Longitudinal craniofacial growth patterns in patients with orofacial clefts: geometric morphometrics.

OBJECTIVE: To demonstrate craniofacial developmental patterns in repaired cleft lip and cleft palate (CLP). DESIGN: Retrospective, longitudinal. SETTING: Center for Craniofacial Disorders, San Juan, Puerto Rico. SAMPLE: Males aged 9 to 17 years: 13 noncleft (NC) Class I occlusion (NCC1); 13 NC Class III malocclusion (NCC3); 12 CLP Class I occlusion (CLPC1); and 15 CLP Class III malocclusion (CLPC3). MAIN OUTCOME MEASURES: Form changes (ages 10, 13, and 16 years), using finite-element scaling analysis. RESULTS: NCC1, 10 to 13 interval: 30% size increase in upper midface (p <.05), mental region (p <.01), mandibular body (p <.05); 13 to 16 interval: 10% to 35% size increase in bimaxillary region and ramus (p <.01). NCC3, 10 to 13 interval: 10% to 40% size increase in posterior cranial base, upper midface, and mandible (p <.05); 13 to 16 interval: 10% to 30% size increase in bimaxillary region (p <.01), especially ramus. CLPC1, 10 to 13 interval: 10% to 15% size increase in posterior cranial base (p <.01), midface (p <.05), and mandibular ramus (p <.05); 13 to 16 interval: 8% to 20% size increase in upper midface (p <.01), lower midface (p <.05), and mandible (p <.05). CLPC3, 10 to 13 interval: no significant changes; 13 to 16 interval: upper midface and cranial base show nonsignificant size decreases, but ramus showed size increase. CONCLUSIONS: Noncleft and CLP Class 1 occlusion groups show similar craniofacial growth patterns. Noncleft Class III groups show excessive cranial and mandibular growth. Class III malocclusion in CLP patients is associated with clinically deficient craniomaxillary growth. Growth guidance may be indicated in children with CLP with unfavorable craniofacial growth patterns.     

Hypodontia and tooth formation in groups of children with cleft, siblings without cleft, and nonrelated controls.

OBJECTIVE: To compare the occurrence of hypodontia, dental age, and asymmetric dental development in children with cleft with their siblings and a nonsibling control group. SUBJECTS: The sample consisted of 54 children with cleft (aged 4.2 to 13.1 years), who had at least one sibling available for an orthopantomogram, 63 siblings without cleft (aged 4 to 14.9 years) and 250 controls without cleft (aged between 4 and 14.9 years). METHOD: Hypodontia, dental age, and asymmetric dental development were assessed on panoramic radiographs of the children with cleft, the siblings without cleft, and the control children without cleft. RESULTS: Both the cleft (p <.001) and the sibling group (p <.05) showed a significantly higher frequency of hypodontia and a significantly higher occurrence (cleft p <.01 and sibling group p <.001) of asymmetric dental development, compared with the control group. Only a small, but insignificant, delay in dental development could be found in the cleft and the sibling group. CONCLUSIONS; The cleft subjects with siblings showed a significantly higher occurrence of hypodontia and asymmetric dental development than the noncleft control group. This may suggest a genetic component for the occurrence of hypodontia and asymmetric dental development.     

Health-related quality of life of children aged 11 to 14 years with orofacial conditions.

OBJECTIVE: To assess the health-related quality of life (HRQoL) of 11- to 14-year-old children with orofacial conditions. DESIGN: Thirty-nine patients with orofacial conditions were compared with 32 patients with dental caries. OUTCOME MEASURE: The multidimensional 37-item Child Perceptions Questionnaire for 11- to 14-year-old children (CPQ(11-14)). This forms one component of the Child Oral Health Quality of Life Questionnaire. RESULTS: The orofacial group had slightly higher scores on the CPQ(11-14) than the dental group (p < .05). The scores were slightly to moderately higher on the functional limitations (p < .01) and social well-being (p < .01) domains. The groups did not differ with respect to oral symptoms or emotional well-being. Mouth breathing, problems with speech, missing school, being teased, and being asked questions about their condition were the only issues reported more frequently by the orofacial group (p < .01). There was no evidence of social inhibition or withdrawal in the orofacial group. The children with orofacial conditions rated their oral health better than the children with dental decay (p < .05). In both groups, the majority of children reported that their condition had little impact on their life overall. CONCLUSIONS: Based on CPQ(11-14) scores, there were few differences in the HRQoL of 11- to 14-year-old children with orofacial conditions, compared with children with dental caries. This suggests that the majority of these children are well adjusted and able to cope with the adversities they experience as a result of their conditions. This may reflect the quality of the team approach used at the treatment setting at which they were recruited.     

