Comparison of two scoring systems in the assessment of nasolabial appearance in cleft lip and palate patients

Objective: The aim of this study was to determine the reliability of 2 scoring systems.

Design: This study used a retrospective analysis of the results of complete unilateral cleft lip and palate patients.

Setting: The study was conducted at the VU Medical Center and the Academic Center for Dentistry of Amsterdam.

Patients: Patients were complete unilateral cleft lip and palate patients at the age of 6 years.

Main Outcome Measures: Assessment of the nose and lip together and separately with a numerical photographic reference scoring system and with a 5-point ordinal scale without the use of a reference photograph by 6 judges. Intraobserver and interobserver reliability was calculated; both ways of assessment were compared by using Kendall tau.

Results: Photographs were available of 55 children (6 years old, 38 boys and 17 girls) with a complete unilateral cleft lip and palate. The interobserver reliabilities of the lip and nose together were 0.53 and, for the nose and lip separately, 0.51 and 0.43, respectively with the use of the numerical scale. In the 5-point scale, these were 0.55 for the nose and lip together and 0.57 and 0.45 for the nose and lip separately, respectively. Furthermore, it was found that the lip dominates in the scorings of the lip and nose together (linear regression analysis).

Conclusions: The 2 tested systems are equivalent in their reliability and outcome. The lip is dominating in the overall scorings. It is advocated to use the 5-point scale without the use of a reference photograph and to assess the lip and nose separately.