Agneta Marcusson

FACIAL APPEARANCE IN ADULTS WHO HAD CLEFT LIP AND PALATE TREATED IN CHILDHOOD

Sixty-eight adults (44 men and 24 women) with treated total cleft lip and palate were compared with a group of 66 adults (49 men and 17 women) without clefts, matched by sex and age. The outcome measures included a self-report questionnaire about body image, quality of life in general, health-related quality of life, somatisation, and depression. The group with clefts were also asked if they had further need of treatment. They reported significantly more dissatisfaction with their facial appearance (nose, lips, mouth, profile, and overall facial appearance) than the group without clefts. Satisfaction with facial appearance was significantly correlated with a better quality of life in both groups, and significantly correlated with a better health-related quality of life and a lower grade of somatisation in the group with clefts. Dissatisfaction with facial appearance was the most significant predictor of depression in both groups. A panel of four professionals from a cleft lip and palate treatment team judged the outcome of treatment in 64 of the subjects on colour slides. The professionals and the subjects with clefts were generally not very satisfied with the results of the surgical outcome. Thirty of the subjects with clefts (47%) wished to have more operations. The professional group recommended further operations in 38 of the cases (59%), in particular, rhinoplasties. We conclude that the subjects with treated clefts were not satisfied with their facial appearance, although they seem to be psychosocially well-adjusted to their disability.

Reliability and validity of a Swedish version of the Oral Health Impact Profile (OHIP‐S)

The aim of this study was to translate the Oral Health Impact Profile (OHIP) into Swedish and evaluate the reliability and validity of the Swedish version (OHIP‐S). The OHIP is a 49‐item, self‐administered questionnaire divided into 7 different subscales. The original version in English was translated into Swedish, accompanied by back‐translation into English, after which the Swedish version was revised. A total of 145 consecutive patients participated and answered a questionnaire. The patients comprised five clinically separate groups: temporomandibular dysfunction (TMD) (n = 30), Primary Sjögrens Syndrome (SS) (n = 30), burning sensation and pain in the oral mucosa (oral mucosal pain, OMP) (n = 28), skeletal malocclusion (malocclusion) (n = 27), and healthy dental recall patients (controls) (n = 30). The TMD group and the control group participated in a test–retest procedure. The internal reliability of each subscale was calculated with Cronbachs alpha and found to be high and to range from 0.83–0.91. The stability (test–retest) of the instrument, calculated using the intraclass correlation coefficient, ranged from 0.87 to 0.98. The construct validity of OHIP‐S was compared with subscales of the Symptom Check List (SCL‐90) (rho 0.65) and the Jaw Function Limitation Scale (JFLS) (rho 0.76) and analyzed with Spearmans correlation coefficient. Convergent validity was evaluated by comparing OHIP with self‐reported health using Spearmans correlation coefficient and was found to be acceptable (rho 0.61). In the evaluation of the discriminative ability of the instrument, significant differences were found in the total OHIP‐S score between the controls and the other four groups (P<0.001). We conclude that the reliability and validity of OHIP‐S is excellent. The instrument can be recommended for assessing the impact of oral health on masticatory ability and psychosocial function.

Quality of life in adults with repaired complete cleft lip and palate

OBJECTIVE This study evaluated the quality of life in adult Swedish subjects with repaired complete cleft lip and palate (CLP). DESIGN/PATIENTS Sixty-eight adults with repaired CLP were compared with a group of 66 adults without cleft matched by gender and age. OUTCOME MEASURES The outcome measures included a self-report questionnaire concerning quality of life in general, well-being, and health-related quality of life. RESULTS The CLP group rated their quality of life significantly lower than did the control group in the areas of life meaning (p <.05), family life (p <.0001), and private economy (p <.01). There were no significant differences between the groups concerning well-being. In the CLP group, the health-related quality of life was significantly lower concerning global life (p <.0001), disturbance to life (p <.01), well-being (p <.0001), social contacts (p <.0001), and family life (p <.05) but significantly higher concerning ability to make the most of leisure time (p <.001) and to be active (p <.001). CONCLUSIONS The CLP group perceived a marked impact of the handicap on their lives concerning global aspects, well-being, and social life. More practical and tangible aspects of their daily living, however, were not affected, and only some minor aspects of their quality of life in general were poor in comparison with the control group, which indicates a fairly good life adjustment in spite of the handicap.

