Date: October 2023.
Source: The Cleft Palate Craniofacial Journal. 0(0). doi:10.1177/10556656231202173.
Objective: Objective measurement of pre-operative severity is important to optimize evidence-based practices given that the wide spectrum of presentation likely influences outcomes. The purpose of this study was to determine the correlation of objective measures of form with a subjective standard of cleft severity.
Design: 3D images were ranked according to severity of nasal deformity by 7 cleft surgeons so that the mean rank could be used as the severity standard.
Patients: 45 patients with unilateral cleft lip and 5 normal control subjects.
Interventions: Each image was assessed using traditional anthropometric analysis, 3D landmark displacements, and shape-based analysis to produce 81 indices for each subject.
Main Outcome: The correlation of objective measurements with the clinical severity standard.
Results: Lateral deviation of subnasale from midline was the best predictor of severity (0.86). Other strongly-correlated anthropometric measurements included columellar angle, nostril width ratio, and lateral lip height ratio (0.72, 0.80, 0.79). Almost all shape-based measurements had tight correlation with the severity standard, however, dorsum deviation and point difference nasolabial symmetry were the most predictive (0.84, 0.82).
Conclusions: Quantitative measures of severity transcend cleft type and can be used to grade clinical severity. Lateral deviation of subnasale was the best measure of severity and may be used as a surrogate of uncoupled premaxillary growth; it should be recorded as an index of pre-operative severity with every cleft lip repair. The correlation of other measures evaluated clarify treatment priorities and could potentially be used to grade outcomes.
Article: Measuring the Unilateral Cleft Lip Nasal Deformity: Lateral Deviation of Subnasale Is a Clinical and Morphologic Index of Unrepaired Severity.
Authors: Raymond W Tse, Thomas J Sitzman, Alexander C Allori, Russell E Ettinger, David M Fisher, Michael Bezuhly, Thomas D Samson, Stephen P Beals, Damir B Matic, Ezgi Mercan. Seattle Children’s Hospital, Seattle, WA, USA.