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Al-Hassani M, Fowler P, Wren Y, Leary S, Davies A. Should left- and right-sided unilateral cleft lip and palate patients be grouped together when reporting the outcomes? Orthod Craniofac Res 2024; 27 Suppl 1:49-61. [PMID: 38193240 DOI: 10.1111/ocr.12747] [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] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Investigate associations between cleft laterality in patients with non-syndromic unilateral cleft lip and palate (UCLP) and oral-health, dental-arch, speech, audiological, psychological and nasolabial-aesthetic outcomes. METHODS Secondary data analysis of the outcomes of 5-year-old children with non-syndromic complete UCLP identified from three studies: Cleft Collective (n = 155), Cleft Care UK (CCUK) (n = 266) and Clinical Standards Advisory Group (CSAG) study (n = 238). Outcome measures included occlusal assessment using the 5-year-old's index score, speech intelligibility rating using the CAPS-A Audit tool, audiological assessment using pure tone audiometry, nasolabial aesthetic assessment using the Asher-McDade tool, oral-health assessment using decayed, missing, filled teeth scores and parent-reported outcomes. Logistic regression with adjustment for age, sex and index-of-multiple-deprivation scores were performed. RESULTS No differences were found in patient-reported outcomes between the left and right clefts in the Cleft Collective study. From the CCUK study, right clefts had poorer speech (n = 236; 95% CI 1.09, 3.42; and P = .03) and hearing outcomes (n = 211; 95% CI 1.03, 3.43; P = .04). In the CSAG study, patients with left clefts were more likely to be teased (n = 213; 95% CI 0.26, 0.85; and P = .01). CONCLUSION Weak associations between cleft laterality, speech, hearing and psychological outcomes were found, however the findings were inconsistent across the studies. This study contributes to evidence of associations between laterality and outcomes in children born with UCLP.
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Fowler PV, Keall H, Kennedy D, Healey D, Thompson JMD. Cleft Laterality Dental Arch Relationship Outcomes for Children with Unilateral Cleft Lip and Palate in New Zealand. Cleft Palate Craniofac J 2024:10556656241234599. [PMID: 38414360 DOI: 10.1177/10556656241234599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To investigate cleft laterality dental arch relationship outcomes of children with non-syndromic complete unilateral cleft lip and palate (UCLP) in New Zealand. DESIGN A retrospective nationwide study. SETTINGS Virtual 3D orthodontic study models collected prior to undertaking secondary alveolar bone grafting. PARTICIPANTS A total of 104 patients with UCLP (L = 80: R = 24). OUTCOME MEASURES Four calibrated assessors used the GOSLON Yardstick and 100 mm Visual Analogue Scale (VAS) to score the randomised models on 2 separate assessment sessions. Weighted Kappa were used to determine the intra/inter-rater reliability for the GOSLON and correlations for the VAS. RESULTS Intra-rater reliability ranged from 0.57-0.88 (GOSLON) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62-0.86 (GOSLON) and 0.64-0.93 (VAS).GOSLON scores for the left UCLP were 31.2% for good/very good; 26.3% for fair; 42.5% for poor/very poor while the right UCLP scored 8.3% for good/very good; 37.5% for fair; 54.2% for poor/very poor. The mean VAS for left and right UCLP were 53.4 (sd 22.5) and 44.6 (sd 17.1) respectively. Neither the GOSLON nor VAS differences reached statistical significance (both P = .08). CONCLUSIONS From a clinical perspective right UCLP had worse dental arch relationship outcomes, however, these differences failed to reach statistical significance. Further studies using larger sample sizes are required to determine if cleft laterality is an important consideration when investigating UCLP dental arch outcomes.
