Unilateral Incomplete Cleft Lip Research Articles

Evaluation of Vermillion Symmetry and Scar Quality in Unilateral Cleft Lip Repair Using Modified Millard's Technique Versus Fisher's Technique

BackgroundSince the primary goal of cleft lip repair is to achieve a symmetrical, aesthetic lip, several surgical techniques have been utilized. Accordingly, in this study, a unilateral cleft lip was surgically repaired using two techniques: modified Millard's and Fisher's techniques. PurposeThis study was designed to compare the vermillion symmetry and scar quality in the surgical management of patients with unilateral incomplete cleft lip using the modified Millard's and Fisher's techniques. Study design, setting, and sampleWe conducted a prospective randomized controlled clinical study. The study involved 20 patients selected from the Department of Plastic Pediatric Surgery at the Specialized Pediatric Hospital, Faculty of Medicine, Cairo University. The patients included in the study were aged between 2 and 6 months old, had a primary non-syndromic unilateral incomplete cleft lip, and had no other associated anomalies. Predictor variableThe predictor variable was operative management of the cleft lip, and subjects were randomly assigned to either the modified Millard or Fisher techniques. Outcome variablesThe primary outcome, vermilion symmetry, was evaluated by computerized photogrammetric lip analysis with Image J software. Additionally, scar quality, considered a secondary outcome, was assessed with the Vancouver Scar Scale and the Image J software. Every measurement was meticulously recorded in millimeters. CovariatesAge, sex, and cleft side were considered. AnalysesThe study comprised 20 children (12 males and 8 females), with a mean age of 140.5 ± 23.7 days in the Fisher’s group and 137.4 ± 25.6 days in the modified Millard’s group (p = 0.8). No statistically significant differences (p = 0.6) were found in vermillion height and width between both groups at 1 week, 3 months, and 6 months. Similarly, there were no statistically significant differences (p = 0.4) between both groups in terms of scar length and width at the 3- and 6-month follow-up periods. Conclusions and RelevanceThis study found no statistically significant differences in vermillion symmetry and scar quality between the two cleft lip repair techniques. Notably, one patient in the modified Millard group exhibited a notch on the vermillion border, which was not statistically significant.

Outcomes of Fisher Technique for Unilateral Incomplete Cleft Lip Repair

Background:-
 Cleft lip repair is imperative for a child’s physical and mental well-being. Fisher’s innovative technique adds versatility to conventional methods with optimal aesthetic results. An inconspicuous scar along the anatomical subunits is a hallmark of this procedure. 
 Objective: This study aimed to evaluate the outcomes of Fisher technique for unilateral incomplete cleft lip.
 Methods:-
 This Quasi experimental study was conducted at the Plastic Surgery Department, Mayo Hospital Lahore from 2017 to 2021. 50 consecutive patients with primary unilateral incomplete cleft lip were included in the study. Qualitative analysis was performed using Steffensen Grading Criteria 9. Improvement in pre-operative and post-operative anthropometric ratios was also analyzed. Symmetry of repaired cleft to normal cleft side was also assessed 9,12 .
 Results:-
 Mean age of patients was 4.14±0.72 months. Parent’s satisfaction score on the Likert scale was 4.84±0.37 (Mean ±SD). Significant improvement in anthropometric parameters (vertical lip height, vermilion height, nostril width and nostril height) except lip width was recorded. Significant symmetry was achieved for all parameters (p-value less than 0.05) except nasal height ratio (p- value=0.071). Good results were also achieved on all parameters according to Steffensen criteria.
 Conclusion:-
 Fisher anatomical subunit repair is a reliable option for unilateral incomplete cleft lip repair producing aesthetically pleasing results.

Outcome Comparisons of Two Different Orbicularis Oris Muscle Reconstruction Techniques in Patients with Unilateral Incomplete Cleft Lip.

