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Duggal I, Talwar A, Duggal R, Chaudhari PK, Samrit V. Comparative evaluation of nasolabial appearance of unilateral cleft lip and palate patients by professional, patient and layperson using 2 aesthetic scoring systems: A cross sectional study. Orthod Craniofac Res 2023; 26:660-666. [PMID: 37061872 DOI: 10.1111/ocr.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/20/2023] [Accepted: 04/02/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE To compare the perspective of healthcare providers (orthodontists), cleft patients and laypersons in judging nasolabial aesthetics in patients with complete unilateral cleft lip, with or without cleft palate (UCL ± P) using 2 scoring systems. DESIGN This cross-sectional study was conducted in a tertiary care government hospital. PATIENTS Photographic records of 100 patients with complete UCL ± P from the age group of 5-18 years (mean age-12.2 ± 3.93 years) were included in this study. METHOD Photographic records of 100 patients with complete UCL ± P from the age group of 5-18 years were included. A panel of 3 orthodontists, 3 laypersons and 3 cleft patients rated nasolabial aesthetics using 2 scoring systems i.e. Asher-McDade index (AMAI) and Cleft Aesthetic Rating Scale (CARS). Spearman's split-half reliability, Intra-class correlation coefficient and Cronbach's alpha were computed to measure internal consistency and reliability. Inter-panel agreement between pair of groups was determined by means of Spearman correlation coefficient. RESULTS Estimated reliability of CARS for 3 raters in each panel was in moderate agreement for orthodontists and cleft patients (0.849 and 0.810). Good repeatability and agreement were recorded with moderate to high intra-panel reliability for all parameters of both AMAI and CARS. Overall inter-panel agreement was moderate for both AMAI and CARS. Pair-wise inter-panel agreement showed a moderately positive correlation in both scales (AMAI and CARS) by cleft patients and professionals. CONCLUSION CARS index can be reliably used for assessment of nasolabial aesthetics by cleft patients, professionals and lay persons on 2D facial photographs. Patients were more critical than clinicians and laypersons using both indices (CARS and AMAI) as they are more self-aware and conscious. Thus, a clear communication between clinician and patient regarding expectations, perception and satisfaction with surgical results is strongly recommended.
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Affiliation(s)
- Isha Duggal
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Talwar
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Duggal
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Kumar Chaudhari
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vilas Samrit
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Stebel A, Urbanová W, Klimova I, Brudnicki A, Dubovska I, Polackova P, Kroupová D, Koťová M, Fudalej PS. The Slavcleft: a three-center study of the outcome of treatment of cleft lip and palate. Nasolabial appearance. PeerJ 2021; 9:e10631. [PMID: 33614265 PMCID: PMC7879938 DOI: 10.7717/peerj.10631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background There is a multitude of protocols of treatment of cleft lip and palate (CLP) worldwide differing in number of operations, surgical techniques, and timings of surgeries. Despite, facial appearance in subjects with CLP is rarely ideal and residual stigmata are easy to notice in many patients irrespective of the protocol. The prospective controlled investigations are optimal for comparing effectiveness of treatment protocols. Because prospective studies are very challenging to perform in CLP field, it is reasonable to retrospectively assess different surgical protocols to identify the promising ones and then to test them in a prospective way. Methods Our objective was to assess the nasolabial appearance in a preadolescent Slavic population with unilateral cleft lip and palate (UCLP) by using the 0-200 numeric scale with reference photographs. Patients treated in Warsaw, Poland (n = 32), Prague, Czech Republic (n = 26) and Bratislava, Slovakia (n = 17) were included in this retrospective study. Each cleft center used a unique surgical protocol. Two panels of professional raters (n = 7) and laypeople (n = 10) scored blindly the nasolabial esthetics on cropped frontal and profile images with cropped reference photograph present on the same slide. Intra- and inter-rater agreement was assessed with Cronbach's alpha, intraclass correlation coefficients, t-tests, and Bland-Altman plots. Inter-group differences were evaluated with one-way ANOVA and regression analysis. Results The agreement within and between raters was acceptable. We found that patients treated in Warsaw, Prague, and Bratislava showed comparable nasolabial appearance on frontal and profile photographs when judged by both professional raters (p > 0.05) and laypeople (p > 0.05). Regression analysis did not identify influence of gender, group (i.e., Warsaw, Prague, and Bratislava), age at lip repair, surgeon, and age at photographic assessment on esthetic outcome (p > 0.05). Conclusion This study showed that none of the surgical protocols showed superiority to produce good nasolabial appearance.
