The Development of the Cleft Aesthetic Rating Scale: A New Rating Scale for the Assessment of Nasolabial Appearance in Complete Unilateral Cleft Lip and Palate Patients

2017 ◽  
Vol 54 (5) ◽  
pp. 555-561 ◽  
Author(s):  
David G.M. Mosmuller ◽  
Lisette M. Mennes ◽  
Charlotte Prahl ◽  
Gem J.C. Kramer ◽  
Melissa A. Disse ◽  
...  
Keyword(s):  
Scoring System ◽  
Cleft Lip ◽  
Interobserver Agreement ◽  
Rating Scale ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Reference Scale ◽  
Academic Center

Objective: The development of the Cleft Aesthetic Rating Scale, a simple and reliable photographic reference scale for the assessment of nasolabial appearance in complete unilateral cleft lip and palate patients. Design: A blind retrospective analysis of photographs of cleft lip and palate patients was performed with this new rating scale. Setting: VU Medical Center Amsterdam and the Academic Center for Dentistry of Amsterdam. Patients: Complete unilateral cleft lip and palate patients at the age of 6 years. Main Outcome Measures: Photographs that showed the highest interobserver agreement in earlier assessments were selected for the photographic reference scale. Rules were attached to the rating scale to provide a guideline for the assessment and improve interobserver reliability. Cropped photographs revealing only the nasolabial area were assessed by six observers using this new Cleft Aesthetic Rating Scale in two different sessions. Results: Photographs of 62 children (6 years of age, 44 boys and 18 girls) were assessed. The interobserver reliability for the nose and lip together was 0.62, obtained with the intraclass correlation coefficient. To measure the internal consistency, a Cronbach alpha of .91 was calculated. The estimated reliability for three observers was .84, obtained with the Spearman Brown formula. Conclusion: A new, easy to use, and reliable scoring system with a photographic reference scale is presented in this study.

Rating Nasolabial Aesthetics in Unilateral Cleft Lip and Palate Patients

2018 ◽  
Vol 55 (5) ◽  
pp. 747-752 ◽  
Author(s):  
Roderic M. F. Schwirtz ◽  
Frans J. Mulder ◽  
David G. M. Mosmuller ◽  
Robin A. Tan ◽  
Thomas J. Maal ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Rating Scale ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Facial Attractiveness ◽  
Facial Trauma ◽  
Face Images ◽  
History Of ◽  
Full Face ◽  
Facial Images

Objective: To determine if cropping facial images affects nasolabial aesthetics assessments in unilateral cleft lip patients and to evaluate the effect of facial attractiveness on nasolabial evaluation. Design: Two cleft surgeons and one cleft orthodontist assessed standardized frontal photographs 4 times; nasolabial aesthetics were rated on cropped and full-face images using the Cleft Aesthetic Rating Scale, and total facial attractiveness was rated on full-face images with and without the nasolabial area blurred using a 5-point Likert scale. Setting: Cleft Palate Craniofacial Unit of a University Medical Center. Patients: Inclusion criteria: nonsyndromic unilateral cleft lip and an available frontal view photograph around 10 years of age. Exclusion criteria: a history of facial trauma and an incomplete cleft. Eighty-one photographs were available for assessment. Main Outcome Measures: Differences in mean CARS scores between cropped versus full-face photographs and attractive versus unattractive rated patients were evaluated by paired t test. Results: Nasolabial aesthetics are scored more negatively on full-face photographs compared to cropped photographs, regardless of facial attractiveness. (Mean CARS score, nose: cropped = 2.8, full-face = 3.0, P < .001; lip: cropped = 2.4, full-face = 2.7, P < .001; nose and lip: cropped = 2.6, full-face = 2.8, P < .001). Conclusion: Aesthetic outcomes of the nasolabial area are assessed significantly more positively when using cropped images compared to full-face images. For this reason, cropping images, revealing the nasolabial area only, is recommended for aesthetical assessments.

Dental Age in Children with a Complete Unilateral Cleft Lip and Palate

2006 ◽  
Vol 43 (5) ◽  
pp. 612-615 ◽  
Author(s):  
Rinske W. F. Huyskens ◽  
Christos Katsaros ◽  
Martin A. Van't Hof ◽  
Anne M. Kuijpers-Jagtman
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Linear Interpolation ◽  
Control Group ◽  
Dental Age ◽  
Significant Delay ◽  
Growth Study ◽  
Academic Center ◽  
Full Complement

