The aims of this investigation were to examine patients' and parents/guardians' motivation for seeking orthodontic treatment and to determine the influence of age and gender in this process. The sample comprised 674 subjects (365 girls and 309 boys) aged 7-18 years and 674 of their parents/guardians, as well as 86 adult patients aged 19-42 years (57 females and 29 males). Similar questionnaires, designed to assess motivation for orthodontic treatment, were completed by all subjects. Statistical analysis was undertaken using Pearson's chi-square test. In the patient groups, a desire to improve aesthetics was the main motivational factor for undergoing treatment. With increasing age, 13 per cent more girls (P = 0.039) were more aware of their malocclusion. The influence of their surroundings on the uptake of treatment decreased with increasing age. Less than 5 per cent of the examined subjects started treatment because other children made fun of them, and only 3 per cent of older patients were motivated by future improvements in health. Between 63 and 67 per cent of parents reported pressurizing their children to seek orthodontic treatment in order to avoid possible future claims of neglect. No statistically significant dependence on gender or age of the children was found. Improvement in dental aesthetics was the principle motivational factor for the children (29-48 per cent), their parents/guardians (54 per cent), and adult patients (55 per cent) seeking orthodontic treatment.

Holoprosencephaly is a congenital abnormality of the prosencephalon associated with median facial defects. Its frequency is 1 in 250 pregnancies and 1 in 16,000 live births. The degree of facial deformity usually correlates with the severity of brain malformation. Early mortality is prevalent in severe forms. This report presents a child with lobar holoprosencephaly accompanied by median cleft lip and palate. The treatment and 9 months' follow-up are presented. This unique case shows that holoprosencephaly may present different manifestations of craniofacial malformations, which are not always parallel to the severity of brain abnormalities. Patients with mild to moderate brain abnormalities may survive into childhood and beyond.

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