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Influence of Repaired Cleft Lip and Palate on Layperson Perception following Orthognathic Surgery

Lin, Lawrence O. B.S.; Zhang, Rosaline S. B.A.; Mazzaferro, Daniel M. M.D., M.B.A.; Hoppe, Ian C. M.D.; Pearl, Rebecca L. Ph.D.; Swanson, Jordan W. M.D.; Bartlett, Scott P. M.D.; Taylor, Jesse A. M.D.

Plastic and Reconstructive Surgery: October 2018 - Volume 142 - Issue 4 - p 1012-1022
doi: 10.1097/PRS.0000000000004778
Pediatric/Craniofacial: Original Articles

Background: Facial scarring and disharmony caused by clefting are associated with psychosocial stress, which may be improved by orthognathic surgery. The authors examine how clefting influences change in layperson perception of a patient following orthognathic surgery.

Methods: One thousand laypersons were recruited through Mechanical Turk to evaluate patient photographs before and after orthognathic surgery. Nineteen patients—five with unilateral and five with bilateral clefting—were included. Respondents assessed six personality traits, six emotional expressions, and likelihood of seven interpersonal experiences on a scale from 1 to 7.

Results: Changes in all aspects of social perception after the procedure differed significantly between cleft versus noncleft cohorts (p < 0.01 for all). Respondents evaluated the change for the cleft cohort compared with the noncleft cohort as more trustworthy, friendly, sad, and afraid; more likely to feel lonely, be teased or bullied by others, or feel anxious around others; less angry, disgusted, threatening, dominant, intelligent, happy, and attractive; and less likely to have romantic relationships, friends, or be praised by others. For unilateral versus bilateral cleft cohorts, change in social perception was significantly different in four of the 19 items (p < 0.05 for all). Social perception change for the unilateral cohort was less surprised, sad, dominant, or happy compared with the bilateral cohort (p < 0.05 for all).

Conclusions: Despite significant improvements in social perception following orthognathic surgery, cleft patients benefit less than noncleft patients. These findings may be useful to counsel postsurgical expectations for cleft patients undergoing orthognathic surgery.

Philadelphia, Pa.

From the Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia; and the Department of Psychiatry and the Center for Human Appearance, Department of Surgery, University of Pennsylvania Perelman School of Medicine.

Received for publication December 22, 2017; accepted April 9, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Jesse A. Taylor, M.D., Department of Surgery, Children’s Hospital of Philadelphia, University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, Pa. 19104,

Copyright © 2018 by the American Society of Plastic Surgeons