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Affiliation(s)
- Peter V Fowler
- Department of Oral Sciences, University of Otago Dental School, Dunedin, New Zealand
| | - H Keall
- Formerly Hospital Dental Department, Middlemore Hospital, Auckland, New Zealand
| | - D Kennedy
- Hospital Dental Department, Middlemore Hospital, Auckland, New Zealand
| | - D Healey
- Formerly School of Dentistry, University of Queensland, Brisbane, Australia
| | - J M D Thompson
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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Fell M, Bradley D, Chadha A, Butterworth S, Davies A, Russell C, Richard B, Wren Y, Lewis S, Chong D. Sidedness in Unilateral Orofacial Clefts: A Systematic Scoping Review. Cleft Palate Craniofac J 2023:10556656231221027. [PMID: 38092732 DOI: 10.1177/10556656231221027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE An overview of the literature relating to the sidedness of unilateral cleft lip with or without cleft palate to map current knowledge on the cause and impact of directional asymmetry. DESIGN Scoping review with a systematic search of Medline and Embase from inception to May 2023. PATIENTS, PARTICIPANTS Humans born with a left or right unilateral cleft lip with or without a cleft palate. MAIN OUTCOME MEASURES Cleft sidedness as a co-occurrence, an outcome or an exposure. RESULTS Forty studies were eligible for inclusion and confirmed the predilection for the occurrence of left sided cleft lips; 12 studies reported cleft sidedness co-occurring with another phenotype, 11 studies report sidedness as an outcome and 17 studies as an exposure. Phenotypes which were reported to co-occur with either left or right sided clefts included congenital dental anomalies, handedness and additional congenital anomalies. Variables investigated as a potential cause of left or right sided clefts as an outcome included chromosomal anomalies, genetic variants and environmental factors. Outcomes investigated in relation to cleft sidedness as an exposure included facial anatomical features, facial growth, educational attainment, functional and psychological characteristics. More studies showed worse outcomes in right sided clefts versus left sided clefts than vice versa, although studies were inconsistent, and a quality assessment was not performed. CONCLUSIONS The field of cleft sidedness research is expanding and there are promising early findings to differentiate cause and outcome by sidedness of the cleft.
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Affiliation(s)
- Matthew Fell
- Spires Cleft Centre, John Radcliffe Hospital, Oxford, UK
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, UK
| | | | - Ambika Chadha
- Cleft.Net.East, University of Cambridge NHS Hospitals Trust, Cambridge, UK
- Department of Perinatal Imaging and Health, Kings College London & South Thames Cleft Service, St. Thomas Hospital, London, UK
| | - Sophie Butterworth
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Amy Davies
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, UK
| | - Craig Russell
- Cleft Care Scotland, Royal Hospital for Children, Queen Elizabeth University Hospital, Glasgow, UK
| | - Bruce Richard
- West Midlands Cleft Service, Birmingham Women and Children's Hospital, Birmingham, UK
| | - Yvonne Wren
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, UK
- Speech and language therapy research unit, North Bristol NHS Trust, Bristol, UK
| | - Sarah Lewis
- The Cleft Collective, Bristol Dental School, University of Bristol, UK
| | - David Chong
- Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Melbourne, Australia
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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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Chadha A, Bradley D, Fell M, Fernanda M, Bustamante A, Chong D. The Implications of Laterality in Unilateral Cleft Lip Reconstruction: A Global Survey of Cleft Surgeons. Cleft Palate Craniofac J 2023:10556656231181904. [PMID: 37448302 DOI: 10.1177/10556656231181904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To explore the impact of directional laterality in complete Unilateral Cleft Lip (UCL) amongst the global cleft surgeon community. DESIGN Cross-sectional survey study. SETTING Global distribution of online survey distributed in English and Spanish. PARTICIPANTS Cleft surgeons from around the world. MAIN OUTCOME MEASURES Survey participant perception of the impact of laterality on: (1) cleft presentation (2) surgical challenge and (3) surgical outcomes. RESULTS Responses were received from 453 cleft surgeons located in 54 countries around the world. 221 (49%) had previously considered differences in patients presenting with a left- versus right-sided UCL. 95 (21%) considered right-sided clefts more difficult to reconstruct, 37 (8%) reported left-sided clefts to be more difficult and 321 (71%) reported no difference in difficulty between the cleft sides. Higher volume cleft surgeons, characterised by those reporting cleft as their principal area of practice and performing >20 cleft operations per year, were more likely to have both previously considered differences in laterality in cleft and to report right-sided unilateral cleft lip to be more difficult to primarily reconstruct. 395 (87%) did not consider surgical outcomes to be influenced by cleft laterality. CONCLUSIONS This survey reports perceptions on cleft laterality from a large body of global surgeons and suggests a trend for increased difficulty in right-sided compared to left-sided cleft lip reconstruction, where such laterality-associated difficulty is perceived.