The long-term postoperative outcomes of two different orbicularis oris muscle reconstruction techniques in patients with unilateral incomplete cleft lip were compared. Forty-seven patients with unilateral incomplete cleft lip were assessed in this study, where 23 underwent a traditional method of reconstruction and 24 underwent a novel method. Preoperative measurements, postoperative results, and three-year follow-up outcomes were measured by photographic anthropometric analysis. Five upper-lip measurement indices and eight nostril indices were included. The postoperative outcomes showed that the shape of the lip and nose was more symmetrical with the new surgical method compared with the conventional technique. Long-term outcomes after three years, although characterized by minimal changes during maxillofacial development, showed better maintenance of lip and nostril symmetry in the novel-method group. The novel technique seeks to balance the perinasal and perioral muscles, resulting in improved symmetry compared with the traditional reconstruction technique.

PREDICTABLE FACIAL ESTHETICS BY PRESURGICAL NASOALVEOLAR MOULDING IN NEONATES - A CASE REPORT

A Cleft is a congenital abnormal space or gap in the upper lip and palate. Although plastic surgery has made great advances in the area of cleft surgery, aesthetical corrections of the decient columella and nasal cartilages were difcult. presurgical naso-alveolar molding (PNAM) at an early stage is used to reduce soft tissue and cartilaginous deformity. This article presents a case report of a 6-day-old baby boy with a left-sided unilateral incomplete cleft lip and palate, with no signicant medical history or any associated systemic illness. He was referred with the primary need for a feeder plate. The width of the cleft was measured from the base of the alveolus on one side to the other and was approximately 7 mm. The nal impression was made with a custom tray. NAM appliance was fabricated and inserted in the patient's mouth. Orthodontic wire of 21 gauzes was used for wire bending to support the acrylic forming a nasal bulb. In 2 months, the followup patient was recalled at each 15 days intervals for 1 and a half months for activation and modication of the plate to gradually approximate the alveolar segments. After 2 months of follow-up, it was shown that the cleft palate gap was reduced to 3mm from 7mm. PNAM allows overall improvement in the aesthetics of nasolabial complex in cleft conditions and minimizes the extent and the numbers of surgery. The cleft deformity was signicantly reduced in size with the NAM therapy in the present case

Primary unilateral incomplete cleft lip repair by a modified rotational advancement technique

PurposeThis study aimed to describe a modified technique for primary unilateral incomplete cleft lip repair together with postoperative outcomes assessment. Study designA Retrospective study. Participants and settingPhotos of 64 consecutive patients with nonsyndromic primary unilateral incomplete cleft lip were reviewed. Of the 64 participants for the study sample, 32 patients had received Millard rotational advancement technique (RA), while the other 32 had modified rotational advancement technique (MRA) with preserving the nasal sill intact. It was conducted at a university-affiliated tertiary hospital between 2013 and 2021. Main measuresThe lip measures were represented by lip height and width, vermillion height, midline-philtrum angle, and angle of Cupid's bow peaks. The nasal measures involved columella length and angle, nostril height and width, and ala width. Both descriptive and comparative data analyses were calculated. ResultsSymmetrical lip height, lip width, philtrum angle, Cupid's bow, as well columellar length, and alar width were obtained following the MRA technique. No significant difference was found between the MRA and RA groups concerning the preoperative lip height, Cupid's bow angle, columellar length and angle. However, the postoperative lip height, width and columellar length were greater in MRA group than RA group (P= .001, 0.004 and 0.002, respectively). On the other hand, the MRA group had significantly smaller columellar and Cupid's bow peaks angles than RA group (0.53±0.36 vs 1.21±0.91 and 1.34±1.84 vs 3.14 ± 2.97, respectively). ConclusionsThe MRA technique has obtained satisfactory lip and nasal outcomes in terms of lip height, lip width, philtrum angle, Cupid's bow, columellar length, and alar width while keeping the nasal sill intact.

Effect of the prophylactic use of antibiotics on wound infection after cleft lip surgery.

To study the effect of preoperative prophylactic use of antibiotics on wound infection in patients with cleft lip. Aretrospective study was conducted on the clinical data of 1 361 patients who underwent one-stage cleft lip repair in the Department of Cleft Lip and Palate in West China Hospital of Stomatology, Sichuan University, from January 2015 to November 2018. The patients were divided into two groups according to whether prophylactic antibiotics were used or not. There were 594 patients in the prevention group, including 373 unilateral incomplete cleft lip (UICL) patients, 157 unilateral complete cleft lip (UCCL) patients, 25 bilateral incomplete cleft lip (BICL) patients, 39 bilateral complete cleft lip (BCCL) patients. There were 767 patients in the non-prophylactic group, including 482 UICL patients, 211 UCCL patients, 31 BICL patients, 43 BCCL patients. The relationship between preoperative and postoperative leukocyte count, preoperative and postoperative body temperature, and postoperative wound infection were compared between the two groups. No significant difference was observed in the leukocyte count and body temperature between both groups (P>0.05). The preoperative prophylactic use of antibiotics has no significant effect on the incidence of postoperative infection in patients undergoing cleft lip repair.

