Comparative study of the aesthetic outcomes of two techniques for bilateral cleft lip repair

Facial aesthetics are an important factor in quality of life following cleft lip surgery with the appearance of the nasolabial region a key outcome measure for patients and their families. Analysing the aesthetic outcome is difficult as it encompasses personal evaluation and judgment. The aim of this study was to determine whether subjective assessment can differentiate aesthetic outcomes between two surgeons who use differing surgical techniques for primary bilateral cleft lip repair. Five-year postoperative frontal photographs of bilateral cleft lip and palate patients (cropped as per the Asher-McDade aesthetic index) were analysed by 35 blinded surgical and lay reviewers using a five-point Likert scale (1 = excellent, 5 = very poor). The repairs were carried out by two different surgeons. The assessments were repeated at a later date to assess intra-rater reliability. A total of 38 consecutive cases of bilateral cleft lip repairs carried out by two surgeons were assessed. Seventeen cases were carried out by Surgeon A and 21 by Surgeon B. The mean Likert score for surgical/lay assessors for Surgeon A was 2.67/2.69 and for Surgeon B 2.90/2.83. Inter-rater reliability was excellent and intra-rater reliability was found to be slight. Subjective assessment using clinical photography is a useful tool in assessing aesthetic outcomes in bilateral cleft lip repair.