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Affiliation(s)
- Ambika Chadha
- Training Interface Group (TIG) Fellow in Cleft Lip & Palate, University of Cambridge NHS Hospitals Trust, Cambridge, UK
- PhD Candidate, Department of Perinatal Imaging and Health, Kings College London & South Thames Cleft Service (St. Thomas Hospital, London, UK)
| | - Daniel Bradley
- Global Surgery Fellow, Operation Smile Inc., Virginia Beach, Virginia, USA
| | - Matthew Fell
- Cleft and Craniofacial Fellow, The Royal Children's Hospital, Melbourne, Australia
- Honorary Research Fellow, Cleft Collective, University of Bristol, Bristol, UK
- Trustee, CLEFT Charity (www.cleft.org.uk)
| | - Maria Fernanda
- Plastic Surgeon & Global Surgery Fellow, Operation Smile Inc., Bolivia & Colombia
| | | | - David Chong
- Consultant in Plastic Surgery, Consultant in Cleft & Craniofacial Surgery, Associate Professor, The Royal Children's Hospital, Melbourne, Australia
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Talwar A, Duggal I, Duggal R, Chaudhari PK, Samrit V. Nasolabial appearance in unilateral cleft lip and palate patients: A comparison of aesthetics using two scoring systems: A cross-sectional study. Orthod Craniofac Res 2023; 26:46-52. [PMID: 35362657 DOI: 10.1111/ocr.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/10/2022] [Accepted: 03/27/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective of the study was to assess nasolabial aesthetics in patients with complete unilateral cleft lip, with or without cleft palate (UCL ± P) using two scoring systems. DESIGN A cross-sectional study conducted in a tertiary care government hospital. PATIENTS Photographic records of 91 patients with complete UCL ± P from the age group of 5-18 years (mean age = 13.2 ± 3.14 years) were included. METHOD A panel of three orthodontists with varying experience in cleft management rated nasolabial aesthetics using two scoring systems, that is Asher Mc-Dade index (AMAI) and Cleft Aesthetic Rating Scale (CARS). Intraclass correlation coefficient, Fleiss' kappa and Cronbach's alpha were used to measure the internal consistency amongst three raters and Spearman-Brown formula was used for measuring overall reliability. Time required for assessment of each photograph was compared with ANOVA. RESULTS Overall, both AMAI and CARS showed high reliability and outcome assessment with good inter-rater reliability and internal consistency, when used independently by orthodontists having varied experience. Statistically significant difference was present in time taken for assessment of nasolabial aesthetics with CARS index (8.75 ± 1.65 seconds) as compared to AMAI (18.62 ± 3.49 seconds). CONCLUSION Asher Mc-Dade index and CARS are equally reliable and consistent for the assessment of nasolabial aesthetics in patients with UCL ± P. However, considerably less time was taken for the assessment using CARS index as compared to AMAI. The use of CARS index is recommended for the initial assessment and screening of patients by orthodontists using two dimensional photographs.