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Affiliation(s)
- Adam Stebel
- Department of Maxillofacial Surgery, F. D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic.,Department of Stomatology and Maxillofacial Surgery, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Wanda Urbanová
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineyard, Prague, Czech Republic
| | - Irena Klimova
- Clinic of Plastic and Reconstructive Surgery, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Andrzej Brudnicki
- Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland
| | - Ivana Dubovska
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Petra Polackova
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineyard, Prague, Czech Republic.,Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Daniela Kroupová
- Clinic of Plastic and Reconstructive Surgery, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Magdalena Koťová
- Department of Orthodontics and Cleft Anomalies, Dental Clinic, 3rd Medical Faculty, Charles University, Faculty Hospital Royal Vineyard, Prague, Czech Republic.,Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Piotr S Fudalej
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic.,Department of Orthodontics, Jagiellonian University Cracow, Krakow, Poland.,Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
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Adetayo AM, Adetayo MO, Funmi A O, Somoye MS, Adeyemi MO, Adeyemo WL. Comparison of professional and laypeople evaluation of nasolabial esthetics following unilateral cleft lip repair. Eur J Dent 2019; 12:516-522. [PMID: 30369796 PMCID: PMC6178684 DOI: 10.4103/ejd.ejd_31_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives: The objective is to know the extent of agreement of clinicians’ perception of nasolabial esthetic compared to that of laypeople (parents). Materials and Methods: This was a prospective study of comparison of clinician's perception of nasolabial esthetics with that of laypeople following surgical repair of UCL. Participants were recruited from the Cleft Clinic of the Lagos University Teaching Hospital, and surgical repair of the cleft was performed under general anesthesia. Surgical evaluation was done through direct clinical evaluation using the modified form of the Christofides’ criteria by laypeople and professionals. Results: A total of 48 cleft participants were enrolled in the study. The evaluation of the lip by both the laypeople and professionals was similar, and there was no difference (0.588) in their rating. However, there was a significant disagreement (P = 0.001) between them in the nose assessment. Conclusion: Neither the solitary opinion of the professionals nor that of the laypeople is satisfactory in the evaluation of facial esthetics; both are equally important, especially in the assessment of nasal esthetics. However, opinion of either the laypeople or the professional might be enough in the evaluation of the lip esthetics.
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Affiliation(s)
- Adekunle Moses Adetayo
- Department of Surgery, Benjamin Carson Snr School of Medicine, Babcock University, Ogun State, Nigeria.,Department of Surgery, Dental Unit, Babcock University Teaching Hospital, Ogun State, Nigeria
| | | | - Oguntade Funmi A
- Department of Surgery, Benjamin Carson Snr School of Medicine, Babcock University, Ogun State, Nigeria.,Department of Anaesthesia, Babcock University Teaching Hospital, Ogun State, Nigeria
| | - Mayowa Solomon Somoye
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos State, Nigeria
| | - Michael O Adeyemi
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos State, Nigeria
| | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos State, Nigeria
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Ivanov AL, Reshetnyak EI, Starikova NV, Udalova NV, Nadtochy AG. [Resorbable vs nonresorbable fixation in alveolar bone grafting in unilateral cleft lip and palate patients]. STOMATOLOGII︠A︡ 2018; 97:40-46. [PMID: 29465075 DOI: 10.17116/stomat201897140-46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the study was to evaluate the resorbable vs nonresorbable fixation efficiency in bone grafting for unilateral cleft lip and palate (UCLP) patients. Thirty eight UCLP patients aged from 7 to 17 years (mean 11.5±3.1 years) were divided in two groups with different types of cortical graft fixation: group 1 ─ titanium screws (22 patients), group 2 ─ resorbable pins (16 patients). The Bergland and Chelsea scales were used to evaluate the outcomes 8 months after surgery. Additional authors' original scales were introduced: bone volume scale and pyriform rim restoration scale. The Bergland and Chelsea scales have shown good results in groups 1 and 2 in 91 and 81% of cases, satisfactory in 4.5 and 19% of cases, respectively. Upon the bone volume scale good results were achieved in groups 1 and 2 in 64 and in 75% of cases, satisfactory results - in 18 and 19% of cases, respectively. Upon the pyriform rim restoration scale good results achieved in 59 and 88% of cases, respectively. We also took into consideration the influence of age, diagnosis, post-op complications. No statistically significant difference between groups was found, with neither age nor diagnosis showing any influence. Only postsurgical complications and the stability of the orthodontic design seem to be important for good bone formation after alveolar bone grafting.
