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Apon I, van Leeuwen N, Polinder S, Versnel SL, Wolvius EB, Koudstaal MJ. Healthcare use and direct medical costs in a cleft lip and palate population: an analysis of observed and protocolized care and costs. Int J Oral Maxillofac Surg 2024; 53:286-292. [PMID: 37734991 DOI: 10.1016/j.ijom.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 07/26/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
This study was performed to describe observed healthcare utilization and medical costs for patients with a cleft, compare these costs to the expected costs based on the treatment protocol, and explore the additional costs of implementing the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set for Cleft Lip and Palate (CL/P). Forty patients with unilateral CL/P between 0 and 24 years of age, treated between 2012 and 2019 at Erasmus University Medical Center, were included. Healthcare services (consultations, diagnostic and surgical procedures) were counted and costs were calculated. Expected costs based on the treatment protocol were calculated by multiplying healthcare products by the product prices. Correspondingly, the additional expected costs after implementing the ICHOM Standard Set (protocol + ICHOM) were calculated. Observed costs were compared with protocol costs, and the additional expected protocol + ICHOM costs were described. The total mean costs were highest in the first year after birth (€5596), mainly due to surgeries. The mean observed total costs (€40,859) for the complete treatment (0-24 years) were 1.6 times the expected protocol costs (€25,198) due to optional, non-protocolized procedures. Hospital admissions including surgery were the main cost drivers, accounting for 42% of observed costs and 70% of expected protocol costs. Implementing the ICHOM Standard Set increased protocol-based costs by 7%.
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Affiliation(s)
- I Apon
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - N van Leeuwen
- Medical Decision-Making Section, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S Polinder
- Health Technology Assessment and Implementation Section, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S L Versnel
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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van der Knaap-Kind LS, Ombashi S, Van Roey V, Kragt L, Peterson P, Jabbari F, Wolvius EB, Versnel SL. Evaluation and recommendations of the oral health, oral function, and orofacial aesthetics-related measures of the ICHOM Standard Set for Cleft Lip and Palate. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00001-8. [PMID: 38228465 DOI: 10.1016/j.ijom.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
This study was performed to evaluate the efficacy of outcome measures for the orofacial domain included in the International Consortium for Health Outcomes Measurement Standard Set for Cleft Lip and Palate (ICHOM-SCS). In this multicentre study involving two cleft centres, suggestions to optimize the type and timing of outcome measures were made based on data and clinical experience. Patient-reported outcome measures (PROMs) (CLEFT-Q Jaw, Teeth, Eating/Drinking; Child Oral Health Impact Profile-Oral Symptoms Scale (COHIP-OSS)) and clinical outcome measures (caries experience and dental occlusion) data were collected retrospectively for age 5, 8, 10, 12, 19, and 22 years. The data were categorized by cleft type and analysed within and between age groups using Spearman correlation, the distribution of responses per item, a two-sample test for equality of proportions, and effect plots. Most correlations between PROMs and clinical outcome measures were weak (r < 0.5), suggesting PROMs and clinical outcome measures complement each other. The COHIP-OSS and CLEFT-Q Eating/Drinking barely detected problems in any patient category and are no longer recommended. A suitable alternative appears complex to find; outcomes of this study and the recent literature doubt an added value. Similar problems were found in the CLEFT-Q Jaw at time-point 12 years. Therefore, time-points 15 and 17 years are currently suggested.
