Asymmetry of Left versus Right Unilateral Cleft Impairments: An Experimental Study of Face Perception

Abstract

Objective

Previous psychosocial studies of adults born with cleft lip and palate have provided circumstantial evidence that surgically repaired right-sided unilateral clefts may be more disfiguring than left-sided clefts. The present study asked if such asymmetries are physiognomic asymmetries or arise “in the eye of the beholder,” representing perceptual processes in face recognition.

Design

Color slides of 160 children (6 years of age) and young teenagers (16 years of age) were rated by subjects for perceived disfigurement. Sixty of the subjects had unilateral complete cleft lip and palate (30 had a right-sided cleft and 30 had a left-sided cleft), 60 had unilateral cleft lip/alveolus (30 right-sided and 30 left-sided clefts), 32 children had bilateral cleft lip and palate, and 6 children had cleft palate only. Faces were shown in normal and in mirror-reversed versions; the order in which faces were shown was randomized, as were other stimulus factors such as cleft type, age, and gender.

Setting

The study was conducted as a classroom-type experiment at the Vision Laboratory, Department of Psychology, Oslo, Norway.

Participants

Thirty-seven students of psychology at the University of Oslo, who were ignorant of the purpose of the study, acted as subjects.

Main outcome measure

Subjects rated perceived disfigurement using a visual analog scale.

Results

Modest but highly consistent hemifacial asymmetries in judged disfigurement were found, with left-sided unilateral clefts rated as less disfiguring than right-sided unilateral clefts. Unilateral clefts were judged as being less disfiguring than the bilateral clefts, and cleft lip/alveolus was judged as being less disfiguring than cleft lip and palate. The patterns of facial judgments were almost identical in the normal and reversed-slides conditions.

Conclusions

Asymmetries between left- and right-sided clefts reside in physiognomic factors rather than in hemispheric asymmetries controlling the perceptual process of face judgment.

Keywords

cleft lip alveolus cleft lip and palate face perception facial asymmetry

Get full access to this article

View all access options for this article.

References

Åbyholm

F.E.

Cleft lip and palate in Norway: registration, incidence and early mortality in infants with CLP.

Scand J Plast Reconstr Surg. 1978; 12: 29–34.

Alley

T.R.

Social and Applied Aspects of Perceiving Faces. Hillsdale, NJ: Erlbaum; 1988.

Alley

T.R.

The developmental stability of facial attractiveness: new longitudinal data and a review, Merill Palmer Q. 1993; 39: 265–278.

Ashmore

R.D.

Longo

L.C.

Accuracy of stereotypes: what research on physical attractiveness can teach us. In: Lee

Y.T.

Jussim

McCauley

C.R.

, eds. Stereotype Accuracy: Toward Appreciating Group Differences. Washington. DC: American Psychological Association; 1995: 63–86.

Bardach

Cutting

Anatomy of the unilateral and bilateral cleft lip and nose. In: Bardach

Morris

H.L.

, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: Saunders; 1990: 150–159.

Berry

D.S.

Taking people at face value: evidence for the kernel of truth hypothesis.

Soc Cogn. 1990; 8: 343–361.

Broder

Strauss

R.P.

Self-concept of early primary school age children with visible or invisible defects.

Cleft Palate J. 1989; 26: 114–118.

Bull

Rumsey

The Social Psychology of Facial Appearance. New York: Springer; 1988.

Capelozza Filho

Normando

A.D.C.

Da Silva Filho

O.G.

Isolated influences of lip and palate surgery on facial growth: comparison of operated and unoperated male adults with UCLP.

Cleft Palate Craniofac J. 1996; 33: 51–56.

10.

Cash

T.F.

Pruzinski

Body images: development, deviance and change. New York: Guilford Press; 1990.

11.

Chen

A.C.

German

Zaidel

D.W.

Brain asymmetry and facial attractiveness: facial beauty is not simply in the eye of the beholder.

Neuropsychologia. 1997; 35: 471–476.

12.

Clifford

Parental ratings of cleft palate infants.

Cleft Palate J. 1968; 6: 235–243.

13.

De Schonen

Some reflections on brain specialization in face processing. In: Young

A.W.

Ellis

H.D.

, eds. Handbook of Research on Fate Processing. Amsterdam: Elsevier; 1989: 379–389.

