The Welsh Centre for Cleft Lip & Palate, Morriston Hospital Swansea, UK.
Swansea Bay Health Board.
Br J Oral Maxillofac Surg. 2021 Apr;59(3):375-379. doi: 10.1016/j.bjoms.2020.09.001. Epub 2020 Sep 11.
Most scoring systems used to assess facial aesthetics in cleft patients tend to lack consistency, and the absence of an internationally agreed system makes comparison challenging. The most widely used and validated tool is the five-point Asher-McDade index. We note that there are currently no reports (to our knowledge) of its use for scoring outcomes after bilateral cleft lip repair. To validate it for this use, the aim was to describe the outcomes of 22 consecutive bilateral cleft lip repairs assessed using this scale. A retrospective review was undertaken of 22 consecutive patients with bilateral cleft lip repairs performed at our centre. Each patient underwent bilateral advancement rotation repair with a vomer flap on one side at three months followed by repair of the remaining hard palate and an intravelar veloplasty three months later. Standardised photographs were taken five years after repair and were cropped to isolate the nasolabial component. Eleven members of the cleft multidisciplinary team were asked to rate each image on a five-point Likert scale. Statistical analysis was performed using a two-way ANOVA test and intraclass correlation coefficient to interrogate intraobserver and interobserver variance. A total of 22 consecutive patients with complete bilateral cleft lips were photographed. The overall mean (range) score for the repairs was 3.2 (4.3 - 1.8). Two-way ANOVA demonstrated that inter-rater variability accounted for just over 10% (11.23% of the total variance, p < 0.0001). As predicted, the single biggest factor affecting score variability was the patient's appearance, which accounted for 44.51% of the total variance between scores (p < 0.0001). Intraobserver variance was not found to be significant, accounting for 0.33% of the total variance (p = 0.0006). We demonstrate that the Asher-McDade scoring system is a valid tool to use when assessing bilateral cleft lip repairs. Variance in the patient's score was significantly related to a true difference in appearance, with only a small percentage of differences being due to intraobserver and interobserver variation.
大多数用于评估唇裂患者面部美学的评分系统往往缺乏一致性，而且缺乏国际公认的系统使得比较具有挑战性。使用最广泛和验证最有效的工具是五点 Asher-McDade 指数。我们注意到，目前没有关于其用于评分双侧唇裂修复后结果的报告（据我们所知）。为了验证其在这种用途中的有效性，目的是描述使用该量表评估的 22 例连续双侧唇裂修复的结果。对在我们中心进行的 22 例连续双侧唇裂修复患者进行了回顾性研究。每位患者均接受双侧推进旋转修复术，一侧采用鼻中隔瓣，三个月后修复剩余硬腭，三个月后行内瓣成形术。修复五年后拍摄标准照片，并裁剪以隔离鼻唇部分。由 11 名唇裂多学科团队成员使用 5 分 Likert 量表对每张图像进行评分。使用双向方差分析和组内相关系数对观察者内和观察者间变异进行统计分析。共拍摄了 22 例完全双侧唇裂患者的连续照片。修复的总体平均（范围）评分为 3.2（4.3-1.8）。双向方差分析表明，评分者间的变异性仅占 10%左右（总方差的 11.23%，p<0.0001）。正如预测的那样，影响评分变异性的最大因素是患者的外观，占评分总方差的 44.51%（p<0.0001）。未发现观察者内变异性具有统计学意义，占总方差的 0.33%（p=0.0006）。我们证明，Asher-McDade 评分系统是评估双侧唇裂修复的有效工具。患者评分的差异与外观的真实差异显著相关，只有一小部分差异归因于观察者内和观察者间的差异。
