While there are internationally validated outcome measures for speech and facial growth in cleft lip and palate patients, there is no such internationally accepted system for assessing outcomes in facial aesthetics.
A systematic critical review of the scientific literature from the last 30 years using PUBMED, Medline and Google Scholar was conducted in-line with the PRISMA statement recommendations. This encompassed the most relevant manuscripts on aesthetic outcomes in cleft surgery in the English language.
Fifty-three articles were reviewed. Four main means of determining outcome measures were found: direct clinical assessment, clinical photograph evaluation, clinical videographic assessment and three-dimensional evaluation. Cropped photographs were more representative than full face. Most techniques were based on a 5-point scale, evolving from the Asher-McDade system. Multiple panel-based assessments compared scores from lay or professional raters, the results of which were not statistically significant. Various reports based on cohorts were poorly matched for gender, age, clinical condition and ethnicity, making their results difficult to reproduce.
The large number of outcome measure rating systems identified, suggests a lack of consensus and confidence as to a reliable, validated and reproducible scoring system for facial aesthetics in cleft patients. Many template and lay panel scoring systems are described, yet never fully validated. Advanced 3D imaging technologies may produce validated outcome measures in the future, but presently there remains a need to develop a robust method of facial aesthetic evaluation based on standardised patient photographs. We make recommendations for the development of such a system.
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Published online: May 17, 2012
Accepted: April 2, 2012
Received: August 31, 2011
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
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- Corrigendum to ‘Outcomes in facial aesthetics in cleft lip and palate surgery: A systematic review’ [J Plast Reconstr Aesthet Surg 65 (2012) 1233–1245]Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 65Issue 12
- PreviewThe authors would like to acknowledge that the study they reviewed by Trotman et al. (2000) ‘Three-dimensional nasolabial displacement during movement in repaired cleft lip and palate patients’, should be re-classified as a three-dimensional objective evaluation method for facial animations/movements. A more recent and comprehensive publication using this method is Trotman CA, Farray JJ, Phillips C, van Aalst J, J Dent Res 2010 Jul;89(7):728–732.