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PubMed2006

The clinical observation of difficult laryngoscopy and difficult intubation in infants with cleft lip and palate.

BACKGROUND: The aims of this study were to evaluate the incidence of difficult laryngoscopy in infants with cleft lip and palate and to observe its relationships with age, sites, and degrees of deformities. METHODS: A total of 985 infants aged 1 month to 3 years, undergoing repair of cleft lip and palate were included in this study. The infants suffering from unilateral cleft lip, simple cleft palate, and combined bilateral cleft lip and palate were 465, 421, and 79 respectively. They were divided into three groups according to age; 1-6 months group, 6-12 months group and 1-3 years group. RESULTS: The total incidence of difficult laryngoscopy was 4.77%. The incidence of difficult laryngoscopy was closely related to age, sites and degrees of deformities, and micrognathia. The incidence of difficult laryngoscopy was 7.06% in 1-6 months group, 2.90% in 6-12 months group, and 3.13% in 1-3 years group, and was greatest for infants with combined bilateral cleft lip and palate, less for those with left cleft lip and least for those with right cleft lip and simple cleft palate. The incidences of difficult laryngoscopy in infants with and without micrognathia were 50% and 3.83% respectively. The incidences of moderately difficult, difficult, and failed intubations were 1.02%, 0.91%, and 0.102% respectively. CONCLUSIONS: Infants with cleft lip and palate, left cleft lip and alveolus, combined bilateral cleft lip and palate, micrognathia, and age <6 months were the important risk factors for difficult laryngoscopy. Difficult intubation occurred mainly in infants with laryngoscopic views of grade III and IV.

Child, Preschool↗
PubMed2000

Lower frequency of focal lip sialadenitis (focus score) in smoking patients. Can tobacco diminish the salivary gland involvement as judged by histological examination and anti-SSA/Ro and anti-SSB/La antibodies in Sjögren's syndrome?

OBJECTIVES: Prospectively collected computer database information was previously assessed on a cohort of 300 patients who fulfilled the Copenhagen classification criteria for primary Sjögren's syndrome. Analysis of the clinical data showed that patients who smoked had a decreased lower lip salivary gland focus score (p<0.05). The aim of this original report is to describe the tobacco habits in patients with primary Sjögren's syndrome or stomatitis sicca only and to determine if there is a correlation between smoking habits and focus score in lower lip biopsies as well as ciculating autoantibodies and IgG. METHODS: All living patients with primary Sjögren's syndrome or stomatitis sicca only, who were still in contact with the Sjögren's Syndrome Research Centre were asked to fill in a detailed questionnaire concerning present and past smoking habits, which was compared with smoking habits in a sex and age matched control group (n=3700) from the general population. In addition, the patients previous lower lip biopsies were blindly re-evaluated and divided by the presence of focus score (focus score = number of lymphocyte foci per 4 mm(2) glandular tissue) into those being normal (focus score </= 1) or abnormal (focus score > 1). Furthermore the cohort was divided into three groups; 10-45, 46-60 and >/= 61 years of age. Finally the focus score was related to the smoking habits. Seroimmunological (ANA; anti-SSA/Ro antibodies; anti-SSB/La antibodies; IgM-RF and IgG) samples were analysed routinely. RESULTS: The questionnaire was answered by 98% (n=355) of the cohort and the percentage of current smokers, former smokers and historical non-smokers at the time of lower lip biopsy was not statistically different from that of the control group. Cigarette smoking at the time of lower lip biopsy is associated with lower risk of abnormal focus score (p<0.001; odds ratio 0.29, 95%CI 0.16 to 0.50). The odds ratio for having focal sialadenitis (focus score > 1) compared with having a non-focal sialadenitis or normal biopsy (focus score </= 1) was decreased in all three age groups (10-45: odds ratio 0.27, 95%CI 0.11 to 0.71; 46-60: odds ratio 0.22, 95%CI 0. 08 to 0.59; and >/= 61: odds ratio 0.36, 95%CI 0.10 to 1.43) although there was only statistical significance in the two younger age groups. Moreover, among current smokers at the time of the lower lip biopsy there was a decreasing odds ratio for an abnormal lip focus score with increasing number of cigarettes smoked per week (p trend 0.00). In the group of former smokers, which included patients that had stopped smoking up to 30 years ago, the results were in between those of the smokers and the historical non-smokers (odds ratio 0.57, 95%CI 0.34 to 0.97, compared with never smokers). Present or past smoking did not correlate with the function of the salivary glands as judged by unstimulated whole sialometry, stimulated whole sialometry or salivary gland scintigraphy. Among former smokers, the median time lapse between the first symptom of primary Sjögren's syndrome and the performance of the lower lip biopsy was approximately half as long as the median time lapse between smoking cessation and biopsy (8 versus 15 years). Hence, symptoms of Sjögren's syndrome are unlikely to have had a significant influence on smoking habits at the time of the biopsy. Among the seroimmunological results only anti-SSA/Ro and anti-SSB/La antibodies reached statistical significance in a manner similar to the way smoking influenced the focus score in lower lip biopsies. On the other hand the level of significance was consistently more pronounced for the influence of smoking on the focus score than for the influence on anti-SSA/Ro and anti-SSB/La autoantibodies. CONCLUSION: This is believed to be the first report showing that cigarette smoking is negatively associated with focal sialadenitis-focus score >1-in lower lip biopsy in patients with primary Sjögren's syndrome. Furthermore, tobacco seems to decrea

