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Unilateral Cleft Lip and Palate: Quality of Life and Nasal Form and Function among Adults
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Unilateral cleft lip and palate (UCLP) is a craniofacial malformation with functional and aesthetical impact on the face and the upper airways. The aims of the current thesis were to evaluate Quality of life (QoL) in adults treated for UCLP  (I), to objectively evaluate nasal form and function and to search for possible differences in residual nasal deformity and impairment of function between patients operated according to one-stage and two-stage palate closure (II) as well as to evaluate the relationship between professional and lay rating and patient satisfaction with nasolabial appearance (III) and to identify factors associated with lower levels of QoL and less satisfaction with nasal appearance among adults treated for UCLP (IV).

Analyses of data from a homogenous population of UCLP patients treated at Uppsala University Hospital form the basis of this thesis. The mean follow-up time after primary surgery was 35 years (20-47 years) and participation rate was 79% (n=86). An age and gender matched control group of 68 people without clefts were evaluated according to the same protocol. The evaluation protocol included the Short Form 36 questionnaire (SF-36), rhinomanometry, acoustic rhinometry, odor test, peak nasal inspiratory flow test and photographies of faces. For the SF-36 data, age- and gender-matched norm data of 1385 people from the Swedish population were used.

Unilateral cleft lip and palate affected QoL differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients in several subscales. However, except for lower values in the Mental Health subscale, QoL was similar among UCLP patients and norm data. Objectively measured nasal function was extensively affected among adults treated for UCLP. No difference in impairment of nasal function was found between one-stage and two-stage palate closure protocols on the cleft side. Judgment of nasolabial appearance differed between professionals, lay people and patients. Large infant cleft width was associated with less satisfaction with nasal appearance and male gender was associated with lower levels of mental QoL. Correlation between high nasal breathing resistance and low levels of physical QoL was found. In conclusion, this thesis provides a platform for future research for optimal evaluation of cleft treatment outcome.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2010. , p. 73
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 558
Keywords [en]
unilateral cleft lip and palate, quality of life, SF-36, nasal function, nasal breathing, nasolabial appearance, cleft width, long-term results
National Category
Surgery
Research subject
Plastic Surgery
Identifiers
URN: urn:nbn:se:uu:diva-122574ISBN: 978-91-554-7799-8 (print)OAI: oai:DiVA.org:uu-122574DiVA, id: diva2:310603
Public defence
2010-06-11, Skoogsalen, Uppsala University Hospital, entrance 79, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2010-04-29 Created: 2010-04-14 Last updated: 2010-05-18
List of papers
1. Quality of Life Varies with Gender and Age among Adults Treated for Unilateral Cleft Lip and Palate
Open this publication in new window or tab >>Quality of Life Varies with Gender and Age among Adults Treated for Unilateral Cleft Lip and Palate
2010 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 47, no 5, p. 491-498Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate health-related quality of life among adults treated for unilateral cleft lip and palate and to investigate whether patients were affected differently depending on gender and age.

Design: Cross-sectional population study with long-term follow-up.

Patients/Settings: All unilateral cleft lip and palate patients born 1960-1987 and treated at Uppsala University Hospital were invited (n = 109). Response rate was 79% (n = 86). Mean follow-up time was 35 years. Norm data matched for age and gender were used for comparison (n = 1385).

Main Outcome Measures: Health-related quality of life measured with the SF-36 questionnaire. High values indicate good level of health-related quality of life.

Results: The total patient group had lower values in the Mental Health subscale compared with norm data (p = .005). Values in all other subscales did not differ from norm data. Women had a higher positive difference than men in the subscale emotional role function compared with the matched norm population (p < .001). The younger age group (20 to 32 years old) consistently had a larger negative difference to matched norm data compared with the older age group (33 to 47 years old) in the subscales social function (p = .009), physical role function (p < .001), and emotional role function (p < .001).

Conclusions: Unilateral cleft lip and palate affected health-related quality of life differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients on several subscales. However, except for the mental health subscale, health-related quality of life was similar among unilateral cleft lip and palate patients and norm data.

Keywords
adults, cleft lip and palate, gender, quality of life, SF-36
National Category
Medical and Health Sciences
Research subject
Plastic Surgery
Identifiers
urn:nbn:se:uu:diva-122380 (URN)10.1597/08-281 (DOI)000281619700007 ()20180705 (PubMedID)
Available from: 2010-04-14 Created: 2010-04-09 Last updated: 2017-12-12Bibliographically approved
2. Objective Assessment of Nasal Airway in Unilateral Cleft Lip and Palate: a Long-term Study
Open this publication in new window or tab >>Objective Assessment of Nasal Airway in Unilateral Cleft Lip and Palate: a Long-term Study
Show others...
2010 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 47, no 3, p. 217-224Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To objectively evaluate the nasal function in adults operated on for unilateral cleft lip and palate with one-stage or two-stage palate closure. DESIGN: The population consists of all unilateral cleft lip and palate patients born from 1960 to 1987 and treated at the Cleft Lip and Palate Center, Uppsala University Hospital, Sweden. The patients were treated according to the same protocol except for palate closure, which was performed in one stage until 1977 and in two stages thereafter. Eighty-three patients participated. Mean follow-up time after primary surgery was 32 years. An age-matched control group underwent the same examinations. MAIN OUTCOME MEASURES: Nasal minimum cross-sectional area (cm(2)) and volume (cm(3)) were assessed (acoustic rhinometry). Airflow resistance (Pa s/cm(3)) (rhinomanometry), peak inspiratory flow (L/min) (peak nasal inspiratory flow), and number of identified odors (Scandinavian Odor Identification Test) were determined. RESULTS: The cleft side of unilateral cleft lip and palate patients had significantly lower values for all parameters compared with controls (p < .001). No difference was found between one-stage and two-stage procedures in values for the cleft side. However, the nasal area and volume of the noncleft side were significantly larger in patients who underwent one-stage as compared with two-stage procedures (p < .05). CONCLUSION: The nasal airway of unilateral cleft lip and palate patients demonstrates a wide range of impairments that can be quantified by objective measurements. However, the measurements used did not differentiate between patients operated on with the one-stage and two-stage procedures except for values of the noncleft side.

