University of Oulu

Svalina, A., Heikura, E., Savolainen, T. et al. Appearance or attitude: what matters to craniosynostosis patients? Association of self-esteem, depressive symptoms, and facial aesthetics in patients with sagittal and metopic synostosis. Childs Nerv Syst 38, 1929–1936 (2022).

Appearance or attitude: what matters to craniosynostosis patients? : Association of self-esteem, depressive symptoms, and facial aesthetics in patients with sagittal and metopic synostosis

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Author: Svalina, Anja1,2,3; Heikura, Emma2; Savolainen, Tuula4;
Organizations: 1Research Unit of Clinical Neuroscience, Oulu University Hospital and University of Oulu, Oulu, Finland
2PEDEGO Research Group, University of Oulu, Oulu, Finland
3Department of Neurosurgery, Oulu University Hospital, PO Box 21, 90029, Oulu, OYS, Finland
4Medical Research Center, Oulu University Hospital, Oulu, Finland
5Department of Children and Adolescent, Oulu University Hospital, Oulu, Finland
6Department of Orthodontics, Faculty of Medicine, Oral Health Sciences, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Springer Nature, 2022
Publish Date: 2022-11-25


Purpose: The aim of this study was to investigate the presence of depressive symptoms and self-esteem, and their association with facial asymmetry in adults who were operated on in early childhood due to metopic and sagittal craniosynostosis.

Methods: The study population consisted of 49 non-syndromic patients of whom 41 had premature fusion of the sagittal and 8 of metopic suture. There were 64 controls from the Finnish National Register. Self-esteem, depressive symptoms, and subjective satisfaction with one’s appearance were evaluated by using the Rosenberg self-esteem questionnaire (RSE), the short form of Beck Depression Inventory (R-BDI), and a purpose-designed questionnaire on satisfaction with facial and overall appearance. Aesthetic evaluation was done from standard photographs using panels. The facial symmetry was calculated by using 3D photogrammetric methods.

Results: Patients did not have a lower self-esteem or experience significantly more moderate or severe depressive symptoms. However, 20% of the patients and 6% of the controls (p = 0.041) experienced mild depressive symptoms. There was no difference between self-assessed evaluation of appearance between the groups. Only weak correlation was found between facial asymmetry and RSE or R-BDI results (cc = 0.27–0.42, p < 0.05). The self-assessed evaluation of facial and overall appearance correlated strongly with the R-BDI results.

Conclusions: Non-syndromic craniosynostosis patients are as satisfied with their appearance in adulthood as the control group and do not experience a lower self-esteem or more depressive symptoms. Facial asymmetry does not correlate with low self-esteem or clinically significant depressive symptoms in adulthood. Subjective evaluation of one’s appearance correlated with depressive symptoms. Age and gender do not influence the former results. Overall, patients are satisfied with their appearance.

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Series: Child's nervous system
ISSN: 0256-7040
ISSN-E: 1433-0350
ISSN-L: 0256-7040
Volume: 38
Issue: 10
Pages: 1929 - 1936
DOI: 10.1007/s00381-022-05587-4
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3124 Neurology and psychiatry
Funding: Open Access funding provided by University of Oulu including Oulu University Hospital. This study has been financially supported by Stiftelsen Alma och K. A. Snellman Säätiö, Finland.
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