**4.2 Psychological aspect of quality of life perception**

The analysis of the quality of life in CL/CLP remains a difficult exercise. Family dynamics, education, and professional factors influence the social development and rehabilitation of these patients [17] .

Psychological problems, such as loss of self-esteem and difficulties in social interaction, are also encountered in patients with cleft lip or palate [8, 18–20].

In our study, the quality of life perceived by parents was close to that of their children, which was confirmed by the linear regression curves (**Figure 2**).

The literature on quality of life in cases of facial malformation (congenital or acquired) is disparate. The quality of life index is considered in the majority of cases to be equal to and, in some cases, lower than that of a control population.

François-Fiquet et al. [4], in his study, found that patients' quality of life was estimated by patients at an average of 65.1/100. This overall quality of life index was comparable (P = 0.66) to that of the control population. The perceived quality of life of patients by their parents was quite close to the quality of life described by patients (66.5/100).

In our study, and during adolescence, problems of attractiveness, peer acceptance, and identity formation are particularly acute in populations and patients in general. With CLP, the results show that 67.5% of patients surveyed are complexed by their physical appearance.

Turner et al. [21] conducted a study in England that showed that a negative reaction from foreigners, real or perceived, can damage our own image. The links between physical attractiveness and the probability of success and social acceptability are well established. These links highlight the potential disadvantages for people affected by CLP because they may have an abnormal facial appearance [22–24].

Broder et al. [7] mainly showed higher levels of dissatisfaction with body image associated with an increase in apparent anxiety in patients related to their CLP.

Similarly, our psychological study revealed that only 2.5% of adolescents have self-confidence and 47.5% tend to take life on the bright side.

Several studies have reported that the majority of patients and their parents report that self-confidence has been affected or "very affected" by the cleft. Lower levels of self-esteem have also been observed in adults with CLP [25–28].
