Feeling Normal? Long-Term Follow-up of Patients with a Cleft Lip–Palate after Rhinoplasty with the Derriford Appearance Scale (DAS-59)

Abstract

The stigma of nasal deformity due to a congenital cleft lip-palate has an undeniable influence on the affected patient's life. It is therefore of interest to investigate if efforts to reduce esthetic and functional impairments by rhinoplasty (single or multiple) can result in an increased satisfaction with appearance and a self-perception similar to the noncleft population. Retrospective scoring before and after rhinoplasty using the validated Derriford Appearance Scale (DAS-59) and subsequent statistical evaluation and comparison to datasets available in the literature for further classification was used. Of the 61 patients who underwent at least one rhinoplasty, 26 responded to all questions. The mean age of responders was approximately 30 years of age and the male:female ratio was 1:1.2. The scale showed a significant overall improvement after surgery. The full scale and all subscale scores of the DAS-59 were significantly reduced after surgery demonstrating an improvement in the respective categories. Most importantly, if postoperative results were compared with a population concerned and unconcerned about appearance, no difference "facial self-consciousness" of appearance was apparent. Also postoperative subscores for "general self-consciousness" (GSC) and "social self-consciousness" of appearance (SSC) showed no difference from those obtained from the population concerned about appearance. The postoperative subscore for "sexual and bodily self-consciousness" of appearance (SBSC) indicated improvement beyond the level found in the concerned control population. Due to only a low improvement in the difference compared with the subscore representing a "negative self-concept," a statistically significant difference to the concerned population remained, possibly indicating that therapy beyond surgery is needed for improvement. After rhinoplasty, the investigated group of cleft lip-palate patients with nasal deformities showed an improvement in their self-conceived appearance as measured by the DAS-59. Their assessment of self-appearance was comparable to that of a group of noncleft persons with concern about their appearance. Taken together, rhinoplasties, primary and revision, add to the psychosocial well-being and an improved self-perception enhancing quality of life and enabling a more normal life. Further research is needed to clarify how the low reduction found in the "negative self-concept" may be addressed successfully.

Sociodemographic Disparities in Access to Cleft Rhinoplasty

“…The age of 13 was chosen for minimum age inclusion criteria, similar to a study by Pagan and colleagues, to include those patients who undergo secondary rhinoplasty in adolescence and have also reached permanent dentition. [9][10][11][12][13][14][15] Post hoc analysis was later performed on this subset of patients who had undergone a secondary rhinoplasty.…”

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

“…The findings from two systematic reviews (Hunt et al, 2005;Al-Namankany and Alhubaishi, 2018) and one narrative review (Stock and Feragen, 2016) indicate that two key issues that often emerge are dissatisfaction with facial appearance and speech. While some research has found no difference in appearance satisfaction between cleft and noncleft groups (Albers et al, 2016), or even higher appearance satisfaction in the former group (Berger and Dalton, 2009), young people with CL/P often report lower appearance and speech satisfaction compared to noncleft control groups (Hunt et al, 2006;Van Lierde et al, 2012;Wehby et al, 2012). Appearance and speech dissatisfaction can impact several major domains of psychosocial functioning, including self-esteem, mental health, and quality of life (Stock and Feragen, 2016).…”

Quality of Life and Poor Oral Health: A Comparison of Postmenopausal Women

“…The American Academy of Pain Medicine notes that the burden of pain is felt in various components of everyday life and quantifies productivity losses as a consequence of it [ 25 ]. Similarly, perceived esthetic compromise is reportedly associated with anxiety and depression in children and adolescents; it is easily extrapolated to adults, especially in light of long-term studies of patients with craniofacial abnormalities which elucidate results of lower facial esthetics in adulthood [ 26 , 27 ]. It is therefore understandable how poor oral health could contribute to a social self-consciousness, having its endpoints in sexual and emotional fields.…”