The Asher-McDade aesthetic index comparison with two scoring systems in nonsyndromic complete unilateral cleft lip and palate patients

Objective: To compare the Asher-McDade aesthetic index with 2 systems used to score the appearance of the nasolabial area in patients with a complete cleft lip and palate.

Design: Retrospective analysis of the results of complete unilateral cleft lip and palate patients.

Setting: Academic Center for Dentistry of Amsterdam and the VU University Medical Center.

Patients: Six-year-olds with complete unilateral cleft lip and palate.

Main outcome measures: Cleft lip and palate patients assessed using the scoring system proposed by Prahl et al, a 5-point ordinal scale, and the scoring system proposed by Asher-McDade et al by 6 judges, 3 orthodontists, and 3 plastic surgeons. A calculation of intra- and interobserver reliability was made. A comparison was made of all the assessment methods using Kendalls’ tau.

Results: Photographs of 55 children (38 boys and 17 girls) with complete unilateral cleft lip and palate were assessed. For the scoring system of Prahl et al, interobserver reliability varied from 0.43 to 0.53, for the 5-point scale between 0.45 and 0.57, and for the scoring system by Asher-McDade et al these varied between 0.52 and 0.66. Multiple significant correlations were found between the used scoring systems.

Conclusion: It can be concluded that the Asher-McDade aesthetic index is still superior to the other scoring systems used in this study. However, all 3 scoring systems can reliably be used when 3 or more observers are used.