Aesthetics Assessment and Patient Reported Outcome of Nasolabial Aesthetics in 18-Year-Old Patients With Unilateral Cleft Lip

Abstract

Objective: To determine if there is a correlation between objective nasolabial aesthetics assessment using the Cleft Aesthetic Rating Scale (CARS) and patient satisfaction. Design: Retrospective analysis of a generic satisfaction questionnaire and independent assessment by three cleft surgeons of the nasolabial area of these patients on 2D frontal photographs, using the CARS. Setting: The Vrije Universiteit Medical Center and The Academic Center for Dentistry Amsterdam. Patients: Thirty-nine 18-year old patients with a repaired complete or incomplete unilateral cleft lip, with or without a cleft palate, and a completed satisfaction questionnaire. Exclusion criteria were an incomplete questionnaire; a history of facial trauma; and congenital syndromes affecting facial appearance. Main Outcome Measures: The correlation between surgeon evaluation (on a 5-point Likert scale) and patient satisfaction (not, moderately or very satisfied) on nasolabial appearance was assessed using Spearman rho (ρ). Results: There was a negligible correlation between surgeon evaluation and patient satisfaction on nose assessment (ρ = 0.20) and a moderate correlation on lip assessment (ρ = 0.32). Conclusions: Most literature supports this discrepancy between different objective aesthetics evaluation methods and subjective patient-reported outcome measures, suggesting there are factors playing a role in patient satisfaction that are impossible to objectify with assessment methods. Therefore, a strong emphasis should remain on clear communication between the physician and patient regarding their expectations, perception, and satisfaction of surgery results.

Appearance and Speech Satisfaction and Their Associations With Psychosocial Difficulties Among Young People With Cleft Lip and/or Palate

“…The few differences found in appearance and speech satisfaction by diagnosis clearly indicate that the presence of a visible facial difference or speech impairment alone is insufficient to understand who may be least satisfied with appearance and speech. This conclusion is supported by the negligible associations found between professional evaluation and patient satisfaction with appearance and speech (Feragen et al, 2017;Mulder et al, 2019). Therefore, conversations about further surgery should always be guided by the individual patient in collaboration with the psychologist who may be best placed to assess desire and expectations for surgery, as well as overall psychosocial wellbeing in relation to appearance and speech.…”

Impacto dos tratamentos de fissuras labiopalatinas na qualidade de vida: avaliação pelo CLEFT-Q

“…Vale salientar que o instrumento CLEFT-Q foi considerado por pacientes como sendo o que melhor avalia sua percepção para informar ao profissional de saúde, uma vez que possui informações mais detalhadas e abrangentes nos itens avaliados (Stiernman et al, 2021). Este dado reforça a necessidade de incluir a perspectiva dos pacientes com FLP no processo de avaliação clínica, considerando que há evidências de que tal prática contribui para a melhora da qualidade de vida relacionada à saúde, bem como contribui na avaliação dos protocolos aplicados (Mulder et al, 2019;Stiernman et al 2021). Os profissionais que cuidam de indivíduos com fissura labiopalatina estão começando a reconhecer a importância de compreender o efeito do tratamento de fissuras ao longo da vida, conforme as experiências dos pacientes e as necessidades clínicas percebidas (Alansari et al, 2014).…”

“…A autopercepção pode ter impacto significativo no estado psicológico e no status social humano, afetando a autoestima e a qualidade de vida (QV) geral do indivíduo. Existem fatores que desempenham importante papel na satisfação do paciente que são impossíveis se objetivar em alguns métodos de avaliação, sendo necessário valorizar uma comunicação clara entre o profissional de saúde e o paciente com FLP, especialmente em relação às suas expectativas, percepção e satisfação com os resultados de cirurgias (Mulder et al, 2019;Stiernman et al, 2021). Assim, considerar a perspectiva do paciente em relação à saúde oral e qualidade de vida relacionada à saúde é importante porque, no decorrer do longo período de tratamentos, ocorrem transformações anatômicas, estéticas, fonéticas e psicológicas e os resultados das intervenções cirúrgicas e demais tratamentos, nem sempre correspondem às expectativas do paciente, podendo levar ao desequilíbrio emocional e à dificuldade de convívio social e interferir negativamente na qualidade de vida.…”

Rhinoplasty in secondary nasal deformities: Subjective and objective outcome evaluation

“…[ 17 ] A commonly used evaluation method for nose satisfaction after ROEQ, assessing the state of the nose preoperatively and postoperatively. [ 18 ]…”