Objective Assessment of the Unilateral Cleft Lip Nasal Deformity Using 3D Stereophotogrammetry: Severity and Outcome

Background: Optimization of care to correct the unilateral cleft lip nasal deformity is hampered by lack of objective measures to quantify pre-operative severity and outcome. The purpose of this study was to: develop a consensus standard of nasal appearance using 3D stereophotogrammetry; determine if anthropometric measurements could be used to quantify severity and outcome; and determine if pre-operative severity predicts post-operative outcome. Methods: We collected facial 3D images of 100 subjects in three groups: 45 infants before cleft lip repair; the same 45 infants after cleft lip repair; and 45 children age 8-10 years with previous repairs. Five additional age-matched unaffected control subjects were included in each group. Seven expert surgeons ranked images in each group according to nasal appearance. The rank sum score was used as consensus standard. Anthropometric analysis was performed on each image and compared to the rank sum score. Pre-operative rank and anthropometric measurements were compared to post-operative rank. Results: Inter-rater and intra-rater reliability was excellent (ICC>0.76 and Pearson correlation>0.75 respectively) on each of the 3 image sets. Columellar angle, nostril width ratio, and lateral lip height ratio were highly correlated with pre-operative severity and moderately correlated with post-operative nasal appearance. Post-operative outcome was associated with pre-operative severity (rank and anthropometric measurement). Conclusions: Consensus ranking of pre-operative severity and post-operative outcome can be achieved on 3d images. Pre-operative severity predicts post-operative outcomes. Columellar angle, nostril width ratio, and lateral lip height ratio are objective measures that correlate with consensus ratings by surgeons at multiple ages. Financial Disclosure: The authors have no financial interest to disclose. Funding: Seattle Children's Hospital CCTR TRIPP fund; Seattle Children's Hospital CCTR Pediatric Pilot fund Presented at: American Cleft Palate – Craniofacial Association's (ACPA) 74th Annual Meeting (2017) in Colorado Springs, Colorado. Acknowledgement: This project was funded by Seattle Children's Hospital CCTR Translational Research Ignition Projects Program and Seattle Children's Hospital CCTR Pediatric Pilot Fund. Thanks to Linda Peters, CRA and Kate Nickel, CRA for subject recruitment, and Jerrie Bishop and Karina Martinez-Lopez for their administrative support. Conflicts of interest: none. Corresponding author: Raymond W. Tse, Seattle Children's Hospital4800 Sand Point Way NE M/SOB.9.527, Seattle, WA 98105, USA. e-mail: raymond.tse@seattlechildrens.org Phone: +1-206-987-2208 Fax: +1-206-987-3064 ©2017American Society of Plastic Surgeons