Adult↗
PubMed2005

Long-term effects of palate repair on craniofacial morphology in patients with unilateral cleft lip and palate.

OBJECTIVE: To identify the long-term effects of palate repair on craniofacial growth in patients with unilateral cleft lip and palate (UCLP). DESIGN: Retrospective cross-sectional study. SETTING: Sri Lankan Cleft Lip and Palate Project. SUBJECTS: Forty-eight adults with nonsyndromic unilateral cleft lip and palate, 29 men and 19 women, had lip repair only (LRO group). Fifty-eight adults with nonsyndromic unilateral cleft lip and palate, 35 men and 23 women, had lip and palate repairs by the age of 9 (LPR group). MAIN OUTCOME MEASURES: Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine craniofacial morphology. RESULTS: In the lip and palate repair group, the depth of the bony pharynx (Ba-PMP), the maxillary length at the alveolar level (PMP-A), the effective length of the maxilla (Ar-IZ, Ar-ANS, Ar-A), the maxillary protrusion (S-N-ANS, SNA), the anteroposterior jaw relation (ANS-N-Pog, ANB), and the overjet were smaller than in the lip repair only group. There were no significant differences in the maxillary length at the basal level (PMP-IZ, PMP-ANS) and the anterior and posterior maxillary heights (N-ANS and R-PMP, respectively) in the two groups. CONCLUSION: Palate repair inhibits the forward displacement of the basal maxilla and anteroposterior development of the maxillary dentoalveolus in patients with unilateral cleft lip and palate. Palate repair has no detrimental effects on the downward displacement of the basal maxilla or on palatal remodeling in patients with unilateral cleft lip and palate.

Adolescent↗
PubMed2006

Antenatal transabdominal ultrasound detection of cleft lip and palate in Western Australia from 1996 to 2003.

OBJECTIVE: To determine the frequency of detection of cleft lip with or without cleft palate and isolated cleft palate from antenatal ultrasound examinations conducted on mothers of infants born with cleft lip and/or palate and isolated cleft palate in Western Australia from 1996 to 2003. DESIGN: Review of patient records and purpose-designed questionnaire sent to parents of children born with cleft lip and/or palate and isolated cleft palate. RESULTS: There were 308 infants born with cleft lip and/or palate and isolated cleft palate in the study period. Of the 293 parents, 218 responses were available for the study (70.7%), and 2.9 +/- 1.8 SD antenatal ultrasound scans were performed on 216 women. No such scans were performed on two women. Cleft lip and/or palate was detected in 22.2% of cases. There was no detection prior to 15 weeks gestational age in the 137 women screened. Between 15 and 19 weeks gestational age, 174 scans detected 30 cases. Between 20 and 29 weeks gestational age, 84 scans detected 11 cases. Between 30 and 40 weeks gestational age, 66 scans detected 7 cases. The detection rate for bilateral cleft lip and/or palate was 44.4% and for unilateral cleft lip and/or palate, 40.6%. Detection rate for isolated cleft lip was 33.3%. Antenatal ultrasound failed to detect any infants with an isolated cleft palate (n = 95). The rate of detection of cleft lip and/or palate increased through the study period. CONCLUSIONS: The rate of detection of cleft lip and/or palate in Western Australia is comparable to that for referral centers worldwide and is increasing. The rate of detection of the various types of cleft anomalies using antenatal ultrasound ranged from 0% to 44%.