Objective: To assess dental age in children with a complete unilateral cleft lip and palate and to compare this with a noncleft control group. Design: Two-group, mixed-longitudinal cohort study. Setting: Cleft group from an academic center for cleft lip and palate treatment. Noncleft control group from the same population. Patients: Participants included 70 Caucasian children with a full complement of teeth and a complete unilateral cleft lip and palate (45 boys and 25 girls) from the Cleft Palate Craniofacial Center at the Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. The control group (90 boys and 91 girls) was taken from the Nijmegen Growth Study. Main outcome measure: Dental age was assessed on orthopantomograms. In the unilateral cleft lip and palate group, linear interpolation in individual age curves was applied to obtain the dental age at 5, 9.5, and 14 years of age. For these ages, a comparison was made with the noncleft control group. Results: Boys and girls with a unilateral cleft lip and palate showed a significant delay in dental age, as compared with their noncleft peers at all three ages. This delay was more pronounced in boys than in girls. The gender effect was significant at chronological ages 5 and 14 years. Conclusions: Children with a complete unilateral cleft lip and palate have a delay in dental age, compared with noncleft children.

scholarly journals Congenital cleft lip and palate in children from Tajikistan in 2009–2019

2020 ◽  
Vol 20 (1-2) ◽  
pp. 75-79
Author(s):  
Abdugafor Z. Abdurahmonov
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Archival Data ◽  
Number Of Children ◽  
National Medical ◽  
Outpatient Visits ◽  
Congenital Cleft ◽  
The Republic

We analyzed the dynamics of congenital cleft lip and palate in children and studied the archival data of the National Medical Center Shifobakhsh (Dushanbe) of the Republic of Tajikistan on the incidence of outpatient visits due to this abnormality in the Republic of Tajikistan over the period from 2009 to 2019. The number of children born with congenital cleft has been increasing for the last ten years. We found out this pathology to develop in families with in-and-in marriage, it also depends upon the sex of a child. Boys are more prone to maxillofacial anomalies.

An Intercenter Comparison of Nasolabial Appearance Including a Center Using Nasoalveolar Molding

2018 ◽  
Vol 55 (5) ◽  
pp. 655-663 ◽  
Author(s):  
Supakit Peanchitlertkajorn ◽  
Ana Mercado ◽  
John Daskalogiannakis ◽  
Ronald Hathaway ◽  
Kathleen Russell ◽  
...  
Keyword(s):  
Interrater Reliability ◽  
Cleft Lip ◽  
Rating Scale ◽  
Cleft Lip And Palate ◽  
Nasal Reconstruction ◽  
Kappa Statistics ◽  
Symmetry Center ◽  
Specific Protocol ◽  
Nasoalveolar Molding ◽  
Presurgical Orthopedics

Objective: To compare nasolabial appearance outcomes of patients with complete unilateral cleft lip and palate (CUCLP) in preadolescence from 4 cleft centers including a center using nasoalveolar molding (NAM) and primary nasal reconstruction. Design: Retrospective cohort study. Setting: Four cleft centers in North America. Patients: 135 subjects with repaired CUCLP. Methods: Frontal and profile facial pictures were assessed using the Asher-McDade rating scale. Intra- and interrater reliability were tested using weighted Kappa statistics. Median scores by center were compared with Kruskal-Wallis statistics. Results: Intrarater reliability scores were moderate to good. Interrater reliability scores were moderate. Significant differences ( P < .05) among centers were found. For nasal form, center G (median = 2.83) had better scores than centers C and D (C median = 3.33, D median = 3.17). For nose symmetry, center G had better scores (median = 2.33) than all other centers (B median = 2.67, C median = 2.83, D median = 2.83). For vermillion border, center G had better scores (median = 2.58) than centers B and C (B median = 3.17, C median = 3.17). For nasolabial profile, center G (median score = 2.67) had better scores than center C (median = 3.00). For total nasolabial score, center G (median = 2.67) had better scores than all other centers (B median = 2.83, C median = 3, D median = 2.83). Conclusion: The protocol followed by center G, the only center that performed NAM and primary nasal reconstruction, produced better results in all categories when compared to center C, the only center that did not perform presurgical orthopedics or lip/nose revisions. When compared to centers that performed traditional presurgical orthopedics and surgical revisions (B and D), center G was not consistently better in all categories. As with other uncontrolled, retrospective intercenter studies, it is not possible to attribute the outcomes to a specific protocol component.

