Tags

Type your tag names separated by a space and hit enter

Assessment of bilateral cleft lip nose deformity: a comparison of results as judged by cleft surgeons and laypersons.
Plast Reconstr Surg 2002; 110(3):733-8; discussion 739-41PR

Abstract

Reconstruction of bilateral cleft lip nose deformity is difficult and the outcome is inconsistent. This study was conducted to evaluate the gross outcome and the difference in the assessment of nasal appearance as judged by two groups of raters, cleft surgeons and laypersons. Sixty-four patients with bilateral cleft lip were selected for review. The patients' ages ranged from 5 to 30 years. All patients had undergone primary cleft lip repair and secondary nasal reconstruction, and had been followed for at least 6 months. One image for each patient, which included a digitized frontal, lateral, and worm's-eye view, was projected for evaluation by the raters. The raters included five cleft surgeons and five laypersons. A rating scheme was used in which a score of 3 was given for a good, close to normal nasal appearance, 2 for an average result that needed minor revision, and 1 for a poor result that needed major reconstruction. The scores were averaged for each patient in each group and for each group as a whole. The final outcome was judged as good, fair, or poor on the basis of the mean score for each patient. Statistical analysis was performed. The mean score for all patients was 2.08 as assessed by the laypersons and 2.18 as assessed by the cleft surgeon group. There was no statistically significant difference between the two groups. Comparisons on rating scores among different raters revealed a fair agreement on the ratings within each of the two groups. The results were found to be good in 29.7 percent, fair in 64.1 percent, and poor in 6.3 percent of patients when evaluated by the surgeons. When rated by the laypersons, the nasal appearance was found to be good in 26.6 percent, fair in 60.9 percent, and poor in 12.5 percent of patients. This difference in distribution between the two groups was not statistically significant. When comparing the results given by the two groups of assessors, there was agreement on the nasal appearance in 65.6 percent of patients, and a difference in grading in the rest. For the patients who received different grading, the surgeons rated them one grade higher in 63.6 percent and one grade lower in 36.4 percent. There was no difference in grading between any of the evaluators that reflected a two-grade discrepancy in evaluation of results. This study shows that the surgical outcome of bilateral cleft lip nose deformity repair, at the authors' institution, is less than optimal. When assessing bilateral cleft lip nose appearance, the judgment of results by cleft surgeons was similar to that of the laypersons. However, different rating of results existed within each of the two groups, supporting the importance of clearly assessing patient/parent expectations and defining realistic surgical goals.

Authors+Show Affiliations

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 199 Tun Hwa North Road, Taipei, Taiwan. lunjoulo@ms1.hinet.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12172130

Citation

Lo, Lun-Jou, et al. "Assessment of Bilateral Cleft Lip Nose Deformity: a Comparison of Results as Judged By Cleft Surgeons and Laypersons." Plastic and Reconstructive Surgery, vol. 110, no. 3, 2002, pp. 733-8; discussion 739-41.
Lo LJ, Wong FH, Mardini S, et al. Assessment of bilateral cleft lip nose deformity: a comparison of results as judged by cleft surgeons and laypersons. Plast Reconstr Surg. 2002;110(3):733-8; discussion 739-41.
Lo, L. J., Wong, F. H., Mardini, S., Chen, Y. R., & Noordhoff, M. S. (2002). Assessment of bilateral cleft lip nose deformity: a comparison of results as judged by cleft surgeons and laypersons. Plastic and Reconstructive Surgery, 110(3), pp. 733-8; discussion 739-41.
Lo LJ, et al. Assessment of Bilateral Cleft Lip Nose Deformity: a Comparison of Results as Judged By Cleft Surgeons and Laypersons. Plast Reconstr Surg. 2002 Sep 1;110(3):733-8; discussion 739-41. PubMed PMID: 12172130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of bilateral cleft lip nose deformity: a comparison of results as judged by cleft surgeons and laypersons. AU - Lo,Lun-Jou, AU - Wong,Fen-Hwa, AU - Mardini,Samir, AU - Chen,Yu-Ray, AU - Noordhoff,M Samuel, PY - 2002/8/13/pubmed PY - 2002/8/31/medline PY - 2002/8/13/entrez SP - 733-8; discussion 739-41 JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 110 IS - 3 N2 - Reconstruction of bilateral cleft lip nose deformity is difficult and the outcome is inconsistent. This study was conducted to evaluate the gross outcome and the difference in the assessment of nasal appearance as judged by two groups of raters, cleft surgeons and laypersons. Sixty-four patients with bilateral cleft lip were selected for review. The patients' ages ranged from 5 to 30 years. All patients had undergone primary cleft lip repair and secondary nasal reconstruction, and had been followed for at least 6 months. One image for each patient, which included a digitized frontal, lateral, and worm's-eye view, was projected for evaluation by the raters. The raters included five cleft surgeons and five laypersons. A rating scheme was used in which a score of 3 was given for a good, close to normal nasal appearance, 2 for an average result that needed minor revision, and 1 for a poor result that needed major reconstruction. The scores were averaged for each patient in each group and for each group as a whole. The final outcome was judged as good, fair, or poor on the basis of the mean score for each patient. Statistical analysis was performed. The mean score for all patients was 2.08 as assessed by the laypersons and 2.18 as assessed by the cleft surgeon group. There was no statistically significant difference between the two groups. Comparisons on rating scores among different raters revealed a fair agreement on the ratings within each of the two groups. The results were found to be good in 29.7 percent, fair in 64.1 percent, and poor in 6.3 percent of patients when evaluated by the surgeons. When rated by the laypersons, the nasal appearance was found to be good in 26.6 percent, fair in 60.9 percent, and poor in 12.5 percent of patients. This difference in distribution between the two groups was not statistically significant. When comparing the results given by the two groups of assessors, there was agreement on the nasal appearance in 65.6 percent of patients, and a difference in grading in the rest. For the patients who received different grading, the surgeons rated them one grade higher in 63.6 percent and one grade lower in 36.4 percent. There was no difference in grading between any of the evaluators that reflected a two-grade discrepancy in evaluation of results. This study shows that the surgical outcome of bilateral cleft lip nose deformity repair, at the authors' institution, is less than optimal. When assessing bilateral cleft lip nose appearance, the judgment of results by cleft surgeons was similar to that of the laypersons. However, different rating of results existed within each of the two groups, supporting the importance of clearly assessing patient/parent expectations and defining realistic surgical goals. SN - 0032-1052 UR - https://www.unboundmedicine.com/medline/citation/12172130/Assessment_of_bilateral_cleft_lip_nose_deformity:_a_comparison_of_results_as_judged_by_cleft_surgeons_and_laypersons_ L2 - http://Insights.ovid.com/pubmed?pmid=12172130 DB - PRIME DP - Unbound Medicine ER -