Adult patients with treated complete cleft lip and palate. Methodological and clinical studies

The purpose of the present thesis was to investigate the quality of life, satisfaction with treatment, prevalence of temporomandibular disorders, psychosocial distress, and occlusal stability in a treated group of adults with complete cleft lip and palate (CLP). Sixty-eight adults (44 men and 24 women) with a mean age of 24.2 years (range 19.5-29.2) with treated CLP were compared with a gender- and age-matched group with no clefts. The CLP subjects were born between 1968 and 1977 and had undergone standardised plastic surgery at the Department of Plastic Surgery, University Hospital, Link?ping, Sweden. Logopaedic, phoniatric, otological, and orthodontic examinations and treatment had been provided locally, supervised by the Cleft Plate Team. The subjects answered a multidimensional, self-report, standardised questionnaire regarding psychological and somatic conditions. The subjects underwent a clinical TMD examination and an evaluation of the occlusion. The reliability of the multidimensional questionnaire was analysed for the CLP group by a test-retest study within a 2-3 week interval and most questions showed an overall good reliability. A panel of professionals judged the outcome of the surgical treatment on colour slides of the CLP subjects. The dental plaster casts of 39 subjects born with complete unilateral cleft lip and palate (UCLP) were analysed (mean age 24.7 years, range 20.2-29.3) and compared with the dental plaster casts taken at mean age of 19.1 years (range 16.0-20.6). The overall level of quality of life was rather high in both groups. The CLP group rated some detached aspects, such as life meaning, family life, and private economy, significantly lower than did the group without clefts. Overall aspects such as well-being and social life were affected by having a treated cleft but not the more practical and tangible aspects of their daily living. There was an overall high level of satisfaction with all the different part of the body in both groups, but the CLP group reported significantly more dissatisfaction with their nose, lips, mouth, profile, and overall facial appearance than the group without clefts. The professionals and the subjects with CLP were generally not very satisfied with the results of surgical treatment. Thirty of the subjects with CLP (47%) wished to have more operations. The professional group recommended further operations in 38 of the subjects (59%) in particular, rhinoplasties. The CLP group had significantly higher frequencies of cross-bite than the group without clefts, but no differences regarding TMD pain were found between the two groups. In the subjects with treated UCLP, there was a significant deterioration in the occlusal score and the maxillary arch dimensions between 19 and 25 years. This was irrespective of the type of retention. The persisting morphological malocclusion with a low frequency of interferences has had no influence on TMD symptoms in the group of CLP patients studied. The conclusion is that the CLP subjects in the present study seemed to be psychosocially well adjusted to their disability. However, 47 per cent wished to have further surgical treatment. The persisting malocclusions did not provoke TMD symptoms.     

Self-reports of psychosocial functioning among children and young adults with cleft lip and palate.

