Social and psychological effects of craniofacial deformity and surgical reconstruction

Psychosocial evaluations of patients undergoing surgery for congenital craniofacial anomalies are being conducted preoperatively and postoperatively to document functioning prior to and following surgery. Our findings to date indicate that presurgically younger patients, those between 6 and 13, fare better than those 14 years and over. The former, for the most part, appear to be functioning adequately and test within normal range on standardized psychometric measures. The latter are more prone to social isolation and problems in self-concept and mood state. Postoperative evaluations are reported only for the younger group because of the small sample size of the older. Overall postoperative adjustment appears improved on several psychometric tests. The majority of patients and families are pleased with outcome. Improvement in appearance postoperatively as rated by independent judges has not reached statistical significance; however, there are significant correlations between changes in appearance and changes on several measures including self-concept and trait anxiety. This finding would tend to support the contention that improvement in appearance brought about by craniofacial surgery is associated with improvement in psychosocial adjustment.