Cleft Lip↗
PubMed2006

Self-reports of psychosocial functioning among children and young adults with cleft lip and palate.

OBJECTIVE: A cross-sectional study was employed to determine the psychosocial effects of cleft lip and/or palate among children and young adults, compared with a control group of children and young adults without cleft lip and palate. PARTICIPANTS: The study comprised 160 children and young adults with cleft lip and/or palate and 113 children and young adults without cleft lip and/or palate. All participants were between 8 and 21 years of age. OUTCOME MEASURES: Psychological functioning (anxiety, self-esteem, depression, and behavioral problems) was assessed using validated psychological questionnaires. Happiness with facial appearance was rated using a visual analog scale. Social functioning, including experience of teasing/bullying and satisfaction with speech, was assessed using a semistructured interview. RESULTS: Participants with cleft lip and/or palate reported greater behavioral problems (p < .001) and more symptoms of depression (p < .01); they were teased more often (p < .001) and were less happy with their facial appearance (p < .01) and speech (p < .001), compared with controls. There were no significant difference between subjects with cleft lip and/or palate and subjects without cleft lip and/or palate in terms of anxiety (p > .05) or self-esteem (p > .05). Having been teased was a significant predictor of poor psychological functioning, more so than having a cleft lip and/or palate per se (p < .001). CONCLUSIONS: Teasing was greater among participants who had cleft lip and/ or palate and it was a significant predictor of poorer psychosocial functioning. Children and young adults with cleft lip and/or palate require psychological assessment, specifically focusing on their experience of teasing, as part of their routine cleft care.

Adolescent↗
PubMedDate not supplied

An initial study on lip perception of electrotactile array stimulation.

We conducted an initial study on tactile sensory characteristics of the lips by applying electrotactile array stimulation on the center surfaces of the upper and lower lips. We performed experiments of threshold measurement and rating of two-line separation to evaluate the tactile sensitivity and spatial discriminating ability of the lips, respectively. Three stimulator arrays of different sizes presented electrotactile patterns on the lips of eight subjects (six male, two female) to measure the electrotactile performance in relation to stimulator size and spacing. Experimental results showed that the lips required very low intensities for effective electrotactile stimulation. As the stimulator diameter increased from 75 micrometers to 1.55 millimeters, the average stimulation intensity at the threshold level decreased from 12.5 to 6.3 V for the lower lip and from 13.3 to 7.1 V for the upper lip. Meanwhile, the two-line separation rating experiment showed that both upper and lower lips possessed high spatial discriminating ability. The average percentages of correct rating of two adjacent lines ranged from 80.5% to 88.2% on the two stimulator arrays with center-to-center spacing of at least 2.40 mm. In addition, sensitivity analysis indicated that the upper lip slightly outperformed the lower lip in spatial discrimination.

Adult↗
PubMed2005

Lip augmentation with liquid silicone.