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Affiliation(s)
- L S van der Knaap-Kind
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - S Ombashi
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose And Throat Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - V Van Roey
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose And Throat Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - L Kragt
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - P Peterson
- Department of Reconstructive Plastic Surgery, Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - F Jabbari
- Department of Dental Medicine, Orthodontics and Paediatric Dentistry, Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose And Throat Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S L Versnel
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose And Throat Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
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Ombashi S, van der Goes PAJ, Versnel SL, Khonsari RH, van der Molen AEM. Guidance to develop a multidisciplinary, international, pediatric registry: a systematic review. Orphanet J Rare Dis 2023; 18:296. [PMID: 37735442 PMCID: PMC10512647 DOI: 10.1186/s13023-023-02901-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
AIM The European Reference Network for craniofacial anomalies and ear, nose and throat disorders (ERN-CRANIO) aims to improve craniofacial care on a European scale. Within ERN-CRANIO, the cleft lip and palate (CL/P) work stream seeks to ameliorate health outcomes for patients with CL/P. This work stream acknowledged the need for a European wide registry for comparable outcome measures and therapy endpoints to achieve this goal. This review aimed to provide a scientific basis for the conceptualization of this registry by studying previous registry initiatives. METHODS This review performed thematic analysis on twenty-four articles through narrative synthesis. An iterative process was used to identify key-themes required for prolonged registry success. RESULTS Analysis of the literature resulted in twenty-one distinct headings including quantitative and qualitative data. Quantitative data including registry characteristics were visualized in a table. The analysis of qualitative data resulted in the identification of fourteen key-themes, which have been summarized and visualized in a guidance. CONCLUSION This review has successfully identified key-themes required for the development of an international, multidisciplinary, pediatric registry for pan-European cleft care. The guidance provided by this review applies to the goals of ERN-CRANIO, but can be used by any initiative developing a registry.
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Affiliation(s)
- S Ombashi
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P A J van der Goes
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - S L Versnel
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R H Khonsari
- Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de Médecine, Université Paris Cité, Paris, France
- Scientific Committee, ERN CRANIO, Rotterdam, The Netherlands
| | - A E Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center, Utrecht, The Netherlands
- Scientific Committee, ERN CRANIO, Rotterdam, The Netherlands
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Ombashi S, Tsangaris E, Heeres AG, van Roey V, Neuteboom RF, van Veelen-Vincent MLC, Jansson K, Mathijssen IMJ, Klassen AF, Versnel SL. Quality of life in children suffering from headaches: a systematic literature review. J Headache Pain 2023; 24:127. [PMID: 37718449 PMCID: PMC10506203 DOI: 10.1186/s10194-023-01595-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/12/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Headaches are the most common complaints among pediatric populations. Determining the cause and appropriate treatment for headaches may be challenging and costly, and the impact of headaches on the lives of patients and their families is not well understood. OBJECTIVE A systematic literature review was conducted to examine what PROMs are currently used, and to identify quality of life (QoL) concepts important to children suffering from headaches and any known determinants of QoL. METHODS Embase, Medline, Web of Science, CINAHL, EBSCOhost, PsychINFO, Cochrane CENTRAL and Google Scholar were searched from their inception through to June 2021. Studies investigating QoL, using a validated outcome measure in pediatric patients with headaches, were included. Relevant studies were identified through title and abstract screening and full text review by two independent reviewers. A citation review of included studies was performed. QoL concepts were extracted from the outcome measures that were used in each study to develop a preliminary conceptual model of QoL in children suffering from headaches. Determinants of QoL were also identified and categorized. RESULTS A total of 5421 studies were identified in the search. Title and abstract screening resulted in the exclusion of 5006 studies. Among the 415 studies included for full text review, 56 were eligible for final analysis. A citation review resulted in the addition of five studies. Most studies were conducted in high-income countries and included a patient-sample accordingly (n = 45 studies). Sixteen different PROMs were identified in the included studies, of which the PedsQL was used the most often (n = 38 studies). The most common health concepts reported were physical functioning (n = 113 items), social and psychological wellbeing (N = 117, n = 91 resp.). Twenty-five unique determinants of QoL were extracted from the included studies. CONCLUSION There is a need for a condition-specific PROM to facilitate the measurement of QoL outcomes in the pediatric headache population. A conceptual model was developed based on the findings from the health concepts. Findings from this review could be used for future qualitative interviews with pediatric patients with headaches to elicit and refine important QoL concepts.
