Facial profile esthetics in operated children with bilateral cleft lip and palate.

Rita De Cássia Moura Carvalho Lauris,Guilherme Janson,Daniela Gamba Garib,Louise Resti Calil,José Roberto Pereira Lauris,Leopoldino Capelozza

doi:10.1590/2177-6709.22.4.041-046.oar

Rita De Cássia Moura Carvalho Lauris, Guilherme Janson + Show 4 more

Open Access

https://doi.org/10.1590/2177-6709.22.4.041-046.oar

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Abstract

ABSTRACTObjective: The aim of this study was to evaluate the facial profile esthetics of rehabilitated children with complete bilateral cleft lip and palate (BCLP), comparing the judgment of professionals related and not related to cleft rehabilitation and laypersons. Methods:Thirty children in the mixed dentition (24 male; 6 female) with a mean age of 7.8 years were evaluated using facial profile photographs by 25 examiners: 5 orthodontists and 5 plastic surgeons with experience in cleft care, 5 orthodontists and 5 plastic surgeons without experience in oral cleft rehabilitation and 5 graduated laymen. Their facial profiles were classified into esthetically unpleasant (grade 1 to 3), esthetically acceptable (grade 4 to 6), and esthetically pleasant (grade 7 to 9). Intraexaminer and interexaminer errors were evaluated using Spearman correlation coefficient and Kendall’s test, respectively. Inter-rater differences were analyzed using Friedman test and Student-Newman-Keuls test for multiple comparisons. Results: Orthodontists dealing with oral clefts rehabilitation considered the majority of the sample as esthetically pleasant. Plastic surgeons of the cleft team and laypersons classified most of the sample as esthetically acceptable. Most of the orthodontists and plastic surgeons not related to cleft care evaluated the facial profile as esthetically unpleasant. The structures associated to unpleasant profiles were the nose, the midface and the upper lip. Conclusions: The facial profile of children with BCLP was classified as esthetically acceptable by laypersons. Professionals related to cleft rehabilitation were more lenient and those not related to cleft care were stricter to facial esthetics than laypersons.

Highlights

Complete bilateral cleft lip and palate (BCLP) is the most severe manifestation of oral clefts, corresponding to 14% of all types of oral clefts.[1]
Differences for the evaluation of facial esthetics were observed for the different types of raters (Table 3)
Orthodontists and plastic surgeons dealing with oral clefts (ODC and PSDC) scored most of the patients as esthetically acceptable even though the mean score was lower for the plastic surgeons

Summary

Introduction

Complete bilateral cleft lip and palate (BCLP) is the most severe manifestation of oral clefts, corresponding to 14% of all types of oral clefts.[1] BCLP causes serious esthetical, functional, anatomic and psychosocial disorders requiring early surgery repair.[2] The rehabilitation protocol for BCLP includes lip and palate repair, alveolar bone graft and orthodontics, isolated or combined with orthognatic surgery.[3] At birth, a patient with complete BCLP presents severe convex facial profile due to premaxilla projection.[4] After lip repair, protrusion of the premaxilla decreases and maxillary deficiency may be observed during growth.[5] According to Semb,[5] in patients with BCLP, the maxilla is prominent at 5 years of age. Maxillary growth deficiency decreases facial convexity in BCLP. Patients with BCLP show hyperdivergent growth of the mandible determining a posteriorly positioned chin.[3]

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