Les fentes labiales et palatines (FLP) sont les malformations faciales humaines les plus fréquentes. Selon l’origine ethnique et/ou géographique des populations étudiées, elles peuvent concerner jusqu’à 1/500 naissances. Les difficultés rencontrées par les familles sont évidemment repérables à la naissance lors de la première rencontre des parents avec leur enfant, puis lors de chaque changement de cycle de vie : à l’entrée en école maternelle qui correspond à la première véritable socialisation de l’enfant, à l’entrée au cours préparatoire qui correspond à l’apprentissage de la lecture puis au collège, période à nouveau critique du fait de l’adolescence. Le parcours médical d’un adulte porteur d’une FLP peut être particulièrement chargé dans la mesure où il a dû subir de nombreux traitements durant toute son enfance, son adolescence et parfois encore à l’âge adulte. Ce contexte médicochirurgical, concernant une malformation atteignant la face et donc le visage, largement impliqué dans les relations interpersonnelles et l’expression des émotions, peut être lourd de conséquences. La majorité des enfants présentant des FLP et vivant en France sont suivis régulièrement dans des centres référents ou compétents par une équipe pluridisciplinaire. Seuls les deux centres référents français bénéficient de la présence permanente d’un psychologue. Il est indispensable de généraliser sous forme de réseau la prise en compte de la santé mentale de ces enfants et de leurs parents à tous les centres compétents en proposant une aide psychologique lors du suivi thérapeutique de ces enfants et cela dès leur plus jeune âge.

Cleft lips and palates (CLPs) are the most common human facial malformations. Depending on the ethnic and/or geographical origin of the studied populations, they can affect up to 1/500 newborns. The treatment of these patients is multidisciplinary because these malformations have not only aesthetic consequences but also functional consequences as the phonation, hearing, deglutition, mastication and ventilation are altered. These consequences can also be psychological since the building of the body image, the way others perceive it, is likely to be seriously altered. In Europe there are over 210 reference hospitals for children affected by CLP. Besides, about 190 different protocols were identified. So far no generic protocol was recognized by the medical community as a whole. This discrepancy can be explained by the fact that the aesthetic and functional result of a protocol cannot be accurately assessed before adulthood when the child’s growth is complete. Patients presenting with CLP don’t usually seem to present with any serious psychological or psychiatric pathology. Yet a close review of the related literature shows that disorders are actually described: behavioural troubles, anxiety, depression and esthetical dissatisfaction with one’s face in children as well as in adults. The difficulty in interpreting these disorders lies in the various factors that are likely to impact this condition (family setting, importance and type of the cleft, surgery protocol, growth, social environment…). A multidisciplinary examination of the face and a careful consideration of concerned families show the importance of the psychological context and the risks of a disharmonious structuring of the parents-child relationships on the child’s development. The identification of the difficulties faced by these families, depending on the child’s age, can be easily identified. Of course they can be identified at birth when the family first sees the child and later on at each stage of the child’s life cycle (when starting at kindergarten where the child socialises for the very first time, at the start of the first year in primary school where pupils learn how to read and then at the start of secondary school which is yet another crucial step for the child due to the adolescence period). It is also obvious that an adult affected by CLP has a particularly heavy medical history as the patient had to go through various treatments and surgical interventions during his childhood and adolescence, which is even sometimes maintained at adulthood. Repeated appointments with the different specialists involved in their treatment punctuate their life as well as their parents’. This medico-surgical setting for facial malformations i.e. the features of the patient’s face which are largely involved in their interpersonal relationships and the expression of emotions can have serious consequences. Most children presenting with CLPs and living in France benefit from regular follow-up schemes carried out in competent reference centres by a multidisciplinary team whose members represent each of the fields of expertise involved in the correction of this malformation: infantile and maxillofacial surgery, otorhinolaryngology (or ENT), orthophony and dentofacial orthopedics. Only the two French reference centres benefit from the permanent presence of a psychologist. This raises the question whether every care centre should take into care these children and their parents’ mental health by offering psychological support during the course of the therapeutic follow-up scheme for these children, and this from an early age on as is recommended by the American Cleft Palate Craniofacial Association.