Evaluation of Facial Appearance and Quality of Life in 4-6 Year Old Patients with Cleft Lip and Palate: A Study at the Tawanchai Center, Thailand
Keywords:
cleft lip and palate, quality of life, patient satisfaction, facial appearance, photo-graphic evaluationAbstract
Background and objective: Facial Appearance and quality of life of patients with cleft lip and palate are essential, so the evaluation and comparison of treatment outcome to improve care and quality of life (QoL) of cleft patients are required.
Methods: We conducted a cross-sectional descriptive study with cleft lip and cleft palate (CLP) patients aged 4-6 years at the Cleft Center. Aesthetic outcomes for the nose, lip, and nasolabial region (NR) were evaluated using standardized digital photographs rated on a five-point scale by both experienced and inexperienced evaluators. QoL was assessed with THAICLEFT QoL Questionnaires. Descriptive statistics are used to analyze data. Inter-rater reliability is evaluated using Cronbach’s alpha coefficient. The Wilcoxon signed-rank test is employed to compare esthetic evaluations between two groups of evaluators.
Results: The study included 6 unilateral and 6 bilateral CLP cases. There were no significant differences in overall agreement between professional groups. Experienced rated the aesthetic outcomes for the lip and nasolabial region significantly higher than inexperienced (p = 0.04 and 0.02, respectively). Inexperienced demonstrated high reliability in assessing the lip and nose (Cronbach’s alpha = 0.76 - 0.88). QoL scores were high for medical treatment, service, and costs; moderate for social psychology; and low for family impact.
Conclusions: The evaluation of facial appearance by experienced and inexperienced evaluators reveals different perspectives on aesthetics. In terms of QoL evaluation, caregivers indicated a good score, and the impact on the family appears to be minimal, indicating a relatively good overall quality of life. However, the findings from this study should be used to further improve patient care in the future.
References
Fuangtharnthip P, Chonnapasatid W, Thiradilok S, Manopatanakul S, Jaruratanasirikul S. Registry-based study of prevalence of cleft lip/palate in Thailand from 2012 to 2015. Cleft Palate Craniofac J 2021;58(11):1430–7. doi:10.1177/1055665620987677
Chowchuen B, Surakunprapha P, Winaikosol K, Punyavong P, Kiatchoosakun P, Pradubwong S. Birth prevalence and risk factors associated with CL/P in Thailand. Cleft Palate Craniofac J 2021;58(5):557–66. doi:10.1177/1055665620956896
Patjanasoontorn N, Pradaubwong S, Rongbutsri S, Mongkholthawornchai S, Chowchuen B. Tawanchai Cleft Center quality of life outcomes: one of studies of patients with cleft lip and palate in Thailand and the Asia Pacific Region. J Med Assoc Thai 2012;95(Suppl 11):141-7.
Pradubwong S, Mongkholthawornchai S, Keawkhamsean N, Patjanasoontorn N, Chowchuen B. Clinical outcomes of primary palatoplasty in pre-school-aged cleft palate children in Srinagarind hospital: quality of life. J Med Assoc Thai 2014;97(Suppl 10):25-31.
Punyavong P, Pradubwong S, Winaikosol K, Jenwitheesuk K, Surakunprapha P, Chowchuen B. Treatment outcomes in four- to seven-year-old patients with cleft lip and cleft palate in Tawanchai Center, Srinagarind hospital: fistula incidence after cleft palate repair. J Med Assoc Thai 2019;102(Suppl 5):5-9.
Klassen AF, Tsangaris E, Forrest CR, Wong KWY, Pusic AL, Cano SJ, et al. Quality of life of children treated for cleft lip and/or palate: a systematic review. J Plast Reconstr Aesthet Surg 2012;65(5):547–57. doi:10.1016/j.bjps.2011.11.004
Patjanasoontorn N, Pradubwong S, Mongkoltawornchai S, Phetcharat T, Chowchuen B. Development and reliability of the THAICLEFT quality of life questionnaire for children with cleft lip/palate and families. J Med Assoc Thai 2010;93(Suppl 4):16-8.
Sinko K, Jagsch R, Prechtl V, Watzinger F, Hollmann K, Baumann A. Evaluation of esthetic, functional, and quality-of-life outcome in adult cleft lip and palate patients. Cleft Palate Craniofac J 2005;42(4):355–61. doi:10.1597/03-142.1.
Mikalsen SKR, Folstad I, Yoccoz NG, Laeng B. The spectacular human nose: an amplifier of individual quality? PeerJ 2014;2:e357. doi:10.7717/peerj.357.
Wehby G, Tyler M, Lindgren S, Romitti P, Robbins J, Damiano P. Oral clefts and behavioral health of young children. Oral Dis 2012;18(1):74–84. doi:10.1111/j.1601-0825.2011. 01847.x
Oosterkamp BCM, Dijkstra PU, Remmelink HJ, van Oort RP, Goorhuis-Brouwer SM, Sandham A, et al. Satisfaction with treatment outcome in bilateral cleft lip and palate patients. Int J Oral Maxillofac Surg 2007;36(1):890–5. doi:10.1016/j.ijom.2007.07.008
Zeraatkar M, Ajami S, Nadjmi N, Faghihi SA, Golkari A. A qualitative study of children’s quality of life in the context of living with cleft lip and palate. Pediatric Health Med Ther 2019;10:13–20. doi:10.2147/PHMT.S173070
Rando GM, Jorge PK, Vitor LLR, Carrara CFC, Soares S, Silva TC, et al. Oral health-related quality of life of children with oral clefts and their families. J Appl Oral Sci 2018;26: e20170106. doi:10.1590/1678-7757-2017-0106
Paiva TS, Andre M, Paiva WS, Mattos BSC. Aesthetic evaluation of the nasolabial region in children with unilateral cleft lip and palate comparing expert versus nonexperience health professionals. Biomed Res Int 2014;2014:460106. doi:10.1155/2014/460106
Paggasang Y, Saothonglang K, Pisek P, Chowchuen B. Sastisfaction with the quality of life of parents of cleft lip and palate patients agwd 8-12 years, Tawanchai center, Northeastern Thailand. Srinagarind Med J 2024;39(3):368-76.
