A 37-year follow-up after Skoog lip repair of unilateral cleft lip and palate: what is the long-term verdict on lip appearance by different panels?

Abstract

Background The study examined long-term lip appearance after Skoog’s lip repair in unilateral cleft, lip, and palate (UCLP) patients. To include different views, three different panels respectively, rated level of lip appearance and desire for improvement. The secondary aim was to investigate the correlation between the self-reported satisfaction of UCLP patients and controls with the panel assessments. Methods Cropped frontal photographs of the lips of 74 UCLP-treated individuals and 61 non-cleft individuals were assessed twice by three panels of five cleft surgeons (Professional panel), nine laymen (Layman panel), and five individuals with CLP (Cleft panel) using a web-based platform, at a mean follow-up of 37 years post-lip surgery. Results All three panels rated the lip appearance of UCLP patients worse than that of the controls (p < 0.001). The Professional panel reported higher satisfaction levels and less desire to change lip appearance than the Layman and Cleft panels. Intra-rater agreements were, in general, moderate in the Professional panel ICC (0.57–0.82) and Laymen panel ICC (0.63–0.73) and poor in the Cleft panel ICC (0.21–0.36). The inter-rater agreement was, in general, poor in all panels. No significant correlation was found between the patient’s Self-assessments and any of the panel assessments. Conclusions All panels’ rated lip appearance of adults born with UCLP treated with Skoog’s technique as worse than that of non-cleft controls. The study highlights a significant discrepancy between the Professional panel’s more favorable assessment and the more critical views of the laymen and cleft panels, contradicting the initial hypothesis of uniform perception across panels. The lack of correlation between patient self-assessment and panel assessments underscores the subjective nature of lip satisfaction, emphasizing the need for personalized patient care strategies in CLP treatment outcomes. Level of evidence Not gradable.