BACKGROUND: Many fillers have been used to augment the lips. One of these that has provided long-term satisfactory results is liquid silicone. OBJECTIVE: To demonstrate the efficacy and safety of lip augmentation with liquid silicone. METHOD: Following a discussion of the benefits and risks of the procedure and the benefits and risks of alternatives and after answering all of the patients' questions, an informed consent form was signed. After obtaining anesthesia with a regional nerve block of the infraorbital and mental nerves, 0.25 to 0.5 cc of liquid silicone (1,000 centistokes) was injected using the microdroplet technique into the vermilion border of both the upper and lower lips. Depending on the desire of the patient, the procedure was repeated monthly. The augmentation of the lips was documented with histology, micrometry, and digital photography. RESULTS: Lip augmentation was achieved gradually during the months following liquid silicone injections into the vermilion border of the lips in the 608 patients studied. Most of the patients requested a second and third injection session. The results were most dramatic in the patients with type I and type II lips and less satisfactory in patients with type III lips. Bruising occurred in the majority of the patients. Eleven patients (2%) developed small palpable granulomas. These granulomas either required no treatment, responded to steroid injections, or were excised. CONCLUSION: The use of liquid silicone remains an effective method of lip augmentation. It returns the adolescent vermilion curl to the lips.

Cosmetic Techniques↗
PubMed2002

Cleft lip and palate incidence among the live births in the Republic of Korea.

We present an epidemiologic study of cleft lip and palate in the Republic of Korea from January 1, 1993 through December 31, 1993. In 1993, the number of total live births was 715,817. And from 1993 through 1995, a total of 1,293 new patients with cleft lip and palate who were born in 1993 were identified. The incidence of cleft lip and palate was 1.81 per 1000, that is, 1 per 554 live births. The cleft lip: cleft lip and palate: cleft palate alone ratio was 1.13:1:1.19. The male: female ratio was 2.1:1 in the cleft lip group, and 2.5:1 in the cleft lip and palate group. We could detect a male predominance in both groups. In contrast, the ratio was 0.95:1 in the cleft palate group. The left: right: bilateral ratio was 1.9:1:0.23 in cleft lip group, and the ratio was 2.2:1:1.1 in the cleft lip and palate group. This is the first nation-wide study to provide detailed data on the incidence of cleft lip and palate in the live births in the Republic of Korea.

Cleft Lip↗
PubMed2000

[Improvement on the individual operative design of unilateral cleft lip repair].

OBJECTIVE: To study the difference of operative designs in unilateral cleft lip repair according to characteristic deformity of each patient with unilateral cleft lip. METHODS: The distance from both alar bases and midpoint of columella base to both peaks of Cupid's bow were consulted is equal as standard design model. The mark point and incision of individual unilateral cleft lip repair were designed using geometrical analysis. RESULTS: The new operative design technique included that the end point of rotational incision should be inside of the cross point from the line dividing both Cupid's bow peaks and philtrum on the non-cleft side, and the other design was that the end point of alar base on the cleft side located at the cross point from the horizontal line that passed the midpoint of alar base on the non-cleft side to meet the alar base on the cleft side. Depending on the above thesis, the new operative methods were created for unilateral cleft lip repair. One of the new individual operative designs was similar with Millard's method in the shape of operative design, but there was a big difference on the principle of marking the columella base and alar base on the cleft side between individual operative designs and Millard's design. This new operative design only suit for unilateral cleft lip with symmetric distances from alar base to Cupid's bow peaks in both sides. Another individual operative design added a new incision on the cleft side comparing with the former individual operative design, which could be used in unilateral cleft lip when the distance from alar base to Cupid's bow peak on the cleft side was shorter than that on the non-cleft side. CONCLUSION: The new individual operative designs of unilateral cleft lip repair have been created, and the important advantages of these new individual operative designs are that each marking point can been decided clearly according to special mathematical principles. Each operative design only suit for one type of unilateral cleft deformity, so the types of deformity in unilateral cleft lip can been also classified depending on the different distances from alar base to Cupid's bow peak between both sides. This classification of unilateral cleft lip only depends on operative designs, and these new individual operative designs of unilateral cleft lip repair are easy to be understanded and applied, as well as easy to obtain stable result after operation.

Cleft Lip↗
PubMed1986

Major gene determination of liability to spontaneous cleft lip in the mouse.