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Affiliation(s)
- A L Ivanov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - E I Reshetnyak
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - N V Starikova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - N V Udalova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A G Nadtochy
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Zhu S, Jayaraman J, Khambay B. Evaluation of Facial Appearance in Patients with Cleft Lip and Palate by Laypeople and Professionals: A Systematic Literature Review. Cleft Palate Craniofac J 2018; 53:187-96. [DOI: 10.1597/14-177] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To identify whether laypeople and professionals rate the facial appearance of patients with cleft lip and palate (CLP) similarly based on viewing full facial images. Design Several electronic databases were searched. A hand search was performed among reference lists and relevant journals. Studies that assessed the full facial appearance of patients with CLP based on two-dimensional (2D) photographs, 3D images, or clinical examination by laypeople and professionals using a visual analog scale (VAS) or a categorical rating scale were included. Two authors independently assessed articles using methodologic-quality scoring protocol. Result Eleven articles were included in qualitative synthesis, including four high-level and seven moderate-level papers. Three studies found that laypeople were more critical than professionals, three found there was no significant difference between laypeople and professionals, and five reported that professionals were more critical than laypeople when assessing facial appearance of patients with CLP. Conclusions It still remains unknown whether laypeople are more or less critical than professionals when rating facial appearance of patients with repaired CLP. Professionals are more familiar with the esthetic outcomes and difficulties of treating patients. The opposite maybe true for laypeople; this disparity between what is achievable by professionals and what is expected by laypeople may be a source of dissatisfaction in facial appearance outcome. Further well-designed studies should be carried out to address this question and the clinical significance of the difference in rating scores for patients with CLP.
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Affiliation(s)
- Shiwen Zhu
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Jayakumar Jayaraman
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Balvinder Khambay
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
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Pausch NC, Unger C, Pitak-Arnnop P, Subbalekha K. Nasal appearance after secondary cleft rhinoplasty: comparison of professional rating with patient satisfaction. Oral Maxillofac Surg 2016; 20:195-201. [PMID: 27106142 DOI: 10.1007/s10006-016-0555-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to compare professional rating and patient satisfaction of nasal appearance after secondary cleft rhinoplasty. METHOD We used a cross-sectional study design and enrolled German adults with nonsyndromic unilateral or bilateral cleft lip and/or palate (UCLP and BCLP, respectively) undergoing secondary cleft rhinoplasty from January 2001 to December 2013. The predictor variable was professional rating. The outcome variable was patient satisfaction with postoperative nasal aesthetics. Other study variables included patient age and gender, type of surgery, and patient rating of nasal function. Appropriate descriptive and univariate statistics were computed, and a P value of <0.05 was regarded as statistically significant. Inter-rater reliability was assessed by the use of Cohen's kappa coefficient. RESULTS The study sample consisted of 242 adult cleft patients of mean age of 22.1 ± 9.2 years (range 14-64), including 97 females (40 %) and 176 unilateral clefts (73 %). Most of the patients reported good function (82 %) and good aesthetics (74 %). The main professional rating was good aesthetics (65 %). Analysis of inter-observer reliability revealed significant differences between patient satisfaction and professional assessment (κ = 0.385; P < 0.0001). CONCLUSIONS Although most of the patients were satisfied with the functional and aesthetic results of secondary cleft rhinoplasty, patient self-assessment of nasal appearance differed from professional assessment.
