Background & Purpose: Children and young adults with a history of cleft lip and palate (CL+/-P) possess various psychosocial stressors and satisfaction with facial appearance is associated with the level of psychosocial functioning. This study is designed to compare how children with CL+/-P evaluate other CL+/-P patient's aesthetic results with how plastic surgeons and other children without CL+/-P evaluate patient aesthetic results. These comparisons are offered here to illustrate who is most critical of outcomes in this patient population and help understand the unique psychosocial stressors our patients confront.
Methods: Photographs of 10 patients 5 to 6 years of age with an isolated unilateral CL+/-P were selected and shown to individual evaluators. All evaluators scored facial appearance based upon red lip, white lip, nose, and overall appearance. Data were recorded on a ten point Likert scale ranging from good to bad. Evaluators were divided into four groups: Group 1; children with CL+/-P (n=10), Group 2; children with isolated craniosynostosis(n=10), Group 3; children with no craniofacial anomaly(n=10), and Group 4; resident and attending plastic surgeons not performing cleft surgery (n=8). No subjects answering the survey knew or had previously seen any of the scored children.
Results: Ages and average scores given by children in Groups 1 through 3 are as follows: Group 1, 9.6 years +/-1.3 and 4.5 +/-2.2; Group 2, 9.2 years +/-0.5 and 5.9+/-1.4; Group 3, 10.7+/-2.3 and 7.8+/-1.6. Plastic surgeons in Group 4 reported an average score of 5.8+/-2.9. Lowest scores were reported for red lip repairs in Group 1 and 4; 3.9 and 4.0, respectively. Highest scores were seen in all groups for nose and nostril appearance and were not significantly different between groups. Free responses in Group 3 did not implicate the lip/nose as aesthetically unappealing.
Conclusions: Children with clefts and craniosynostosis, and plastic surgeons reported significantly lower facial aesthetic scores than children lacking craniofacial anomalies (p=0.023) The repaired cleft lip appears to go more unnoticed by unaffected children.