Functioning, Disability, and Health: Children and Youth Version categories and codes. This provided a first draft of a core set for use in the cleft lip and/or palate field.

Conclusions

Adopting International Classification of Functioning, Disability, and Health: Children and Youth Version domains in cleft lip and/or palate may aid experts in identifying appropriate starting points for assessment, counseling, and therapy. When used as a clinical tool, it encourages health care professionals to go beyond treatment and outcome perspectives that are focused solely on the child and to include the children's environment and their familial/societal context. In order to establish improved, evidence-based interdisciplinary treatments for children with cleft lip and/or palate, more studies are needed that seek to identify all the influencing conditions of activities, children's participation, and barriers/facilitators in their environments.