Problems With Reliability of Speech Variables for Use in Quality Registries for Cleft Lip and Palate—Experiences From the Swedish Cleft Lip and Palate Registry

2018 ◽  
Vol 55 (8) ◽  
pp. 1051-1059 ◽  
Author(s):  
Jan-Olof Malmborn ◽  
Magnus Becker ◽  
Kristina Klintö
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Intraclass Correlation ◽  
Weighted Kappa ◽  
University Hospital ◽  
Percentage Agreement ◽  
Quality Registry ◽  
Audio Recordings ◽  
Absolute Agreement ◽  
Velopharyngeal Function

Objective: To test the reliability of the speech data in the Swedish quality registry for cleft lip and palate. Design: Retrospective study. Setting: Primary care university hospital. Participants: Ninety-four children born with cleft palate with or without cleft lip between 2005 and 2009 who had been assessed and registered in the quality registry at the age of 5 years. Main Outcome Measures: Data in the registry on percent oral consonants correct, percent oral errors, percent nonoral errors, perceived velopharyngeal function (PVPF), and intelligibility were compared with results based on reassessments by 3 independent raters from audio recordings. Agreement was calculated by the intraclass correlation coefficient (ICC), quadratic weighted kappa, and percentage agreement. Results: Absolute agreement calculated by average measures ICC for percent oral consonants correct, percent oral errors, and percent nonoral errors was above >0.90. Single measures ICC for percent oral consonants correct was 0.82, for percent oral errors 0.69, and for percent nonoral errors 0.83. The kappa coefficient for PVPF was 0.5 to 0.59 and for intelligibility 0.65 to 0.77. Exact percentage agreement for PVPF was 33% and for intelligibility 47.8%. Conclusions: The data on oral consonants correct and nonoral errors in the quality registry seem to be reliable. The data on oral errors, PVPF, and intelligibility should be interpreted with caution. If differences among treatment centers are detected, one should go back and examine the collected raw data before drawing any definitive conclusions about treatment outcome.

scholarly journals Scoring System for Identifying Impending Complete Fractures in Incomplete Atypical Femoral Fractures

2016 ◽  
Vol 102 (2) ◽  
pp. 545-550 ◽  
Author(s):  
Byung-Woo Min ◽  
Kyung-Hoi Koo ◽  
Youn-Soo Park ◽  
Chang-Wug Oh ◽  
Seung-Jae Lim ◽  
...  
Keyword(s):  
Roc Curve ◽  
Scoring System ◽  
Interobserver Reliability ◽  
Radiolucent Line ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Femoral Fractures ◽  
Atypical Femoral Fractures ◽  
Pain Status ◽  
Complete Fracture

Abstract Context: Although impending incomplete atypical femoral fractures (AFFs) require prophylactic fixation, there is still a lack of study on predicting complete fracture among the incomplete AFFs. Objective: Our purposes are to develop a scoring system to predict progression into complete fracture and to evaluate its reliability and validity. Design, Setting, and Patients: We reviewed 46 incomplete AFFs in 44 patients who did not undergo prophylactic fixation. A weighted scoring system, including four identified risk factors (the site, severity of pain, status of the contralateral femur, and the extent of radiolucent line), was developed. We evaluated its interobserver reliability by using intraclass correlation coefficiency (ICC) and its accuracy using receiver operator characteristic (ROC) curve. The validity of the scoring system was tested in a different cohort. Intervention: Observational study. Main Outcome Measure: Progression to complete fracture within 6 months. Results: Among 46 incomplete fractures, 13 developed a complete fracture within 6 months. The probability of complete fracture increased abruptly when the score was 8 points or more. The proposed scoring system showed an almost perfect reliability (ICC, 0.997; 95% confidence interval, 0.995 to 0.998) and higher accuracy than any single risk factor in ROC curve. In the different series, the positive predictive value was 100% and the sensitivity was 75%, when cutoff value was 8 points. Conclusion: The progression to complete fracture could be predicted by using our scoring system. Incomplete AFF with scores &lt;8 points can be treated conservatively, whereas lesions with scores ≥8 require prophylactic fixation.

Long-Term Otologic and Audiometric Outcomes in Patients with Cleft Palate

2017 ◽  
Vol 157 (4) ◽  
pp. 676-682 ◽  
Author(s):  
Terence E. Imbery ◽  
Lindsay B. Sobin ◽  
Emily Commesso ◽  
Lindsey Koester ◽  
Sherard A. Tatum ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Closure Rate ◽  
Pressure Equalization

Objective Describe longitudinal audiometric and otologic outcomes in patients with cleft palates. Study Design Case series with chart review. Setting Single academic medical center. Methods Charts of 564 patients with a diagnosis of cleft palate (59% syndromic etiology, 41% nonsyndromic) from 1998 to 2014 were reviewed. Patients without at least 1 audiometric follow-up were excluded from analysis. Patient demographics, surgeries, audiometric tests, and otologic data were recorded for 352 patients. Results Forty-five percent had isolated cleft palates, 34% had unilateral cleft lip and palate, and 21% had bilateral cleft lip and palate. Patients were followed for a mean of 50.3 months with a mean of 3.2 separate audiograms performed. Patients received a mean of 2.93 pressure equalization tubes. Increased number of pressure equalization tubes was not associated with incidence of cholesteatoma, which was identified in only 4 patients. Nine patients underwent eventual tympanoplasty with an 89% closure rate. Analysis of mean air-bone gap by cleft type did not reveal significant differences ( P = .08), but conductive losses and abnormal tympanometry persisted into teenage years. Conclusions Patients with cleft palates have eustachian tube dysfunction, which, in our cohort, resulted in persistent conductive hearing loss, highlighting the importance of long-term follow-up. Cholesteatoma incidence was low and not associated with number of tubes, which at our institution were placed prophylactically. Tympanoplasty was successful in those with persistent perforations.

