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Updated: Jun 28, 2026
A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Central ray deficiency: subjective and objective outcome of cleft reconstruction
Charles A Goldfarb1, Ben Chia, Paul R Manske
1Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes Jewish Hospitals, St. Louis, MO, USA. goldfarbc@wudosis.wustl.edu
Purpose:
To assess the long-term subjective and objective outcome of cleft reconstruction in patients with central ray deficiency.
Methods:
Twelve patients with 16 central ray deficiency hands were included. Each hand had been treated with cleft reconstruction using soft tissue and/or bony procedures. A surgeon and parent assessed the subjective outcome using a visual analog scale to compare preoperative and postoperative appearance. Objective outcome was assessed with a clinical examination for digital range of motion and with a radiographic examination for preoperative and postoperative divergence angles of the index finger and ring finger metacarpals and phalanges.
Results:
The surgeon's visual analog scale score significantly increased from 4 to 7. Nine parents were very satisfied, 4 were satisfied, and 3 were somewhat satisfied with hand appearance. A ring finger proximal interphalangeal joint flexion contracture averaging 31 degrees was the most notable clinical finding. The metacarpal divergence angle significantly improved from 33 degrees to 12 degrees , and the phalangeal divergence angle significantly improved from 38 degrees to 12 degrees .
Conclusions:
Cleft reconstruction improves hand appearance in patients with central deficiency. A new technique of quantifying the radiographic divergence of the border rays of the cleft demonstrates improved alignment at long-term follow-up.
Type Of Study/Level Of Evidence:
Therapeutic IV.
