Aesthetic Outcomes in Cleft Care: Exploring Patterns in Patient-Reported Outcomes across Adolescence

Background: For patients with cleft lip/palate, adolescence is a time of maxillofacial growth and complex psychosocial stressors. The personal significance of facial differences may change, making patient-reported outcomes measures invaluable. In this study, we use several scales from the CLEFT-Q and FACE-Q to explore how aesthetic outcomes differ by age and by gender among patients with unilateral cleft lip/palate. Methods: This was a multicenter, cross-sectional study that prospectively collected CLEFT-Q and FACE-Q data across 6 cleft treatment centers during clinical appointments from 2019 to 2022. Subjects were aged 8 to 22 years, with unilateral cleft lip, alveolus, and palate, who had not undergone tertiary operative care (maxillary advancement or septorhinoplasty) at the time of survey response. Data cross-sections were prepared by age (8 to 10, 11 to 13, and 14 years or older), by gender, and by age and gender together. Results: Older age groups reported poorer aesthetic outcomes and worse appearance-related distress compared with younger groups. Although male and female subjects reported similar aesthetic outcomes, female subjects reported more appearance-related distress. When considered simultaneously, age and gender appear to have an intersectional impact on perceived aesthetic outcome and appearance-related distress during adolescence. Conclusions: This exploratory project suggests that patients with cleft lip/palate may perceive worsening of facial aesthetics throughout the course of adolescence, the exact pattern of which may be dependent on gender. Future work will evaluate this hypothesis using longitudinal cohorts. It will be important to investigate psychosocial factors that may impact these outcomes, and also to quantify the impact of tertiary operative care on these outcomes.