Quality of Life Varies With Gender and Age Among Adults Treated for Unilateral Cleft Lip and Palate

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.

Surgically assisted rapid maxillary expansion: long-term stability

The purpose of this study was to evaluate treatment outcomes and long-term stability in patients treated by surgically assisted rapid maxillary expansion (SARME) and to compare the results with a matched, untreated control group. The sample comprised consecutive study models from 31 subjects (17 males and 14 females) with a mean pre-treatment age of 25.9 years [standard deviation (SD) 9.6]. The mean follow-up time was 6.4 years (SD 3.3). The transverse distances between the maxillary canines and maxillary first molars were measured with digital sliding callipers before treatment (T0), after treatment (T1), and at follow-up (T2). The data were analysed with a Mann-Whitney U, Spearmans rho, and Wilcoxon signed-rank tests. At T1, all posterior crossbites were corrected and the expansions were statistically significant. At T2, despite some reduction in the transverse measurements, the posterior crossbites remained corrected. There were no statistically significant differences between the treatment and control groups at T2 regarding transverse measurements, except for the distance between the mesio-buccal cusp tips of the maxillary first molars. In the treatment group, there was no significant difference in terms of reductions in the transverse dimensions over the short- or long-term, no significant correlations between age or gender and the decrease in transverse dimensions or between the degree of anterior and posterior expansion. There were no significant correlations between the degree of expansion and subsequent post-treatment decrease. The results indicate that SARME normalizes the transverse discrepancies and is stable a mean of 6 years post-treatment. The decreases in the transverse dimensions are most pronounced during the first 3 years post-treatment.

Reliability of a multidimensional questionnaire for adults with treated complete cleft lip and palate.

The purpose of this study was to evaluate the reliability of a multidimensional questionnaire for Swedish adults with treated complete unilateral or bilateral cleft lip and palate (CLP). The questionnaire was designed to be used in the evaluation of adults with treated CLP after treatment. Before any conclusions were drawn from the results of the study we assessed the test-retest reliability of the questionnaire. The questionnaire included 168 questions and assessed the following domains: aesthetics, functions associated with CLP, satisfaction with treatment and perceived need for treatment, quality of life, depression and non-specific physical symptoms, body image, and jaw function. The subjects answered the questionnaire twice at a 2-3-week interval. Sixty-one adults (38 men, 23 women) mean age 24 years (range 20-29) participated in the study. The response rate for the questionnaire was acceptable at 75%. The test-retest reliability varied among the different domains. The reliability of questions regarding aesthetics, functions associated with CLP, and treatment satisfaction was good to excellent (intraclass correlation coefficient (ICC) = 0.51 to 0.89). Good to excellent (ICC = 0.61 to 1.0) reliability was also found for the quality of life in various life domains and the wellbeing scales. The reliability of the body image scale was moderate (kappa = 0.43-0.60) for most items and lower than that of other scales used in this study. The reliability of the mean depression symptom score (ICC = 0.93) and the mean non-specific physical symptoms score (ICC = 0.85) were excellent. The reliability of the mandibular function impairment was good (ICC = 0.67). The conclusion of the study is that an overall reliability was good for the multidimensional questionnaire.The purpose of this study was to evaluate the reliability of a multidimensional questionnaire for Swedish adults with treated complete unilateral or bilateral cleft lip and palate (CLP). The questionnaire was designed to be used in the evaluation of adults with treated CLP after treatment. Before any conclusions were drawn from the results of the study we assessed the test-retest reliability of the questionnaire. The questionnaire included 168 questions and assessed the following domains: aesthetics, functions associated with CLP, satisfaction with treatment and perceived need for treatment, quality of life, depression and non-specific physical symptoms, body image, and jaw function. The subjects answered the questionnaire twice at a 2-3-week interval. Sixty-one adults (38 men, 23 women) mean age 24 years (range 20-29) participated in the study. The response rate for the questionnaire was acceptable at 75%. The test-retest reliability varied among the different domains. The reliability of questions regarding aesthetics, functions associated with CLP, and treatment satisfaction was good to excellent (intraclass correlation coefficient (ICC) = 0.51 to 0.89). Good to excellent (ICC = 0.61 to 1.0) reliability was also found for the quality of life in various life domains and the wellbeing scales. The reliability of the body image scale was moderate (kappa = 0.43-0.60) for most items and lower than that of other scales used in this study. The reliability of the mean depression symptom score (ICC = 0.93) and the mean non-specific physical symptoms score (ICC = 0.85) were excellent. The reliability of the mandibular function impairment was good (ICC = 0.67). The conclusion of the study is that an overall reliability was good for the multidimensional questionnaire.