Morphological Correlations in Nasolabial Formation After Primary Lip Repair for Unilateral Cleft Lip

We aim to reveal postoperative morphological correlations between the nasolabial components in patients with unilateral cleft lip (UCL). The hypothetical correlations are first, a correlation between the vertical height of the cleft-side alar base and the length of the cleft-side red lip, and second, a correlation between the length of the cleft-side red lip and the vertical position of the cleft-side oral commissure. We explain how these morphological balances are controlled by surgery. Three-dimensional bilateral measurements of the length of the red lip, vertical height of the nasal alar base, and vertical height of the oral commissure were conducted retrospectively on 31 patients with UCL and palate (complete UCL: 26; incomplete UCL: 5) who underwent primary lip plasty at Osaka Women's and Children's Hospital from 2017 to 2019. We found a statistically significant correlation between the vertical height of the cleft-side alar base and cleft-side red lip length (P=.012, r=0.45); thus, the longer the red lip, the lower was the nasal alar base. The correlation between the cleft-side red lip length and the vertical height of the cleft-side oral commissure also showed a statistical significance (P=.00074, r=0.57); thus, the shorter the red lip, the higher was the oral commissure. The present results provided objective evidence showing basic morphological relationships between the postoperative nasolabial features of patients with UCL. The results lead to a reasonable approach to define the proposed peak of the Cupid's bow, an unsettled major controversy in cleft lip surgery.

Primary rhinoplasty in unilateral incomplete cleft lip nose: A 4-year follow up

ObjectiveThe aim of this study was to assess aesthetic result and parents’ satisfaction of primary rhinoplasty in unilateral incomplete cleft lip patients. MethodsThirty-two consecutive unilateral incomplete cleft lip nose patients were operated in the tertiary hospital from 2012 to 2014. Primary rhinoplasty was done following the principle of the modified McComb repair. Nostril height, dome height, alar base width, nostril height to width ratio, dome height to nostril width ratio, nasolabial angle and columella deviation were measured on preoperative and 4-year postoperative photographs. Visual analogue scale (VAS) was assessed for each parent before the surgery and 4-year postoperatively. ResultsThe preoperative and postoperative photographic analysis revealed significant improvement in nostril height ratio and dome height ratio. Nostril height to width ratio and dome height to nostril width ratio significantly increased. Alar base width significantly decreased. The nasolabial and columella deviation angles improved significantly. The mean parent-related satisfactory assessment based on the VAS showed statistically improved scores postoperatively. ConclusionWe believe this technique with minimal dissection could improve symmetry and satisfaction, although every individual surgeon could choose his preferable technique based on the components of correction that he is capable of executing reliably while considering the long-term outcomes.

Modified Unilateral Incomplete Cleft Lip Repair with Primary Nasal Overcorrection: A Muscle-Driven Technique.

Millard's rotation-advancement principle, first-described 60 years ago, continues to guide surgeons in reconstruction of the unilateral cleft lip. Modifications of the rotation-advancement repair are commonly used; however, distinction between the complete and incomplete forms of cleft lip has received less emphasis in surgical procedure descriptions. As a unilateral incomplete cleft lip could present with more tissue overall and a larger lip on the cleft side than a complete form of cleft lip, the authors have adopted a deformity-specific technical approach to treat each particular cleft form. This article highlights the 10 key steps for execution of a modified unilateral incomplete cleft lip repair using the rotation-advancement principle plus the "skin-follows-muscle" model. The intraoperative design and the reconstruction of the skin, muscle, vermilion, intraoral mucosal, and nasal elements are fully detailed in the accompanying videos.