OBJECTIVE: A cross-sectional study was employed to determine the psychosocial effects of cleft lip and/or palate among children and young adults, compared with a control group of children and young adults without cleft lip and palate. PARTICIPANTS: The study comprised 160 children and young adults with cleft lip and/or palate and 113 children and young adults without cleft lip and/or palate. All participants were between 8 and 21 years of age. OUTCOME MEASURES: Psychological functioning (anxiety, self-esteem, depression, and behavioral problems) was assessed using validated psychological questionnaires. Happiness with facial appearance was rated using a visual analog scale. Social functioning, including experience of teasing/bullying and satisfaction with speech, was assessed using a semistructured interview. RESULTS: Participants with cleft lip and/or palate reported greater behavioral problems (p < .001) and more symptoms of depression (p < .01); they were teased more often (p < .001) and were less happy with their facial appearance (p < .01) and speech (p < .001), compared with controls. There were no significant difference between subjects with cleft lip and/or palate and subjects without cleft lip and/or palate in terms of anxiety (p > .05) or self-esteem (p > .05). Having been teased was a significant predictor of poor psychological functioning, more so than having a cleft lip and/or palate per se (p < .001). CONCLUSIONS: Teasing was greater among participants who had cleft lip and/ or palate and it was a significant predictor of poorer psychosocial functioning. Children and young adults with cleft lip and/or palate require psychological assessment, specifically focusing on their experience of teasing, as part of their routine cleft care.     

Temporomandibular disorders in adults with repaired cleft lip and palate: a comparison with controls

The purpose of this study was to investigate the prevalence of temporomandibular disorders (TMD), and assess psycho-social distress in adult subjects with repaired complete cleft lip and palate (CLP). Sixty-three adults (42 males and 21 females, mean age 24.2 years, range 19.5-29.2) with repaired CLP (CLP group) were compared with a group of 66 adults without cleft (non-cleft group, 49 males and 17 females, mean age 25.5 years, range 20.2-29.9). All subjects underwent a clinical TMD examination, which followed the guidelines in the Research Diagnostic Criteria for TMD (RDC/TMD). Jaw function was assessed by evaluating answers to the mandibular function impairment questionnaire (MFIQ). Tension-type headache was diagnosed according to the International Headache Society (IHS) classification. Psychological status was assessed using the depression score and the non-specific physical symptom score with subscales of the Revised Symptom Checklist-90 (SCL-90-R). The prevalence of reported pain in the face, jaws and/or TMJs was 14 and 9 per cent for the CLP and non-cleft group, respectively, and did not differ significantly between the groups. The CLP group exhibited a significantly reduced jaw-opening pattern (P < 0.001) and a higher frequency of crossbites (P < 0.05) compared with the non-cleft group. Whilst jaw function was similar in both groups, a few items, e.g. speech and drinking, were significantly more impaired (P < 0.01) in the CLP group than in the non-cleft group. There were no significant differences between the two groups concerning tension-type headache or psycho-social distress. The study found that overall TMD pain or psycho-social distress was not more common in this CLP group than in a non-cleft group.     

Psychological profile of Chinese with cleft lip and palate deformities.

OBJECTIVE: To assess the psychological well-being of patients with cleft lip and palate (CLP). PATIENTS/SETTING: Ninety-four Chinese CLP subjects between 10 and 40 years of age were recruited from the Discipline of Oral and Maxillofacial Surgery, The University of Hong Kong, between June and December 2003. They were divided into two groups for comparison: adolescents (10-16 years old) and adults (17- 40 years old). A control group of 116 healthy non-CLP patients was also recruited during the same period. INTERVENTIONS: All CLP and non-CLP patients were asked to complete a set of four questionnaires to assess their psychological status. The questionnaires included the Social Avoidance and Distress Scale, the Satisfaction with Life Scale, the Culture-Free Self-Esteem Inventory, and the Chinese Miller Behavioral Style Scale. RESULTS: Chinese CLP patients exhibited levels of subjective well-being and social anxiety that were similar to the published levels of a group of British CLP patients. They also had significantly lower general and social self-esteem but higher parental self-esteem than the non-CLP control group. CONCLUSION: CLP patients were generally satisfied with life and did not exhibit more social anxiety than the non-CLP control group. They also had a good relationship with their parents. Gender and educational level had no influence on their psychological profile. However, these CLP patients had lower self-esteem than non-CLP patients.     

Evaluation of esthetic, functional, and quality-of-life outcome in adult cleft lip and palate patients.

