Assesing the Lower Lip in Esthetics of Patients with Clefts

Objectives:

The Asher-McDade scale is used to evaluate nasolabial esthetics in patients with complete unilateral cleft lip and palate (CUCLP).  This scale rates the severity of repaired cleft deformity on facial images that show the nose and upper lip.  The objective of this study is to evaluate the effect of including the lower lip within the facial images on the Asher-McDade ratings.

Methods: 

Facial images (frontal and profile) of 41 patients with CUCLP (mean age 8 years, 2 months) were cropped and placed in slides.  For each patient, two slides were created; one with the nasolabial region including the lower lip, and another excluding the lower lip.  Three orthodontic residents were raters.  Categories were nasal form, nasal symmetry, vermillion border, nasolabial profile, and overall appearance.   Intra- and inter-rater reliability were tested using weighted Kappa statistics.  Median differences between ratings with the lower lip and without the lower lip were calculated and compared to 0 using the Wilcoxon Sign Rank test.

Results:

For overall appearance, intra-rater reliabilities were good to very good (0.68 to 0.87).   Inter-rater comparisons were moderate to good (0.43 to 0.69).  When combining scores from all raters, the median differences between scores with the lower lip and without the lower lip were not statistically different from 0 for all categories in the Asher-McDade scale and overall appearance.  Similar results were found for individual raters.

Conclusions:

Displaying the lower lip in addition to the upper lip in facial images of patients with CUCLP does not have a significant effect on the assessment of nasolabial esthetics when evaluated by orthodontic residents.