Two genetic analyses suggested that the spontaneous and low frequency trait of cleft lip (primary palate) in the mouse is determined either by a recessive gene at one autosomal locus or by two loci with duplicate epistasis. The low frequency trait of open eyelids, which is characteristic of the A/J strain and sometimes reported to be associated with cleft lip as part of a "syndrome," has not been analyzed genetically. A backcross and test-mating study between A/J and C57BL/6J, done originally to define the genetic control of embryonic tolerance to cortisone-induced cleft palate (secondary palate), was reanalyzed for the cleft lip and open eyelids traits. Cleft lip frequencies in A/J did not change in dose-response studies of either cortisone- or 6-aminonicotinamide-induced cleft palate; for both teratogens the frequencies of open eyelids differed between doses but did not exhibit any obvious dose response. It appeared that the frequency of 7.6% cleft lip and 17.6% open eyelids in A/J in the genetic study, in which all pregnant A/J test-females were treated with a single dose of cortisone (100 mg/kg, day 12), did reflect the occurrence of the spontaneous traits. Within the A/J strain, the traits were not associated and, as expected on outcrossing to C57BL/6J (A.B6 F1 fetuses), both traits are recessive. Significant bimodality of the cleft lip scores of the BC1 sires (BC2 fetuses), test-mated with A/J, suggested that liability to cleft lip is determined by a single autosomal recessive gene. The distribution of open eyelids scores of the BC1 sires did not differ from one normal distribution, and this trait is, therefore, controlled by more than one genetic locus with additivity between loci. Cleft lip and open eyelids segregated independently and do not form a syndrome, in A/J, with one underlying genetic cause. There was no association between cleft lip and three autosomal marker genes, brown (b, chromosome 4), albinism (c, chromosome 7) and H-2 (chromosome 17), or the genetically independent tolerance traits of cortisone- and 6-aminonicotinamide-induced cleft palate. There was significant association between open eyelids and albinism (c) that is in a direction suggesting linkage or pleiotropy. Whether liability of the embryo to cleft lip is determined by one or two genes may be solved by a concerted effort to map the trait; a marker gene will be the key to further analysis of its cause.

Animals↗
PubMed1984

Secondary repair of cleft lip deformity.

A considerable number of procedures have been described for secondary improvements of the lip. They involve the scars, the Cupid's bow, the philtrum, the alar base, the vestibulum and the columella. In fact, these procedures may give a good aesthetic result in a static position, but the truly successful results occur with normal movements. A normal motion of the lip is impossible without a proper dissection and reorientation of the muscles. Satisfactory lip motion cannot be realized with a defective alveolus or piriform aperture that retracts the alar base. Consequently, a good lip or nasal base cannot be achieved without bony restoration of the alveolus and piriform aperture. A transversely short lip never has normal mobility, and it must be widened by an Abbé flap. A tight, retruded lip on a retruded maxilla cannot be improved by a prosthetic vestibular plate because a greater tension will restrict movements. The lip must be advanced with the maxilla, then widened if necessary by an Abbé flap. A thick prolapsed lip never has normal movement; it must be raised by an infranasal excision. A cleft lip has nothing to gain from being displayed under a short nose, or, still worse, under a upturned nose. The nose must be kept long enough to cast a shadow on the lip. For the same reason, a bone graft is often necessary in bilateral clefts because the nose is short and retruded.

Adolescent↗
PubMed1997

Results of a modified staircase technique for reconstruction of the lower lip.

Our experience with a modified staircase technique for closure of lower lip defects is reported. The procedure is based on the original technique of Johanson et al. (1974). However, the integrity of the orbicularis oris muscle is respected when advancing lower lip flaps. Twenty patients with squamous cell carcinoma of the lower lip were treated using this modified reconstruction technique. The size of the defects ranged from 30-60% of lower lip width. No recurrences were observed during a 3-year to 5-year follow-up. All patients showed symmetrical lip movement, an adequate buccal sulcus and intact labial commissures. No symptomatic microstomia was seen and the aesthetic results were excellent. The surgical technique is explained in detail. Four types of flap are presented according to the size and location of lip defects. Lower lip defects up to 60% of the lip width can be closed easily, with good aesthetic results. The technique is also applicable to upper lip reconstruction.

