Facial Aesthetic Outcomes of Cleft Surgery: Assessment of Discrete Lip and Nose Images Compared with Digital Symmetry Analysis

Deall, Ciara; Kornmann, Nirvana S. S.; Bella, Husam; Wallis, Katy L.; Hardwicke, Joseph; Su, Ting-Li; Richard, Bruce

doi:10.1097/prs.0000000000002601

Cited by 16 publications

(8 citation statements)

References 23 publications

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“…Most studies have used the base view as a part of the overall aesthetic assessment, using a 3-point or 5-point Likert scale as proposed by Asher-McDade et al (Paiva et al, 2014; Pausch et al, 2016). Deall et al (2016) found no significant relation between the aesthetic assessment of the nose by human raters and the asymmetry assessed with SymNose. Freeman et al (2013) also found that the asymmetry results with SymNose for nose front perimeter (AP view) were in contrast with the perimeters as measured on the base view images, illuminating that aesthetic assessment of the nose is more complex, possibly because more features such as the shape of the alar base, the shape of the nostrils, septal deviation, and the width height ratio should be taken into account.…”

Section: Discussionmentioning

confidence: 67%

“…In 2015, Deall et al showed there was a significant association between the subjective assessment of the lip (Likert scores) and the asymmetry as measured with SymNose, where SymNose was more accurate as it overcame the human perception bias of negatively scoring right- over left-sided clefts (Bella et al., 2016; Deall et al, 2016). Until now, it remains unclear to which extent asymmetry plays a role in assessing facial aesthetics after cleft surgery and if scarring, or the shape of the facial features, are similarly contributing to the postoperative results.…”

Section: Discussionmentioning

confidence: 99%

“…The aesthetic assessment is commonly performed on 2-dimensional (2D) photographs using some form of the Asher-McDade system with a 5-point Likert scale ranging from “excellent” to “very poor” (Asher-McDade et al, 1991). However, the inter- and intrarater reliability of this scoring system remains only moderately reliable and is only slightly improved by using reference photographs (Kuijpers-Jagtman et al, 2009; Mercado et al, 2015) or assessment of discrete lip and nose (Mosmuller et al, 2014; Deall et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Defining the Aesthetic Range of Normal Symmetry for Lip and Nose Features in 5-Year-Old Children Using the Computer-Based Program SymNose

Kornmann

Tan

Mulder

et al. 2018

The Cleft Palate-Craniofacial Journal

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Objective: To provide a normal comparison group against which to judge symmetry results after cleft surgery and to introduce the thin lip correction (TLC) feature in SymNose. A lip–aspect ratio algorithm has been added to the latest version of SymNose to compensate for the higher degree of overlap in thicker lips when compared to thin lips. Design: Retrospective analysis of symmetry in healthy participants, using the computer-based program SymNose on both anteroposterior (AP) and base view images. Photographs of 91 noncleft children were traced twice by 3 independent investigators experienced with SymNose. Participants: Five-year-old healthy participants from a local state school in Tavistock (West Devon, United Kingdom). Main Outcome Measure: Asymmetry expressed as the perimeter mismatch percentage for nose and lip features on AP view images and for nose features on base view images. Results: The perimeter mismatch reference range for the nose (AP view) was 2.65% to 30.91%, for the lip 2.13% to 15.44%, for the nose (base view) 1.69% to 14.84%, for the nostrils 4.68% to 26.6%, and for the width–height ratio 1.15% to 1.80%. The perimeter mismatch percentage for the lip without TLC was significantly higher compared to the perimeter mismatch percentage with TLC ( P < .001). Conclusion: This article provides a noncleft reference range for all perimeters drawn from SymNose against which to compare results after cleft surgery at 5 years of age. Furthermore, it shows the importance of correcting for variance in lip volume per child.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Defining the Aesthetic Range of Normal Symmetry for Lip and Nose Features in 5-Year-Old Children Using the Computer-Based Program SymNose

Kornmann

Tan

Mulder

et al. 2018

The Cleft Palate-Craniofacial Journal

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“…We believe that there is little value in having participants provide a score without further comparison to their eye-tracking data. [33][34][35] Value from eye-tracking as a research tool comes from comparing how participants view images with different scores, as these data can form the basis of a standardized outcome measurement tool. We suggest that future work that incorporates a form of scoring into eye-tracking research should directly compare the scoring data to the eye-tracking data, as this represents the ideal way to further advance work in this field.…”