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Affiliation(s)
- S Ombashi
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - E Tsangaris
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A G Heeres
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - V van Roey
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - R F Neuteboom
- Children's Brain Lab, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M L C van Veelen-Vincent
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Children's Brain Lab, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Neurosurgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - K Jansson
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Reconstructive Surgery and Craniofacial Surgery, Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - I M J Mathijssen
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Children's Brain Lab, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - S L Versnel
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Children's Brain Lab, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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van Dalen M, Leemreis WH, Kraaij V, De Laat PCJ, Pasmans SGMA, Versnel SL, Koudstaal MJ, Hillegers MHJ, Utens EMWJ, Okkerse JME. Parenting Children With a Cleft Lip With or Without Palate or a Visible Infantile Hemangioma: A Cross-Sectional Study of Distress and Parenting Stress. Cleft Palate Craniofac J 2021; 58:1536-1546. [PMID: 33583213 PMCID: PMC8586175 DOI: 10.1177/1055665621993298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: Parents of children with a medical condition and a visible difference can experience challenging situations. We evaluated distress and parenting stress in parents of children with a cleft lip with or without cleft palate (CL±P) or a visible infantile hemangioma (IH). Setting: This cross-sectional study took place in an academic medical hospital in Rotterdam, the Netherlands. Participants: Three-hundred nine parents (mean age = 40.30, 56.00% mothers) of children with CL±P and 91 parents (mean age = 36.40, 58.24% mothers) of children with IH. Main Outcome Measures: The Dutch version of the Parenting Stress Index – Short Form and the subscales Anxiety, Depression, and Hostility of the Symptom Checklist – 90. Results: One sample t tests and mixed linear modeling were used. On average, parents of children with CL±P and of children with IH showed significantly lower parenting stress compared to normative data. Anxiety was significantly lower in parents of children with CL±P than that in the norm group. Visibility of the condition was not related to distress or parenting stress. Child behavioral problems were positively related to parenting stress, depression, and hostility. Conclusions: Parents of children with CL±P and IH report less distress and parenting stress compared to the norm. On average, these parents seem well adjusted. A practical implication is to monitor parents of children with behavioral problems.
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Affiliation(s)
- M van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - W H Leemreis
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - V Kraaij
- Department of Clinical Psychology, 4496Leiden University, the Netherlands
| | - P C J De Laat
- Department of Pediatrics, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Centre of Pediatric Dermatology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - S L Versnel
- Department of Plastic and Reconstructive Surgery and Hand Surgery, The Dutch Craniofacial Centre, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry, Academic Center for Child Psychiatry Levvel, Amsterdam, the Netherlands
| | - J M E Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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van der Plas PPJM, Yang S, Streppel M, Pullens B, Versnel SL, Koudstaal MJ, Wolvius EB, Mathijssen IMJ, Joosten KFM. Functional outcomes in patients with facial dysostosis and severe upper airway obstruction. Int J Oral Maxillofac Surg 2020; 50:915-923. [PMID: 33334637 DOI: 10.1016/j.ijom.2020.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/27/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023]
Abstract
An increased risk of upper airway obstruction (UAO) is seen in up to 95% of patients with facial dysostosis. Secondary to respiratory problems are feeding difficulties and increased nutritional requirements. Little has been described regarding these outcomes in this patient population. Hence, a retrospective cohort study was performed to gather data on functional outcomes. Eighteen patients with facial dysostosis and severe UAO were included. The median follow-up time was 3.42 years. A tracheostomy tube was placed in 13 patients, of whom 10 subsequently underwent mandibular distraction. Three of the five patients without a tracheostomy underwent mandibular distraction as the primary surgical treatment; the remaining two patients were treated conservatively with oxygen supplementation. At presentation, 13 patients had feeding difficulties. Overall malnutrition was present in 16 patients during follow-up. At the end of follow-up, severe UAO was present in 12 patients, feeding difficulties in seven patients, and malnutrition in four patients, while two patients died. In conclusion, patients with facial dysostosis have a high prevalence of severe UAO, feeding difficulties, and malnutrition. Importantly, mandibular distraction has limited success in treating severe UAO in these patients. Close follow-up by a specialized craniofacial team is of paramount importance to manage the long-term consequences.
