Factors Related to Quality of Life and Satisfaction with Nasal Appearance in Patients Treated for Unilateral Cleft Lip and Palate

Objective To identify factors related to quality of life (QoL) and satisfaction with nasal appearance among patients treated for unilateral cleft lip and palate (UCLP). Design Cross-sectional population study with long-term follow-up. Patients/Settings All patients with UCLP born between 1960 and 1987, treated at Uppsala University Hospital, were invited (n = 109); 86 (79%) participated. Mean follow-up time was 35 years. Main Outcome Measures Quality of life was measured with Short Form–36 (SF-36) and analyzed using mental and physical cluster scores (MCS and PCS). Nasal appearance was self-assessed with the “Satisfaction With Appearance” questionnaire and by panel judgment. Multivariate regression analyses explored endogenous factors (age, gender, infancy cleft width, nasal function, nasolabial appearance) and exogenous factors (marital status, number of children, education level, operation method, number of rhinoplasties performed). Results A larger cleft width in infancy was associated with less satisfaction with nasal appearance as adults. A lower mental health QoL was associated with less satisfaction with nasal appearance. Despite female gender being linked to less satisfaction with nasal appearance, it was associated with higher mental health QoL. Higher resistance during nasal breathing was associated with lower physical health QoL. Conclusions Gender and infant cleft width may affect QoL and satisfaction with nasal appearance among adults. They are potential predictive factors for satisfaction with nasal appearance and QoL during adulthood. The correlation of nasal function impairment and decreased physical health QoL underlines the importance of treatment of nasal symptoms in these patients.

[1]  R. Roberts,et al.  General Health-Related Quality of Life and Oral Health Impact among Australians with Cleft Compared with Population Norms; Age and Gender Differences , 2012, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[2]  G. Semb,et al.  Nasolabial appearance in adults with repaired unilateral cleft lip and palate: Relation between professional and lay rating and patients' satisfaction , 2010, Journal of plastic surgery and hand surgery.

[3]  M. Carlsson,et al.  Quality of Life Varies with Gender and Age among Adults Treated for Unilateral Cleft Lip and Palate , 2010, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[4]  B. Gerdin,et al.  Association between Cleft Size and Crossbite in Children with Cleft Palate and Unilateral Cleft Lip and Palate , 2010, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[5]  K. Feragen,et al.  Peer harassment and satisfaction with appearance in children with and without a facial difference. , 2010, Body image.

[6]  M. Mani,et al.  Objective Assessment of the Nasal Airway in Unilateral Cleft Lip and Palate—A Long-Term Study , 2009, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[7]  A. Gosain Social Experience in 10-Year-Old Children Born With a Cleft: Exploring Psychosocial Resilience , 2010 .

[8]  Gautam Biswas,et al.  Width of cleft palate and postoperative palatal fistula--do they correlate? , 2009, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[9]  I. Sharp,et al.  The Continuing Multidisciplinary Needs of Adult Patients with Cleft Lip and/or Palate , 2008, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[10]  P. Dijkstra,et al.  Satisfaction with treatment outcome in bilateral cleft lip and palate patients. , 2007, International journal of oral and maxillofacial surgery.

[11]  S. Musa,et al.  Assessment of Patients’ Level of Satisfaction with Cleft Treatment Using the Cleft Evaluation Profile , 2007, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[12]  H. Friede Maxillary Growth Controversies after Two-Stage Palatal Repair with Delayed Hard Palate Closure in Unilateral Cleft Lip and Palate Patients: Perspectives from Literature and Personal Experience , 2007, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[13]  S. Ho,et al.  Psychological Profile of Chinese with Cleft Lip and Palate Deformities , 2007, The Cleft Palate-Craniofacial Journal.

[14]  N. Gellrich,et al.  One- or Two-Stage Palate Closure in Patients with Unilateral Cleft Lip and Palate: Comparing Cephalometric and Occlusal Outcomes , 2007, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[15]  D. Aizenbud,et al.  Nasal airflow and olfactory function after the repair of cleft palate (with and without cleft lip). , 2005, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[16]  A. Fukushiro,et al.  Nasal Airway Dimensions of Adults with Cleft Lip and Palate: Differences among Cleft Types , 2005, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[17]  F. Watzinger,et al.  Evaluation of Esthetic, Functional, and Quality-of-Life Outcome in Adult Cleft Lip and Palate Patients , 2005, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[18]  Chris Johnston,et al.  The psychosocial effects of cleft lip and palate: a systematic review. , 2005, European Journal of Orthodontics.