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Affiliation(s)
- Niels Christian Pausch
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany.
| | - Carolin Unger
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Poramate Pitak-Arnnop
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Kiel, Kiel, Germany
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Kocher K, Kowalski P, Kolokitha OE, Katsaros C, Fudalej PS. Judgment of Nasolabial Esthetics in Cleft Lip and Palate Is Not Influenced by Overall Facial Attractiveness. Cleft Palate Craniofac J 2015; 53:e45-52. [PMID: 25932752 DOI: 10.1597/14-019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine whether judgment of nasolabial esthetics in cleft lip and palate (CLP) is influenced by overall facial attractiveness. DESIGN Experimental study. SETTING University of Bern, Switzerland. SUBJECTS AND METHODS Seventy-two fused images (36 of boys, 36 of girls) were constructed. Each image comprised (1) the nasolabial region of a treated child with complete unilateral CLP (UCLP) and (2) the external facial features, i.e., the face with masked nasolabial region, of a noncleft child. Photographs of the nasolabial region of six boys and six girls with UCLP representing a wide range of esthetic outcomes, i.e., from very good to very poor appearance, were randomly chosen from a sample of 60 consecutively treated patients in whom nasolabial esthetics had been rated in a previous study. Photographs of external facial features of six boys and six girls without UCLP with various esthetics were randomly selected from patients' files. Eight lay raters evaluated the fused images using a 100-mm visual analogue scale. Method reliability was assessed by reevaluation of fused images after >1 month. A regression model was used to analyze which elements of facial esthetics influenced the perception of nasolabial appearance. RESULTS Method reliability was good. A regression analysis demonstrated that only the appearance of the nasolabial area affected the esthetic scores of fused images (coefficient = -11.44; P < .001; R(2) = 0.464). The appearance of the external facial features did not influence perceptions of fused images. CONCLUSION Cropping facial images for assessment of nasolabial appearance in CLP seems unnecessary. Instead, esthetic evaluation can be performed on images of full faces.
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Chung EH, Borzabad-Farahani A, Yen SLK. Clinicians and laypeople assessment of facial attractiveness in patients with cleft lip and palate treated with LeFort I surgery or late maxillary protraction. Int J Pediatr Otorhinolaryngol 2013; 77:1446-50. [PMID: 23871270 PMCID: PMC3943337 DOI: 10.1016/j.ijporl.2013.05.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 05/28/2013] [Accepted: 05/31/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the changes in the facial attractiveness (FA) in two groups of cleft lip and palate patients with Class III malocclusions treated using LeFort I surgery or late maxillary protraction. MATERIALS AND METHODS Standardized pre- and post-treatment photographs were taken of 32 patients (17 corrected by orthognathic surgery and 17 by late maxillary protraction). The photographs were randomized and 42 clinicians and 121 laypeople rated them on a 10-point FA scale via a web-based survey. RESULTS Clinicians' mean FA values increased from 4.45 to 5.16 [95% CI of mean difference (MD), 0.59-0.82, p<0.001] in surgical cases and 4.84 to 5.30 (95% CI of MD, 0.35-0.56, p<0.001) in protraction cases. The laypeople mean FA values increased from 5.07 to 5.54 (95% CI of MD, 0.40-0.53, p<0.001) in surgical cases and 5.51 to 5.68 (95% CI of MD, 0.11-0.23, p<0.001) in protraction cases. When patients combined, laypeople rated FA 0.64 points higher (95% CI, 0.54-0.74, p<0.001) in pre-treatment and 0.38 points higher (95% CI, 0.27-0.48, p<0.05) in post-treatment relative to clinicians. CONCLUSION Both clinicians and laypeople perceived an improvement of FA after both treatments. Laypeople rated FA higher compared to clinicians.
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Affiliation(s)
- Eun Hee Chung
- Formerly, Pediatric Dentistry, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Ali Borzabad-Farahani
- Orthodontics, Warwick Dentistry, Warwick Medical School, University of Warwick, Coventry, UK; Formerly, Craniofacial Orthodontics, Children’s Hospital of Los Angeles; Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
| | - Stephen L-K Yen
- Craniofacial Orthodontics, Children’s Hospital of Los Angeles; Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, USA
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