**4.3 CLP and social aspect**

In our study, socially, more than 60% of adolescents reported a better quality of life in their relationships with friends and 72.5% found that they are understood and reassured by their friends with only 27.5% of adolescents worried about their future. The highest index in this field explains our patients by the fact that they have developed a privileged relationship with their "best friend," integrating almost total trust, a greater complicity than between classmates without a surgical background.

These results disagree with those observed in several studies, in particular that of Antoun et al. [29] who found that children with facial malformations may have specific attitudes that influence or even interfere with interactions with others. Facial malformations are not the most accepted physical abnormality in the population with a higher incidence of facial mockery; another factor that affects the social life of their children is the visible deficiency, nose and lips by this abnormality having a negative impact on peer interactions or even in the field of marriage.

Stock et al. [28] conducted a study in which they found that children with CLP were less socially motivated, less competent, and less effective in overall social functioning than their peers without CLP.

The study by François-Fiquet et al. [4] is consistent with our study which shows that these patients have achieved better results in the areas of friendship.

On the other hand, concerning the fields of schooling showed that the quality of life index was proportionally lower than that of the other fields [4]. Another study by Turner et al. [21] indicates that social anxiety was associated with poor academic performance, in addition to communication difficulties and words encountered in patients. The study by Broder et al. [7] found that patients with CLP requiring multiple surgical procedures had lower school scores.

## **4.4 Parent's relationship and quality of life**

In our study, 75% of parents thought that their children spoke freely with them and 45% thought that their children spoke well with other family members as well.

The highest scores in the literature on parent-child relationships are partly explained by the importance of parents' investment in care over many years and also by daily concerns about the mockery and stigma that could affect their child [30].

The study by François-Fiquet et al. [4] confirmed the presence of a fusional and overprotective parental relationship that can be established, leading in some cases to an increased dependence of adolescents on their parents. This may even lead to a later departure from the family unit.

Parents' feelings about their children's facial anomaly are expected to be critical to their well-being in developing the child's self-esteem, although at the birth of their babies, they may experience feelings of uneasiness, shock, confusion, pain, and guilt; over time, they seek to adapt and better understand it to ensure maximum comfort and social integration.

The announcement of a facial malformation affecting their child is a major psychological test for parents. Other studies [10, 31–33] have found that parents' first relationships with their children are based on conscious and unconscious emotions, which essentially involve touch, sound of voice, gaze, and facial expression.

When the newborn is carrying a CLP, parents are brutally confronted with their child's "spoiled, open, cracked" face, and the emotional overload of this event can slow down their emotional investment. Thus, the parent-child relationship can be affected from birth [34]. The mother's attachment to her child during childhood does not seem to be a problem, quite the contrary. This is because a mother protects her child more when he or she has an unsightly face [8, 35].

Aslan et al. [36] identified in their study the multiple variables affecting family functions and life quality of parents with cleft lip and/or palate children. In fact, the parents of CLP children need to be strengthened in behavioral control, roles, and the required attention areas of family functions at early childhood and at required attention area in all age groups of children. In addition, families need to be supportive for social, physical, and the psychological fields of QoL when their children are in adolescence growth period. Therefore, concepts of psychological services in cleft centers should be developed, and a family-centered approach should be applied caring the psychosocial needs of parents, children, and their families.

## **4.5 Orofacial functions and quality of life**

In our study, 50% of adolescents lacked vitality and energy according to them and 45%, according to their parents.

Grollemund et al. [9] and François-Fiquet et al. [4] confirmed that although patients with bilateral FLP are functionally satisfied with their speech, swallowing, and hearing, they are significantly dissatisfied with their appearance, particularly

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*Quality of Life in Adolescents with Cleft Lip and Palate DOI: http://dx.doi.org/10.5772/intechopen.91348*

can influence the quality of life of these people.

an early sign of depression [37].

adolescents [38].

**5. Conclusion**

and 60.58 for the latter.

**Conflict of interest**

dissatisfied with their lives.

**4.6 Limitation of this study**

in the upper lip and nose. This dissatisfaction with the esthetic result may even be

People with CLP can suffer from a variety of disorders: behavioral disorders, anxiety, depression, and facial esthetic dissatisfaction in both children and adults. The difficulty in interpreting these disorders lies in the multiplicity of factors that

A retrospective cohort study including 220 child born with unilateral CL+A, concluded that the findings of this study provide a reference for morphologic variations in CL+A and insight into the surgical burden of care until the age of 18 years. These results are consistent with the results of our study on the influence of the management of cleft lip and palate on the quality of life of children and

Our study was a retrospective monocentric study for the evaluation of the quality of life in patients with cleft lip or labial palate and their parents. This is justified by the difficulty of accessing this particular population; in general, these anomalies affect with disparity a population with an unfavorable socio-economic and cultural context. On the other hand, a prospective longitudinal study with an evaluation at the beginning and at the end of treatment and long-term follow-up with a compari-

At the end of this work, we concluded that patients' and their parents' perceptions of quality of life remain average, with satisfaction rates of 59.61 for the former

Teenagers had the lowest quality of life rates in the items: physical appearance and self-esteem, while their parents did not like the fact that their children were

Multidisciplinary management is the rule in the treatment of the after-effects of cleft lip and palate. However, it will be necessary to strengthen the role of the psychologist in the therapeutic chain of these patients, as they are currently still

The authors declare no conflict of interest in relation to this chapter.

neglected at the expense of surgeons and orthodontists.

son group of children without CL and CLP would have been more relevant.

*Quality of Life in Adolescents with Cleft Lip and Palate DOI: http://dx.doi.org/10.5772/intechopen.91348*

in the upper lip and nose. This dissatisfaction with the esthetic result may even be an early sign of depression [37].

People with CLP can suffer from a variety of disorders: behavioral disorders, anxiety, depression, and facial esthetic dissatisfaction in both children and adults. The difficulty in interpreting these disorders lies in the multiplicity of factors that can influence the quality of life of these people.

A retrospective cohort study including 220 child born with unilateral CL+A, concluded that the findings of this study provide a reference for morphologic variations in CL+A and insight into the surgical burden of care until the age of 18 years. These results are consistent with the results of our study on the influence of the management of cleft lip and palate on the quality of life of children and adolescents [38].
