To evaluate general health-related quality of life (HRQoL) and oral health impact among adults treated for cleft to determine age and gender differences, and to compare against population norms.
Design
Cross-sectional prospective study.
Participants/Setting
Nonsyndromic cleft patients treated by the Australian Craniofacial Unit from 1975 to 2009 were recruited (n = 112). Response rate was 79% (n = 88).
Main outcome measures
HRQoL was measured by the Short Form (SF)-36 questionnaire. Oral health impact was measured by the Oral Health Impact Profile (OHIP)-14 questionnaire. State-based and national norms were used for comparative purposes.
Results
There were no significant age or sex differences in the cleft sample's SF-36 and OHIP-14 scores. When compared against South Australian 2002 state-level norms, cleft participants scored higher on physical function and physical role function but lower on vitality and mental health. The prevalence of having experienced one or more of OHIP–14 items “fairly often” or “very often” was 2.7 times higher than national-level estimates, while extent was 2.8 times and severity 1.7 times higher.
Conclusions
The oral health impact among cleft patients included in our study was poor compared with population-level estimates. The HRQoL showed mixed results, with the vitality and mental health components being poorer in the cleft group compared with population-level estimates. These results indicate that treatment for orofacial clefting does not entirely remove the factors contributing to poor HRQoL and oral health.
AdamsG.The effects of physical attractiveness on the socialisation process. In: LuckerG.W.RibbensK.A.McNamaraJ.A., eds. Psychological Aspects of Facial Form. Craniofacial Growth Series, Monograph No 11.Ann Arbor: Center for Human Growth and Development;1980: 25–48.
2.
AdamsG.CraneP.An assessment of parents' and teachers' expectations of preschool children's social preference for attractive or unattractive children and adults. Child Dev.1980; 5: 224–231.
3.
BakerS.R.OwensJ.SternM.WillmotD.Coping strategies and social support in the family impact of cleft lip and parents' adjustment and psychological distress. Cleft Palate Craniofac J.2009; 46: 229–236.
4.
BerkN.CooperM.E.LiuY.E.MarazitaM.L.Social anxiety in Chinese adults with oral-facial clefts. Cleft Palate Craniofac J.2001; 38: 126–133.
5.
BerscheidE.Overview of the psychological effects of physical attractiveness In: LuckerG.W.RibbensK.A.McNamaraJ.A., eds. Psychological Aspects of Facial Form. Craniofacial Growth Series, Monograph No 11.Ann Arbor: Center for Human Growth and Development;1980: 1–23.
6.
BerscheidE.GangestadS.The social psychological implications of facial physical attractiveness. Clin Plast Surg.1982; 9: 189–296.
7.
BoukydisZ.Infant attractiveness and the infant-caretaker relationship. Pediatrics.1978; 61: 373–379.
8.
BrazierJ.E.HarperR.JonesN.M.B.O'CathainA.ThomasK.J.UsherwoodT.WestlakeL.Validating the SF-36 health survey questionnaire: new outcome measure for primary health care. Br Med J.1992; 305: 160–164.
9.
BressmannT.SaderR.Ravens-SiebererU.ZeilhoferH.F.HorchH.H.Quality of life research in patients with cleft lip and palate: preliminary results [in German]. Mund Kiefer Gesichtschir.1999; 3: 134–139.
10.
BroderH.L.SmithF.B.StraussR.P.Effects of visible and invisible orofacial defects on self-perception and adjustment across developmental eras and gender. Cleft Palate Craniofac J.1994; 31: 429–436.
CheungL.K.LohJ.S.HoS.M.Psychological profile of Chinese with cleft lip and palate deformities. Cleft Palate Craniofac J.2007; 44: 79–86.
13.
CliffordE.CrockerE.C.PopeB.A.Psychological findings in the adulthood of 98 cleft lip-palate children. Plast Reconstr Surg.1972; 50: 234–237.
14.
CliffordM.WalsterE.The effect of physical attractiveness on teacher expectations. Sociol Educ.1973; 46: 248–258.
15.
CorterC.TrehubS.BoukydisZ.BoukydisZ.FordL.CelhofferL.MindeK.Nurses' judgements of the attractiveness of premature infants. Infant Behav Dev.1978; 1: 373–380.
16.
Dal GrandeE.Quality of life in South Australia as measured by the SF-36: population norms for 2002, trends from 1994 to 2002 and impact of chronic diseases and health risk factors on quality of life.South Australian Department of Human Services; 2004.
17.
DavidD.J.AndersonP.J.SchnittD.E.NugentM.A.SellsR.From birth to maturity: a group of patients who have completed their protocol management. Part II. Isolated cleft palate. Plast Reconstr Surg.2006 Feb; 117: 515–526.
18.
DillmanD.A.Mail and Internet Surveys: The Tailored Design Method.New York: John Wiley & Sons; 2000.
19.
HuntO.BurdenD.HepperP.JohnstonC.The psychosocial effects of cleft lip and palate: a systematic review. Eur J Orthod.2005; 27: 274–285.
20.