Carcinoma, Squamous Cell↗
PubMed1995

Cephalometric profile evaluations in patients with cleft lip and palate.

This study was done to determine those abnormal cephalometric features found in adult cleft lip and palate patients. The sample population consisted of 30 randomly selected white patients with cleft lip and palate who were treated by the same team that had been accredited by the American Cleft Palate-Craniofacial Association. Twenty patients had unilateral complete clefts, and 10 had bilateral complete clefts. Thirteen different cephalometric parameters were measured and compared with normal. The results from this study showed that there were few statistically significant differences between the unilateral and bilateral cleft palate patient populations. There were only three measurements that had statistically significant differences between the unilateral cleft patients and the bilateral cleft patients: subnasale-stomion, subnasale-stomion: stomion-soft-tissue menton, and subnasale-lower lip vermillion: lower lip vermillion-soft tissue menton. However, 10 of the 13 measurements had statistically significant variations from normal. These measurements included subnasale=stomion; stomion=soft tissue menton, subnasale=lower lip vermillion; lower lip vermillion=soft tissue menton, interlabial distance, subnasale-perpendicular to upper lip, subnasale-perpendicular to lower lip, subnasale-perpendicular to chin, angle formed between sella turcica=nasion and nasion=A=point, maxillary depth angle, A-point to nasion-pogonion, and angle formed between A=point=nasion and nasion=B=point. The data indicated that a multiplicity of vertical and horizontal abnormalities exist in the person with cleft lip and palate in addition to the well-known transverse deficiencies, and that cephalometric abnormalities are not limited to anteroposterior maxillary deficiency.

Adolescent↗
PubMed2002

The dynamics of interlip coupling in speakers with a repaired unilateral cleft-lip history.

In this paper, data are presented on individual movement characteristics of the upper and lower lip and on interlip coordination in speakers with a repaired unilateral cleft upper lip history and age-matched control participants. The data were acquired using the AG100 EMMA system while the participants produced a selection of nonspeech and speech tasks. The participants with a repaired unilateral cleft upper lip history showed reduced upper-lip movement ranges and peak velocities and a more variable spatiotemporal pattern for individual upper-lip movement cycles, in addition to a more variable interlip coupling. The latter difference also proved to be more pronounced for the younger speakers with a repaired cleft upper lip. Overall, for both groups, the linguistically more complex task showed more variability in the individual upper- and lower-lip movement cycles and their coupling. In the discussion, we address the potential relationships between the kinematic data for upper lip in the repaired-cleft-lip speakers and the findings on movement and coordination stability as they might fit within current notions of coordination dynamics theory.

Adolescent↗
PubMed1988

The influence of lip repair with and without soft-tissue undermining on facial growth in beagles.

The present study was designed to test the hypothesis that undermining of the soft tissues on the surface of the maxilla at the time of lip repair in unilateral cleft lip, alveolus, and palate results in more severe craniofacial growth aberrations than lip repair alone. Sixty-seven purebred beagles were used in this experiment. The animals were divided into four groups: two control groups (unoperated and unrepaired) and two experimental groups (lip repair without undermining and lip repair with undermining). Lip pressures were monitored in all groups. Significantly higher lip pressures were observed in animals with soft-tissue undermining. Cephalometric measurements were analyzed using univariate and multivariate techniques. The results of this study indicate that lip repair performed with soft-tissue undermining results in more severe craniofacial growth aberrations than lip repair performed alone.

Analysis of Variance↗
PubMed1993

A comparative study of facial growth following lip and palate repair performed in sequence and simultaneously: an experimental study in beagles.