14.

Eagly

A.H.

Ashmore

R.D.

Mäkijani

M.G.

Longo

L.C.

What is beautiful is good, but…: a meta-analytic review of research on the physical attractiveness stereotype.

Psychol Bull. 1991; 110: 109–128.

15.

Eliason

M.J.

Hardin

M.A.

Olin

W.H.

Factors that influence ratings of facial appearance for children with cleft lip and palate.

Cleft Palate Craniofac J. 1991; 28: 190–194.

16.

Ellis

H.D.

Young

A.W.

Are faces special? In: Bruyer

, ed. The Neuropsychology of Face Perception and Facial Expression. Hillsdale. NJ: Erlbaum; 1986: 1–26.

17.

Fara

Anatomy of unilateral and bilateral cleft lip. In: Bardach

Morris

H.L.

, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: Saunders; 1990: 134–144.

18.

Ferrario

V.F.

Sforza

Minami

A.J.

Tartaglia

Craniofacial morphometry by photographic evaluations.

Am J Orthod Dentofacial Orthop. 1993; 101: 327–337.

19.

Ferrario

V.F.

Sforza

Pogio

C.E.

Tartaglia

Distance from symmetry: a three-dimensional evaluation of facial asymmetry.

J Oral Maxillofac Surg. 1994; 52: 1126–1132.

20.

Gallois

Buquet C. Charlier J, Paris V. Vache JC, Dereux JF. Asymmétrie dans l'activité perceptive visuelle des visages et des expressions faciales émotionnelles.

Rev Neurol (Paris). 1989; 145: 661–664.

21.

Gilbert

Bakan

Visual asymmetry in perception of faces.

Neuropsychologia. 1973; 11: 355–362.

22.

Grammar

Thornhill

Human (Homo sapiens) facial attractiveness and sexual selection: the role of symmetry and averageness.

J Comp Psychol. 1994; 108: 233–242.

23.

Hatfield

Sprecher

Mirror, Mirror: The Importance of Looks in Everyday Life. Albany, NY: State University of New York Press; 1986.

24.

Jackson

L.A.

Physical Appearance and Gender: Sociohiological and Sociocultural Perspectives. Albany, NY: State University of New York Press; 1992.

25.

Kapp-Simon

K.A.

Psychological interventions for the adolescent with CLP

Cleft Palate Craniofac J. 1995; 32: 104–108.

26.

Kapp-Simon

K.A.

Simon

D.J.

Kristovich

Self-perception, social skills, adjustment, and inhibition in young adolescents with craniofacial anomalies.

Cleft Palate Craniofac J. 1992; 29: 352–356.

27.

Koff

Borod

J.C.

White

Asymmetries for hemiface and size and mobility.

Neuropsychologia. 1981; 19: 825–830.

28.

Kruekeberg

S.M.

Kapp-Simon KA. Effect of parental factors on social skills of preschool children with craniofacial anomalies.

Cleft Palate Craniofac J. 1993; 30: 490–496.

29.

Kykriandes

Bellohusen

Subtelny

J.D.

Asymmetries of the upper lip and nose in noncleft and postsurgical unilateral cleft lip and palate individuals.

Cleft Palate Craniofac J. 1996; 33: 306–311.

30.

Leonard

B.J.

Dwyer Brust

Abrahams

Sielaff

Self-concept of children and adolescents with cleft lip and/or palate.

Cleft Palate Craniofac J. 1991; 28: 347–353.

31.

Locher

Unger

Sociedade

Wahl

At first glance: accessibility of the physical attractiveness stereotype.

Sex Roles. 1993; 28: 729–743.

32.

Luh

K.E.

Rueckert

L.M.

Levey

Perceptual asymmetries for free viewing of several types of chimeric stimuli.

Brain Cogn. 1991; 16: 83–103.

33.

Magnussen

Sunde

Dyrncs

Patterns of perceptual asymmetry in processing facial expression.

Cortex. 1994; 30: 215–229.

34.

McComb

Anatomy of the unilateral and bilateral cleft lip nose. In: Bardach

Morris

H.L.

, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: Saunders; 1990: 144–149.

35.

Mertens

Siegmund

Grüsser

O.J.

Gaze motor asymmetries in the perception of faces during a memory task.

Neuropsychologia. 1993; 31: 989–998.