OBJECTIVE: Evaluation of esthetic, functional, and health-related quality-of-life (HRQoL) outcomes in adult patients with a repaired cleft lip and palate. The treatment for all patients was based on the so-called Vienna concept. PATIENTS/DESIGN: Seventy adult patients with a repaired complete cleft lip and palate, ranging in age from 18 to 30 years, were included in the study. Esthetic and functional outcomes were assessed by the patients themselves and by five experts using a visual analog scale. Patients also completed the MOS Short-Form 36 questionnaire to evaluate health-related quality of life. RESULTS: Patients rated their esthetic outcome significantly worse than the experts did. No significant differences were observed in the ratings for function. Female patients, especially, were dissatisfied with their esthetic outcomes. In a personal interview, nearly 63% of them asked for further treatment, particularly for upper-lip and nose corrections. The health-related quality-of-life questionnaire revealed low scores for only two subscales, namely social functioning and emotional role. In most subscales of health-related quality of life, patients who desired further treatment had significantly lower scores than did patients who desired no further treatment. CONCLUSION: Surgery of the lip and nose appears to be of prime importance for patients with a cleft lip and palate. Cleft patients who do not request secondary treatment are not always satisfied with the treatment. Patients with realistic expectations in regard to further treatment should be treated by specialists, whereas those with unrealistic expectations should be referred to a clinical psychologist.     

Comparison of obstructive sleep apnea syndrome in children with cleft palate following Furlow palatoplasty or pharyngeal flap for velopharyngeal insufficiency.

OBJECTIVE: To evaluate the incidence and severity of obstructive sleep apnea syndrome (OSAS) in patients with cleft palate having a Furlow palatoplasty or pharyngeal flap for correction of velopharyngeal insufficiency (VPI). PATIENTS: A total of 48 nonsyndromic children with repaired cleft palate with VPI were enrolled in the study. Twenty of the children had a Furlow palatoplasty (F group) and 28 children had a pharyngeal flap (P group) for correction of VPI. INTERVENTIONS: An overnight polysomnography evaluation was done to evaluate the incidence and severity of OSAS 6 months or more postoperatively. MAIN OUTCOME MEASURES: Symptoms of OSAS, respiratory disturbance index (RDI), oxyhemoglobin desaturation index (DI), and sleep stages were measured. RESULTS: In the P group, the mean percentage of stage 2 sleep was lower than the F group (p <.05). The mean RDI and DI were larger in the P group, compared with the F group (p <.001). The incidence and severity of OSAS were higher in the P group, compared with the F group (p <.001 and p = 0.05, respectively). CONCLUSIONS: A Furlow palatoplasty should be used in deference to a pharyngeal flap whenever possible on the basis of the preoperative evaluation of VPI because of the decreased incidence and severity of OSAS.     

Seasonal variation and regional distribution of cleft lip and palate in zambia

Objective: To assess variations in seasonality and regional distribution of orofacial clefts in babies born in Zambia. Design: A retrospective chart review was done using records of all cleft procedures performed by the only plastic surgeon in Zambia (G.J.). Delivery data from the University Teaching Hospital (UTH) were also examined to estimate the birth prevalence of orofacial clefts (55,108 live births between 2001 and 2005). Patients: All cleft patients operated in Zambia from 2000 to 2006 (413 patients). Results: A low birth prevalence of clefts (1/4239 live births) was found using UTH delivery data. Surgical data showed no difference for the frequency of one gender over another overall (M:F ratio is 1.04; p = .70). More bilateral clefts occurred in cleft lip and palate (CLP) patients than in cleft lip (CL) patients (p < .01), and more unilateral left-sided clefts occurred in CL than in CLP patients (p = .03). The data reflected seasonal variation in month of birth of cleft lip with or without cleft palate (CL+/-P) patients (p < .01), with a peak in April and May and more births in March through August (57.2%) than in September through February (42.8%). There was regional variation in cleft births among the nine Zambian provinces (p < .01). Conclusions: This study shows seasonal variation in clefts that may be explained, at least in part, by environmental factors affecting the development of CL+/-P. Access to treatment is likely the major determinant of regional disparity in clefts. These results provide a basis for further epidemiological studies of orofacial clefts in Zambia.     

