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Prominent Ears: The Effect of Reconstructive Surgery on Self-Esteem and Social Interaction in Children with a Minor Defect Compared to Children with a Major Orthopedic Defect
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
2008 (English)In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 122, no 5, 1390-98 p.Article in journal (Refereed) Published
Abstract [en]

Background: In a prospective study of patients with prominent ears, the effect of reconstructive surgery on self-esteem and social interaction was examined 1 year after surgery.Methods: Of 42 patients with prominent ears aged 7 to 15 years, 21 were matched with a comparison group of orthopedic patients (leg lengthening) and a control group of schoolchildren. Psychological measures evaluated self-esteem, depression, anxiety, cognition, parents' ratings of child behavior and symptoms, and parent anxiety. Semistructured interviews with the child and parents were also conducted.Results: The motivation to be operated on was pain, teasing, and feelings of being different. The satisfaction rate with the result of reconstructive surgery was high. The psychological measures of the prominent ears group had results close to those of the control group, although the leg lengthening group had lower self-esteem and higher depression and anxiety scores. With few exceptions, all patients had scores within the normal range on self-rating scales. Parents reported less activity at leisure time in both patient groups than in the control group. After surgery, parents reported improved behavior on the Child Behavior Checklist total problem score.Conclusions: Patients with minor defects had fewer self-reported psychological and behavior problems than the major defect group. Interestingly, prominent ears patients also had low activity levels. Reconstructive surgery had no adverse effect on the prominent ears patients in this interim study but rather resulted in improved well-being. It is important to investigate further the effect of reconstructive surgery on children's self-esteem and social interaction.

Place, publisher, year, edition, pages
2008. Vol. 122, no 5, 1390-98 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-97928DOI: 10.1097/PRS.0b013e3181881fb0ISI: 000261138700011OAI: oai:DiVA.org:uu-97928DiVA: diva2:173051
Available from: 2009-01-23 Created: 2009-01-23 Last updated: 2013-01-17Bibliographically approved
In thesis
1. Mental Health in Children Undergoing Reconstructive Surgery: Studies on Self-Esteem and Social Interaction
Open this publication in new window or tab >>Mental Health in Children Undergoing Reconstructive Surgery: Studies on Self-Esteem and Social Interaction
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

While the functional and anatomical aspects of reconstructive surgery in children with leg length inequality (LLI), prominent ears (PE) and cleft lip and palate (CLP) have been studied in detail, the psychological aspects of surgery have been less explored. The benefit of a changed appearance and function on self-esteem and ability to social interaction are other areas where information is lacking. The aim of this thesis is to examine, during the process of reconstructive surgery, the mental health, self-esteem and social interaction of children with defects in appearance and function.

Children, aged 6-16 years, with LLI (n=27) and PE (n=31) were invited to participate in interviews and psychological assessments by filling in a battery of questionnaires and tests (depression; anxiety; self-esteem; cognitive ability; and behaviour) before Ilizarov and otoplasty surgery and one year after. Parents filled in a child symptom check list and a state and trait anxiety questionnaire. Another six adolescents with CLP and their parents participated in interactive interviews with the aim of identifying relevant psychological issues for individuals with this condition. These issues were subsequently used to create new questionnaires. Being different, the development of self-esteem and social interaction were the central themes of the questionnaires designed after the interview study. The new questionnaires were explored in a retrospective study on other adolescents (n=26) with CL/P and their parents. Beck’s Youth Inventories (BYI) was used as comparative data.

The LLI group had significantly lower mental health and self-esteem scores than the control group before surgery. The leisure activity level in both patient groups was low according to parents’ report before surgery. The mental health scores of both patient groups (LLI and PE) were improved after reconstructive surgery, but self-esteem was not affected.

The questionnaires for CL/P patients proved to be useful in the exploration of self-esteem from a developmental perspective and in the search for strengthening factors of social interaction. Self-esteem was average or high on group level for adolescents with CL/P compared to BYI measure. Parents rated their adolescents to have higher self-esteem than the adolescents themselves. Females had a less positive development of self-esteem, there was an interaction effect between the female and male patients’ evaluation of self-esteem by higher age.

Even a minor appearance defect like PE may affect mental health negatively. There were no adverse psychological effects one year after surgery in LLI and PE patients, rather, there were signs of improved mental health. Adolescents with CL/P have an anticipated risk of more mental health problems and especially those individuals who have been bullied. Cleft teams and Child and Adolescent Psychiatric Clinics should be attentive and offer psychological support to those individuals most affected by their conditions.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 65 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 408
National Category
urn:nbn:se:uu:diva-9510 (URN)978-91-554-7376-1 (ISBN)
Public defence
2009-01-15, Auditoriet, Gustavianum, 75310, Uppsala, 13:15
Available from: 2009-01-23 Created: 2009-01-23Bibliographically approved

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Sundelin Wahlsten, Viveka
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