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.