Yao Caroline A, Imahiyerobo Thomas, Swanson Jordan, Auslander Allyn, De Cardenas Diego, Figueiredo Jane C, McCullough Meghan, Costa Melinda, Vanderburg Richard, Magee William P
Los Angeles, Calif.; New York, N.Y.; and Norfolk, Va.
From the Division of Plastic and Reconstructive Surgery, the University of Southern California Institute of Global Health, and the Department of Preventive Medicine, Keck School of Medicine of the University of Southern California; the Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children; the Division of Plastic and Reconstructive Surgery, Children's Hospital Los Angeles; the Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital; and Operation Smile International.
Plast Reconstr Surg. 2018 Jan;141(1):137-146. doi: 10.1097/PRS.0000000000003931.
Unilateral cleft lip has a spectrum of disease morphology, but severity classifications are difficult given the absence of accessible, objective assessment tools or reference data. The authors characterize the spectrum of cleft morphology before and after surgical repair for a large, multi-ethnic population using easily identifiable facial landmarks collected through a novel smart phone-based application.
Anthropometric measurements and standardized photographs were prospectively collected in Morocco, Bolivia, Vietnam, and Madagascar during medical missions in 2015 using an application designed specifically for the study. After data collection, two experienced cleft surgeons and two laypersons subjectively ranked photographs based on the degree of deformity/aesthetics.
One hundred forty-seven patients were analyzed. Mean preoperative cleft width ratio was 0.4 ± 0.12. Nasolabial symmetry improved significantly from preoperatively to postoperatively for the following measurements: columellar angle (65 ± 17 degrees to 87 ± 8 degrees), nostril width ratio (1.7 ± 0.68 to 1.0 ± 0.22), philtral height ratio (0.8 ± 0.14 to 1.0 ± 0.14), and lip length ratio (0.9 ± 0.26 to 1.0 ± 0.11) (p < 0.001). Surgeon and layperson rankings showed high inter-rater reliability (r = 0.64, p < 0.001). Preoperatively, multivariate regression showed that cleft width ratio, nostril width ratio, and philtral height ratio were predictive of rank (p < 0.01). Postoperatively, philtral height ratio was most predictive of rank (p = 0.0097). Most cleft characteristics were not significantly different between countries.
The authors present simpler, more straightforward measures to quantify preoperative and postoperative morphology/aesthetics and introduce a novel technology to streamline and standardize measurements to make data collection more accessible.
单侧唇裂具有一系列疾病形态，但由于缺乏可获取的客观评估工具或参考数据，严重程度分类较为困难。作者使用通过一款基于智能手机的新型应用程序收集的易于识别的面部标志，对一个大型多民族人群手术修复前后的唇裂形态范围进行了特征描述。
2015年在摩洛哥、玻利维亚、越南和马达加斯加的医疗任务期间，使用专门为该研究设计的应用程序前瞻性地收集人体测量数据和标准化照片。数据收集后，两名经验丰富的唇裂外科医生和两名外行人根据畸形程度/美观程度对照片进行主观排名。
分析了147例患者。术前平均唇裂宽度比为0.4±0.12。以下测量结果显示，鼻唇对称性从术前到术后有显著改善：鼻小柱角（65±17度至87±8度）、鼻孔宽度比（1.7±0.68至1.0±0.22）、人中高度比（0.8±0.14至1.0±0.14）和唇长度比（0.9±0.26至1.0±0.11）（p<0.001）。外科医生和外行人的排名显示出较高的评分者间信度（r = 0.64，p<0.001）。术前，多变量回归显示唇裂宽度比、鼻孔宽度比和人中高度比可预测排名（p<0.01）。术后，人中高度比最能预测排名（p = 0.0097）。大多数唇裂特征在不同国家之间没有显著差异。
作者提出了更简单、更直接的方法来量化术前和术后的形态/美观程度，并引入了一种新技术来简化和标准化测量，使数据收集更容易。