JefferyS.BoormanJ.G.Patient satisfaction with cleft lip and palate services in a regional centre. Br J Plast Surg.2001; 54: 189–191.
21.
JohnM.PatrickD.L.SladeG.D.The German version of the Oral Health Impact Profile—translation and psychometric properties. Eur J Oral Sci.2002; 110: 425–433.
22.
LancasterP.PedisichE.Congenital Malformations Australia 1981–1992.Sydney: AIHW National Perinatal Statistics Unit; 1995. ISSN 1321-8352.
23.
LangloisJ.RoggmanL.A.CaseyR.J.RitterJ.M.DannerA.W.YenkinsV.Y.Infant preferences for attractive faces: rudiments of a stereotype?Dev Psychol.1987; 23: 363–369.
24.
ManiM.CarlssonM.MarcussonA.Quality of life varies with gender and age among adults treated for unilateral cleft lip and palate. Cleft Palate Craniofac J.2010; 47: 491–498.
25.
MarcussonA.ListT.PaulinG.AkerlindI.Reliability of a multidimensional questionnaire for adults with treated complete cleft lip and palate. Scand J Plast Reconstr Surg Hand Surg.2001; 35: 271–278.
26.
MarcussonA.PaulinG.OstrupL.Facial appearance in adults who had cleft lip and palate treated in childhood. Scand J Plast Reconstr Surg Hand Surg.2002; 36: 16–23.
27.
MarquisP.ChassanyO.AbetzL.A comprehensive strategy for the interpretation of quality-of-life data based on existing methods. Value Health.2004; 7: 93–104.
28.
McCallumJ.The new ‘SF-36’ Health Status Measure: Australian Validity Tests. National Centre for Epidemiology and Population Health.Canberra: The Australian National University;1994.
29.
McCallumJ.The SF-36 in an Australian sample: validation. Aust J Public Health.1995; 19: 160–166.
30.
McHorneyJ.E.WareJ.E.RaczekA.E.The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions and reliability across diverse patient groups. Med Care.1994; 32: 247–263.
31.
McWilliamsB.J.ParadiseL.P.Educational, occupational, and marital status of cleft palate adults. Cleft Palate J.1973; 10: 223–229.
MurrayJ.C.Face facts: genes, environment, and clefts. Am J Hum Genet.1995; 57: 227–232.
34.
PeterJ.P.ChinskyR.R.FisherM.J.Sociological aspects of cleft palate adults. III. Vocational and economic aspects. Cleft Palate J.1975; 12: 193–199.
35.
RamstadT.OttenE.ShawW.C.Psychosocial adjustment in Norwegian adults who had undergone standardised treatment of complete cleft lip and palate. Part II. Self-reported problems and concerns with appearance. Scand J Plast Reconstr Surg Hand Surg.1995; 29: 329–336.
36.
Sanson-FisherR.W.PerkinsJ.J.Adaptation and validation of the SF-36 health survey for use in Australia. J Clin Epidemiol.1998; 51: 961–967.
37.
SchnittD.E.AgirH.DavidD.J.From birth to maturity: a group of patients who have completed their protocol management. Part I. Unilateral cleft lip and palate. Plast Reconstr Surg.2004; 113: 805–817.
38.
SigelmanC.MillerT.E.WhitworthL.A.The early stigmatizing reactions to physical differences. J Appl Dev Psychol.1986; 7: 17–32.
39.
SinkoK.JagschR.PrechtlV.WatzingerF.HollmannK.BaumannA.Evaluation of esthetic, functional, and quality-of-life outcome in adult cleft lip and palate patients. Cleft Palate Craniofac J.2005; 42: 355–361.
40.
SladeG.D.Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol.1997; 25: 284–290.
41.
SladeG.D.SpencerA.J.Development and evaluation of the Oral Health Impact Profile. Community Dent Health.1994; 11: 3–11.
42.
SladeG.D.SpencerA.J.Roberts-ThomsonK.F., eds. Australia's Dental Generations; The National Survey of Adult Oral Health 2004–2006.Canberra: Australian Institute of Health and Welfare;2007. AIHW cat. no. DEN 165.
43.
StraussR.P.BroderH.Directions and issues in psychosocial research and methods as applied to cleft lip and palate and craniofacial anomalies. Cleft Palate Craniofac J.1991; 28: 150–156.
44.
SullivanM.K.KarlssonJ.TaftC., eds. Swedish Manual and Interpretation Guide.2nd ed.Gothenburg, Sweden: Sahlgrenska University Hospital;2002.
45.
ThompsonA.KentG.Adjusting to disfigurement: processes involved in dealing with being visibly different. Clin Psychol Rev.2001; 21: 663–682.
46.
WareJ.E.ShelbourneC.D.The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care.1992; 30: 473–483.
47.
WareJ.E.SnowK.K.KosinskiM.GandekB.SF-36® Health Survey Manual and Interpretation Guide.Boston: New England Medical Center, The Health Institute;1993.
48.
WyrwichK.W.BullingerM.AaronsonN.HaysR.D.PatrickD.L.SymondsT.Estimating clinically significant differences in quality of life outcomes. Qual Life Res.2005; 14: 285–295.
