Facial Asymmetry and Social Functioning in Children and Adolescents with Cleft Lip and/or Palate
BACKGROUND: While orofacial clefts may affect the facial appearance of children and adolescents with this condition, research has yet to examine the impact of facial difference on social functioning in this population. Characteristics of facial appearance, such as symmetry, are important in social interaction. Given that individuals with CL/P often present with a degree of facial asymmetry, their social experience may differ from that of the general population. This study aimed to examine the relationship between facial asymmetry and social functioning in children and adolescents with CL/P. PARTICIPANTS: Participants included children and adolescents seen in a multidisciplinary team clinic at a large plastic and craniofacial surgery center. Data was obtained from children and adolescents with a cleft lip and/or palate (CL/P) diagnosis, between the ages of 8 and 18 years of age. Participants with other complex medical or genetic diagnoses were excluded from this study. Participants were separated into groups based on cleft diagnosis (bilateral CL/P, unilateral CL/P, cleft lip only, and cleft palate only). METHOD: Data was collected via retrospective chart review and included demographic information, medical and surgical history, and responses to self-report questionnaires measuring quality of life (PedsQL). Three-dimensional images of each patient were also taken as part of routine care at each clinic visit. This study utilized measurements obtained from the three-dimensional images, as well as scores on the social functioning scale from the PedsQL. RESULTS: The current study found three-dimensional stereophotogrammetric analysis for facial asymmetry to have high interobserver reliability in the CL/P population. Overall, the current study found that there were no significant differences between diagnosis groups in regard to facial asymmetry scores and reported social functioning. Furthermore, the current study found no significant correlation between reported social functioning and facial asymmetry scores. DISCUSSION: The results suggest that three-dimensional image analysis is a useful and reliable tool for objectively evaluating facial asymmetry in youth with CL/P. The results also suggest that social functioning of youth with CL/P is not significantly associated with facial asymmetry. Future studies should focus on evaluating other factors that may determine social functioning.