Keywords
Cleft, Airways
National Category
Surgery
Research subject
Plastic Surgery
Identifiers
urn:nbn:se:uu:diva-122571 (URN)10.1597/09-057.1 (DOI)000277435400001 ()20426672 (PubMedID)
Available from: 2010-04-14 Created: 2010-04-14 Last updated: 2018-01-26Bibliographically approved
3. Nasolabial Appearance in Adults with Repaired Unilateral Cleft Lip and Palate: Relation between Professional and Lay Rating and Patients' Satisfaction
Open this publication in new window or tab >>Nasolabial Appearance in Adults with Repaired Unilateral Cleft Lip and Palate: Relation between Professional and Lay Rating and Patients' Satisfaction
2010 (English)In: Journal of plastic surgery and hand surgery, ISSN 2000-6764, Vol. 44, no 4-5, p. 191-198Article in journal (Refereed) Published
Abstract [en]

The aim of the current study was to evaluate the relation between professional and lay rating and patients' satisfaction with nasolabial appearance in adults with repaired unilateral cleft lip and palate (UCLP). A cross-sectional population study, long-term follow-up with controls matched for age and sex was performed. All patients with complete UCLP born between 1960 and 1987 (n = 109), treated at Uppsala University Hospital, Sweden were invited and 83 (76%) agreed to participate. Follow-up was 20-47 years after primary lip surgery. An age-and sex-matched control group of 65 people were evaluated in the same way. Ratings from professional and lay panels of cropped photographs using a 5 point categorical scale for 4 features of the nasolabial appearance and the satisfaction with appearance questionnaire (SWA) for self-assessment were used. Professional and lay ratings correlated positively but the professionals consistently rated nasolabial appearance as better than did the lay panel (p < 0.001). Self-assessment of nasolabial appearance with the SWA (by patients and controls) did not correlate with the judgement of lay or professional panels. Judgement of nasolabial appearance in adults with repaired UCLP differs among professionals, lay people, and patients. This should be considered when deciding about secondary surgical treatment of signs of clefts.

National Category
Surgery
Research subject
Plastic Surgery
Identifiers
urn:nbn:se:uu:diva-122572 (URN)10.3109/02844311.2010.499671 (DOI)000288238800002 ()
Available from: 2010-04-14 Created: 2010-04-14 Last updated: 2011-08-22Bibliographically approved
4. Factors Related to Quality of Life and Satisfaction with Nasal Appearance in Patients Treated for Unilateral Cleft Lip and Palate
Open this publication in new window or tab >>Factors Related to Quality of Life and Satisfaction with Nasal Appearance in Patients Treated for Unilateral Cleft Lip and Palate
Show others...
2013 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 50, no 4, p. 432-439Article in journal (Refereed) Published
Abstract [en]

Objective:

To identify factors related to Quality of Life (QoL) and satisfaction with nasal appearance among patients treated for unilateral cleft lip and palate (UCLP).

Design:

Cross sectional population study with long-term follow-up.

Patients/Settings:

All patients with UCLP born between 1960-1987, treated at Uppsala University Hospital, were invited (n=109), 86 (79%) participated. Mean follow-up time was 35 years.

Main outcome measures:

QoL was measured with Short Form-36 (SF-36) and analyzed using mental and physical cluster scores (MCS and PCS). Nasal appearance was self-assessed with "Satisfaction with Appearance" questionnaire and by panel judgment. Multivariate regression analyses explored endogenous factors (age, gender, infancy cleft width, nasal function, nasolabial appearance) and exogenous factors (marital status, number of children, education level, operation method, number of rhinoplasties performed).

Results:

A larger cleft width in infancy was associated with less satisfaction with nasal appearance as adults. A lower mental health QoL was associated with less satisfaction with nasal appearance. Despite female gender being linked to less satisfaction with nasal appearance, it was associated with higher mental health QoL. Higher resistance during nasal breathing was associated to lower physical health QoL.

Conclusions:

Gender and infant cleft width may affect QoL and satisfaction with nasal appearance among adults. They are potential predictive factors for satisfaction with nasal appearance and QoL during adulthood. The correlation of nasal function impairment and decreased physical health QoL underlines the importance of treatment of nasal symptoms in these patients.

National Category
Surgery
Research subject
Plastic Surgery
Identifiers
urn:nbn:se:uu:diva-122573 (URN)10.1597/11-035 (DOI)000327535400010 ()
Available from: 2010-04-14 Created: 2010-04-14 Last updated: 2017-12-12Bibliographically approved

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