The Goslon Yardstick Applied to a Consecutive Series of Patients with Unilateral Clefts of the Lip and Palate

Frenchay Hospital, Bristol, United Kingdom.
The Cleft Palate-Craniofacial Journal (Impact Factor: 1.2). 12/1996; 33(6):494-6. DOI: 10.1597/1545-1569(1996)033<0494:TGYATA>2.3.CO;2
Source: PubMed
First described in 1987, the Goslon yardstick has been used since as a reliable and reproducible means of measuring dental arch relationships and, therefore, the quality of facial growth. The dental study models of a group of 32 consecutively treated patients with unilateral clefts of lip and palate, from the Frenchay Hospital, Bristol, U.K., were analyzed using the Goslon yardstick. More than 50% of the sample were in the unfavorable Goslon groups IV and V. Because of these results, we at Frenchay Hospital now base our related surgical procedures on the early vomerine closure of the anterior hard palate without nasal or alveolar repair at 3 months, followed by primary hard and soft palate closure at 6 months.

Full-text preview

Available from:
Intraoral Photographs for Rating Dental Arch Relationships in Unilateral Cleft
Lip and Palate
Yu-Fang Liao, D.D.S., Ph.D., Chiung-Shing Huang, D.D.S., Ph.D., I-Feng Lin, Ph.D.
Background and Purpose: The Goslon Yardstick is one of the most
commonly used methods to assess dental arch relationships of patients with
unilateral cleft lip and palate. This system was originally applied to dental casts.
For reasons of economy and convenience, we aimed to determine whether
intraoral photographs could substitute for dental casts for rating dental arch
Methods: Records of 58 patients with nonsyndromic complete unilateral cleft
lip and palate from the Chang Gung Craniofacial Center, Taipei, Taiwan, were
used in this study. A set of dental casts and digital intraoral photographs taken
at around 9 years of age were available for all patients. An experienced
examiner rated the dental casts using the Goslon Yardstick to provide the
reference scores. The other three examiners rated the intraoral photographs
and repeated the rating 1 week later to calculate inter- and intraexaminer
reliability. The photographic scores for each examiner were then compared with
the reference scores to determine the validity of the photographs.
Results: The results showed no significant difference between the rating of
dental casts and photographs using the Goslon Yardstick. Reliability was also
high for rating on photographs.
Conclusions: Intraoral photographs appear to be a viable alternative to the
application of the Goslon Yardstick on dental casts.
KEY WORDS: dental arch relationships, Goslon Yardstick, intraoral photo-
graphs, treatment outcome, unilateral cleft lip and palate
In addition to speech, growth, appearance, and hearing,
a criterion for assessing treatment outcomes of patients
with clefts is occlusion (i.e., dental arch relationships). A
major means of evaluating occlusion is dental cast analysis.
In 1987, in an attempt to be simple and rapid, Mars and
coworkers implemented a rating system for occlusion of
children with unilateral cleft lip and palate (UCLP), the
Goslon Yardstick. The Goslon Yardstick is a rating system
specifically developed to grade dental arch relationships in
the late mixed or early permanent dentition into five
categories. This system assures reliability and reproducibil-
ity (Mars et al., 1992; Hathorn et al., 1996; Johnson et al.,
2000; Morris et al., 2000).
The Goslon Yardstick also has been successfully used in
studies discriminating the quality of the dental arch
relationships among different centers (Mars et al., 1992;
Mølsted et al., 2005). This makes the Goslon Yardstick a
useful tool for comparative cross-center studies. However,
for intercenter studies or studies that require ratings by
external examiners, the examiners, the dental casts, or both
must travel to the place at which the rating will be carried
out. This inevitably is associated with some expense and
inconvenience. For reasons of economy and convenience,
Nollet and coworkers (2004) recently tested the reliability
of rating dental arch relationships using the Goslon
Yardstick on dental casts and photographs of dental casts.
They demonstrated that no significant differences were
found between the rating of dental casts and photographs
of dental casts. Therefore, they concluded that photographs
of dental casts are a reliable alternative to the application of
the Goslon Yardstick on dental casts. Indeed, an assess-
ment method that could be performed over the Internet
would be cost effective. Although applying the assessment
to photographs of dental casts is cost effective, a more
economic and convenient approach would be to substitute
the photographs of dental casts with similar views of
intraoral photographs, due to the reduced need for
obtaining dental casts. The purpose of this study, therefore,
was to determine whether intraoral photographs could be
Submitted December 2007; Accepted December 2008.
Address correspondence to: Dr. Yu-Fang Liao, Department of
Dentistry, Chang Gung Memorial Hospital, 199 Tung-Hwa North Road,
Taipei 105, Taiwan. E-mail
DOI: 10.1597/07-220.1
Dr. Liao is Assistant Professor, Department of Dentistry, Chang Gung
Memorial Hospital, Taipei, Taiwan; and College of Medicine, Chang
Gung University, Taoyuan, Taiwan. Dr. Huang is Professor, Department
of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan; and
College of Medicine, Chang Gung University, Taoyuan, Taiwan. Dr. Lin
is Associate Professor, Institute and Department of Social Medicine,
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Page 1

