Scaling facial impairment.

A major goal of the treatment of cleft lip and palate is to improve the esthetic acceptability of the face. It is assumed that an improved esthetic appearance is associated with significant psychosocial benefits, but there is almost no empiric support for this assumption. Researchers have been hindered in the study of this problem because scales to measure severity of facial impairment of clefts have not been available; however, standard scales of facial impairment have been developed for occlusal traits, orthognathic structure, and facial attractiveness. The purpose of this paper is to describe selected theoretic and methodologic approaches to scaling the esthetic acceptability of various facial characteristics and to discuss how these methods have been applied to the study of relationships between facial morphology and psychosocial variables. It is argued that these approaches may be useful, as models for the development of scales of severity of cleft impairment, to clinicians and researchers who are interested in the treatment of facial clefts.