Variational Characteristics of Nasolabial Appearance and Its Influencing Factors for the Unilateral Cleft Lip Repair With Modified Huaxi Technique.

After many years in clinical practice, the authors found that the long-term aesthetics of the upper lip and nose following repair of a unilateral cleft lip deformity using the Huaxi method remained unsatisfactory. The immediate postoperative effect was often good, while the long-term postoperative effect was poor. Therefore, this study aimed to evaluate the characteristics and influencing factors of a modified Huaxi method for repairing unilateral cleft lip over time, and to explore the relationship between immediate and long-term outcomes after cleft lip surgery. Patients with unilateral cleft lip who visited the Department of Maxillofacial Surgery of the Stomatological Hospital of Zunyi Medical University from June 2014 to March 2016 were selected. The study group consisted of 51 consecutive patients (30 boys and 21 girls), aged between 3 months and 2 years. Of these, 24 presented with complete unilateral cleft lip (12 wore a nasoalveolar mold as required, 12 did not) and 27 with incomplete unilateral cleft lip (13 wore a nasoalveolar mold as required, 14 did not). Photographs were taken of 51 patients before surgery and immediately, 7 days, and 6 months postoperatively. Various indexes of nasolabial contour of each patient were measured using iWitness photogrammetry, and the slit width; lip height ratio, lip width ratio, nostril width ratio, and nostril height ratio of the healthy side; and degree of deviation of the nasal columella were calculated. Long-term symmetry of lip height and width remained stable postoperatively (P > 0.05), whereas nostril height symmetry was significantly reduced (P > 0.05). Nasal width symmetry and midpoint deviation of the nasal columella were stable in patients with nasoalveolar molding (P > 0.05), but significantly decreased in patients without nasoalveolar molding (P < 0.05). In patients with complete unilateral cleft lip, there was a significant correlation between fissure width and lip width symmetry 6 months postoperatively (r = 0.431, P < 0.05). The symmetry of the upper lip is satisfactory and stable following surgical repair with the modified Huaxi technique. However, undercorrection of nasal symmetry is commonplace. Fissure width and nasoalveolar molding may influence long-term aesthetics following unilateral cleft lip repair.

Unilateral Cleft Lip Repair Using the Chang Gung Technique: An Outcome Analysis.

This retrospective study analyzed the outcomes of patients undergoing complete or incomplete unilateral cleft lip repair using the Chang Gung technique. The goal was to compare the symmetry and change of the technique through the measurement of anthropometric points on digital photographs. From 2010 to 2016, a total of 274 complete and incomplete cleft lip patients without other craniofacial deformities were included in the study. All included patients had a minimum 1-year follow-up with frontal view photographs taken. The vermilion area, lip width, vermilion height, lateral lip length, lip height, and Cupid's bow width of both cleft and noncleft sides were measured for all patients. The Cleft Lip Component Symmetry Index was used to determine the symmetry of the cleft and noncleft sides in both incomplete and complete cleft groups. A total of 152 complete and 122 incomplete cleft lip patients were included in the study. The mean Cleft Lip Component Symmetry Index values showed that the vermilion area, lip height, and Cupid's bow width were symmetric on both cleft and noncleft sides. Lip width and lateral lip length were noted to be shorter, whereas the vermilion height was thicker on the cleft side than on the noncleft side. Significant differences between the complete and incomplete cleft group measurements were found for lateral lip length and lip height, and complete cleft measurements were shorter than those for incomplete clefts. There were no significant differences in vermilion area, lip width, vermilion height, and Cupid's bow width. The outcome analysis showed that vermilion height reduction and modifications could be made for both complete and incomplete groups. The complete cleft lip has been found to have a significantly shorter lateral lip length and lip height, reflecting a more severe anatomical soft tissue deficiency in this group. A long-term outcome anthropometric point study may further verify the results of this surgical technique.

