Analysis of the cleft lip-nose in the submental-vertical view. Part II. Panel study: which is the most important deformity?

BACKGROUND: In part I, we presented an anthropometric measurement instrument that uses standardized facial pictures in the submental-vertical view, Adobe Photoshop 7.0, and Scion Software for Windows to determine both form and symmetry of the cleft nose. This instrument was found to be both reliable and universally suitable for comparing results of cleft rhinoplasties. However, the quality of the overall result needs to be based on weights assigned to different measurable parameters/deformities. Therefore, we carried out a panel study to evaluate the relative importance of the different parameters/deformities according to the parents of the patients.
MATERIALS AND METHODS: A questionnaire with both pictorial and textual representations of 10 distinct nasal cleft deformities was sent twice to the parents of 14 complete unilateral and 14 complete bilateral cleft lip-nose patients. The deformities were rank-ordered by the parents, and the responses were analyzed for intraobserver and interobserver reliabilities.
RESULTS: The most important deformity according to both groups was the asymmetric position of the nose within the facial frame. Alar position was also important whereas nostril form was least important. There was fair test reliability for both intraobserver and interobserver rankings.
CONCLUSION: Rankings of the different nasal cleft deformities by the parents of cleft patients are reproducible and, hence, a useful preparatory guide for surgeons.