BACKGROUND: There is a multitude of protocols of treatment of cleft lip and palate (CLP) worldwide differing in number of operations, surgical techniques, and timings of surgeries. Despite, facial appearance in subjects with CLP is rarely ideal and residual stigmata are easy to notice in many patients irrespective of the protocol. The prospective controlled investigations are optimal for comparing effectiveness of treatment protocols. Because prospective studies are very challenging to perform in CLP field, it is reasonable to retrospectively assess different surgical protocols to identify the promising ones and then to test them in a prospective way. METHODS: Our objective was to assess the nasolabial appearance in a preadolescent Slavic population with unilateral cleft lip and palate (UCLP) by using the 0-200 numeric scale with reference photographs. Patients treated in Warsaw, Poland (n = 32), Prague, Czech Republic (n = 26) and Bratislava, Slovakia (n = 17) were included in this retrospective study. Each cleft center used a unique surgical protocol. Two panels of professional raters (n = 7) and laypeople (n = 10) scored blindly the nasolabial esthetics on cropped frontal and profile images with cropped reference photograph present on the same slide. Intra- and inter-rater agreement was assessed with Cronbach's alpha, intraclass correlation coefficients, t-tests, and Bland-Altman plots. Inter-group differences were evaluated with one-way ANOVA and regression analysis. RESULTS: The agreement within and between raters was acceptable. We found that patients treated in Warsaw, Prague, and Bratislava showed comparable nasolabial appearance on frontal and profile photographs when judged by both professional raters (p > 0.05) and laypeople (p > 0.05). Regression analysis did not identify influence of gender, group (i.e., Warsaw, Prague, and Bratislava), age at lip repair, surgeon, and age at photographic assessment on esthetic outcome (p > 0.05). CONCLUSION: This study showed that none of the surgical protocols showed superiority to produce good nasolabial appearance.

Clinic of Plastic and Reconstructive Surgery Comenius University in Bratislava Bratislava Slovak Republic

Department of Maxillofacial Surgery F D Roosevelt University Hospital Banska Bystrica Slovak Republic

Department of Orthodontics and Cleft Anomalies Dental Clinic 3rd Medical Faculty Charles University Faculty Hospital Royal Vineyard Prague Czech Republic

Department of Orthodontics and Dentofacial Orthopedics University of Bern Bern Switzerland

Department of Orthodontics Jagiellonian University Cracow Krakow Poland

Department of Pediatric Surgery Institute of Mother and Child Warsaw Poland

Department of Stomatology and Maxillofacial Surgery Comenius University in Bratislava Bratislava Slovak Republic

Institute of Dentistry and Oral Sciences Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic

Zobrazit více v PubMed

Asher-McDade C, Roberts C, Shaw WC, Gallager C. Development of a method for rating nasolabial appearance in patients with clefts of the lip and palate. Cleft Palate-Craniofacial Journal. 1991;28(4):385–390. doi: 10.1597/1545-1569_1991_028_0385_doamfr_2.3.co_2. PubMed DOI

Bearn D, Mildinhall S, Murphy T, Murray JJ, Sell D, Shaw WC, Williams AC, Sandy JR. Cleft lip and palate care in the United Kingdom--the clinical standards advisory group (CSAG) study. part 4: outcome comparisons, training, and conclusions. Cleft Palate-Craniofacial Journal. 2001;38(1):38–43. doi: 10.1597/1545-1569_2001_038_0038_clapci_2.0.co_2. PubMed DOI

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8486):307–310. doi: 10.1016/S0140-6736(86)90837-8. PubMed DOI

Bongaarts CA, Prahl-Andersen B, Bronkhorst EM, Spauwen PH, Mulder JW, Vaandrager JM, Kuijpers-Jagtman AM. Effect of infant orthopedics on facial appearance of toddlers with complete unilateral cleft lip and palate (Dutchcleft) Cleft Palate-Craniofacial Journal. 2008;45(4):407–413. doi: 10.1597/07-043.1. PubMed DOI

Brattström V, Mølsted K, Prahl-Andersen B, Semb G, Shaw WC. The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. part 2: craniofacial form and nasolabial appearance. Cleft Palate-Craniofacial Journal. 2005;42(1):69–77. doi: 10.1597/02-119.2.1. PubMed DOI

Eichenberger M, Staudt CB, Pandis N, Gnoinski W, Eliades T. Facial attractiveness of patients with unilateral cleft lip and palate and of controls assessed by laypersons and professionals. European Journal of Orthodontics. 2014;36(3):284–289. doi: 10.1093/ejo/cjt047. PubMed DOI

Foo P, Sampson W, Roberts R, Jamieson L, David D. Facial aesthetics and perceived need for further treatment among adults with repaired cleft as assessed by cleft team professionals and laypersons. European Journal of Orthodontics. 2013;35(3):341–346. doi: 10.1093/ejo/cjr129. PubMed DOI

Fudalej PS, Urbanova W, Klimova I, Dubovska I, Brudnicki A, Polackova P, Kroupova D, Kotova M, Rachwalski M. The slavcleft: a three-center study of the outcome of treatment of cleft lip and palate. Part 2: dental arch relationships. Journal of Cranio-Maxillofacial Surgery. 2019;47(7):1092–1095. doi: 10.1016/j.jcms.2019.03.023. PubMed DOI