Rationale for the treatment of unilateral cleft lip – GC4 protocol

Introduction: The aim of this study is to retrospectively analyze the surgical outcomes of 200 patients who were treated for unilateral cleft lip (UCL) over a period of 4 months in our cleft care center. Materials and Methods: This is a retrospective audit of all the patients who had undergone UCL repair from January to April 2019. The patients were stratified based on the cleft severity. Fisher technique was employed for the correction of incomplete cleft lip while modified Mohler technique was the choice of repair for complete cleft lip. Clinical records including each patient's preoperative and postoperative photographs were taken into consideration. Results: Of the 200 patients who had undergone lip repair, 56% were male and 44% were female. The average age of the patients treated was 10.5 months. Visual Analog Scale (VAS) and Scar Assessment Scale were used to evaluate the scar, taking into account pigmentation, vascularity, acceptability, parent comfort, and contour. The results ranged from “excellent” and “good” in the case of incomplete cleft lip repair to “good” and “acceptable” in the case of complete cleft lip repair. Postoperative follow-up revealed that 5 of them had complications related to dehiscence and bleeding. Conclusion: Fisher's method in patients with unilateral incomplete cleft lip proved the effectiveness in improving the esthetic results with good symmetry while the Mohler modification of Millard technique helped achieve optimal lip length with acceptable esthetics.

Nasolabial Revisions in Unilateral Incomplete Cleft Lip: One Surgeon's 28-Year Experience.

Repair of unilateral incomplete cleft lip is the surgeon's opportunity to achieve a superior result with few revisions. This study is a retrospective review of consecutive patients with unilateral incomplete cleft lip, defined as a defect extending 30 to 90 percent of cutaneous labial height, treated between 1985 and 2013 by one surgeon. Rates and types of revisions were collected, and photographs of patients who did not have a revision were reviewed to determine whether a revision was needed. One hundred thirty-six patients met inclusion criteria. Fifty-seven percent needed revision of the mucosal free margin; less than 10 percent needed other minor labial revisions. Fifteen percent required a nasal revision, most commonly reelevation of the lower lateral cartilage. Over time, the only statistically significant change in frequency was increased revisions of the free border. Nasal revision rates are low in unilateral incomplete cleft lip compared to complete forms in previously published data by the senior author (J.B.M.). In contrast, labial revisions of the free margin are more common. The reason is that the surgeon became more cognizant of vermilion-mucosal deficiency on the noncleft side and more likely to offer a submucosal flap or dermis-fat graft to level the lip for normal upper incisor show. Therapeutic, IV.

Rotational Composite Flap Technique for Primary Incomplete Cleft Nose Deformity.

Nasal deformities accompanying unilateral incomplete cleft lip have minor skeletal and soft tissue deficiencies compared with deformities associated with unilateral complete cleft lip. Extended dissection and surgical incisions (often required for nasal deformities in complete cleft lip) are not recommended to address deformities accompanying incomplete cleft lip. The purpose of this study is to describe an innovative method involving a rotational composite flap for nasal repair in patients with unilateral cleft lip. Since 2016, 49 consecutive patients with unilateral incomplete cleft lip have undergone primary anatomical repair of accompanying nasal deformities. The technique involves a skin incision along the marginal and intercartilaginous borders to create a V-shaped composite flap consisting of vestibular skin and alar cartilage. Rotational mobilization of the composite flap creates a triangular raw surface laterally, which is closed by advancement of the vestibular skin. This innovative method, which is based on the use of a rotational composite vestibular flap, achieves proper symmetry of the repaired nose. The herein described composite flap rhinoplasty is a good surgical option, which provides a good overall nasal symmetry in patients with nasal deformities accompanying unilateral incomplete cleft lip.

Delayed maturation and reduced crown width of the permanent first mandibular molar in all subgroups of cleft lip and palate.

Surgical closure of the cleft damages nerves and blood supply in the area and may possibly negatively influence dental development in children with cleft lip and palate (CLP). Previous studies of the permanent first mandibular molar (M1inf ) in children with unilateral complete CLP found delayed maturation and decreased follicle/crown width before any surgical interventions. This study aimed to investigate if these findings are representative for the total population of individuals born with CLP. A population-based consecutive longitudinal sample of 224 children with clefts: 183 with CLP (66 with complete [47 unilateral, 19 bilateral], 117 with incomplete [70 unilateral, 47 bilateral], and 41 with unilateral incomplete cleft lip (controls), was examined pre- and post-lip closure (at 2 and 22months of age). In lateral cephalometric X-rays (obtained as part of a standard treatment protocol), M1inf follicle maturation and follicle/crown width were assessed. Mantel-Haenszel test and Pearson's correlation coefficient R were used to describe relationships. Differences between group means were tested using Wilcoxon rank sum test. Significance level was set to 5%. Follicle maturation was significantly delayed in all groups with CLP compared to that in controls (P<.01). Follicle and crown width were significantly reduced in all CLP groups compared with those in controls (P<.01). Sex did not influence these variables. Delayed follicle maturation and decreased follicle/crown/tooth size were found to be part of the congenital traits characterizing individuals with all types of CLP and not a result of surgical iatrogenesis.