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Affiliation(s)
- Aditya Talwar
- Division of Orthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Isha Duggal
- 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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Maggiulli F, Hinton C, Simpson L, Gujral S, Hardwicke J, Slator R, Pigott R, Su T, Richard B. Lip symmetry following rotation advancement cleft lip repair in 5-year-old children treated by Ralph Millard and Ron Pigott. JPRAS Open 2022; 33:145-154. [PMID: 35928808 PMCID: PMC9343930 DOI: 10.1016/j.jpra.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the symmetry of the lip following Rotation-Advancement cleft lip repair by Millard and Pigott and to investigate the effect on the symmetry of cleft side and gender by using different surgical protocols. Symmetry following cleft surgery was compared to that of non-cleft children. Design Retrospective study of photographs of children aged 5 years. Setting Three decades of post-operative photographs of children treated by Millard and Pigott. Patients Eighty-nine children treated by Millard, 87 by Pigott and 91 non-cleft children. Interventions Photographs were assessed using the Symnose Computer program, a rapid semi-objective quantitative assessment of lip symmetry. Main Outcome Measure(s) Asymmetry score for each surgeon, and non-cleft children. Results There was no significant difference in the median lip % mismatch score of Millard, 36.65% and Pigott, 38.52%. Right-sided clefts showed better symmetry than left-sided clefts for Millard (p<.001). This was reversed for Pigott (P=.0121). There was a difference (P<.001) between the symmetry of the two cleft cohorts and the non-cleft children (asymmetry 19.9%), and between Millard's outcomes following different lip surgical protocols (P < .0001), but no difference between Pigott's outcomes using different palate surgical protocols (P = 0.59). Conclusions Cleft lip repair by Millard and Pigott resulted in similar lip asymmetry (37% and 39% symmetry mismatch, respectively). Lip surgical protocol and cleft side may affect lip asymmetry. Palate surgery did not affect lip asymmetry. Following cleft surgery, children were more asymmetric than non-cleft children.
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9
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Comparison of Presurgical Anthropometric Measures of Right and Left Complete Unilateral Cleft Lip and/or Palate. Plast Reconstr Surg 2022; 149:248e-253e. [PMID: 35077422 DOI: 10.1097/prs.0000000000008769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left clefts occur twice as frequently as right ones. The sidedness has been suggested to influence certain outcomes. Some surgeons consider a right cleft more challenging to repair. This is often attributed to their reduced prevalence. The authors question whether this may be caused by morphologic differences. The authors' hypothesis is that there are anthropometric differences between left and right complete cleft lips. METHODS Patients with complete unilateral cleft lip, with or without cleft palate, operated on at the age of 3 to 6 months, between 2000 and 2018, by a single surgeon, were included. Eight standardized anthropometric measurements of the cleft lip, collected just before cleft lip repair, compare lip and vermillion dimensions and ratios between left and right clefts. RESULTS One hundred thirty-nine left and 80 right unilateral cleft lips were compared. A significant difference was found between left and right clefts for cleft-side to non-cleft-side ratios comparing the lateral lip element vertical heights and vermillion heights. CONCLUSIONS Patients with right cleft lips have a greater degree of lateral lip element hypoplasia, demonstrating greater deficiencies of lateral lip element vertical height and vermillion height when compared to patients with left clefts. This has clinical implications for preoperative assessment, choice of surgical technique, and postoperative and long-term outcomes.
