From the Division of Plastic Surgery, Saint Louis University School of Medicine.
Rector Consulting.
Plast Reconstr Surg. 2023 Jul 1;152(1):126e-133e. doi: 10.1097/PRS.0000000000010184. Epub 2023 Jun 29.
Modern cleft lip surgery aims to restore symmetry and create a level, normal-appearing Cupid's bow. However, families' concerns often center on the degree of scarring. The authors hypothesized that the lip angle would be less influential than scar severity in layperson ratings.
The authors received institutional review board approval for modifying patients' postoperative photographs to create systematic variations displaying different levels of scarring and lip angle. Each child's resulting composite images were presented in pairs to internet raters using Amazon Mechanical Turk. Users selected the simulated postoperative result they felt to be most normal. The Bradley-Terry model was used to determine raters' preferences between different levels of scarring and lip angle.
Four children with primary unilateral cleft lip repair had their postoperative photographs modified (mean age, 1.4 years; mean follow-up, 1.0 years). Twelve-hundred crowdsourced pairwise ratings were collected for each patient (4800 combined ratings). For all four children, raters preferred images with more severe scarring than those with a greater lip angle, suggesting uneven lip angle has a more negative effect on perceived appearance.
Online crowdsourcing postoperative lip angle had a significantly greater influence on ratings of normal appearance than does the severity of scarring. Although patients may ask about scars more often, clinically, this study suggests perceptions of a cleft lip repair result may be more likely influenced by the angle of the cleft lip repair.
现代唇裂手术旨在恢复对称性，塑造出平坦、正常外观的丘比特弓。然而，患者家庭的关注点通常集中在疤痕的严重程度上。作者假设在非专业人士的评估中，唇角的影响小于疤痕的严重程度。
作者通过修改患者术后照片，创建了系统的变化，展示了不同程度的疤痕和唇角，以获得机构审查委员会的批准。每个孩子的复合图像都通过亚马逊 Mechanical Turk 以成对的形式呈现给互联网评估者。用户选择他们认为最正常的模拟术后结果。使用 Bradley-Terry 模型来确定评估者在不同程度的疤痕和唇角之间的偏好。
对 4 名接受单侧唇裂初次修复的儿童的术后照片进行了修改（平均年龄 1.4 岁；平均随访时间 1.0 年）。每位患者收集了 1200 个众包的成对评分（共 4800 个评分）。对于所有 4 名儿童，评估者更喜欢有更严重疤痕的图像，而不是唇角更大的图像，这表明不均匀的唇角对外观感知有更负面的影响。
在线众包术后唇角对正常外观的评分影响明显大于疤痕严重程度。尽管患者可能更频繁地询问疤痕问题，但从临床角度来看，这项研究表明，对唇裂修复结果的看法可能更容易受到唇裂修复角度的影响。
