Impact of secondary surgical correction on self-perception, function and psychosocial outcomes in cleft lip and palate patients evaluated with the cleft-Q

Authors

  • Jorge Luis Leal-Silva Department of Plastic and Reconstructive Surgery, Hospital General de México “Dr. Eduardo Liceaga.” Mexico City, Mexico
  • Nohemí C. López Department of Plastic and Reconstructive Surgery, Hospital General de México “Dr. Eduardo Liceaga.” Mexico City, Mexico
  • Eduardo D. Ramírez Medical Social Service, Hospital General de México “Dr. Eduardo Liceaga.” Mexico City, Mexico
  • Diana V. Díaz Medical Social Service, Hospital General de México “Dr. Eduardo Liceaga.” Mexico City, Mexico
  • Silverio Tovar-Zamudio Department of Plastic and Reconstructive Surgery, Hospital General de México “Dr. Eduardo Liceaga.” Mexico City, Mexico
  • Ricardo Fernandez-Riera Department of Plastic and Reconstructive Surgery, Hospital General de México “Dr. Eduardo Liceaga.” Mexico City, Mexico

DOI:

https://doi.org/10.18203/2320-6012.ijrms20261850

Keywords:

Cleft lip and palate, CLEFT-Q, Secondary correction, Patient

Abstract

Background: Cleft lip and/or palate (CLP) is associated with persistent aesthetic and psychosocial sequelae. While secondary corrections aim to improve appearance and function, their impact on patient-reported outcomes (PROMs) remains variable. This study compares facial self-image, functional outcomes and psychosocial well-being between CLP patients with and without secondary aesthetic correction.

Methods: A cross-sectional study was conducted using the CLEFT-Q instrument. Patients were divided into two groups based on their history of secondary aesthetic correction (Yes/No). Scores for facial self-image, function and psychosocial well-being were compared using Student’s t-tests, with significance set at p<0.05.

Results: Sixty-nine patients were included (n=29 Yes; n=40 No). Patients who underwent secondary correction reported significantly higher scores in facial self-image (2.37 vs. 1.95; p=0.015) and psychosocial well-being (2.96 vs. 2.69; p=0.019). No significant difference was found in functional outcomes (2.86 vs. 2.61; p=0.11).

Conclusions: Secondary correction significantly improves facial self-image and psychosocial well-being in CLP patients. These findings underscore the clinical value of secondary revisions as an essential component of comprehensive cleft care, demonstrating that benefits extend beyond anatomical reconstruction to significantly impact patient quality of life.

References

Garcia-Perez SAR, Guzman-Pantoja VI. Paciente con secuela de labio y paladar hendido. Rev Mex Ortodon. 2019;7(4):247-57.

Fattel-Servin OS. Long-term impacts of cleft lip and palate: challenges and treatment. Genesis J Surg Med. 2022;1(2):1-10. DOI: https://doi.org/10.52793/GJSM.2022.1(2)-7

Monson LA. Secondary cleft lip and palate surgery. Clin Plast Surg. 2014;41(2):301-9. DOI: https://doi.org/10.1016/j.cps.2013.12.008

González-Osorio CA, Medina-Solís CE, Pontigo-Loyola AP, Casanova-Rosado JF, Escoffié-Ramírez M, Corona-Tabares MG, et al. Estudio ecológico en México sobre labio y/o paladar hendido. An Pediatr (Barc). 2011;74(6):377-87. DOI: https://doi.org/10.1016/j.anpedi.2011.01.011

Tsangaris E, Wong Riff KWY, Dreise M, Stiernman M, Kaur MN, Piplani B, et al. Establishing Content Validity of the CLEFT-Q. Plast Reconstr Surg Glob Open. 2017;5(4):e1305. DOI: https://doi.org/10.1097/GOX.0000000000001305

Miroshnychenko A, Thabane L, Wong Riff KWY, Tsangaris E, Kaur MN, Dreise M, et al. Psychometric Validation of the CLEFT-Q: A Prospective Study. Cleft Palate Craniofac J. 2023;60(3):327-35. DOI: https://doi.org/10.1177/10556656211062837

Aycart MA, Caterson EJ. Advances in Cleft Lip and Palate Surgery. Medicina (Kaunas). 2023;59(11):1932. DOI: https://doi.org/10.3390/medicina59111932

Klassen AF, Tsangaris E, Forrest CR, Wong Riff KWY, Echlin K, Shore S, et al. International development and validation of the CLEFT-Q. Plast Reconstr Surg. 2018;141(6):835e-46.