Nasal cavity size, airway resistance, and subjective sensation after surgically assisted rapid maxillary expansion: a prospective longitudinal study.

INTRODUCTION The aims of this study were to measure changes in nasal minimum cross-sectional area and nasal airway resistance after surgically assisted rapid maxillary expansion and to explore a possible correlation with the subjective sensation of nasal obstruction. METHODS Minimum cross-sectional area and nasal airway resistance were measured in 39 consecutive patients treated with surgically assisted rapid maxillary expansion. Subjective nasal obstruction was assessed by a questionnaire at pretreatment and at 3 and 18 months postoperatively. RESULTS Subjective nasal obstruction had improved significantly by 3 months postoperatively. Minimum cross-sectional area increased and nasal airway resistance decreased. No correlations were found. In subjects with pretreatment subjective nasal obstruction and initially narrow anterior minimum cross-sectional area, there was a significant correlation between a moderate increase in anterior minimum cross-sectional area and improvement in perceived nasal obstruction. Eighteen months postoperatively, no changes were found from pretreatment values for subjective nasal obstruction, minimal cross-sectional area, or nasal airway resistance, and there were no correlations. Subjects with a sensation of nasal obstruction at treatment start reported a lasting significant subjective improvement. CONCLUSIONS The postoperative effects of surgically assisted rapid maxillary expansion did not persist in the long term. No correlation was found between objective and subjective findings. Subjects with pretreatment nasal obstruction, however, reported a lasting sensation of improved nasal function after surgically assisted rapid maxillary expansion.

Three-dimensional assessment of transverse skeletal changes after surgically assisted rapid maxillary expansion and orthodontic treatment: A prospective computerized tomography study

INTRODUCTION The aim of this prospective longitudinal study was to evaluate transverse skeletal changes after surgically assisted rapid maxillary expansion. The changes were registered by using a 3-dimensional computerized tomography technique based on superimposition on the anterior base of the skull. METHODS The subjects comprised 35 patients (mean age, 19.7 years; range, 16.1-43.9 years). Low-dose, helical computerized tomography images were taken at treatment start and after orthodontic treatment. The 3-dimensional models were registered and superimposed at the anterior cranial base. RESULTS Surgically assisted rapid maxillary expansion had a significant transverse skeletal treatment effect, significantly greater posteriorly than anteriorly. The expansion was parallel anteriorly, but posteriorly there was significant transverse tipping. Although there was no statistically significant difference between the changes at the corresponding landmarks, the range of standard deviations was marked. CONCLUSIONS The results showed that, for registering transverse skeletal changes after surgically assisted rapid maxillary expansion, 3-dimensional superimposition is a reliable method, circumventing projection and measurement errors. Surgically assisted rapid maxillary expansion had a significant but nonuniform skeletal treatment effect. Despite careful surgical separation, pronounced posterior tipping occurred. No correlation was found between the severity of tipping and the patients age.

Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management

Abstract Background and aims: Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project. Method: Ten established national or regional cleft centres participated. Lip and soft palate closure at 3–4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3–4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3–4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes. Results: Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years. Conclusion: The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series. Trial registration: ISRCTN29932826.

Caries prevalence and enamel defects in 5- and 10-year-old children with cleft lip and/or palate: A case-control study

Abstract Objective. To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls. Materials and methods. The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization. Results. The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected. Conclusions. Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.