36.

Nyrén

Visual analogue scale. In: Herscn

Bellach

A.C.

, eds. Dictionary of Behavior Assessment Techniques. New York: Pergamon; 1988: 490–492.

37.

Peck

Kataia

Skeletal asymmetry in aesthetically pleasing faces.

Angle Orthod 1991; 61: 43–48.

38.

Pillemer

F.G.

Cook

K.V.

The psychosocial adjustment of pediatric craniofacial patients after surgery.

Cleft Palate J. 1989; 26: 201–207.

39.

Ramstad

Ottem

Shaw

W.C.

Psychosocial adjustment in Norwegian adults who had undergone standardized treatment of complete cleft lip and palate. II. Self-reported problems and concerns with appearance.

Scand J Plast Reconstr Hand Surg. 1995; 29: 329–336.

40.

Ras

Habets

L.L.M.H.

Van Ginkel

F.C.

Prahl-Andersen

Three-dimensional evaluation of facial asymmetry in cleft lip and palate.

Cleft Palate Craniofac J. 1994a; 31: 116–121.

41.

Ras

Habets

L.L.M.H.

Van Ginkel

F.C.

Prahl-Andersen

Facial left-right dominance in cleft lip and palate: three-dimension evaluation.

Cleft Palate Craniofac J. 1994b; 31: 46l–465.

42.

Rhodes

Lynskey

Face perception: attributions, asymmetries and stereo-types.

Br J Soc Psychol. 1990; 29: 375–377.

43.

Roberts-Harry

D.P.

Evans

Hathorn

I.S.

Effects of different surgical regimes on nasal asymmetry and facial attractiveness in patients with clefts of the lip and palate.

Cleft Palate Craniofac J. 1991; 28: 274–278.

44.

Schneiderman

C.R.

Harding

J.B.

Social ratings of children with cleft lip by school peers.

Cleft Palate J. 1984; 21: 219–223.

45.

Semb

Analysis of the Oslo Cleft Up and Palate Archive: Long-Term Dentofacial Development. Oslo: University of Oslo; 1991. Dissertation.

46.

Semb

Shaw

W.C.

Facial growth in orofacial clefting disorders. In: Turvey

T.A.

Vig

K.W.L.

Fonseca

R.J.

eds. Facial Clefts and Craniosynostosis. Philadelphia: Saunders; 1996: 28–56.

47.

Shaw

W.C.

Asher-McDade

Brattström

Mars

McWilliam

Mølsted

Plint

D.A.

Prahl-Andersen

Roberts

Semb

The

R.P.S.

Intercenter clinical audit for cleft lip and palate—a preliminary European investigation. In: Jackson

I.T.

Sommerlad

B.C.

, eds. Recent Advances in Plastic Surgery. London: Churchill Livingstone; 1992: 1–15.

48.

Shaw

W.C.

Rees

Dawe

Charles

C.R.

The influence of dentofacial appearance on the social attractiveness of young adults.

Am J Orthod. 1985; 87: 21–26.

49.

Stella

J.P.

Epker

B.N.

Diagnosis of and treatment planning for facial asymmetries. In: Turvey

T.A.

Vig

K.W.L.

Fonseca

R.J.

, eds. Facial Clefts and Craniosynostosis. Philadelphia: Saunders; 1996: 320–359.

50.

Tobiasen

J.M.

Psychosocial adjustment to cleft lip and palate. In: Bardach

Morris

H.L.

, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia: Saunders; 1990: 820–825.

51.

Tobiasen

J.M.

Hiebert

J.M.

Combined effects of severity of cleft impairment and facial attractiveness on social perception: an experimental study.

Cleft Palate Craniofac J. 1993; 30: 82–86.

52.

Vig

Hewitt

A.B.

Asymmetry of the human facial skeleton.

Angle Orthod. 1975; 45: 125–129.

53.

Wirsen

Af Klintenberg

Levander

Schalling

Differences in asymmetric perception of facial expression in free-viewing chimeric stimuli and reaction time.

Brain Cogn. 1990; 12: 229–239.

54.

Zaidel

D.W.

Chen

A.C.

German

She is not a beauty even when she smiles: possible evolutionary basis for a relationship between facial attractiveness and hemispheric specialization.

Neuropsychologia. 1995; 33: 649–655.