This study was designed to assess the effects of the commonly accepted sequence of cleft lip and palate repair on subsequent maxillofacial growth and to compare these effects with those resulting from simultaneous lip and palate repair. Using 62 eight-week-old normal beagles, we tested the hypothesis that sequential repair (lip first, palate second) of surgically induced lip and palate defects is less detrimental to maxillofacial growth than simultaneous repair of both surgically created defects. Animals were assigned to one of four groups: two control groups (unoperated and unrepaired) and two experimental groups. Defects simulating cleft of the lip, alveolus, and palate were surgically created in the unrepaired controls and in the experimental animals. In one experimental group, the lip and palate defects were repaired immediately and simultaneously. In the other experimental group--simulating current clinical practice--the lip defect was repaired first at the time that it was created, while closure of the palatal defect was delayed 4 weeks. After the animals were killed at 36 weeks of age, 11 maxillary variables were measured directly from cleaned skulls and analyzed by using univariate and multivariate techniques. Animals that had lip and palate defects closed in sequence had less severe maxillofacial aberrations than animals with simultaneously closed defects. Sequential closure of the defects also had identifiable effects on maxillofacial form. The growth aberrations observed among animals with sequential closure, however, are primarily attributable to surgical creation of the defects and not to the surgical repair. Delaying palate repair is less traumatic to the subsequent growth of the maxillary complex than simultaneous repair of lip and palate defects.

Animals↗
PubMed2002

Validity of subjective evaluations for the assessment of lip scarring and impairment.

OBJECTIVE: In patients with cleft lip and palate, the aim of the study was (1) to determine and compare the level of agreement among examiners' subjective evaluations of static and dynamic lip form; (2) assess possible bias of examiners' subjective evaluations; and (3) determine the impact of lip scarring on an examiner's subjective assessment of dynamic lip form. SETTING: Patients and subjects were recruited from the University of North Carolina Cleft Lip and Palate Center and School of Dentistry. PATIENTS, PARTICIPANTS: Thirteen patients with unilateral cleft lip and palate and varying degrees of cleft scar severity were selected and one subject without cleft who wore artificial scars of varying severity. INTERVENTIONS: For the patients with cleft, a previously repaired complete cleft lip and palate. Photographs and videotape recordings were made of the patients with cleft and the subject without cleft, with and without the artificial scars, at rest and smiling. MAIN OUTCOME MEASURE(S): Rankings of cleft scar severity and impairment on a 6-point Likert scale by a lay and professional panel. RESULTS: Intra- and interexaminer reliability was good for the lower facial regions at rest but not during movement. Professionals gave ratings of greater severity and impairment than laypersons, and professionals agreed when rating the lower faces at rest more so than during movement. Lip scarring affected perceptions of impairment during movement by viewers in both panels. CONCLUSIONS: Subjective assessments can be affected by methodological approaches, professional experience, and stimulus type. Future research should focus on establishing objective methods to evaluate patients with cleft lip and palate at rest and during function.

Adolescent↗
PubMed2003

Association between subjective and objective measures of lip form and function: an exploratory analysis.

OBJECTIVE: In patients with cleft lip and palate, the aims of this study were to generate objective measures of different attributes of lip movement and to explore the utility of these objective measures by examining the association between examiners' subjective assessments with the objective measures. PATIENTS AND PARTICIPANTS: Thirteen patients with unilateral cleft lip and palate with varying degrees of cleft scar severity were selected. All patients had a previously repaired complete unilateral cleft lip and palate. INTERVENTIONS: Photographs and videotape recordings were made of the patients with cleft at rest and during smiling. Measurements of lip movement were obtained by means of a motion analysis system. MAIN OUTCOME MEASURES: The study sought to obtain rankings of cleft scar severity and impairment on a 6-point Likert scale by a lay and professional panel and measurements of displacement, asymmetry, speed, and velocity of upper lip during smiling. RESULTS: Displacement was the most consistent and valid objective measurement. An objective analysis of the entire upper lip provided the most information. In general, there was a decrease in the objective measures of upper lip movement as examiners' perceptions of facial appearance or disfigurement at rest and impairment during movement became worse. This relationship was stronger for the at-rest perceptions, implying that subjective assessments should be made with the face at rest. CONCLUSIONS: Objective measures provided the promise for differentiation of the components of movement and should be used to supplement subjective evaluations of lip appearance at rest and during movement.

Adolescent↗