Mental development in infants with cleft lip and/or palate.

OBJECTIVE: Investigated mental development in infants and toddlers with cleft lip and/or palate (CLP). DESIGN: This was a retrospective analysis of developmental scores on qualified children between 4 and 36 months of age. Cross-sectional analysis included children in four age groups (6, 12, 18, and 24 months); longitudinal analysis included children at mean age 9.1 (range = 4 to 15) months at Time 1 and 24 months (range = 16 to 36) at Time 2. PARTICIPANTS: Cross-sectional analysis included 180 children (59% male participants) in four diagnostic groups (cleft lip only [CL], cleft lip and palate [CLP], cleft palate only [CP], and Pierre Robin). The longitudinal sample included 85 children (64% male children) in the same diagnostic groups. MAIN OUTCOME MEASURES: Mental Scale (MDI) of the Bayley Scales of Infant Development. RESULTS: Mean MDIs were in the average range but decreased significantly between youngest and oldest groups in both cross-sectional (F(3,179) = 4.9, p<.01) and longitudinal samples (F(1,84) = 6.87, p<.01). There was a significant difference among cleft types (F(3,179) = 3.5, p<.025). Infants with CL obtained the highest scores, and infants with Pierre Robin Sequence obtained the lowest. Perceptual-motor development in the first year of life was predictive of developmental status at age 2. CONCLUSIONS: The number of children with CLP who may be at risk for developmental problems during the second year of life is greater than would be expected. Children at greatest risk may demonstrate early delays in acquisition of perceptual-motor skills during the first year of life.     

Parent reports of the psychosocial functioning of children with cleft lip and/or palate.

OBJECTIVES: (1) to determine the opinion of parents regarding the psychosocial functioning of their child with cleft lip and/or palate (CLP); (2) to identify predictors of psychosocial functioning; and (3) to determine the level of agreement between children with CLP and their parents. Participants: One hundred twenty-nine parents of children with CLP and 96 parents of children without CLP participated in this cross-sectional study. OUTCOME MEASURES: Parental opinion of the child's self-esteem, anxiety, happiness, and problems caused by facial appearance were assessed using visual analogue scales. Parents completed the Child Behavior Checklist and were interviewed. RESULTS: Children with CLP were more anxious (p < 0.05), less happy with their appearance (p < 0.001), and in general (p < 0.05) had lower self-esteem (p < 0.05) and greater behavioral problems (p < 0.001) compared with non-CLP children. Parents reported that their child with CLP was teased more often (p < 0.001) and was less satisfied with his/her speech (p < 0.01) compared with reports of parents in the control group. A number of factors affected parents' ratings of their child's psychosocial functioning (presence of CLP, appearance happiness, previous history of CLP, and visibility of scar). Children who had been teased were more anxious (p < or = 0.01), less happy with their appearance (p < 0.001) and had greater behavioral problems (p < 0.001). CONCLUSIONS: Parents of children with CLP reported various psychosocial problems among their children. Parents considered children who had been teased to have greater psychosocial problems.     

The relationship between temporal aspects of oral-nasal balance and classification of velopharyngeal status in speakers with cleft palate.

OBJECTIVE: The purpose of this investigation was to determine whether temporal patterns of oral-nasal balance differentiate speakers with cleft palate who exhibit adequate and inadequate velopharyngeal function. DESIGN: The Nasal Accelerometric Vibrational Index (NAVI) was used to measure the time course and amplitude of oral-nasal balance during the productions of syllables, words, and sentences. The measures obtained include mean amplitude, time integral (area under the curve), absolute duration, relative duration, rise time, and fall time. PARTICIPANTS: The subjects for this study were 20 children with repaired cleft palates with or without cleft lip. Ten children (aged 5 through 18 years) were assigned to the velopharyngeal competence (VPC) group (normal oral-nasal resonance, no nasal emission of air). Ten children (aged 3 through 19) were assigned to the velopharyngeal insufficiency (VPI) group (hypernasal speech, velopharyngeal gap observed via nasal endoscopy). RESULTS: Both mean amplitude and time integral of NAVI were greater in the VPI group than in the VPC group (p < .01). Absolute duration and relative duration of the NAVI signal were greater in the VPI group (p < .01). NAVI rise time was shorter in the VPI group (p < .01), and NAVI fall time was longer in the VPI group (p < .01). The amplitude measures contributed the most to discrimination of speaker group, but the durational measures become increasingly influential as a function of a speech task. CONCLUSIONS: Although amplitude of nasalization may have the strongest perceptual salience in classification of velopharyngeal status, the temporal component may exert greater influence during more complex speech tasks.     

