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A Novel Bilateral Cleft Lip Severity Index: Correlation With Long-Term Outcomes.
Jinggang J Ng1, Manisha Banala1, Benjamin Ballard Massenburg1
1Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Summary
The Bilateral Cleft Lip Severity Index (BCLSI) shows high reliability among surgeons and laypeople for assessing cleft lip severity. A higher BCLSI score correlates with worse aesthetic outcomes, indicating its value in cleft lip research.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Preoperative severity classification for bilateral cleft lip lacks standardization.
- A reliable index is needed to correlate initial deformity with surgical outcomes.
Purpose of the Study:
- Validate the Bilateral Cleft Lip Severity Index (BCLSI) for interrater reliability.
- Assess the relationship between preoperative BCLSI scores and long-term aesthetic outcomes.
Main Methods:
- Retrospective cohort study at a tertiary pediatric hospital.
- Surgeons and lay raters assessed preoperative cleft severity using the BCLSI.
- Anthropometric analysis and crowdsourced aesthetic ratings (Likert scales, pairwise comparisons) were performed.
Main Results:
- High interrater reliability for BCLSI: 0.94 (surgeons), 0.84 (laypeople), 0.88 (combined).
- Higher BCLSI correlated with increased columellar-labial angle (r=0.686, P=.002).
- BCLSI predicted poorer aesthetic ratings (lateral, frontal, composite) independent of confounding factors.
Conclusions:
- The BCLSI is a reliable tool for classifying bilateral cleft lip severity.
- Higher BCLSI scores predict worse aesthetic outcomes, particularly nasal appearance.
- BCLSI can standardize classification and improve cleft lip outcomes research.
