Stebel Adam, Urbanová Wanda, Klimova Irena, Brudnicki Andrzej, Dubovska Ivana, Polackova Petra, Kroupová Daniela, Koťová Magdalena, Fudalej Piotr S
Department of Maxillofacial Surgery, F. D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic.
Department of Stomatology and Maxillofacial Surgery, Comenius University in Bratislava, Bratislava, Slovak Republic.
PeerJ. 2021 Feb 9;9:e10631. doi: 10.7717/peerj.10631. eCollection 2021.
There is a multitude of protocols of treatment of cleft lip and palate (CLP) worldwide differing in number of operations, surgical techniques, and timings of surgeries. Despite, facial appearance in subjects with CLP is rarely ideal and residual stigmata are easy to notice in many patients irrespective of the protocol. The prospective controlled investigations are optimal for comparing effectiveness of treatment protocols. Because prospective studies are very challenging to perform in CLP field, it is reasonable to retrospectively assess different surgical protocols to identify the promising ones and then to test them in a prospective way.
Our objective was to assess the nasolabial appearance in a preadolescent Slavic population with unilateral cleft lip and palate (UCLP) by using the 0-200 numeric scale with reference photographs. Patients treated in Warsaw, Poland ( = 32), Prague, Czech Republic ( = 26) and Bratislava, Slovakia ( = 17) were included in this retrospective study. Each cleft center used a unique surgical protocol. Two panels of professional raters ( = 7) and laypeople ( = 10) scored blindly the nasolabial esthetics on cropped frontal and profile images with cropped reference photograph present on the same slide. Intra- and inter-rater agreement was assessed with Cronbach's alpha, intraclass correlation coefficients, -tests, and Bland-Altman plots. Inter-group differences were evaluated with one-way ANOVA and regression analysis.
The agreement within and between raters was acceptable. We found that patients treated in Warsaw, Prague, and Bratislava showed comparable nasolabial appearance on frontal and profile photographs when judged by both professional raters ( > 0.05) and laypeople ( > 0.05). Regression analysis did not identify influence of gender, group (i.e., Warsaw, Prague, and Bratislava), age at lip repair, surgeon, and age at photographic assessment on esthetic outcome ( > 0.05).
This study showed that none of the surgical protocols showed superiority to produce good nasolabial appearance.
全球唇腭裂（CLP）的治疗方案众多，在手术次数、手术技术和手术时机方面存在差异。尽管如此，唇腭裂患者的面部外观很少能达到理想状态，而且许多患者无论采用何种治疗方案，都容易出现明显的面部缺陷。前瞻性对照研究最适合比较不同治疗方案的效果。由于前瞻性研究在唇腭裂领域实施起来非常具有挑战性，因此回顾性评估不同的手术方案以找出有前景的方案，然后进行前瞻性测试是合理的。
我们的目的是通过使用0至200的数字评分量表和参考照片，评估青春期前斯拉夫单侧唇腭裂（UCLP）人群的鼻唇外观。本回顾性研究纳入了在波兰华沙（n = 32）、捷克共和国布拉格（n = 26）和斯洛伐克布拉迪斯拉发（n = 17）接受治疗的患者。每个腭裂治疗中心都采用了独特的手术方案。两组专业评分者（n = 7）和外行人（n = 10）在同一张幻灯片上呈现裁剪后的正面和侧面图像以及裁剪后的参考照片，对鼻唇美学进行盲评。通过Cronbach's α系数、组内相关系数、t检验和Bland-Altman图评估评分者内部和评分者之间的一致性。通过单因素方差分析和回归分析评估组间差异。
评分者内部和评分者之间的一致性可以接受。我们发现，无论是专业评分者（P > 0.05）还是外行人（P > 0.05）判断，在华沙、布拉格和布拉迪斯拉发接受治疗的患者在正面和侧面照片上的鼻唇外观具有可比性。回归分析未发现性别、治疗组（即华沙、布拉格和布拉迪斯拉发）、唇裂修复时的年龄、外科医生以及拍照评估时的年龄对美学效果有影响（P > 0.05）。
本研究表明，没有一种手术方案在产生良好的鼻唇外观方面表现出优越性。
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