Association of distinct craniofacial features in nonsyndromic cleft lip and palate family members.

OBJECTIVE: To assess the relationship of distinct craniofacial features among family members with cleft lip and palate (CLP). METHODS: Lateral cephalometric and anthropometric measurements of the members of 28 Costa Rican families with CLP were analyzed. The distinct craniofacial features in subjects with CLP were identified by comparing their craniofacial measurements with published normative values. The presence of these features was assessed in the unaffected family members. Regression coefficients were computed to evaluate the association of the distinct craniofacial measurements between parents and their offspring with and without CLP. RESULTS: The male and female subjects with CLP were characterized by shortened head (HL), anterior cranial base (S-N), and palatal length (ANS-PNS, A-PNS) measurements as well as hyperdivergent angle of S-N plane to palatal plane (相似文献   

Bite force of children with repaired unilateral and bilateral cleft lip and palate

ObjectiveTo assess the bite force (BF) of children with repaired cleft lip and palate (CLP).DesignChildren aged 6–12 years, with and without CLP, were divided into the following 5 groups: (1) control group (CON): 34 children without CLP (17 female, 17 male, mean age 8.2 ± 1.4); (2) cleft lip group (CL): 31 children with cleft lip involving the pre-maxilla (15 female, 16 male, mean age 9.7± 1.3); (3) unilateral CLP group (UCLP): 36 children with complete unilateral CLP (11 female, 25 male, mean age 9.4± 1.6); (4) bilateral CLP group (BCLP): 32 children with complete bilateral CLP (11 female, 21 male, mean age 9.5± 1.7); and 5) cleft palate group (CP): 17 children with complete cleft palate (9 female, 8 male, mean age 9.4± 1.6). Briefly, in this clinical trial, BF was assessed before alveolar bone grafting with a gnathodynamometer (IDDK, Kratos, Cotia, SP, Brazil). For CON, BCLP, CL and CP groups, BF was obtained in the anterior and posterior region of the maxilla. For the UCLP group, BF was assessed in the anterior and posterior regions of both segments. Differences among groups were evaluated by ANOVA test, and Tukey’s test was used to assess any correlations among variables (P < 0.05).ResultsUnexpectedly, no differences of BF were observed among CON and any of the cleft groups. However, a stronger BF was observed in the CL group when compared to the UCLP and BCLP groups. Next, no differences were observed between the cleft side and the noncleft side in the UCLP group. Lastly, in all groups, BFs from the anterior region of the maxilla were less when compared to the posterior regions.ConclusionThe BF of children with CLP is no different from children without CLP.     

The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 3: dental arch relationships.

OBJECTIVE: To compare dental arch relationships up to age 17 in individuals with complete unilateral cleft lip and palate (UCLP) treated at five European centers. DESIGN: Longitudinal cohort study, where results were previously reported at 9 years and follow-up measurements were obtained for 12 and 17 years. SETTING: Multidisciplinary cleft services in Northern Europe. SUBJECTS: 127 consecutively treated individuals with repaired UCLP. MAIN OUTCOME MEASURE: Panel rating of dental arch relationship. RESULTS: The results revealed that at 17 years of age three of the centers had better ratings in dental arch relationship (means scores: 1.7, 1.9, and 2.2, respectively) than the other two centers (3.3, 3.4) at statistically significant levels ( p < .01 to p < .001). CONCLUSION: The results confirm that systematic differences in dental arch relationships may occur between different cleft centers, but do not allow specific causal factors to be identified.     

