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Adult patients with treated complete cleft lip and palate: Methodological and clinical stndies
Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of the present thesis was to investigate the quality of life, satisfaction with treatment, prevalence of temporomandibular disorders, psychosocial distress, and occlusal stability in a treated group of adults with complete cleft lip and palate (CLP).

Sixty-eight adults ( 44 men and 24 women) with a mean age of 24.2 years (range 19.5-29.2) with treated CLP were compared with a gender- and agematched group with no clefts. The CLP subjects were born between 1968 and 1977 and had undergone standardised plastic surgery at the Department of Plastic Surgery, University Hospital, Linköping, Sweden. Logopaedic, phoniatric, otological, and orthodontic examinations and treatment had been provided locally, supervised by the Cleft Palate Team.

The subjects answered a multidimensional, self-report, standardised questionnaire regarding psychological and somatic conditions. The subjects underwent a clinical TMD examination and an evaluation of the occlusion. The reliability of the multidimensional questionnaire was analysed for the CLP group by a test-retest study within a 2-3 week interval and most questions showed an overall good reliability. A panel of professionals judged the outcome of the surgical treatment on colour slides of the CLP subjects. The dental plaster casts of 39 subjects born with complete unilateral cleft lip and palate (UCLP) were analysed (mean age 24.7 years, range 20.2-29.3) and compared with the dental plaster casts taken at mean age of 19.1 years (range 16.0-20.6).

The overall level of quality of life was rather high in both groups. The CLP group rated some detached aspects, such as life meaning, family life, and private economy, significantly lower than did the group without clefts. Overall aspects such as well-being and social life were affected by having a treated cleft but not the more practical and tangible aspects of their daily living.

There was an overall high level of satisfaction with all the different part of the body in both groups, but the CLP group reported significantly moredissatisfaction with their nose, lips, mouth, profile, and overall facial appearance than the group without clefts. The professionals and the subjects with CLP were generally not very satisfied with the results of surgical treatment. Thirty of the subjects with CLP (47%) wished to have more operations. The professional group recommended further operations in 38 of the subjects (59%) in particular, rhinoplasties.

The CLP group had significantly higher frequencies of cross-bite than the group without clefts, but no differences regarding TMD pain were found between the two groups. In the subjects with treated UCLP, there was a significant deterioration in the occlusal score and the maxillary arch dimensions between 19 and 25 years. This was irrespective of the type of retention. The persisting morphological mal occlusion with a low frequency of interferences has had no influence on TMD symptoms in the group of CLP patients studied.

The conclusion is that the CLP subjects in the present study seemed to be psycho-socially well adjusted to their disability. However, 47 per cent wished to have further surgical treatment. The persisting malocclusions did not provoke TMD symptoms.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2001. , 57 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 666
Series
Swedish Dental Journal Supplement, ISSN 0348-6672 ; 145
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-25690Local ID: 10066ISBN: 91-7219-959-8 (print)OAI: oai:DiVA.org:liu-25690DiVA: diva2:246238
Public defence
2001-04-20, Berzeliussalen, Hälsouniversitetet, Linköping, 09:00 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-06Bibliographically approved
List of papers
1. Reliability of a multidimensional questionnaire for adults with treated complete cleft lip and palate
Open this publication in new window or tab >>Reliability of a multidimensional questionnaire for adults with treated complete cleft lip and palate
2001 (English)In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 35, no 3, 271-278 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to evaluate the reliability of a multidimensional questionnaire for Swedish adults with treated complete unilateral or bilateral cleft lip and palate (CLP). The questionnaire was designed to be used in the evaluation of adults with treated CLP after treatment. Before any conclusions were drawn from the results of the study we assessed the test-retest reliability of the questionnaire. The questionnaire included 168 questions and assessed the following domains: aesthetics, functions associated with CLP, satisfaction with treatment and perceived need for treatment, quality of life, depression and non-specific physical symptoms, body image, and jaw function. The subjects answered the questionnaire twice at a 2-3-week interval. Sixty-one adults (38 men, 23 women) mean age 24 years (range 20-29) participated in the study. The response rate for the questionnaire was acceptable at 75%. The test-retest reliability varied among the different domains. The reliability of questions regarding aesthetics, functions associated with CLP, and treatment satisfaction was good to excellent (intraclass correlation coefficient (ICC) = 0.51 to 0.89). Good to excellent (ICC = 0.61 to 1.0) reliability was also found for the quality of life in various life domains and the wellbeing scales. The reliability of the body image scale was moderate (kappa = 0.43-0.60) for most items and lower than that of other scales used in this study. The reliability of the mean depression symptom score (ICC = 0.93) and the mean non-specific physical symptoms score (ICC = 0.85) were excellent. The reliability of the mandibular function impairment was good (ICC = 0.67). The conclusion of the study is that an overall reliability was good for the multidimensional questionnaire.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27872 (URN)10.1080/028443101750523177 (DOI)12632 (Local ID)12632 (Archive number)12632 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
2. Quality of life in adults with repaired complete cleft lip and palate
Open this publication in new window or tab >>Quality of life in adults with repaired complete cleft lip and palate
2001 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 38, no 4, 379-385 p.Article in journal (Refereed) Published
Abstract [en]