Asher-McDade C, Roberts C, Shaw WC, Gallager C. Development of a method for rating nasolabial appearance in patients with clefts of the lip and palate. Cleft Palate Craniofac J 1991;28(4):385–90. doi:10.1597/1545-1569_1991_028_0385_doamfr_2.3.co_2
Alley TR, Hildebrandt KA. Determinants and consequences of facial aesthetics. In: Alley TR, editor. Social and Applied Aspects of Perceiving Faces. 1st ed. New York: Psychology Press; 1988:101–40.
Power SM, Matic DB. Critical analysis of consecutive unilateral cleft lip repairs: determining ideal sample size. Cleft Palate Craniofac J 2013;50(2):144–9. doi:10.1597/11-104
Nollet PJPM, Kuijpers-Jagtman AM, Chatzigianni A, Semb G, Shaw WC, Bronkhorst EM, et al. Nasolabial appearance in unilateral cleft lip, alveolus and palate: a comparison with Eurocleft. J Craniomaxillofac Surg 2007;35(6-7):278–86. doi:10.1016/j.jcms.2007.04.011
Raposo-do-Amaral C, Kuczynski E, Alonso N. Quality of life among children with cleft lips and palates: a critical review of measurement instruments. Rev Bras Cir Plást 2011;26(4):639–44.
Papamanou DA, Gkantidis N, Topouzelis N, Christou P. Appreciation of cleft lip and palate treatment outcome by professionals and laypeople. Eur J Orthod 2012;34(5):553–60. doi:10.1093/ejo/cjr073
Eichenberger M, Staudt CB, Pandis N, Gnoinski W, Eliades T. Facial attractiveness of patients with unilateral cleft lip and palate and of controls assessed by laypersons and professionals. Eur J Orthod 2014;36(3):284–9. doi:10.1093/ejo/cjt047
Eliason MJ, Hardin MA, Olin WH. Factors that influence ratings of facial appearance for children with cleft lip and palate. Cleft Palate Craniofac J 1991;28(2):190–3. doi:10.1597/1545-1569_1991_028_0190_ftirof_2.3.co_2
Foo P, Sampson W, Roberts R, Jamieson L, David D. Facial aesthetics and perceived need for further treatment among adults with repaired cleft as assessed by cleft team professionals and laypersons. Eur J Orthod 2013;35(3):341–6. doi:10.1093/ejo/cjr129
Tobiasen JM, Hiebert JM, Boraz RA. Development of scales of severity of facial cleft impairment. Cleft Palate Craniofac J 1991;28(4):419–24. doi:10.1597/1545-1569_1991_028_0419_dososo_2.3.co_2
Meyer-Marcotty P, Stellzig-Eisenhauer A. Dentofacial self-perception and social perception of adults with unilateral cleft lip and palate. J Orofac Orthop 2009;70(3): 224–36. doi:10.1007/s00056-009-8813-9
Mosmuller DGM, Bijnen CL, Kramer GJC, Disse MA, Prahl C, Kuik DJ, et al. The Asher-McDade aesthetic index in comparison with two scoring systems in nonsyndromic complete unilateral cleft lip and palate patients. J Craniofac Surg 2015;26(4):1242–5 doi:10.1097/SCS.0000000000001784
Prahl C, Prahl-Andersen B, van ’t Hof MA, Kuijpers-Jagtman AM. Infant orthopedics and facial appearance: a randomized clinical trial (Dutchcleft). Cleft Palate Craniofac J 2006;43(6):659–64. doi:10.1597/05-139
Stebel A, Desmedt D, Bronkhorst E, Kuijpers MA, Fudalej PS. Rating nasolabial appearance on three-dimensional images in cleft lip and palate: a comparison with standard photographs. Eur J Orthod 2016;38(2):197–201. doi:10.1093/ejo/cjv024
De Buys Roessingh AS, Dolci M, Zbinden-Trichet C, Bossou R, Meyrat BJ, Hohlfeld J. Success and failure for children born with facial clefts in Africa: a 15-year follow-up. World J Surg 2012;36(8):1963–9. doi:10.1007/s00268-012-1607-z
Rosanowski F, Eysholdt U. Phoniatric aspects in cleft lip patients. Facial Plast Surg 2002;18(3):197–203. doi:10.1055/s-2002-33066
Gkantidis N, Papamanou DA, Christou P, Topouzelis N. Aesthetic outcome of cleft lip and palate treatment. Perceptions of patients, families, and health professionals compared to the general public. J Craniomaxillofac Surg 2013;41(7):e105–10. doi:10.1016/j.jcms.2012.11.034
Gkantidis N, Papamanou DA, Karamolegkou M, Dorotheou D. Esthetic, functional, and everyday life assessment of individuals with cleft lip and/or palate. Biomed Res Int 2015;2015:e510395. doi:10.1155/2015/510395
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