Determination of Facial Symmetry in Unilateral Cleft Lip and Palate Patients from Three-Dimensional Data: Technical Report and Assessment of Measurement Errors

2006 ◽  
Vol 43 (2) ◽  
pp. 129-137 ◽  
Author(s):  
Emeka Nkenke ◽  
Bernhard Lehner ◽  
Manuel Kramer ◽  
Gerd Haeusler ◽  
Stefanie Benz ◽  
...  
Keyword(s):  
Measurement Errors ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Intraclass Correlation ◽  
Three Dimensional ◽  
Correlation Coefficients ◽  
Intraclass Correlation Coefficients ◽  
Surface Areas ◽  
Technical Report

Objective To assess measurement errors of a novel technique for the three-dimensional determination of the degree of facial symmetry in patients suffering from unilateral cleft lip and palate malformations. Design Technical report, reliability study. Setting Cleft Lip and Palate Center of the University of Erlangen-Nuremberg, Erlangen, Germany. Patients The three-dimensional facial surface data of five 10-year-old unilateral cleft lip and palate patients were subjected to the analysis. Distances, angles, surface areas, and volumes were assessed twice. Main Outcome Measures Calculations were made for method error, intraclass correlation coefficient, and repeatability of the measurements of distances, angles, surface areas, and volumes. Results The method errors were less than 1 mm for distances and less than 1.5° for angles. The intraclass correlation coefficients showed values greater than .90 for all parameters. The repeatability values were comparable for cleft and noncleft sides. Conclusion The small method errors, high intraclass correlation coefficients, and comparable repeatability values for cleft and noncleft sides reveal that the new technique is appropriate for clinical use.

Infant Orthopedics Has No Effect on Maxillary Arch Dimensions in the Deciduous Dentition of Children with Complete Unilateral Cleft Lip and Palate (Dutchcleft)

2006 ◽  
Vol 43 (6) ◽  
pp. 665-672 ◽  
Author(s):  
Catharina A. M. Bongaarts ◽  
Martin A. van't Hof ◽  
Birte Prahl-Andersen ◽  
Iris V. Dirks ◽  
Anne M. Kuijpers-Jagtman
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Vertical Position ◽  
Controlled Clinical Trial ◽  
Deciduous Dentition ◽  
Surgical Closure ◽  
Infant Orthopedics ◽  
Maxillary Arch

Objective: Evaluation of the effect of infant orthopedics on maxillary arch dimensions in the deciduous dentition in patients with unilateral cleft lip and palate. Design: Prospective two-arm randomized controlled clinical trial with three participating cleft palate centers. Setting: Cleft palate centers of the Radboud University Nijmegen Medical Center, Academic Center of Dentistry Amsterdam, and University Medical Center Rotterdam, the Netherlands. Patients: Children with complete unilateral cleft lip and palate (n = 54) were included. Interventions: Patients were randomly divided into two groups. Half of the patients (IO+) had a presurgical orthopedic plate until surgical closure of the soft palate at the age of 52 weeks; the other half (IO−) did not undergo presurgical orthopedics. Mean outcome measures: Maxillary arch dimensions were assessed on dental casts at 4 and 6 years of age with measurements for arch width, arch depth, arch length, arch form, and the vertical position of the lesser segment. Contact and collapse were assessed also. Results: There were no clinically significant differences found between IO+ and IO− for any of the variables. Conclusions: Infant orthopedics had no observable effect on the maxillary arch dimensions or on the contact and collapse scores in the deciduous dentition at the ages of 4 and 6 years. Considering the Dutchcleft results to date, there is no need to perform infant orthopedics for unilateral cleft lip and palate patients.

The Cleft Aesthetic Rating Scale for 18-Year-Old Unilateral Cleft Lip and Palate Patients

2018 ◽  
Vol 55 (7) ◽  
pp. 1006-1012 ◽  
Author(s):  
F.J. Mulder ◽  
D.G.M. Mosmuller ◽  
H.C.W. de Vet ◽  
C.M. Mouës ◽  
C.C. Breugem ◽  
...  
Keyword(s):  
Medical Students ◽  
Cleft Lip ◽  
Rating Scale ◽  
Cleft Lip And Palate ◽  
Intraobserver Reliability ◽  
Ordinal Scale ◽  
Average Score ◽  
Facial Trauma ◽  
Old Patients ◽  
Significant Difference

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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