Force balance reconstruction of the orbicularis oris in unilateral incomplete cleft lip

PurposeTo demonstrate a maneuver for achieving optimal force balance of reconstructed orbicularis oris during primary unilateral incomplete cleft lip reconstruction. MethodsThe surgical maneuver was performed as follows: the length of the orbicularis oris on the noncleft side is first isolated and adjusted to be equal to the length of the muscle on the cleft side. The remaining muscle from the noncleft side near the midline is used to fill in the vermilion tubercle, and finally, the two orbicularis oris muscles are sutured at the midline. Finite element analysis was utilized to model the biomechanics of our novel surgical method. ResultsFinite element analysis showed that when the lengths of two orbicularis oris muscles were the same after primary cleft lip repair, the stress on this muscle system was minimized under different lip conformations. Seventeen cleft lip patients were enrolled to receive reconstruction with this new maneuver. Significant differences were found in (1) noncleft/cleft alar base width, nasal dorsum angle, columella length relationship between two sides, and columella angle under the comparison between preoperative and postoperative; (2) noncleft/cleft alar base width, nasal dorsum angle, and columella angle under the comparison between preoperative and follow-up; and (3) columella length relationship between two sides under the comparison between postoperative and follow-up. ConclusionForce balance of the orbicularis oris muscles is important during unilateral incomplete cleft lip repair. This surgical maneuver for achieving force balance of the orbicularis oris and the muscle system of the lips is easy to perform and can help avoid relapses.

Photogrammetric Outcomes of Primary Nasal Correction in Unilateral Cleft Lip Patients: Early Childhood Results From a Single Surgeon's Experience.

Concerns of nonlasting results and potential nasal growth damage precluded cleft nasal correction at the time of initial cleft lip repair. Our goal was to evaluate the outcome of primary cleft nasal correction in our patients with unilateral cleft lip. A retrospective review of patients with complete and incomplete unilateral cleft lip who underwent primary cleft nasal correction from 2010 to 2017 by the same surgeon was performed. The cleft-to-noncleft nostril height, width, one-fourth medial part of nostril height, nasal sill height, and nostril area ratios, as well as inner nostril height-to-width ratios were determined from standard basilar view photographs taken in different time points (T1, <3 months; T2, 3-12 months; T3, 12-36 months; and T4, >36 months after surgery). A 5-point visual analog scale (1 = worst, 5 = best) was used to assess each patient's nose appearance. Seventy-two patients were identified (66.7% male, 51.3% with a complete cleft lip). Average visual analog scale scores T1-T4 were 3.88 ± 0.85, 3.72 ± 0.93, 3.54 ± 0.99, and 3.40 ± 0.71, respectively. Intraclass correlation ranged from 0.61 to 0.94. A significant decrease [mean difference (SD)] was found for cleft-to-noncleft nostril width ratio [0.15 (0.18)] from T1 to T2, and an increase for one-fourth medial height ratio [-0.09 (0.07)] and for inner nostril height-to-width ratio in the noncleft side [-0.23 (0.25)] from T1 to T3. Thirteen patients required secondary surgical revision. Based on photogrammetry, primary cleft nasal correction in our patients with unilateral cleft lip achieved acceptable and stable outcomes during early childhood.

CLEFT-Q: Detecting Differences in Outcomes among 2434 Patients with Varying Cleft Types.

