How well does quantitative measurements of the lip and panel ratings of the lip outcomes correlate in adults treated for unilateral cleft, lip, and palate with Skoog lip repair in childhood.

Abstract

Little is known about the long-term lip symmetry after cleft repair and correlation between objective measures and subjective human ratings. Therefore, we examined long-term lip asymmetry among adults who were treated for unilateral cleft, lip, and palate (UCLP) with the Skoog's lip repair in their infancy. Furthermore, we investigated the correlation between patient-reported scores of lip appearance and percentage of lip asymmetry as measured using SymNose. The symmetry of the lip was measured twice using SymNose by two users on frontal uncropped photographs of 74 UCLP-treated adults at a mean follow-up of 37 years postlip surgery. Previously collected self-assessment of lip appearance and panel ratings (from professionals, laypersons, and cleft panels) of these photographs were included in this study. The overall median lip asymmetry was relatively low at 18%. Men exhibited slightly higher asymmetry than women (P<0.05). There was no difference between SymNose measurements taken by the two users (P>0.05). Intrarater agreement of both users ranged from good to excellent (intraclass correlation coefficient 0.84-0.96). The interrater agreement was moderate, (intraclass correlation coefficient 0.52-0.66). No significant correlation was found between the human ratings: self-assessment and panel assessments to that of lip asymmetry (%) measured using SymNose. Although SymNose is confirmed to be a reliable tool for quantifying asymmetry, it does not correlate with subjective human ratings. Thus, it should be complemented with subjective assessment and clinical findings to define lip outcomes among patients with UCLP.