Section: Discussionmentioning

confidence: 99%

The Use of Eye-tracking Technology in Cleft Lip: A Literature Review

Plonkowski

Breakey

Read

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Eye-tracking has become an increasingly popular research tool within the field of cleft lip and/or palate (CL+/−P). Despite this, there are no standardized protocols for conducting research. Our objective was to conduct a literature review of the methodology and outcomes of previous publications using eye-tracking in CL+/−P. Methods: The PubMed, Google Scholar, and Cochrane databases were searched to identify all articles published up to August 2022. All articles were screened by two independent reviewers. Inclusion criteria included using eye-tracking, image stimuli of CL+/−P, and outcome reporting using areas of interest (AOIs). Exclusion criteria included non-English studies, conference articles, and image stimuli of conditions other than CL+/−P. Results: Forty articles were identified, and 16 met the inclusion/exclusion criteria. Thirteen studies only displayed images of individuals following cleft lip surgery with three only displaying unrepaired cleft lips. Significant variation was found in study design, particularly in the AOIs used to report gaze outcomes. Ten studies asked participants to provide an outcome score alongside eye-tracking; however, only four compared outcome data to eye-tracking data. This review is primarily limited by the minimal number of publications in this area. Conclusions: Eye-tracking can be a powerful tool in evaluating appearance outcomes following CL+/−P surgery. It is currently limited by the lack of standardized research methodology and varied study design. Before future work, a replicable protocol should be developed to maximize the potential of this technology.

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“…Our data signify the importance of a good nose result, not only aesthetically but functionally too, as the highest correlation to a wish for surgical correction of the nasolabial area was when the patient was less satisfied with their nose appearance or experienced functional nose problems more often. Some other studies, however, conclude that the lip is of more influence than the nose when assessing CL±P faces, because the lip is both functionally and aesthetically a dominant structure of the face (Deall et al, 2016; Nadjmi et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Aesthetics Assessment and Patient Reported Outcome of Nasolabial Aesthetics in 18-Year-Old Patients With Unilateral Cleft Lip

Mulder

Mosmuller

Vet

et al. 2019

The Cleft Palate Craniofacial Journal

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Objective: To determine if there is a correlation between objective nasolabial aesthetics assessment using the Cleft Aesthetic Rating Scale (CARS) and patient satisfaction. Design: Retrospective analysis of a generic satisfaction questionnaire and independent assessment by three cleft surgeons of the nasolabial area of these patients on 2D frontal photographs, using the CARS. Setting: The Vrije Universiteit Medical Center and The Academic Center for Dentistry Amsterdam. Patients: Thirty-nine 18-year old patients with a repaired complete or incomplete unilateral cleft lip, with or without a cleft palate, and a completed satisfaction questionnaire. Exclusion criteria were an incomplete questionnaire; a history of facial trauma; and congenital syndromes affecting facial appearance. Main Outcome Measures: The correlation between surgeon evaluation (on a 5-point Likert scale) and patient satisfaction (not, moderately or very satisfied) on nasolabial appearance was assessed using Spearman rho (ρ). Results: There was a negligible correlation between surgeon evaluation and patient satisfaction on nose assessment (ρ = 0.20) and a moderate correlation on lip assessment (ρ = 0.32). Conclusions: Most literature supports this discrepancy between different objective aesthetics evaluation methods and subjective patient-reported outcome measures, suggesting there are factors playing a role in patient satisfaction that are impossible to objectify with assessment methods. Therefore, a strong emphasis should remain on clear communication between the physician and patient regarding their expectations, perception, and satisfaction of surgery results.

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Facial Aesthetic Outcomes of Cleft Surgery: Assessment of Discrete Lip and Nose Images Compared with Digital Symmetry Analysis

Abstract: Therapeutic, III.

Cited by 16 publications

References 23 publications

Defining the Aesthetic Range of Normal Symmetry for Lip and Nose Features in 5-Year-Old Children Using the Computer-Based Program SymNose

Defining the Aesthetic Range of Normal Symmetry for Lip and Nose Features in 5-Year-Old Children Using the Computer-Based Program SymNose

The Use of Eye-tracking Technology in Cleft Lip: A Literature Review

Aesthetics Assessment and Patient Reported Outcome of Nasolabial Aesthetics in 18-Year-Old Patients With Unilateral Cleft Lip

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