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Affiliation(s)
- P P J M van der Plas
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Centre, Rotterdam, The Netherlands
| | - S Yang
- Department of Plastic, Reconstructive and Hand Surgery, Sophia Children's Hospital - Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - M Streppel
- Department of Otorhinolaryngology, Sophia Children's Hospital - Erasmus Medical Centre, Rotterdam, The Netherlands
| | - B Pullens
- Department of Otorhinolaryngology, Sophia Children's Hospital - Erasmus Medical Centre, Rotterdam, The Netherlands
| | - S L Versnel
- Department of Plastic, Reconstructive and Hand Surgery, Sophia Children's Hospital - Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Centre, Rotterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Centre, Rotterdam, The Netherlands
| | - I M J Mathijssen
- Department of Plastic, Reconstructive and Hand Surgery, Sophia Children's Hospital - Erasmus Medical Centre, Rotterdam, The Netherlands
| | - K F M Joosten
- Department of Paediatric Intensive Care, Sophia Children's Hospital - Erasmus Medical Centre, Rotterdam, The Netherlands
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Driessen C, van Veelen MLC, Joosten KFM, Versnel SL, van Nieuwenhoven CA, Wolvius EB, Bredero-Boelhouwer HH, Arnaud E, Mathijssen IMJ. Apert syndrome: the Paris and Rotterdam philosophy. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1335195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- C. Driessen
- Department of Plastic and Reconstructive Surgery, Dutch Craniofacial Center, Sophia children’s hospital, Rotterdam, The Netherlands
| | - M. L. C. van Veelen
- Department of Neurosurgery, Dutch Craniofacial Center, Sophia children’s hospital, Rotterdam, The Netherlands
| | - K. F. M. Joosten
- Department of Paediatric Intensive Care Medicine, Dutch Craniofacial Center, Sophia children’s hospital, Rotterdam, The Netherlands
| | - S. L. Versnel
- Department of Plastic and Reconstructive Surgery, Dutch Craniofacial Center, Sophia children’s hospital, Rotterdam, The Netherlands
| | - C. A. van Nieuwenhoven
- Department of Plastic and Reconstructive Surgery, Dutch Craniofacial Center, Sophia children’s hospital, Rotterdam, The Netherlands
| | - E. B. Wolvius
- Department of Maxillofacial surgery, Dutch Craniofacial Center, Sophia children’s hospital, Rotterdam, The Netherlands
| | - H. H. Bredero-Boelhouwer
- Department of Plastic and Reconstructive Surgery, Dutch Craniofacial Center, Sophia children’s hospital, Rotterdam, The Netherlands
| | - E. Arnaud
- Department of Plastic and Reconstructive Surgery, Pediatric Craniofacial Unit Hospital Necker, Paris, France
| | - I. M. J. Mathijssen
- Department of Plastic and Reconstructive Surgery, Dutch Craniofacial Center, Sophia children’s hospital, Rotterdam, The Netherlands
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Versnel SL, Duivenvoorden HJ, Passchier J, Mathijssen IMJ. Satisfaction with facial appearance and its determinants in adults with severe congenital facial disfigurement: a case-referent study. J Plast Reconstr Aesthet Surg 2009; 63:1642-9. [PMID: 19944661 DOI: 10.1016/j.bjps.2009.10.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 10/04/2009] [Accepted: 10/21/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with severe congenital facial disfigurement have a long track record of operations and hospital visits by the time they are 18 years old. The fact that their facial deformity is congenital may have an impact on how satisfied these patients are with their appearance. This study evaluated the level of satisfaction with facial appearance of congenital and of acquired facially disfigured adults, and explored demographic, physical and psychological determinants of this satisfaction. Differences compared with non-disfigured adults were examined. METHODS Fifty-nine adults with a rare facial cleft, 59 adults with a facial deformity traumatically acquired in adulthood, and a reference group of 201 non-disfigured adults completed standardised demographic, physical and psychological questionnaires. RESULTS The congenital and acquired groups did not differ significantly in the level of satisfaction with facial appearance, but both were significantly less satisfied than the reference group. In facially disfigured adults, level of education, number of affected facial parts and facial function were determinants of the level of satisfaction. High fear of negative appearance evaluation by others (FNAE) and low self-esteem (SE) were strong psychological determinants. Although FNAE was higher in both patient groups, SE was similar in all three groups. CONCLUSION Satisfaction with facial appearance of individuals with a congenital or acquired facial deformity is similar and will seldom reach the level of satisfaction of non-disfigured persons. A combination of surgical correction (with attention for facial profile and restoring facial functions) and psychological help (to increase SE and lower FNAE) may improve patient satisfaction.
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Affiliation(s)
- S L Versnel
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Postbox 2040, 3000 CA Rotterdam, the Netherlands.
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