The Asher-McDade Aesthetic Index in Comparison With Two Scoring Systems in Nonsyndromic Complete Unilateral Cleft Lip and Palate Patients

Cleft Lip and Palate (CLP) - a common facial malformation in newborns – is typically corrected by surgical intervention to allow for normal speech development, psychosocial adjustment, and facial attractiveness. The long term treatment outcome can be evaluated after a number of years, possibly in adulthood. We investigated the aesthetics of the nasolabial region by subjective ratings. To compare various surgical approaches we recruited 12 raters to evaluate 429 patients. Expert and lay raters judged photographs from patients, who have completed treatment with one of three different surgical strategies performed in our institution over 50 years. Facial photographs were cropped, presented to the raters in a randomized sequence, and judged by the raters on a 5 point Likert scale. The subjective ratings between the raters revealed a fair to substantial inter-rater reliability. The average ratings of the surgical outcome improved continuously over the investigated 5 decades. Despite possible differences between raters and rater groups this overall result was consistently seen in the gender groups (male/female), or expertise related groups (expert/lay). Our analysis revealed that patients with bilateral CLP scored worse than patients with unilateral CLP when treated in the fifties; more recently treated patients of both groups scored similarly.

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“…According to Mosmuller et al . 24 , this is a reliable and cheap method to rate treatment outcomes non-invasively.…”

Section: Discussionmentioning

confidence: 99%

Facial Aesthetics in Young Adults after Cleft Lip and Palate Treatment over Five Decades

Sinko

Cede

Jagsch

et al. 2017

Sci Rep

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“…The disadvantage of using photographs, slides, or prints is that they present the 3-dimensional face in just 2 dimensions. In addition, any change in lighting, head orientation, and the distance of the camera to the subject will all have an effect on the 2D photographs (Mosmuller et al, 2015). As a result, standardized photographs are encouraged (Vegter and Hage, 2000).…”

Section: Introductionmentioning

confidence: 99%

Is There a Correlation Between Nasolabial Appearance and Dentoalveolar Relationships in Patients With Repaired Unilateral Cleft Lip and Palate?

Lee

Ireland

Atack

et al. 2019

The Cleft Palate-Craniofacial Journal

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Objective: To determine whether a relationship exists between the aesthetic scores given to photographic records of the nasolabial region of patients with repaired unilateral cleft lip and palate (UCLP) and the 5-Year Olds’ Index scores of study models for the same participants. Design: Retrospective study. Setting: University of Bristol Dental Hospital, United Kingdom. Participants: Patients with nonsyndromic UCLP previously enrolled in the Cleft Care UK (CCUK) Study. Methods: The CCUK participants, who had both study models and photographs (frontal and worm’s eye view), were identified and their records retrieved. These were rated by 2 consultants and 2 senior registrars in orthodontics. The 5-Year Olds’ Index was used to score the study models, and at a separate sitting, a 5-point Likert scale was used to score the cropped frontal and worm’s eye view photographs of the same children. The results were analyzed using intraclass correlation coefficients and Cohen κ. Main Outcome Measures: Correlation between the aesthetic scores of the photographic views and the concordant 5-Year Olds’ Index scores of the study models. Results: The intraclass correlation coefficient scores showed very poor agreement between the photographic views and their concordant study models. The level of inter- and intra-rater reliability was strongest when scoring the study models. Conclusions: There was no agreement between the scores given to various photographic views and their corresponding study models. Scoring the study models using the 5-Year Olds’ Index was the most reliable outcome measure for this age-group.

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“…The method of assessment we used in this study was a Asher-McDade aesthetic index; one of the most commonly used methods used to measure the aesthetic results of surgical cleft lip and nose repair [ 5 ]. When using this scoring system, favorable aesthetic results can be achieved with this modified Millard technique.…”

Section: Discussionmentioning

confidence: 99%

“…Photographs were presented simultaneously as color slide in a PowerPoint presentation in a darkened room. Two weeks after first assessment, the same judges assessed the same number of pictures, once again in random order [ 5 ]. The Cohen’s kappa statistics was used to measure the degree of agreement between judges (interobserver scores) as well as to determine the intraobserver scores.…”

Section: Methodsmentioning

confidence: 99%

Personal technique for definite repair of complete unilateral cleft lip: modified Millard technique

Han

Park

Lee

et al. 2018

Arch Craniofac Surg

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BackgroundMillard’s rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed surgical procedure.MethodsWe retrospectively reviewed 82 patients’ medical records and presented surgical technique and outcomes. The main features of the authors’ strategy are emphasizing horizontal length of the lip, orbicularis oris muscle duplication for improving the definition of the philtral column, overcorrection of domal portion than the non-cleft side in order to compensate for the recurrence during growth. Two judges rated two times the appearance of the patients’ nose and lip using Asher-McDade aesthetic index. Intra- and interobserver reliabilities were determined using Cohen’s kappa statistics.ResultsAll patients recovered eventually after surgery; however, two patients have a minor complications (wound infection in one patient, wound disruption due to trauma in the other patient). The improvement of the aesthetic results can be achieved with this modified Millard technique. Total mean scores of the Asher-McDade index was 2.08, fair to good appearance. The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement.ConclusionWe modified Millard method for repair of complete unilateral cleft lip. The surgical outcomes were favorable in long-term follow-up. We hope our technique will serve as a guide for those new to the procedure.

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The Asher-McDade Aesthetic Index in Comparison With Two Scoring Systems in Nonsyndromic Complete Unilateral Cleft Lip and Palate Patients

Abstract: It can be concluded that the Asher-McDade aesthetic index is still superior to the other scoring systems used in this study. However, all 3 scoring systems can reliably be used when 3 or more observers are used.

Cited by 29 publications

References 15 publications

Facial Aesthetics in Young Adults after Cleft Lip and Palate Treatment over Five Decades

Facial Aesthetics in Young Adults after Cleft Lip and Palate Treatment over Five Decades

Is There a Correlation Between Nasolabial Appearance and Dentoalveolar Relationships in Patients With Repaired Unilateral Cleft Lip and Palate?

Personal technique for definite repair of complete unilateral cleft lip: modified Millard technique

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