Measuring the patient perspective is important in evaluating outcomes of cleft care. Understanding how treatment outcomes vary depending on cleft type may allow for better planning of treatments, setting of expectations, and more accurate benchmarking efforts. The CLEFT-Q is a patient-reported outcome measure for patients with cleft lip and/or palate. The 12 CLEFT-Q scales measuring appearance (i.e., face, nose, nostrils, lips, cleft lip scar, teeth, and jaws), function (i.e., speech), and health-related quality of life (i.e., psychological, school, social, and speech-related distress) were field tested in a cross-sectional study in 30 centers in 12 countries. Patients with cleft lip and/or cleft palate aged 8 to 29 years were recruited from clinical settings. Differences in CLEFT-Q scores by cleft subtypes were evaluated using one-way analysis of variance or Kruskal-Wallis H tests, with Tukey or Dunn procedure with Bonferroni corrections post hoc analyses, respectively. Scores are presented using radar charts to visualize all outcomes simultaneously. The field test included 2434 patients. Scores on all CLEFT-Q scales varied significantly with cleft subtype. Patients with unilateral or bilateral cleft lip and/or palate scored lower on all appearance scales compared with patients with cleft palate or unilateral incomplete cleft lip. Scores on the speech function and speech-related distress scales decreased with each progressive group in the Veau classification. Patients with complete bilateral cleft lip and palate scored lowest on the social, school, and psychological scales. Patient-reported outcomes measured with the CLEFT-Q vary significantly with cleft type. Visualizing multiple outcomes simultaneously with radar charts allows for an understanding of a patient's overall status in a single graph.

Aesthetics Assessment and Patient Reported Outcome of Nasolabial Aesthetics in 18-Year-Old Patients With Unilateral Cleft Lip.

Objective:To determine if there is a correlation between objective nasolabial aesthetics assessment using the Cleft Aesthetic Rating Scale (CARS) and patient satisfaction.Design:Retrospective analysis of a generic satisfaction questionnaire and independent assessment by three cleft surgeons of the nasolabial area of these patients on 2D frontal photographs, using the CARS.Setting:The Vrije Universiteit Medical Center and The Academic Center for Dentistry Amsterdam.Patients:Thirty-nine 18-year old patients with a repaired complete or incomplete unilateral cleft lip, with or without a cleft palate, and a completed satisfaction questionnaire. Exclusion criteria were an incomplete questionnaire; a history of facial trauma; and congenital syndromes affecting facial appearance.Main Outcome Measures:The correlation between surgeon evaluation (on a 5-point Likert scale) and patient satisfaction (not, moderately or very satisfied) on nasolabial appearance was assessed using Spearman rho (ρ).Results:There was a negligible correlation between surgeon evaluation and patient satisfaction on nose assessment (ρ = 0.20) and a moderate correlation on lip assessment (ρ = 0.32).Conclusions:Most literature supports this discrepancy between different objective aesthetics evaluation methods and subjective patient-reported outcome measures, suggesting there are factors playing a role in patient satisfaction that are impossible to objectify with assessment methods. Therefore, a strong emphasis should remain on clear communication between the physician and patient regarding their expectations, perception, and satisfaction of surgery results.

Use of Nasal Conformer After Birth Effectively Improves Nostril Symmetry in Patients With Unilateral Incomplete Cleft Lip

To investigate the clinical effects of preoperative nasoalveolar molding (NAM) and nasal conformer use in patients with unilateral incomplete cleft lip on the basis of their medical records and images. Data and images of 16 patients born with unilateral incomplete cleft lip who were hospitalized between January 2015 and August 2017 were retrieved from the medical records. The primary outcome was the extent of improvement in columella height (CH) before cheiloplasty. Other outcome measurements included the CH, nostril width, and nostril height, which were measured by ImageJ image processing software (version 1.4; National Institutes of Health, Bethesda, MD) and presented as ratios. Mann-Whitney U tests were used to compare the non-normally distributed data. Patients in the NAM group and those in the nasal conformer group showed significantly improved (P<.05) preoperative cleft-side CH-to-normal-side CH ratios compared with the corresponding ratios at birth. There was no significant difference in terms of the extent of improvement in CH between the groups. Preoperative use of nasal conformers in patients with unilateral incomplete cleft lip not only corrects the deformed nasal cartilage but also increases the CH and improves the overall preoperative nasal symmetry. In addition, compared with NAM, this method costs less, is more straightforward, and requires fewer outpatient clinic visits.