title: Esthetic evaluation of the facial profile in rehabilitated adults with complete bilateral cleft lip and palate.
abstract: OBJECTIVE
  To assess the facial esthetics of patients with complete bilateral cleft lip and palate, and to compare the judgment of raters related and unrelated to cleft care.
  
  
  METHODS
  The sample comprised 23 adult patients (7 women and 16 men) with a mean age of 26.1 years, rehabilitated at a single center. Standardized photographs of the right and left facial profile were taken of each patient and subjectively evaluated by 25 examiners: 5 orthodontists and 5 plastic surgeons with expertise in oral cleft rehabilitation, 5 orthodontists and 5 plastic surgeons without expertise in oral cleft rehabilitation, and 5 laypersons. The facial profiles were classified into 3 categories: esthetically unpleasant, esthetically acceptable, and esthetically pleasant. Intraexaminer and interexaminer agreements were evaluated with the Spearman correlation coefficient and Kendall coefficient of concordance. The differences between rater categories were analyzed using the Student-Newman-Keuls test (with P < .05 indicating a statistically significant difference).
  
  
  RESULTS
  Most of the sample was classified as esthetically acceptable. Orthodontists and plastic surgeons related to oral cleft rehabilitation gave the best scores to the facial profiles, followed by layperson examiners and by orthodontists and plastic surgeons unrelated to oral cleft rehabilitation. The middle third of the face, the nose, and the upper lip were frequently pointed out as contributors to the esthetic impairment.
  
  
  CONCLUSIONS
  The facial profile of rehabilitated adult patients with complete bilateral cleft lip and palate was considered esthetically acceptable because of morphologic limitations in the structures affected by the cleft. Laypersons and professionals unrelated to oral cleft rehabilitation seem to be more critical regarding facial esthetics than professionals involved with cleft rehabilitation.
authors.affiliation: Orthodontist, Private Practice, and Coordinator, Interceptive Orthodontics Course, Society for the Social Promotion of the Cleft Lip and Palate Patient, Bauru, São Paulo, Brazil. Electronic address: fferrari@travelnet.com.br.
authors.forename: Flávio Mauro
authors.initials: FM
authors.lastname: Ferrari Júnior
authors.affiliation: Masters Student, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.
authors.forename: Priscila Vaz
authors.initials: PV
authors.lastname: Ayub
authors.affiliation: Professor of Orthodontics, Oral Biology Department, University of Sagrado Coração, Bauru, Brazil.
authors.forename: Leopoldino
authors.initials: L
authors.lastname: Capelozza Filho
authors.affiliation: Professor, Department of Public Heath, Bauru Dental School, University of São Paulo, Bauru, Brazil.
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Pereira Lauris
authors.affiliation: Associate Professor of Orthodontics, Hospital for Rehabilitation of Craniofacial Anomalies and Bauru Dental School, University of São Paulo, Bauru, Brazil.
authors.forename: Daniela Gamba
authors.initials: DG
authors.lastname: Garib
mesh_terms: D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002971:Cleft Lip / Q000523:psychology* / Q000601:surgery; D002972:Cleft Palate / Q000523:psychology* / Q000601:surgery; D004954:Esthetics; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008046:Lip / Q000033:anatomy & histology; D008297:Male; D008437:Maxilla / Q000033:anatomy & histology; D009666:Nose / Q000033:anatomy & histology; D015588:Observer Variation; D009970:Orthodontics; D009971:Orthodontics, Corrective; D056948:Orthognathic Surgical Procedures / Q000379:methods; D010781:Photography; D013518:Surgery, Plastic; D055815:Young Adult