Comprehensive care for craniofacial anomalies

Nasolabial appearance in unilateral cleft lip, alveolus and palate: a comparison with Eurocleft

OBJECTIVE

To evaluate nasolabial appearance of patients with UCLAP treated in Nijmegen and to compare them with those from six other individual centers from the Eurocleft study. Relationships between nasolabial aesthetics, dental arch relationships and cleft width at birth were also investigated.

PATIENTS

Children of Caucasian origin with complete UCLAP (n=42 consecutive cases) from the Nijmegen Cleft Palate Unit, The Netherlands.

METHODS

Nasolabial appearance was assessed by applying an aesthetic index and subsequently compared with the six-centre Eurocleft study. Cleft width at birth was measured on maxillary plaster casts.

RESULTS

The 90% central range for the overall aesthetic rating of the 42 Nijmegen patients is 2.0-3.7 on a scale from 1 to 5 (1=very good nasolabial appearance, 5=very poor nasolabial appearance). With regard to the overall aesthetic rating, Nijmegen showed similar treatment outcomes with Eurocleft centres A, D, E and F. Nijmegen scored significantly better than Eurocleft centre C and significantly worse than Eurocleft centre B (p<or=0.05). No significant correlations between aesthetic ratings, dental arch relationships and cleft width at birth could be established for the Nijmegen patients.

CONCLUSION

Treatment protocol could not explain differences in treatment results. The current comparative study is supportive in the selection of patient records that are suitable for the "good practice archive" which is part of the EUROCRAN project.

Psychosocial adjustment in children with port-wine stains and prominent ears

OBJECTIVE

To evaluate psychosocial adjustment in children with port-wine stain (PWS) and children with prominent ears (PE).

METHOD

Thirty-two children aged 7 to 16 years with facial PWS and 42 children with PE were evaluated using the Harter Self-Perception Profile, the Revised Children's Manifest Anxiety Scale, the Children's Depression Inventory, the Disfigurement Perception Scale, and the Child Behavior Checklist. Results were compared with normative data for the local population or with a control group. Profile scores were correlated with severity of the PWS or prominence of the ears.

RESULTS

Children with PE had poorer self-perception, higher concentration anxiety, and more internalizing and externalizing symptoms, and they were more withdrawn and had more social problems than children with PWS. The children with PWS functioned as well as or better than nondisfigured peers on measurements of psychosocial adjustment, while children with PE scored lower than nondisfigured peers on measures of self-perception and parent-rated social and attention problems. There was no correlation between degree of disfigurement and level of psychosocial adjustment.

CONCLUSIONS

Psychosocial adjustment varied according to the nature of the disfigurement or deformity and was unrelated to the severity of the disfigurement.

Development of scales of severity of facial cleft impairment

The reliability and validity of human judgments in rating the severity of cleft-related facial impairment were examined in this series of studies. The goal of the research was to develop scales for rating the severity of facial cleft impairment using psychophysical methods for measuring human judgment. The principle findings were: (1) Four photographic categorized scales with high inter-group reliability and satisfactory content and construct validity were developed; (2) Raters used objective stimulus characteristics of the face to scale impairment; (3) Ratings of facial attractiveness decreased as the severity of impairment increases; (4) Full face ratings of the severity of impairment correlated highly with ratings of the same photographs cropped below the eyes. The implications of these findings for clinical and research application are discussed.