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Prasad V, Moungkhom P, Singh A, Mishra B, Upadhyay D. Assessment of mandibular symmetry in cleft lip and cleft palate patients. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2022. [DOI: 10.4103/jclpca.jclpca_37_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mulder FJ, Mosmuller DGM, de Vet HCW, Mouës CM, Breugem CC, van der Molen ABM, Don Griot JPW. The Cleft Aesthetic Rating Scale for 18-Year-Old Unilateral Cleft Lip and Palate Patients: A Tool for Nasolabial Aesthetics Assessment. Cleft Palate Craniofac J 2018; 55:1006-1012. [PMID: 27996297 DOI: 10.1597/16-123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To develop a reliable and easy-to-use method to assess the nasolabial appearance of 18-year-old patients with unilateral cleft lip and palate (CLP). DESIGN Retrospective analysis of nasolabial aesthetics using a 5-point ordinal scale and newly developed photographic reference scale: the Cleft Aesthetic Rating Scale (CARS). Three cleft surgeons and 20 medical students scored the nasolabial appearance on standardized frontal photographs. SETTING VU University Medical Center, Amsterdam. PATIENTS Inclusion criteria: 18-year-old patients, unilateral cleft lip and palate, available photograph of the frontal view. EXCLUSION CRITERIA history of facial trauma, congenital syndromes affecting facial appearance. Eighty photographs were available for scoring. MAIN OUTCOME MEASURES The interobserver and intraobserver reliability of the CARS for 18-year-old patients when used by cleft surgeons and medical students. RESULTS The interobserver reliability for the nose and lip together was 0.64 for the cleft surgeons and 0.61 for the medical students. There was an intraobserver reliability of 0.75 and 0.78 from the surgeons and students, respectively, on the nose and lip together. No significant difference was found between the cleft surgeons and medical students in the way they scored the nose ( P = 0.22) and lip ( P = 0.72). CONCLUSIONS The Cleft Aesthetic Rating Scale for 18-year-old patients has a substantial overall estimated reliability when the average score is taken from three or more cleft surgeons or medical students assessing the nasolabial aesthetics of CLP patients.
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Rajpara Y, Shyagali TR. An assessment of sexual dimorphism in relation to facial asymmetry in esthetically pleasing faces. Acta Inform Med 2015; 23:44-8. [PMID: 25870491 PMCID: PMC4384877 DOI: 10.5455/aim.2015.23.44-48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/12/2015] [Indexed: 11/18/2022] Open
Abstract
Objective: The aim of the study is to detect gender-wise difference in the skeletal asymmetry in the esthetically pleasing faces. Materials and methods: a cross sectional study was conducted on 25 females and 25 males of age 18 -25 years using the posterior-anterior cephalograms. The selected part of grummon’s frontal analysis for analyzing the vertical skeletal asymmetries, mandibular morphology, transverse asymmetry and mandibular deviation was used. The obtained data was subjected to independent student’s‘t’ test for comparing the difference between males and females. Results: there was statistically significant difference between the males and females for the measurements like Gonion-Menton length for the mandibular morphology and for the transverse parameters like zygomatico frontal suture length, jular length and antegonial notch length. There was no significant difference for the sidedness of asymmetry for the males and females. Conclusion: frontal facial asymmetry showed sexual dimorphism with males showing greater asymmetric values than the females. The asymmetry showed right sided prominence for both the males and females. This knowledge can be utilized for planning facial reconstruction and remodeling surgeries.
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Affiliation(s)
- Yagnesh Rajpara
- Department of Orthodontics and Dentofacial Orthopedics, Goneka Research Institute of Dental Sciences, Gandhinagar, Gujarat, India
| | - Tarulatha R Shyagali
- Department of Orthodontics and Dentofacial Orthopedics, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
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Investing in a surgical outcomes auditing system. PLASTIC SURGERY INTERNATIONAL 2013; 2013:671786. [PMID: 23401763 PMCID: PMC3562677 DOI: 10.1155/2013/671786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/19/2012] [Indexed: 11/17/2022]
Abstract
Background. Humanitarian surgical organizations consider both quantity of patients receiving care and quality of the care provided as a measure of success. However, organizational efficacy is often judged by the percent of resources spent towards direct intervention/surgery, which may discourage investment in an outcomes monitoring system. Operation Smile's established Global Standards of Care mandate minimum patient followup and quality of care. Purpose. To determine whether investment of resources in an outcomes monitoring system is necessary and effectively measures success. Methods. This paper analyzes the quantity and completeness of data collected over the past four years and compares it against changes in personnel and resources assigned to the program. Operation Smile began investing in multiple resources to obtain the missing data necessary to potentially implement a global Surgical Outcomes Auditing System. Existing personnel resources were restructured to focus on postoperative program implementation, data acquisition and compilation, and training materials used to educate local foundation and international employees. Results. An increase in the number of postoperative forms and amount of data being submitted to headquarters occurred. Conclusions. Humanitarian surgical organizations would benefit from investment in a surgical outcomes monitoring system in order to demonstrate success and to ameliorate quality of care.
