Does Repairing a Cleft Lip Neonatally Have Any Effect on the Longer-Term Attractiveness of the Repair?

Objective To determine whether attractiveness and success of surgical outcome differ according to the timing of cleft lip repair. Design Three experiments were conducted: (1) surgeons rated postoperative medical photographs of infants having either neonatal or 3-month lip repair; (2) lay panelists rated the same photographs; (3) lay panelists rated dynamic video displays of the infants made at 12 months. Normal comparison infants were also rated. The order of stimuli was randomized, and panelists were blind to timing of lip repair and the purposes of the study. Setting Four U.K. regional centers for cleft lip and palate. Participants Infants with isolated clefts of the lip, with and without palate. Intervention Early lip repair was conducted at median age 4 days (interquartile range [IQR] = 4), and late repair at 104 days (IQR = 57). Main Outcome Measures Ratings of surgical outcome (Experiment 1 only) and attractiveness (all experiments) on 5-point Likert scales. Results In Experiment 1 success of surgical outcome was comparable for early and late repair groups (difference = −0.08; 95% confidence interval [CI] = −0.43 to 0.28; p = .66). In all three experiments, attractiveness ratings were comparable for the two groups. Differences were, respectively, 0.10 (95% CI = −2.3 to 0.44, p = .54); −0.11 (95% CI = −0.42 to −0.19, p = .54); and 0.08 (95% CI = −0.11 to 0.28, p = .41). Normal infants were rated more attractive than index infants (difference = 0.38; 95% CI = 0.24 to 0.52; p < .001). Conclusion Neonatal repair for cleft of the lip confers no advantage over repair at 3 months in terms of perceived infant attractiveness or success of surgical outcome.

Relationships between Cleft Severity and Attractiveness of Newborns with Unrepaired Clefts

Perceptions of attractiveness of newborns with unrepaired clefts were investigated by using a range of photographs with clefts of differing severity as ordered by a rule of thumb system commonly adopted by surgeons. The investigation involved a combination of factors such as completeness, unilaterality or bilaterality, and palate involvement. Orderings of attractiveness by surgeons, nursing staff, and adult groups unfamiliar with clefts were remarkably consistent. In addition, the responses reflected the rule of thumb system with ranked preferences of the raters being significantly related to the severity of cleft impairment. The scale devised could be used for comparative treatment outcome studies requiring assessments of initial infant attractiveness.