You are reading a preview. Would you like to access the full-text?

  • Source
    • "This is to ensure standardization, so that scoring between operators and units is as reliable as possible, and because there are various conventions within the scoring system which must be adhered too. Much work has subsequently been done using the GOSLON Yardstick which is widely accepted to have good face validity and good reliability (Noverraz et al., 1993; Hathorn et al., 1996), and as a result, is the most widely used outcome measure of the occlusal effects of primary surgery (Hathaway et al., 2011; Jack et al., 2011). The 5 Year Olds' Index Although the GOSLON Yardstick provides a useful outcome measure of the primary surgery in the early permanent dentition, it still means that surgeons have to wait at least ten years to get standardized dentoalveolar outcomes from their treatment. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Feb 2014 · Journal of Orthodontics
  • Source
    • "Summaries of the articles are presented inTable 2. Furthermore, the prevalence and a brief description of these indices are presented in Tables 3 and 4. Within the included studies, zero assessed the reliability of the GOAL Yardstick, one assessed the EUROCRAN Yardstick (Patel, 2011), one assessed the BCLP Yardstick (Bartzela et al., 2011), two assessed the reliability of the Five-Year-Old Index (Atack et al., 1997a; Atack et al., 1997b), two assessed the reliability of the HB IndexTable 1 QUADAS (Whiting et al., 2003) criteria for evaluating diagnostic accuracy studies. @BULLET The validity of the Five-Year-Old Index is worse than the GOSLON Yardstick's validity at 5 y, when using the GOLSON score at 10 y as the gold standard @BULLET In 5 y, the GOSLON group 3 should be modified to a 2, and group 4 should become Downloaded from (Huddart and Bodenham, 1972; Bartzela et al., 2011), four assessed the GOSLON Yardstick (Mars et al., 1987; Hathorn et al., 1996; Mars et al., 2006; Manosudprasit et al., 2011), and six assessed the MHB Index nine times (Mossey et al., 2003; Gray and Mossey, 2005; Tothill and Mossey, 2007; Manosudprasit et al., 2011; Patel, 2011; Dobbyn et al., 2012), although some studies assessed the MHB more than once in the same study using a different sample. Moreover, the validity was assessed zero time for the EUROCRAN Yardstick and GOAL Yardstick; one time for the BCLP Yardstick (Bartzela et al., 2011), HB index (Bartzela et al., 2011), and the MHB (Mossey et al., 2003); three times for the Five-Year-Old Index (Atack et al., 1997a; Atack et al., 1997b; Mars et al., 2006); and two times for the GOSLON Yardstick (Mossey et al., 2003; Mars et al., 2006). "
    [Show abstract] [Hide abstract] ABSTRACT: BACKGROUND:Several indices are now available to assess the severity of the malocclusion in cleft lip and/or palate (CLP) patients; and although it has been quite some time since the introduction of these indices, there is no consensus as to which index should be used for CLP populations.OBJECTIVE:To systematically review the available literature on the indices used to assess the occlusal schemes in dental models of CLP patients, with respect to the most commonly used index and the index that most fulfils the World Health Organization (WHO) criteria.SEARCH METHODS:Ten electronic databases, grey literature, and reference list searches were conducted.SELECTION CRITERIA:The inclusion criteria consisted of studies that aimed to assess a particular malocclusion index on study models of patients with CLP.DATA COLLECTION AND ANALYSIS:Full articles were retrieved from abstracts/titles that appeared to have met the inclusion -exclusion criteria which were subsequently reviewed using more detailed criteria for a final selection decision. The Quality Assessment of Diagnostic Accuracy Studies