Abstract
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.
Highlights
In the Caucasian population, about 1 in 700 newborns is born with a unilateral or bilateral cleft lip and palate (CLP)
A modern treatment method considers both function and aesthetics, and attempts to keep the number and impact of scars associated with the surgical intervention low[2]
We evaluated the photographic records from 429 patients (283 unilateral and 146 bilateral) with Cleft Lip and Palate (CLP), who were treated in our center from the 50′s to recently
Summary
In the Caucasian population, about 1 in 700 newborns is born with a unilateral or bilateral cleft lip and palate (CLP). Within the first year of life all anatomical structures that developed incompletely (lips, hard palate, soft palate) are repaired. Only the soft tissue of the clefted area (lip, soft palate) is closed in the first year of life, while the structures covered by periost are not touched. The hard palate is closed later between the age of four and twelve[6] This strategy ameliorates denudation of the periost in the first years of life, allowing for more time with less impact of surgery associated scars[7]. In the last 20 years mixed models became widely adopted They merged the different methods and treat the patient at the pre-school age between 3 month to 3 years
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