Objective: This study evaluated the quality of life in adult Swedish subjects with repaired complete cleft lip and palate (CLP).

Design/Patients: Sixty-eight adults with repaired CLP were compared with a group of 66 adults without cleft matched by gender and age.

Outcome Measures: The outcome measures included a self-report questionnaire concerning quality of life in general, well-being, and health-related quality of life.

Results: The CLP group rated their quality of life significantly lower than did the control group in the areas of life meaning (p < .05), family life (p < .0001), and private economy (p < .01). There were no significant differences between the groups concerning well-being. In the CLP group, the health-related quality of life was significantly lower concerning global life (p < .0001), disturbance to life (p < .01), well-being (p < .0001), social contacts (p < .0001), and family life (p < .05) but significantly higher concerning ability to make the most of leisure time (p < .001) and to be active (p < .001).

Conclusions: The CLP group perceived a marked impact of the handicap on their lives concerning global aspects, well-being, and social life. More practical and tangible aspects of their daily living, however, were not affected, and only some minor aspects of their quality of life in general were poor in comparison with the control group, which indicates a fairly good life adjustment in spite of the handicap.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27871 (URN)10.1597/1545-1569(2001)038<0379:QOLIAW>2.0.CO;2 (DOI)12631 (Local ID)12631 (Archive number)12631 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Facial appearance in adults who had cleft lip and palate treated in childhood
Open this publication in new window or tab >>Facial appearance in adults who had cleft lip and palate treated in childhood
2002 (English)In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 36, no 1, 16-23 p.Article in journal (Refereed) Published
Abstract [en]

Sixty-eight adults (44 men and 24 women) with treated total cleft lip and palate were compared with a group of 66 adults (49 men and 17 women) without clefts, matched by sex and age. The outcome measures included a self-report questionnaire about body image, quality of life in general, health-related quality of life, somatisation, and depression. The group with clefts were also asked if they had further need of treatment. They reported significantly more dissatisfaction with their facial appearance (nose, lips, mouth, profile, and overall facial appearance) than the group without clefts. Satisfaction with facial appearance was significantly correlated with a better quality of life in both groups, and significantly correlated with a better health-related quality of life and a lower grade of somatisation in the group with clefts. Dissatisfaction with facial appearance was the most significant predictor of depression in both groups. A panel of four professionals from a cleft lip and palate treatment team judged the outcome of treatment in 64 of the subjects on colour slides. The professionals and the subjects with clefts were generally not very satisfied with the results of the surgical outcome. Thirty of the subjects with clefts (47%) wished to have more operations. The professional group recommended further operations in 38 of the cases (59%), in particular, rhinoplasties. We conclude that the subjects with treated clefts were not satisfied with their facial appearance, although they seem to be psychosocially well-adjusted to their disability.

