Campbell Alex, Restrepo Carolina, Park Eugene, Navas Genesis, Deshpande Gaurav, Swanson Jordan, Schonmeyr Bjorn, Wendby Lisa, Ayala Ruben
Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, Pa.
Operation Smile, Virginia Beach, Va.
Plast Reconstr Surg Glob Open. 2019 Jan 22;7(1):e2083. doi: 10.1097/GOX.0000000000002083. eCollection 2019 Jan.
Although efforts to improve access to care for patients with cleft lip in the developing world have grown tremendously, there is a dearth of data regarding aesthetic outcomes after cleft lip repairs in this setting. Defining severity-outcome relationships has the potential to improve efficiency of care delivery in resource-limited settings, and to improve overall results. In this study, we investigate the relationship between initial cleft lip severity and early aesthetic outcomes following surgical repair of primary unilateral cleft lip.
Using previously validated tools to assess unilateral cleft lip severity and aesthetic outcome after repair, we evaluated 1,823 consecutive patients who underwent primary unilateral cleft lip/nose (UCL/N) repair. Three separate evaluators scored each case for a total of 5,469 total independent evaluations.
Our results show that with increasing severity of UCL/N deformity, there is a corresponding decrease in early aesthetic outcome scores. Using our results, we established normative early aesthetic outcomes following repair for each severity grade of UCL/N deformity.
In conclusion, this study has achieved a standardized, timely, and cost-effective evaluation of 1,823 surgical cases of primary UCL/N repair. This data set provides a normal distribution of aesthetic results according to initial cleft severity and defines a standard of "expected" aesthetic results after primary UCL/N repair. Our results also show a clear correlation between initial severity and immediate aesthetic result after surgery, though we also show that excellent results are possible regardless of initial cleft severity.
尽管在发展中国家，为唇裂患者改善医疗服务可及性的努力有了巨大增长，但在这种情况下，关于唇裂修复术后美学效果的数据却很匮乏。确定严重程度与结果之间的关系有可能提高资源有限环境下的医疗服务效率，并改善总体结果。在本研究中，我们调查了原发性单侧唇裂手术修复后初始唇裂严重程度与早期美学效果之间的关系。
我们使用先前经过验证的工具来评估单侧唇裂的严重程度和修复后的美学效果，对1823例连续接受原发性单侧唇裂/鼻（UCL/N）修复的患者进行了评估。三名独立评估者对每个病例进行评分，总共进行了5469次独立评估。
我们的结果表明，随着UCL/N畸形严重程度的增加，早期美学效果评分相应降低。利用我们的结果，我们为UCL/N畸形的每个严重程度等级建立了修复后的标准早期美学效果。
总之，本研究对1823例原发性UCL/N修复手术病例进行了标准化、及时且具有成本效益的评估。该数据集根据初始唇裂严重程度提供了美学结果的正态分布，并定义了原发性UCL/N修复术后“预期”美学结果的标准。我们的结果还显示了初始严重程度与术后即时美学效果之间存在明显的相关性，不过我们也表明，无论初始唇裂严重程度如何，都有可能取得优异的效果。