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Bermudez L, Carter V, Magee W, Sherman R, Ayala R. Surgical outcomes auditing systems in humanitarian organizations. World J Surg 2011; 34:403-10. [PMID: 19838753 DOI: 10.1007/s00268-009-0253-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Operation Smile is a humanitarian volunteer-based organization that provides cleft care around the world. Successful primary surgery is the key to improving the quality of life of patients with oral clefts. A cleft surgery outcomes database and evaluation system has been developed and implemented. METHODS During Operation Smile's "World Journey of Smiles" in November 2007, a total of 4100 patients were operated on during a 10-day period at 40 simultaneous missions in 25 countries. Photographs taken before surgery, right after surgery, and at the follow-up consultations were entered in a database and used as media to evaluate surgical outcomes objectively by independent unbiased evaluators. Data about complications collected during the postoperative consultations were also entered. RESULTS A postoperative consultation, 6 months to 1 year after surgery was conducted at 24 sites, 19 of which sent back postoperative images; and most returned postoperative examination forms. At those 19 sites, 703 of 1917 patients returned for a 6- to 9-month postoperative visit, for a 36.67% return rate. After matching before and after pictures, 562 patients were able to be entered into the database, allowing 580 procedures to be evaluated. Feedback reports have been sent to 134 volunteer surgeons around the world. Results were compared among sites and locations; and the places where future actions were needed to improve the quality of surgery were identified. CONCLUSIONS The current outcomes evaluation system has proven beneficial in tracking patient outcomes, auditing surgical performance, and providing feedback to surgeons and other team members. Challenges are discussed.
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Affiliation(s)
- Luis Bermudez
- Operation Smile, Inc., 6435 Tidewater Drive, Norfolk, VA 23509, USA.
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15
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Al-Omari I, Millett DT, Ayoub AF. Methods of assessment of cleft-related facial deformity: a review. Cleft Palate Craniofac J 2005; 42:145-56. [PMID: 15748105 DOI: 10.1597/02-149.1] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To review the stimulus media, measurements and scoring system, rater's characteristics, and facial region used in assessment of the appearance of cleft-related deformity. METHODS A review of the literature was conducted using MedLine from January 1966 to June 2003. Key orthodontic journals and The Cleft Palate-Craniofacial Journal were hand searched as well. RESULTS Most studies used a static two-dimensional means of assessment. Direct clinical assessment, three-dimensional media, or both have been used to a lesser extent. Only one study utilized all three assessment media. Three studies, however, attempted to compare the direct clinical assessment with that obtained using two-dimensional media. Most of the studies demonstrated that appearance of the cleft-related deformity could be measured by a variety of judges. The reliability and validity of the three different media as methods of assessment have received limited attention. The facial area assessed has varied from the full face, nasolabial area, or specific features of the lip or nose. CONCLUSIONS Wide variation exists in the study design related to assessment of cleft-related deformity. An internationally agreed objective method of assessment for this facial deformity is required. A three-dimensional, rather than a two-dimensional, means of assessment should be adopted.