Patients' expectations and experiences of fixed orthodontic appliance therapy. Impact on quality of life

OBJECTIVE: To compare patients' expectations of the impact of wearing fixed orthodontic appliances on life quality with realities experienced over a 6-month period. MATERIALS AND METHODS: Two-hundred and seventeen consecutive orthodontic patients (mean age 13.1 +/- 1.5 years) self-completed a 37-item Child Perception Questionnaire (CPQ) in relation to how they expected wearing fixed orthodontic appliances would affect their QoL during orthodontic treatment. The CPQ assessed the attributes of oral symptoms, functional limitations (FL), emotional well-being (EWB), and social well-being (SWB). Expectations were compared with the patients' pretreatment values and reported experiences at 1 week, 1 month, 3 months, and 6 months after insertion of the fixed appliances. RESULTS: The response rate was 91% (197/217). Patients expected that wearing fixed appliances would considerably compromise their overall oral health-related QoL (OHQoL) compared with pretreatment (P < .001). At 1 week they reported that EWB (P < .001) and SWB (P < .05) were less compromised than expected. At 1, 3, and 6 months, FL (P < .001), EWB (P < .001), SWB (P < .001), and overall OHQoL (P < .001) were less compromised than expected. CONCLUSIONS: This study indicated the impact on QoL after insertion of fixed orthodontic appliances was considerately less than what child patients expected.     

Can third molar surgery improve quality of life? A 6-month cohort study.

PURPOSE: In this study, we evaluated patients' perceptions of changes in oral health-related quality of life (OHQOL) over a 6-month period after third molar surgery. Patients and Methods: One hundred patients participated in this prospective study. Two specific OHQOL measures, the 14-item Oral Health Impact Profile (OHIP-14) and the 16-item UK Oral Health-Related Quality of Life measure (QHQoL-UK), were administered to the study group before surgery. Standardized surgical and analgesic protocols were used. Patients kept a diary of changes in life quality each postoperative day (POD) for 7 days and were contacted at 1, 3, and 6 months after surgery. RESULTS: Both measures identified a significant deterioration in quality of life in the immediate postoperative period (P <.01). However, there was an improvement in OHQOL compared with preoperative status at 1 (P <.05), 3 (P <.05), and 6 (P <.01) months after surgery. Patients perceived physical, social, and psychologic changes in life quality after surgery. Previous pericoronitis was associated with changes in quality of life (P <.05). CONCLUSION: The study concludes that third molar surgery is associated with changes in OHQOL. This has implications for understanding the value of third molar surgery from patients' perspectives and in assessing health gain.     

Health-related quality of life after maxillectomy: a comparison between prosthetic obturation and free flap.

PURPOSE: The purpose of this cross sectional study was to evaluate the health-related quality of life of patients following maxillectomy and to compare obturation and free flap reconstruction. PATIENTS AND METHODS: At the Regional Maxillofacial Unit in Liverpool, United Kingdom, between 1992 to 1996, 39 patients underwent maxillectomy for malignant pathology. Of these patients, 28 (10 underwent obturation and 18 underwent free tissue reconstruction) completed a postoperative semi-structured interview. Eight questionnaires were used to test aspects of health-related quality of life and function. RESULTS: The main findings were the associations between the size of maxillectomy defect and the University of Washington activity (-0.53; P =.005) and recreation (-0.70; P <.001) domains, and with the physical functioning (-0.58; P =.001) and quality of life (-0.51; P =.007) domains of the European Organization for Research and Treatment of Cancer questionnaire. No statistically significant differences were seen between the obturator and free flap groups. Borderline trends were for obturator patients to be more concerned about their appearance, to have more pain and soreness in their mouths, to be more aware of their upper teeth, more self-conscious and less satisfied with their upper dentures, and less satisfied with function. CONCLUSION: Similar subjective outcomes were found for both groups, and a larger longitudinal study is needed to test these relationships more rigorously.