Stock NM, Feragen KB. Psychological and social aspects of cleft lip and palate: A systematic review of the literature. Cleft Palate Craniofac J. 2020;57(3):322-37.

Hlongwa P, Rispel LC. Quality of life in patients with cleft lip and palate: A systematic review. J Stomatol Oral Maxillofac Surg. 2021;122(1):83-7. DOI: https://doi.org/10.1016/j.jormas.2020.06.012

Sitzman TJ, Chee-Williams JL, Temkit M, Wills AK, Toms S, Sell D, et al. Comparison of secondary surgery before and after centralisation of cleft services in the UK: a whole-island cross-sectional analysis. BMJ Open. 2025;15(8):e105396. DOI: https://doi.org/10.1136/bmjopen-2025-105396

Wong Riff KWY, Tsangaris E, Klassen AF. Measuring Outcomes in Cleft Lip and Palate: The Importance of Patient-Reported Outcomes. Facial Plast Surg Clin North Am. 2023;31(4):451-62.

Zubairi AJ, Riff KWYW, Tsangaris E, Thabane L, Klassen AF. Patient-reported outcomes in cleft lip and palate: A comprehensive review of the CLEFT-Q. J Plast Reconstr Aesthet Surg. 2021;74(9):2120-31.

Klassen AF, Tsangaris E, Wong Riff KWY, Forrest CR, Dreise M, Stiernman M, et al. Are Patients With Cleft Lip and/or Palate Satisfied With Their Appearance? A CLEFT-Q Study. Commun Disord Q. 2021;42(4):215-24.

Alomari SM, Al-Mouagket MA, Al-Hadi MA, Al-Khalidi AA, Al-Saleh AM, Al-Khalaf AA. Psychosocial impact of secondary cleft deformities: A cross-sectional study. J Craniofac Surg. 2022;33(2):510-4.

Crerand CE, Kittel J, Marohn M, Stock NM. Psychosocial functioning in individuals with cleft lip and palate across the lifespan. Cleft Palate Craniofac J. 2020;57(2):170-82.

Tsangaris E, Wong Riff KWY, Forrest C, Dreise M, Stiernman M, Kaur MN, et al. Translation and cultural adaptation of the CLEFT-Q into Arabic, Dutch, Hindi, Swedish, and Turkish. Eur J Plast Surg. 2018;41(5):1-10. DOI: https://doi.org/10.1007/s00238-018-1445-9

Wong Riff KWY, Tsangaris E, Forrest CR, Klassen AF. Use of CLEFT-Q in the clinical setting to measure outcomes. Plast Reconstr Surg. 2021;147(1):112-21.

Eisemann BS, Dralle AJ, Lu M, Maricevich MA. Patient-Reported Outcomes after Secondary Cleft Rhinoplasty. J Craniofac Surg. 2021;32(5):1745-8.

Vaca EE, Purnell CA, Gosain AK, Alghoul MS. Secondary Cleft Rhinoplasty: An Outcomes Analysis. Plast Reconstr Surg. 2020;145(5):940e-51.

Patel NA, Goyal N, Smetona J, Gosain AK. The Economic and Social Impact of Secondary Cleft Reconstructions. J Craniofac Surg. 2023;34(1):45-9.

Kootstra J, Van der Ark W, Van der Veer V, Van der Hulst RR, Van der Berg J, Mureau MA, et al. CLEFT-Q scores in a Dutch cleft population. J Plast Reconstr Aesthet Surg. 2022;75(8):2670-7.

Homsy P, Grann A, Lassus P. Patient-Reported Esthetic Outcomes Following Secondary Rhinoplasty in Adult Patients with a Cleft Lip and Palate. Cleft Palate Craniofac J. 2024;63(1):31-7. DOI: https://doi.org/10.1177/10556656241296793

Saha S, Grewal NS, Gupta S. Socioeconomic barriers to secondary cleft surgery in low-income settings. World J Surg. 2022;46(4):789-96.

De la Torre J, Flores RL, Rodriguez-Feliz J. Secondary Cleft Care in Latin America: Challenges and Opportunities. Plast Reconstr Surg Glob Open. 2023;11(2):e4801.

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Published

2026-06-09

How to Cite

Leal-Silva, J. L., López, N. C., Ramírez, E. D., Díaz, D. V., Tovar-Zamudio, S., & Fernandez-Riera, R. (2026). Impact of secondary surgical correction on self-perception, function and psychosocial outcomes in cleft lip and palate patients evaluated with the cleft-Q. International Journal of Research in Medical Sciences. https://doi.org/10.18203/2320-6012.ijrms20261850

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Original Research Articles