Fudalej SA, Desmedt D, Bronkhorst E, Fudalej PS. Comparison of three methods of rating nasolabial appearance in cleft lip and palate. Cleft Palate-Craniofacial Journal. 2017;54(4):400–407. doi: 10.1597/14-189. PubMed DOI

Gkantidis N, Papamanou DA, Christou P, Topouzelis N. Aesthetic outcome of cleft lip and palate treatment: perceptions of patients, families, and health professionals compared to the general public. Journal of Cranio-Maxillofacial Surgery. 2013;41(7):e105–e110. doi: 10.1016/j.jcms.2012.11.034. PubMed DOI

Hunt O, Burden D, Hepper P, Johnston C. The psychosocial effects of cleft lip and palate: a systematic review. European Journal of Orthodontics. 2005;27(3):274–285. doi: 10.1093/ejo/cji004. PubMed DOI

Kuijpers MAR, Maal TJJ, Meulstee JW, Carels CEL, Bronkhorst EM, Bergé SJ, Fudalej PS. Nasolabial shape and aesthetics in unilateral cleft lip and palate: an analysis of nasolabial shape using a mean 3D facial template. International Journal of Oral and Maxillofacial Surgery. 2021;50(2):267–272. doi: 10.1016/j.ijom.2020.06.003. PubMed DOI

Mercado A, Russell K, Hathaway R, Daskalogiannakis J, Sadek H, Long RE, Jr, Cohen M, Semb G, Shaw W. The Americleft study: an inter-center study of treatment outcomes for patients with unilateral cleft lip and palate part 4. Nasolabial aesthetics. Cleft Palate-Craniofacial Journal. 2011;48(3):259–264. doi: 10.1597/09-186.1. PubMed DOI

Meyer-Marcotty P, Stellzig-Eisenhauer A. Dentofacial self-perception and social perception of adults with unilateral cleft lip and palate. Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopädie. 2009;70(3):224–236. doi: 10.1007/s00056-009-8813-9. PubMed DOI

Mosmuller DG, Bijnen CL, Kramer GJ, Disse MA, Prahl C, Kuik DJ, Niessen FB, Don Griot JP. The Asher-McDade aesthetic index in comparison with two scoring systems in nonsyndromic complete unilateral cleft lip and palate patients. Journal of Craniofacial Surgery. 2015;26(4):1242–1245. doi: 10.1097/SCS.0000000000001784. PubMed DOI

Offert B, Janiszewska-Olszowska J, Dudkiewicz Z, Brudnicki A, Katsaros C, Fudalej PS. Facial esthetics in children with unilateral cleft lip and palate 3 years after alveolar bonegrafting combined with rhinoplasty between 2 and 4 years of age. Orthodontics & Craniofacial Research. 2013;16(1):36–43. doi: 10.1111/ocr.12002. PubMed DOI

Russell K, Long RL, Hathaway R, Daskalogiannakis J, Mercado A, Cohen M, Semb G, Shaw WC. The Americleft study: an inter-center study of treatment outcomes for patients with unilateral cleft lip and palate part 5. General discussion and conclusions. Cleft Palate-Craniofacial Journal. 2011;48(3):265–270. doi: 10.1597/09-187.1. PubMed DOI

Semb G, Brattström V, Mølsted K, Prahl-Andersen B, Zuurbier P, Rumsey N, Shaw WC. The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 4: relationship among treatment outcome, patient/parent satisfaction, and the burden of care. Cleft Palate-Craniofacial Journal. 2005;42(1):83–92. doi: 10.1597/02-119.4.1. PubMed DOI

Sharma VP, Bella H, Cadier MM, Pigott RW, Goodacre TE, Richard BM. Outcomes in facial aesthetics in cleft lip and palate surgery: a systematic review. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2012;65(9):1233–1245. doi: 10.1016/j.bjps.2012.04.001. PubMed DOI

Shaw WC, Brattström V, Mølsted K, Prahl-Andersen B, Roberts C, Semb G. The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 5: discussion and conclusions. Cleft Palate-Craniofacial Journal. 2005;42(1):93–98. doi: 10.1597/02-119.5.1. PubMed DOI

Urbanova W, Klimova I, Brudnicki A, Polackova P, Kroupova D, Dubovska I, Rachwalski M, Fudalej PS. The Slav-cleft: a three-center study of the outcome of treatment of cleft lip and palate. Part 1: craniofacial morphology. Journal of Cranio-Maxillofacial Surgery. 2016;44(11):1767–1776. doi: 10.1016/j.jcms.2016.06.010. PubMed DOI

Zhu S, Jayaraman J, Khambay B. Evaluation of facial appearance in patients with cleft lip and palate by laypeople and professionals: a systematic literature review. Cleft Palate-Craniofacial Journal. 2016;53(2):187–196. doi: 10.1597/14-177. PubMed DOI

Zhu S, Yang Y, Gu M, Khambay B. A comparison of three viewing media for assessing dental arch relationships in patients with unilateral cleft lip and palate. Cleft Palate-Craniofacial Journal. 2016;53(5):578–583. doi: 10.1597/15-144. PubMed DOI