Abstract
Objective:To reassess reliability and validity of the Submental Nasal Appearance Scale (SNAS) compared to the preliminary pilot study, for assessment of patient photographs with repaired unilateral cleft lip and palate (UCLP). When utilizing the SNAS, 3 nasal features (1. nasal outline; 2. alar base position; 3. nostril axis) must be graded according to symmetry between the cleft and noncleft side using a 5-point scale with reference photographs for each feature. The mean score calculated from the graded features reflects the overall degree of nasal symmetry, which is considered an important goal when repairing UCLP.Design:Fifty patient photographs were selected and cropped, displaying the submental view. Six raters assessed these photographs using the SNAS and a separate 5-point scale to assess the overall submental appearance. Interrater reliability was determined for both methods and correlation was calculated between these as an indication of construct validity.Setting:Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.Patients:Six- to 9-year-old patients with repaired UCLP.Results:Interrater reliability of 0.73 and 0.48 was found for the SNAS and overall appearance assessment, respectively, while in the pilot study values of 0.79 and 0.69 were found. Correlation of 0.59 and 0.74 was found in the current and pilot study, respectively, between the SNAS and overall appearance assessment.Conclusions:The SNAS is a reliable tool to assess nasal symmetry from the submental perspective. Reliability of the SNAS is higher compared to grading overall appearance, but validity of the SNAS was less well supported.
Highlights
In patients with unilateral cleft lip and palate (UCLP), nasolabial appearance can be denoted as a highly important factor with major impact on patient’s perceived quality of life (Mani et al, 2013; Wong Riff et al, 2018; Zeraatkar et al, 2019)
The mean duration to assess a single photograph with the Submental Nasal Appearance Scale (SNAS) and the overall appearance scale was 13.4 seconds
The goal of the current study was to test the SNAS on its reliability and validity in order to confirm the results of the pilot study, before it might be used for research and/or clinical purposes on 6- to 9-year-old patients with repaired UCLP
Summary
In patients with unilateral cleft lip and palate (UCLP), nasolabial appearance can be denoted as a highly important factor with major impact on patient’s perceived quality of life (Mani et al, 2013; Wong Riff et al, 2018; Zeraatkar et al, 2019). Tan et al (2019) conducted a pilot study to assess nasal appearance on submental view photographs of 6- to 9-year-old patients with repaired UCLP. The usefulness of 2-dimensional (2D) photographs and the advantages of grading from the submental perspective were emphasized. Important nasal structures are clearly visualized from this perspective, making it convenient to assess symmetry, which is a crucial element a surgeon strives to achieve when repairing UCLP (Baudouin and Tiberghien, 2004; Mulliken and LaBrie, 2012; He et al, 2015; Knight et al, 2016).
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Schedule a callMore From: The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association
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