Keyword
Adults, Cleft lip and palate, Facial appearance, Satisfaction with treatment outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-47061 (URN)10.1080/028443102753478327 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
4. Temporomandibular disorders in adults with repaired cleft lip and palate: a comparison with controls
Open this publication in new window or tab >>Temporomandibular disorders in adults with repaired cleft lip and palate: a comparison with controls
2001 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 23, no 2, 193-204 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to investigate the prevalence of temporomandibular disorders (TMD), and assess psycho‐social distress in adult subjects with repaired complete cleft lip and palate (CLP). Sixty‐three adults (42 males and 21 females, mean age 24.2 years, range 19.5–29.2) with repaired CLP (CLP group) were compared with a group of 66 adults without cleft (non‐cleft group, 49 males and 17 females, mean age 25.5 years, range 20.2–29.9). All subjects underwent a clinical TMD examination, which followed the guidelines in the Research Diagnostic Criteria for TMD (RDC/TMD). Jaw function was assessed by evaluating answers to the mandibular function impairment questionnaire (MFIQ).

Tension‐type headache was diagnosed according to the International Headache Society (IHS) classification. Psychological status was assessed using the depression score and the non‐specific physical symptom score with subscales of the Revised Symptom Checklist‐90 (SCL‐90‐R).

The prevalence of reported pain in the face, jaws and/or TMJs was 14 and 9 per cent for the CLP and non‐cleft group, respectively, and did not differ significantly between the groups. The CLP group exhibited a significantly reduced jaw‐opening pattern (P < 0.001) and a higher frequency of crossbites (P < 0.05) compared with the non‐cleft group. Whilst jaw function was similar in both groups, a few items, e.g. speech and drinking, were significantly more impaired (P < 0.01) in the CLP group than in the non‐cleft group. There were no significant differences between the two groups concerning tension‐type headache or psycho‐social distress.

The study found that overall TMD pain or psycho‐social distress was not more common in this CLP group than in a non‐cleft group.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27873 (URN)10.1093/ejo/23.2.193 (DOI)12633 (Local ID)12633 (Archive number)12633 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
5. Alterations in occlusion and maxillary dental arch dimensions in adults with treated unilateral complete cleft lip and palate
Open this publication in new window or tab >>Alterations in occlusion and maxillary dental arch dimensions in adults with treated unilateral complete cleft lip and palate
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The purpose of this stndy was to evaluate the occlusion and maxillary dental arch dimensions in adults with repaired complete unilateral cleft lip and palate (UCLP) and to investigate the patterns of change in early adulthood. Study models from 39 subjects (25 men, 14 women) (mean age 24.7 years, range 20.2-29.3) with the diagnosis complete UCLP taken at a follow-up examination were analysed and compared with the study models taken at baseline examination (mean age 19.1 years, range 16.0-20.6). Lip closure was made according to the Millard technique and palatal closure according to the Wardill-Kilner technique. All subjects had received orthodontic treatment with fixed appliances. The subjects were divided into three groups according to the type of retention in the upper jaw: no retention (n = 15), retention with bonded twisted retainer (n = 13), onlay or fixed bridge (n = 11).

Occlusion was evaluated according to a scoring system (Huddart and Bodenham, 1972). The maxillary dental arch dimensions were measured with a video imaging system. In the total sample there was a significant deterioration in the total occlusal score during the follow-up period. The impairment was larger on the cleft side than on the non-cleft side. There were no significant differences in the frontal scores. A comparison of the transversal and sagittal maxillary arch dimensions revealed significant differences in all measurements during the follow-up interval. The reduction was largest for the maxillary second premolar width, followed by the first molar width. The oveijet differed significantly between the registrations. The occlusal score and the maxillary arch dimensions were reduced in all of the three subgroups, but there were no differences between the groups. No gender differences were found.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81068 (URN)
Available from: 2012-09-06 Created: 2012-09-06 Last updated: 2012-09-06Bibliographically approved

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