tool was used to appraise the methodological quality of the finally included studies. Due to the heterogeneity of the data, only a qualitative analysis was performed.RESULTS:A total of 13 studies met the inclusion -exclusion criteria. These studies revealed seven utilized indices, namely the GOSLON Yardstick, Five-Year-Old, Bauru-Bilateral Cleft Lip and Palate Yardstick, Huddart -Bodenham, Modified Huddart -Bodenham, EUROCRAN Yardstick, and GOAL Yardstick. The GOSLON Yardstick was the most commonly used index, and the Modified Huddart -Bodenham performed the best according to the WHO criteria.CONCLUSIONS:Current evidence suggests that the Modified Huddart -Bodenham Index equalled or outperformed the rest of the indices on all the WHO criteria and that the GOSLON Yardstick was the most commonly used index, possibly due to a longer time in use. Therefore, the Modified Huddart -Bodenham could be considered as the standard to measure outcomes of patients with CLP.
    Full-text · Article · Mar 2013 · The European Journal of Orthodontics
  • Source
    • "ipation of multiple low - volume surgeons . As a result , the Eurocleft comparison studies of the outcomes of six European cleft centers and Americleft comparison studies showed that centers with centralized care and high - volume operators seemed to get better results ( Mars et al . , 1992 ; Molsted et al . , 1992 ; Shaw et al . , 1992a , 1992b ; Hathorn et al . , 1996 ; Morris et al . , 2000 ; Bearn et al . , 2001 ; Williams et al . , 2001 ; Molsted et al . , 2005 ; Nollet et al . , 2005 ; Shaw et al . , 2005 ; Susami et al . , 2006 ; Sinko et al . , 2008 ; Fudalej et al . , 2009 ; Zreaqat et al . , 2009 ; Hathaway et al . , 2011 ; Long et al . , 2011 ; Love et al . , 2011 ; Ozawa et al . , 2011 ; ) "
    [Show abstract] [Hide abstract] ABSTRACT: Abstract Objective: To compare the dental arch relationships of Turkish patients with complete unilateral cleft lip and palate (UCLP) with the results reported for participants in the Eurocleft study. Patients: Study models of 109 patients with complete UCLP from five university clinics in Turkey were evaluated (clinic A = 25 patients, clinic B = 23 patients, clinic C = 20 patients, clinic D = 21 patients, and clinic E = 20 patients). The mean age of the patient cohort was nine years old (range = 8-11 years old), and the cohort was born between 1976 and 1990. Methods: The examiners rated the three-dimensional (3D) models using the GOSLON Yardstick. The scores were compared with those from the Eurocleft centers: E1(B), E2(E), E3(A), E4(F), E5(C), and E6(D). Intra- and interexaminer agreements were evaluated using weighted kappa statistics. Results: The mean Goslon scores for the Turkish clinics were as follows: clinic A = 3.16, clinic B = 3.13, clinic C = 3.25, clinic D = 3.67, and clinic E = 3.70. Scores for three of the Turkish clinics (A, B, and C) were significantly worse than the scores for the three best Eurocleft centers, E1(B), E2(E), and E3(A) (p < 001, p < 001, and p < 05, respectively). Scores for two of the Turkish clinics (D and E) were similar to those for Eurocleft center E6(D) but worse than the scores for the other Eurocleft centers (p < 0001, p < 001, respectively). Conclusions: This was the first study in which three-dimensional models were used to derive scores to compare with those of the Eurocleft centers. According to the results of analysis of 109 3D models, 50.4 % of the patients in Turkey were classified as Goslon score 4 and 5. This may have been attributable to poor surgical procedures, low-volume surgeons, and the decentralized treatment approach in Turkey between 1985 and 2000. Further research is needed to assess the situation in Turkey in more recent years.
    Full-text · Article · Jul 2012 · The Cleft Palate-Craniofacial Journal
Show more