title: Self-image perception of 171 children and adolescents with cleft lip and palate from 22 countries.
abstract: BACKGROUND
  Cleft lip (CL) and cleft palate (CP) are among the most common congenital deformities of the head and neck. They are associated with many problems, physical and psychological. We describe 171 children and adolescents with CL/CP from 22 countries who were asked to draw their faces in a self-image perception drawing 2 hours before surgery to repair their deformities.
  
  
  METHODS
  The aim of the study was to explore whether children and adolescents with CL and CP perceived themselves as deformed when given the opportunity to draw their faces before surgery to repair their deformities. Children were asked to lie down on a large piece of paper to have their body outline traced. Subsequently, the children were asked to draw their faces within the outline.
  
  
  RESULTS
  All of the children included in this study drew their faces with normal mouths.
  
  
  CONCLUSIONS
  None of the 171 patients with CL/CP drew their deformity when asked to draw their faces; the reasons are not clear. The children may have wanted to compensate for their disability with the constructive use of fantasy as they anticipated the surgery to repair their CL/CP. An additional hypothesis is that the children felt the need to draw an image that they knew represented their parents' desires.
authors.affiliation: Department of Anesthesiology, University of Cincinnati, Cincinnati, OH.
authors.forename: Alaa A
authors.initials: AA
authors.lastname: Abd-Elsayed
authors.forename: Sergio V
authors.initials: SV
authors.lastname: Delgado
authors.forename: Morgan
authors.initials: M
authors.lastname: Livingstone
keywords: Art therapy; cleft lip; cleft palate; fantasy; self-concept