[19]  A. Danino,et al.  Impact social sur de jeunes adultes du traitement standardisé de fentes labiomaxillopalatines unilatérales complètes traitées dans l’enfance , 2005 .

[20]  A. Ayoub,et al.  Methods of Assessment of Cleft-Related Facial Deformity: A Review , 2005, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[21]  W. Shaw,et al.  The Eurocleft Study: Intercenter Study of Treatment Outcome in Patients with Complete Cleft Lip and Palate. Part 4: Relationship among Treatment Outcome, Patient/Parent Satisfaction, and the Burden of Care , 2005, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[22]  C. Hervé,et al.  [Social adjustment in French adults from who had undergone standardised treatment of complete unilateral cleft lip and palate]. , 2005, Annales de chirurgie plastique et esthetique.

[23]  Amanda Bates,et al.  Relationships between self-esteem, social experiences and satisfaction with appearance: standardisation and construct validation of two cleft audit measures , 2004 .

[24]  L. Östrup,et al.  Facial appearance in adults who had cleft lip and palate treated in childhood , 2002, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[25]  M Sullivan,et al.  SF-36 Hälsoenkät: Svensk Manual och Tolkningsguide, 2 upplagan (Swedish Manual and Interpretation Guide) , 2002 .

[26]  G. Paulin,et al.  Quality of life in adults with repaired complete cleft lip and palate. , 2001, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[27]  Rod J. Rohrich,et al.  Optimal timing of cleft palate closure. , 2000, Plastic and reconstructive surgery.

[28]  H. Svensson,et al.  Von Langenbeck or Wardill procedures for primary palatal repair in patients with isolated cleft palate--speech results. , 2000, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[29]  M. Kunkel,et al.  Acoustic airway profiles in unilateral cleft palate patients. , 1999, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[30]  K. Kapp-Simon,et al.  Psychological issues in craniofacial care: state of the art. , 1999, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[31]  H. Friede,et al.  Comparisons of facial growth in patients with unilateral cleft lip and palate treated by different regimens for two-stage palatal repair. , 1999, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[32]  K. Uccellini Learning disability, school achievement, and grade retention among children with cleft: a two-center study. , 1999, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[33]  U. Joos,et al.  Evaluation of the results of delayed rhinoplasty in cleft lip and palate patients. Functional and aesthetic implications and factors that affect successful nasal repair. , 1998, The British journal of oral & maxillofacial surgery.

[34]  M. Sullivan,et al.  The Swedish SF-36 Health Survey III. Evaluation of criterion-based validity: results from normative population. , 1998, Journal of clinical epidemiology.

[35]  J. Sandy,et al.  Satisfaction with facial appearance among subjects affected by a cleft. , 1997, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[36]  J. Ware,et al.  The Swedish SF-36 Health Survey--I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. , 1995, Social science & medicine.

[37]  W H Rogers,et al.  Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. , 1995, Medical care.

[38]  R. Strauss,et al.  Effects of visible and invisible orofacial defects on self-perception and adjustment across developmental eras and gender. , 1994, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[39]  J. Tobiasen,et al.  Clefting and psychosocial adjustment. Influence of facial aesthetics. , 1993, Clinics in plastic surgery.

[40]  W. Shaw,et al.  A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 4. Assessment of nasolabial appearance. , 1992, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[41]  W. Shaw,et al.  Development of a method for rating nasolabial appearance in patients with clefts of the lip and palate. , 1991, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[42]  O. Jakobsson,et al.  Closure of the cleft palate in one or two stages: the surgical methods. , 1990, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[43]  R. Strauss,et al.  Self-concept of early primary school age children with visible or invisible defects. , 1989, The Cleft palate journal.

[44]  R. Hellquist,et al.  A longitudinal study of delayed periosteoplasty to the cleft alveolus. , 1983, The Cleft palate journal.

[45]  E. Berscheid,et al.  The social psychological implications of facial physical attractiveness. , 1982, Clinics in plastic surgery.

[46]  G. Semb,et al.  Secondary bone grafting of alveolar clefts. A surgical/orthodontic treatment enabling a non-prosthodontic rehabilitation in cleft lip and palate patients. , 1981, Scandinavian journal of plastic and reconstructive surgery.

[47]  M. Perko Two-stage closure of cleft palate (progress report). , 1979, Journal of maxillofacial surgery.

[48]  B. Cannon Plastic Surgery: New Methods and Refinements , 1975 .

[49]  W. Widmaier [The primary elevated velum extension, a method of closing the cleft palate]. , 1961, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[50]  T. Skoog A design for the repair of unilateral cleft lips. , 1958, American journal of surgery.

[51]  W. Wardill The technique of operation for cleft palate , 1937 .