Original Articles

The Americleft Project: Comparison of Ratings Using Two-Dimensional Versus Three-Dimensional Images for Evaluation of Nasolabial Appearance in Patients With Unilateral Cleft Lip and Palate

Jones, Christine M. MD; Roth, Benjamin DMD; Mercado, Ana M. DMD, PhD; Russell, Kathy A. DDS, MSc; Daskalogiannakis, John DDS, MSc; Samson, Thomas D. MD; Hathaway, Ronald R. DDS, MS; Smith, Andrea DDS; Mackay, Donald R. MD; Long, Ross E. Jr DMD, PhD

Author Information

^∗Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey

^†Lancaster Cleft Palate Clinic, Lancaster

^‡Albert Einstein Medical Center, Philadelphia, PA

^§Division of Orthodontics, Ohio State University, Columbus, OH

^||Division of Orthodontics, Dalhousie University/IWK Health Care Centre, Halifax, Canada

^¶Division of Orthodontics, SickKids Hospital and University of Toronto, Toronto, ON, Canada

^#Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Address correspondence and reprint requests to Christine M. Jones, MD, Penn State Hershey Medical Center, 500 University Drive, Mail Code H071, Hershey, PA 17033; E-mail: [email protected]

Received 14 April, 2017

Accepted 4 August, 2017

This article was presented, in part, at the 71st Annual Meeting of the American Cleft Palate-Craniofacial Association, March 2014, Indianapolis, IN; the 30th Annual Meeting of the Northeastern Society of Plastic Surgeons, September 2013, Washington, DC; the 59th Annual Meeting of the Robert H. Ivy Society of Plastic Surgeons, March 2013, Bethlehem, PA; and the Americleft Project: Comparison of Ratings Using 2D vs. 3D Images for Evaluation of Nasolabial Appearance in Patients with Unilateral Cleft Lip and Palate.

The Americleft Project has received funding from the American Cleft Palate-Craniofacial Association and the Cleft Palate Foundation. REL has also received partial support through grants for the Americleft Project to the Lancaster Cleft Palate Clinic from the HG Barsumian Medical Research Foundation, Winston-Salem, NC, and from the Livingston/Trout-Mellinger Medical Research Fund, Lancaster, PA. The remaining authors report no conflicts of interest.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com).

Journal of Craniofacial Surgery 29(1):p 105-108, January 2018. | DOI: 10.1097/SCS.0000000000004102

Abstract

This study was conducted to determine if nasolabial appearance is rated with comparable results and reliability on 3-dimensional stereophotogrammetric facial images versus standard clinical photographs (2-dimensional). Twenty-seven consecutively treated patients with repaired complete unilateral cleft lip and palate were selected. Six trained and calibrated raters assessed cropped 2- and 3-dimensional facial images. Nasolabial profile, nasolabial frontal, and vermillion border esthetics were rated with the 5-point scale described by Asher-McDade using the modified Q-sort method. Cropped 3-dimensional images were available for viewing by each rater, allowing for complete rotational control for viewing the images from all aspects. Two- and three-dimensional ratings were done separately and repeated the next day.

Interrater reliability scores were good for 2-dimensional (κ = 0.607–0.710) and fair to good for 3-dimensional imaging (κ = 0.374–0.769). Intrarater reliability was good to very good for 2-dimensional (κ = 0.749–0.836) and moderate to good for 3-dimensional imaging (κ = 0.554–0.855). Bland–Altman analysis showed satisfactory agreement of 2- and 3-dimensional scores for nasolabial profile and nasolabial frontal, but more systematic error occurred in the assessment of vermillion border.

Although 3-dimensional images may be perceived as more representative of a direct clinical facial evaluation, their use for subjective rating of nasolabial aesthetics was not more reliable than 2-dimensional images in this study. Conventional 2-dimensional images provide acceptable reliability while being readily accessible for most cleft palate centers.