Scoring Systems of Cleft-Related Facial Deformities: A Review of Literature

Mosmuller, David G. M.; Griot, J. Peter W. Don; Bijnen, C.L.; Niessen, Frank B.

doi:10.1597/11-207

Cited by 56 publications

(59 citation statements)

References 65 publications

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“…Depending on the complexity of the pathology, CL/P patients require a multidisciplinary approach in order to ameliorate functional, social and psychological aspects of their life. Generally, patients are longitudinally submitted to several types of treatments, comprising orthopedic and surgical procedures [2,3]. In particular, the orthopedic treatment, performed with active and passive acrylic plates, can help to align the cleft segments and facilitate surgery [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Palatal Volume Changes in Unilateral Cleft Lip and Palate Paediatric Patients

Pucciarelli¹,

Pisoni²,

Menezes³

et al. 2015

Proceedings of the 6th International Conference on 3D Body Scanning Technologies, Lugano, Switzerland, 27-28 October 2015

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Cleft lip and/or palate (CL/P) are the most common craniofacial abnormalities. CL/P therapy involves also orthopedic and surgical treatments. In particular, the orthopedic treatment can help to align the cleft segments and facilitate surgery. Traditionally, facial and palatal structures have been analyzed by 2D methods, omitting information of volume bone defects. A pre-surgical volume estimation can be useful to determine the anatomical boundaries of the alveolar bone defect; subsequently, volume assessments can appreciate the outcome of secondary alveolar bone grafting. In the present study, we developed a 3D stereophotogrammetric technique for volume estimation of the dental arches of children with CL/P. The method was employed to assess the 3D changes occurring in the maxillary arch of unilateral CLP (UCLP) patients with the use of plates before the first year of life. We collected 96 palatal casts of 32 neonatal patients with UCLP. Palatal casts were obtained before orthopedic treatment, before cheiloplasty, and after cheiloplasty. Half patients were treated with an active plate, half with a passive one. Casts were marked with a set of landmarks, digitized using a stereophotogrammetric system, and then analyzed. Volumes of the greater and the minor alveolar segments were separately assessed, and compared with a 3-w repeated measures ANOVA. Method accuracy was assessed using objects of known size, while repeatability was evaluated using Student's t test and technical error of measurements. Volume estimates were accurate, without systematic errors; random errors were lower than 5% of the total variance. Significant effects of alveolar segment and time were observed (p<0.0001). Instead, no differences were found for the kind of plate. In conclusion, stereophotogrammetric systems can be a valid instrument to estimate palatal volumes of patients with CL/P during treatment, that can be followed up in a safe, rapid and non-invasive way.

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Section: Introductionmentioning

confidence: 99%

Palatal Volume Changes in Unilateral Cleft Lip and Palate Paediatric Patients

Pucciarelli¹,

Pisoni²,

Menezes³

et al. 2015

Proceedings of the 6th International Conference on 3D Body Scanning Technologies, Lugano, Switzerland, 27-28 October 2015

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“… 25 – 28 The Asher-McDade system for evaluating nasolabial appearance has limitations, including subjectivity and imperfect agreement among clinicians. 11 , 13 , 22 , 29 This study’s limited sample also reduced the ability to detect small differences in nasolabial appearance. Whether the study’s results reflect cleft care delivery across North America will need to be determined in future studies with a larger, more diverse sample of patients.…”

Section: Discussionmentioning

confidence: 98%

The Americleft Project

Sitzman¹,

Mara

Long

et al. 2015

Plastic and Reconstructive Surgery - Global Open

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Background:The burden of care for children with cleft lip and palate extends beyond primary repair. Children may undergo multiple secondary surgeries to improve appearance or speech. The purpose of this study was to compare the use of secondary surgery between cleft centers.Methods:This retrospective cohort study included 130 children with complete unilateral cleft lip and palate treated consecutively at 4 cleft centers in North America. Data were collected on all lip, palate, and nasal surgeries. Nasolabial appearance was rated by a panel of judges using the Asher-McDade scale. Risk of secondary surgery was compared between centers using the log-rank test, and hazard ratios estimated with a Cox proportional hazards model.Results:Median follow-up was 18 years (interquartile range, 15–19). There were significant differences among centers in the risks of secondary lip surgery (P < 0.001) and secondary rhinoplasty (P < 0.001). The cumulative risk of secondary lip surgery by 10 years of age ranged from 5% to 60% among centers. The cumulative risk of secondary rhinoplasty by 20 years of age ranged from 47% to 79% among centers. No significant differences in nasolabial appearance were found between children who underwent secondary lip or nasal surgery and children who underwent only primary surgery (P > 0.10).Conclusions:Although some cleft centers were significantly more likely to perform secondary surgery, the use of secondary surgery did not achieve significantly better nasolabial appearance than what was achieved by children who underwent only primary surgery.

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“…Using a continuous VAS to score overcomes these issues and provides greater statistical sensitivity. A recent systematic review concluded that there remained a lack of consensus as to a reliable, validated and reproducible scoring system, a situation that still effectively exists as evidenced by a more recent study of 3D assessment methods which suggested 2D and 3D methods were measuring different nasolabial aspects . Currently, the use of 3D imaging is not common in NZ and as yet there is little methodology data on its assessment worldwide.…”

Section: Discussionmentioning

confidence: 99%

Nasolabial outcomes in a nationwide study of orofacial cleft in New Zealand

Thompson

Stone

Williams

et al. 2019

Orthod Craniofacial Res

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Structured Abstract Objectives To (a) assess nasolabial outcomes across four main cleft subgroups, (b) assess agreement using a categorical and a continuous scoring measure and (c) compare outcomes to international studies. Settings and Sample Population Analysis of 470 images of which 218 was unilateral cleft lip and palate (UCLP), 128 unilateral cleft lip (UCL), 90 bilateral cleft lip and palate (BCLP) and 34 bilateral cleft lip (BCL). Images were taken around five (n = 279) and eight‐ten (n = 191) years of age. Materials & Methods Cropped images were assessed using the Asher‐McDade (AM) and a 100 mm visual analogue scale (VAS) by a panel of six raters. Scoring was undertaken for vermillion border and nasal form, symmetry and profile. Analysis was undertaken for each subscore, a total score with sensitivity analysis using a total score based on the subscores for each patient. AM intra‐ and inter‐rater reliability was assessed using weighted kappa and for the VAS components reliability was assessed using Pearson correlation. Results The AM intra‐rater reliability was moderate/substantial, whilst inter‐rater reliability was fair. The VAS intra‐rater correlations were high, and inter‐rater correlations were moderate. Better outcomes were found with cleft lip (CL) vs cleft lip and palate (CLP). No differences were found for sex, ethnicity, age and cleft laterality (unilateral). The AM found no difference between unilateral or bilateral. The VAS found bilateral scored worse than unilateral for both CL and CLP. Conclusions The nasolabial outcomes differ by cleft type. The correlation was relatively high for the VAS whilst the AM had relatively poor reliability.

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Scoring Systems of Cleft-Related Facial Deformities: A Review of Literature

Cited by 56 publications

References 65 publications

Palatal Volume Changes in Unilateral Cleft Lip and Palate Paediatric Patients

Palatal Volume Changes in Unilateral Cleft Lip and Palate Paediatric Patients

The Americleft Project

Nasolabial outcomes in a nationwide study of orofacial cleft in New Zealand

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