Outcomes in facial aesthetics in cleft lip and palate surgery: A systematic review
ABSTRACT 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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ABSTRACT: Background. The upper lip-nose complex contributes significantly to the concept of symmetry and proportion of the face. A study of the morphology and aesthetic preferences of the lip-nose complex will provide a database that will serve as a guide for reconstruction. Subjects and Methods. Hundred Nigerian children participated in this study. Demographic data and standard photographs of the philtral column and nostrils were obtained. Sixty volunteers were recruited to evaluate the photographs. Each volunteer was asked to rank the photographs based on their aesthetic preference. Results. The morphology of the philtral columns was classified into four groups: (1) triangular, (2) concave, (3) flat, and (4) parallel. The nostril shape was also classified into four groups: (1) triangular, (2) round, (3) teardrop, and (4) rectangular. In both genders, the triangular shape of philtral column was the most common. There are significant age differences in the aesthetic rankings of philtral columns and nostril shapes. Conclusion. Our study establishes the basal values for the morphometric and aesthetic parameters of the lip-nose complex of 5- and 6-year-old children in Nigeria. We hope our results and reconstructive surgery will intersect at a point to treat disfigurements of the philtrum and nostrils successfully.06/2013; 2013:382754. DOI:10.1155/2013/382754
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ABSTRACT: The aim of the present prospective and descriptive study was to assess the impact of facial aesthetic and reconstructive surgeries on quality of life. Ninety-one patients, of whom 43 had aesthetic surgery and 48 had reconstructive surgery, were analysed. The data were collected using the patient information form, body cathexis scale, and short form (SF)-36 quality of life scale. There were significant differences between before and after the surgery in both groups in terms of body cathexis scale and quality of life (p < 0.05 for both). It was observed that problems regarding the body image perception were encountered more, and the quality of life was poorer in both aesthetic and reconstructive surgery patients before the surgery. However, the problems were decreased, and the quality of life was enhanced after the surgery. Among the parameters of SF-36 quality of life scale, particularly the mean scores of social functioning, physical role functioning, emotional role functioning, mental health, and vitality/fatigue were found low before the surgery, whereas the mean scores were significantly improved after the surgery. The results revealed that facial aesthetic and reconstructive surgical interventions favourably affected the body image perception and self-esteem and that positive reflections in emotional, social, and mental aspects were effective in enhancing self-confidence and quality of life of the individual.Indian Journal of Surgery 01/2014; DOI:10.1007/s12262-013-1024-z · 0.27 Impact Factor
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ABSTRACT: This article provides a summary of the main outcome measures currently available and in use within modern cleft care. The fact that there are such a diverse range, including surgical, orthodontic, dental, speech and patient satisfaction measures, is a reflection of the complex, multidisciplinary and longitudinal nature of the care provided. The use of such measures of outcome is essential in the auditing and drive for continued improvements in the standards of care for patients affected with cleft lip and palate.Journal of Orthodontics 02/2014; 41(2). DOI:10.1179/1465313313Y.0000000086