Paper Title
Evaluation of Psychological Status of Cleft Palate Children Over Five Years of Age in Southern Sri Lanka

Abstract
Introduction: Cleft palate is one of the commonest congenital malformations of the head and neck region. Patients with oral clefts may also exhibit other anomalies. Cleft palate is associated with long term disability and psychological stress among individuals. Objective: To identify the psychological status of cleft palate subjects in southern Sri Lanka. Materials and methods. The subjects were identified among those who are currently under review in the Regional Cleft Centre & Maxillo-Facial Department, Teaching Hospital, Karapitiya, Galle, Sri Lanka. Psychological status was assessed by the researcher by interviewing the subjects older than 5 years of age. Results: There were 149 subjects more than five years of age, of which 79 (59.73%) were females (p<0.05). A total of 67 (44.97%) subjects had other clinical features associated with the cleft palate. There were 28 (18.79%) subjects with dysmorphic features, 21 (14.09%) with congenital heart defects, 18 (12.08%) with developmental delay. There were twenty five subjects (16.34%) with altered psychological status, of which there were seventeen females (68%) and eight males (32%). Fear to talk in public was the commonest problem reported and was identified among seventeen (68%) subjects. Aggressive behavior was reported among four (16%), other psychological problems included attention deficit disorder in one subject (4%) and unusual behavior in three subjects (12%) were reported. Discussion: Cleft palate is a condition that causes significant psychological stress among affected individuals and families. Hypernasal speech, speech delay, disfiguring facial features and other associated birth defects are associated with increasing prevalence of psychological stress among cleft palate subjects. The results of this study clearly indicated female predominance of occurrence of cleft palate and higher incidence of other associated anomalies which may be a cause for higher incidence of psychological stress among cleft palate subjects. Conclusion: Study results concluded that it is very important to address psychological aspect of cleft palate subjects with the concomitant correction of cleft deformity and other birth defects which will help to enhance the quality of life of the cleft palate patients. Keywords: Cleft palate, Associated clinical anomalies, Psychological status, Sri Lanka