Unilateral Cleft Lip and Palate : Quality of Life and Nasal Form and Function among Adults

Abstract: Unilateral cleft lip and palate (UCLP) is a craniofacial malformation with functional and aesthetical impact on the face and the upper airways. The aims of the current thesis were to evaluate Quality of life (QoL) in adults treated for UCLP  (I), to objectively evaluate nasal form and function and to search for possible differences in residual nasal deformity and impairment of function between patients operated according to one-stage and two-stage palate closure (II) as well as to evaluate the relationship between professional and lay rating and patient satisfaction with nasolabial appearance (III) and to identify factors associated with lower levels of QoL and less satisfaction with nasal appearance among adults treated for UCLP (IV). Analyses of data from a homogenous population of UCLP patients treated at Uppsala University Hospital form the basis of this thesis. The mean follow-up time after primary surgery was 35 years (20-47 years) and participation rate was 79% (n=86). An age and gender matched control group of 68 people without clefts were evaluated according to the same protocol. The evaluation protocol included the Short Form 36 questionnaire (SF-36), rhinomanometry, acoustic rhinometry, odor test, peak nasal inspiratory flow test and photographies of faces. For the SF-36 data, age- and gender-matched norm data of 1385 people from the Swedish population were used. Unilateral cleft lip and palate affected QoL differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients in several subscales. However, except for lower values in the Mental Health subscale, QoL was similar among UCLP patients and norm data. Objectively measured nasal function was extensively affected among adults treated for UCLP. No difference in impairment of nasal function was found between one-stage and two-stage palate closure protocols on the cleft side. Judgment of nasolabial appearance differed between professionals, lay people and patients. Large infant cleft width was associated with less satisfaction with nasal appearance and male gender was associated with lower levels of mental QoL. Correlation between high nasal breathing resistance and low levels of physical QoL was found. In conclusion, this thesis provides a platform for future research for optimal evaluation of cleft treatment outcome.