[Self presentation of patients disfigured by head and neck cancer]

Surgery for maxilofacial cancer is often radical and disfiguring, and therefore can have an influence on patient's interpersonal relationship and social activities. However, little is known about self-presentation of disfigured patients during rehabilitation. This is an inductive and qualitative study based on 26 extensive interviews. The results demonstrate that patients with disfigurement cope actively with problems in their interpersonal relationship and even go through the empowerment process. Self-presentation of the disfigured patients consisted of four dimensions: (1)self-evaluation: (2)judgment of others' reactions; (3)intention of personal relations and style of self-presentation; and (4) concrete self-presentation using six "strategies". Each of the dimensions 1-3 included several processes that were generally taken in sequence according to time after surgery, but also strongly influenced by behaviors of family members or medical staff. "Strategies" chosen in dimension 4 depending upon the situations in dimensions 1-3 corresponded to the five type of "self-presentation" reported by Goffman (1959), except for "letting others be used to the patients", which was one of the continuous efforts to overcome their chronic disfigurement. Importantly, the patients became confident by focusing upon their chronic disfigurement. Importantly, the patients became confident by focusing upon their healthy parts such as maxiofacial functions recovered to some degree, and this confidence led to the acceptance of disfigurement and further to the expansion of their social behaviors.