Facial aesthetics and perceived need for further treatment among adults with repaired cleft as assessed by cleft team professionals and laypersons Reply

School of Dentistry.
The European Journal of Orthodontics (Impact Factor: 1.48). 11/2011; 35(6). DOI: 10.1093/ejo/cjr129
Source: PubMed


The objectives of this study were to compare the ratings of professionals and laypeople with and without a cleft regarding the facial aesthetics of adult patients previously treated for orofacial clefting. The necessity for further treatment, as perceived by the respective groups, is also compared. The design of the study was a cross-sectional study. Professionals (two plastic surgeons, one dentist, one orthodontist, and one psychologist) and laypeople (one male and one female adult without a cleft and one male and one female adult with a cleft) were recruited to rate photographs of 80 non-syndromic cleft patients treated by the Australian Craniofacial Unit from 1975 to 2009. Facial aesthetics were measured by a visual analogue scale (VAS; 0-100 mm). High values indicated good aesthetics. Necessity for further treatment was also measured by a VAS (0-100 mm). High values indicated high perceived need for further treatment. The professionals rated facial aesthetics significantly lower and had a lower perception of need for further treatment than the raters with and without a cleft. The laypeople with a cleft rated facial aesthetics significantly higher and had a lower perceived need for further treatment than laypeople without a cleft. The non-surgical professionals rated facial aesthetics significantly lower and had a lower perceived need for further treatment than the surgical professionals. Differences exist in the facial aesthetics ratings and perceived need for further surgery between professionals and laypeople with and without a cleft. This should be considered when managing cleft treatment expectations.

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    • "Since the aim of present systematic review is to identify the difference between professionals and laypeople, different specialists were regarded as a whole and included in the professional panel. Besides laypeople and professionals, two studies included patients with cleft lip and palate and their parents in the rater group (Foo et al., 2013; Gkantidis et al., 2013). This is of importance because patientcentered healthcare requires health professionals, patients , their families, and friends to cooperate as a ''treatment team'' (Lutz and Bowers, 2000). "
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    ABSTRACT: Objective : To identify whether laypeople and professionals rate the facial appearance of patients with cleft lip and palate (CLP) similarly based on viewing full facial images. Design : Several electronic databases were searched. A hand search was performed among reference lists and relevant journals. Studies that assessed the full facial appearance of patients with CLP based on two-dimensional (2D) photographs, 3D images, or clinical examination by laypeople and professionals using a visual analog scale (VAS) or a categorical rating scale were included. Two authors independently assessed articles using methodologic-quality scoring protocol. Results : Eleven articles were included in qualitative synthesis, including four high-level and seven moderate-level papers. Three studies found that laypeople were more critical than professionals, three found there was no significant difference between laypeople and professionals, and five reported that professionals were more critical than laypeople when assessing facial appearance of patients with CLP. Conclusions : It still remains unknown whether laypeople are more or less critical than professionals when rating facial appearance of patients with repaired CLP. Professionals are more familiar with the esthetic outcomes and difficulties of treating patients. The opposite maybe true for laypeople; this disparity between what is achievable by professionals and what is expected by laypeople may be a source of dissatisfaction in facial appearance outcome. Further well-designed studies should be carried out to address this question and the clinical significance of the difference in rating scores for patients with CLP.
    The Cleft Palate-Craniofacial Journal 02/2015; DOI:10.1597/14-177 · 1.20 Impact Factor
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    • "Some authors [10] [22] [24] [25] also reported that experienced practitioners showed higher satisfaction with the appearance of the nasolabial region than lay assessors. However , there are studies that have reported opposite results, with the lay assessors giving higher attractiveness ratings than the experienced professionals [18] [26]. Furthermore, some studies have shown no differences in ratings between professionals and lay people [20] [27]. "
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    ABSTRACT: Esthetic evaluation of cleft lip and palate rehabilitation outcomes may assist in the determination of new surgical interventions and aid in reevaluation of treatment protocols. Our objective was to compare esthetics assessments of the nasolabial region in children with a unilateral cleft lip and palate between healthcare professionals who were experienced in the treatment of cleft lip and palate and those who were inexperienced. The study group included 55 patients between 6 and 12 years of age who had already undergone primary reconstructive surgery for unilateral cleft lip. Standardized digital photographs were obtained, and the esthetic features of the nose, lip, and nasolabial region were evaluated. We used only cropped photographic images in the assessments of healthcare professionals with and without experience in cleft lip and palate. Interrater analysis revealed highly reliable assessments made by both the experienced and inexperienced professionals. There was no statistically significant difference in the esthetic attractiveness of the lip and nose between the experienced and inexperienced professionals. Compared with the inexperienced professionals, the experienced professional evaluators showed higher satisfaction with the esthetic appearance of the nasolabial region; however, no difference was observed in the analysis of the lip or nose alone.
    BioMed Research International 07/2014; 460106(1):5. DOI:10.1155/2014/460106 · 2.71 Impact Factor
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    • "In the past, there have been conflicting results as far as a gender difference in the need for secondary corrective facial surgery is concerned. There have been authors who described that female patients with cleft lip and palate malformations deemed corrective surgery significantly less necessary than male patients [5]. On the other hand, it has been shown that female cleft lip and palate patients wished to have corrective surgery twice as often as male patients [12]. "
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    ABSTRACT: Purpose: This prospective study was aimed at assessing cleft lip and palate (CLP) patients' opinions and attitudes towards their upper lip and nose and the number of secondary corrective surgical interventions electively undertaken to upper lip and nose that were carried out during a 2 year follow-up period.Materials and methods: During a 2 year follow-up period CLP outpatients were recruited for the study who attended follow-up examinations at a cleft lip and palate craniofacial center and received a recommendation for secondary corrective facial surgery. The participants filled in a questionnaire that included questions regarding the patients' opinions and attitudes towards appearance of lip and nose and need for secondary corrective facial surgery. During an additional interval of 2 years the rate of patients who underwent secondary corrective surgery to lip and nose was documented. Out of 362 CLP patients 37 (mean age 13.6 +/- 7.6 years) received a recommendation for secondary corrective surgery to upper lip and/or nose. 22 patients (mean age 12.6 +/- 6.3 years) filled in the questionnaire (response rate of 62.1%). The satisfaction with the overall facial appearance following the first corrective operation was statistically significantly better than the satisfaction with the nose (p = .016). The satisfaction with facial symmetry (5.6 +/- 2.0) did not differ statistically significantly from the overall satisfaction with the facial appearance (6.2 +/- 1.8; p = .093). Significantly fewer patients (n = 9) opted for corrective surgery compared to the number of patients who got the recommendation to have secondary corrective surgery done (n = 22, p < .0005). The findings of the present study may reflect a high overall patient satisfaction with the primary treatment outcome following surgery for CLP. Perceived patient need for secondary operation for the lip/nose may be as low as 5%.
    Head & Face Medicine 12/2013; 9(1):38. DOI:10.1186/1746-160X-9-38 · 0.85 Impact Factor
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