Comparison of Two Scoring Systems in the Assessment of Nasolabial Appearance in Cleft Lip and Palate Patients

Abstract

The 2 tested systems are equivalent in their reliability and outcome. The lip is dominating in the overall scorings. It is advocated to use the 5-point scale without the use of a reference photograph and to assess the lip and nose separately.

Nasolabial Aesthetics Following Cleft Repair: An Objective Evaluation of Subjective Assessment

“…Raters used cropped images in the standard views originally described by Asher-McDade for rating, while uncropped images were used for overall subjective ranking of aesthetic outcomes, which might lead to rater bias in rating and ranking images, as mixed evidence exists regarding whether nasolabial aesthetic rating is affected by overall facial attractiveness or image cropping (Kocher et al, 2016; Schwirtz et al, 2018). Although we utilized the Asher-McDade scale for rating nasolabial aesthetic outcomes given its popularity, widespread adoption, and use in The Eurocleft and Americleft studies, conflicting evidence exists regarding the ideal rating system, despite previous studies comparing the Asher-McDade scale to others (Mosmuller et al, 2014; Fudalej et al, 2017). Finally, our study relied on evaluations by expert cleft practitioners with significant experience in treating patients with cleft lip and/or palate.…”

“…In 1991, Asher-McDade et al developed a standardized rating system for this purpose, which remains popular among cleft practitioners to this date, and has undergone multiple refinements and modifications since its introduction (Asher-McDade et al, 1991; Rowett et al, 2016). Other popular methods aimed at quantifying nasolabial aesthetics include the Cleft Aesthetic Rating scale, the cleft lip evaluation profile, visual analog scales, reference scores methods, and simplified versions of visual analog scales (Prahl et al, 2006; Ohannessian et al, 2011; Mosmuller et al, 2014; Fudalej et al, 2017; Mosmuller et al, 2017). Importantly, these different methods and scales rely on diverse parameters and items to assess postoperative nasolabial aesthetics, and despite comparative studies evaluating them, the optimal approach to nasolabial assessment remains to be determined, highlighting the subjective nature of the task (Mosmuller et al, 2014; Fudalej et al, 2017).…”

Response to “Concerning the Article Entitled ‘Judgment of Nasolabial Esthetics in Cleft Lip and Palate is not Influenced by Overall Facial Attractiveness’”

“…Second, comments regarding our statistical methods are rather surprising because we followed the recommendation of (Mosmuller et al 2013) who advocated “calculating the interobserver and intraobserver reliability [with ICC] in combination with the Cronbach”. Moreover, we find the remark that “the very high ICC (0.90) in this study needs to be questioned” as completely inappropriate in the light of arguments of Mosmuller et al (in press).…”

“…The authors claim that-based on their own experience and earlier publications-“it is very unlikely the interobserver reliability is this high when eight different observers judge 72 photographs with a visual analog scale”. However, three systematic reviews (Al-Omari et al, 2005; Sharma et al, 2012; Mosmuller et al, 2013) showed that no study focusing on assessment of the nasolabial area in subjects with UCLP used visual analogue scale (VAS) and ICC for evaluation of rater reliability. In addition, (Mosmuller et al 2014, 2015) did not use VAS in their studies; instead, they applied a 5-point Likert-type scale and 200-point numerical scale in their works.…”

Defining the Aesthetic Range of Normal Symmetry for Lip and Nose Features in 5-Year-Old Children Using the Computer-Based Program SymNose

“…The aesthetic assessment is commonly performed on 2-dimensional (2D) photographs using some form of the Asher-McDade system with a 5-point Likert scale ranging from “excellent” to “very poor” (Asher-McDade et al, 1991). However, the inter- and intrarater reliability of this scoring system remains only moderately reliable and is only slightly improved by using reference photographs (Kuijpers-Jagtman et al, 2009; Mercado et al, 2015) or assessment of discrete lip and nose (Mosmuller et al, 2014; Deall et al, 2016).…”