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Affiliation(s)
- I Al-Omari
- University of Jordan Dental School, Amman, Jordan
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Al-Omari I, Millett DT, Ayoub A, Bock M, Ray A, Dunaway D, Crampin L. An appraisal of three methods of rating facial deformity in patients with repaired complete unilateral cleft lip and palate. Cleft Palate Craniofac J 2003; 40:530-7. [PMID: 12943433 DOI: 10.1597/1545-1569_2003_040_0530_aaotmo_2.0.co_2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the reliability of clinical assessment, two-dimensional color transparencies and three-dimensional imaging for evaluating the residual facial deformity in patients with repaired complete unilateral cleft lip and palate (UCLP) and compare the ratings of facial deformity made by health care professionals with those made by lay assessors. PATIENTS AND PARTICIPANTS Thirty-one randomly selected subjects aged 10 to 30 years with repaired complete UCLP. Five professionals and five laypersons evaluated each subject's residual cleft-related facial deformity using clinical assessment, two-dimensional color transparencies, and three-dimensional images. MAIN OUTCOME MEASURES The facial deformity of the full face, lip, nose, and midface were scored using a 5-point ordinal scale on two occasions with a 1-month interval. Intra- and interexaminer agreements were calculated from weighted kappa statistics. Bootstrap permutation tests were used to detect any differences in agreement. RESULTS Assessment of facial deformity showed good reproducibility across the three assessment media (kappa = 0.42 to 0.83, SE 0.08). Clinical assessment among lay assessors, however, was poor to moderate (kappa = 0.16 to 0.58, SE 0.07). For all assessors, there was no difference in the two nonclinical media relative to the standard clinical assessment for assessments of the full face (p =.377). For assessments of the lip or nose, transparency scores were in greater agreement with the clinical scores than were the three-dimensional assessment scores (p =.017 and.011, respectively). For rating the midface, the three-dimensional scores were in greater agreement with the clinical scores than were the color transparencies scores (p =.047). CONCLUSIONS In comparison with lay assessors, clinical assessment among professionals was more reproducible. This was not so for nonclinical media. The equivalence of using the color transparencies and three-dimensional media relative to the clinical assessment depends on the region of the face being considered.
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Affiliation(s)
- I Al-Omari
- Orthodontics, University of Glasgow Dental School, Glasgow, United Kingdom
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Terwee CB, Dekker FW, Bonsel GJ, Heisterkamp SH, Prummel MF, Baldeschi L, Wiersinga WM. Facial disfigurement: is it in the eye of the beholder? A study in patients with Graves' ophthalmopathy. Clin Endocrinol (Oxf) 2003; 58:192-8. [PMID: 12580935 DOI: 10.1046/j.1365-2265.2003.01695.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The importance of facial disfigurement in many diseases necessitates a reliable and valid measure of disfigurement severity for clinical studies. The hypothesis is that a universal concept of disfigurement exists and can be measured in a reliable way. The objectives of this study were to investigate if persons, in particular patients and physicians, can agree on facial disfigurement severity; and to determine the relative contribution of predefined clinical characteristics of patients with Graves' ophthalmopathy (GO) to the overall rating of facial disfigurement severity. DESIGN A panel study was carried out in four different panels, each consisting of four members. PATIENTS We randomly selected 100 slide pairs of GO patients from four available study populations, involving mild, moderate and severe GO patients (mean age 49 years, 76% female) who were treated with either radiotherapy, sham-irradiation, prednisone or orbital decompression. MEASUREMENTS All panel members individually scored the disfigurement severity of 100 GO patients shown on standardized slides on a Visual Analog Scale. In total, 1600 ratings were collected. We calculated within- and between-panel agreement of disfigurement severity and identified determinants of disfigurement. RESULTS Agreement within a panel varied from 0.65 to 0.79 and was highest within the panel of ophthalmologists. Between-panel agreement was 0.67 and was highest between ophthalmologists and laypersons. Compared with the global average, patients overrated and endocrinologists underrated disfigurement severity. Female panellists rated the patients, on average, more disfigured than male panellists. Important determinants of disfigurement were eyelid retraction, severe eyelid swelling and proptosis. Their relative importance was consistent across panels and in contrast to current measures of GO severity. CONCLUSION Facial disfigurement severity can be measured in a reliable way using panels of panellists. Except for some systematic differences between panellists, facial disfigurement does not seem to be in the eye of the beholder.
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Affiliation(s)
- Caroline B Terwee
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Institute for Research in Extramural Medicine, Amsterdam, the Netherlands.
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