Clinical Study On The Subjective Evaluation System Of Nasolabial Appearance In Postoperative Patients With Cleft Lip And Palate

Objective:This study intends to establish a reliable subjective evaluation system of postoperative appearance for clinical evaluation of postoperative appearance of patients with CLP.Methods:First,this study proposes a subjective evaluation system for postoperative appearance of patients with CLP.The evaluation media in this system was a standardized cropped photograph of the patient after surgery.The evaluators in this system were divided into professional group,family group and non-professional group according to their understanding of CLP.And the evaluation rules in this system were a five-point subjective system for seven evaluation items:nasal symmetry,nasal shape,philtrum,upper lip thickness,lip symmetry,red lip contour,and overall nasolabial area.Then,the initial proposed subjective evaluation system was experimentally verified and improved and optimized in three steps.In the first step,the proposed subjective evaluation system was initially validated by three evaluation teams,and 40 randomly selected groups of photos in the sample database were subjectively evaluated on a five-point scale for seven evaluation items,and the experimental results were statistically analyzed to determine the reliability of the evaluation system.In the second step,the evaluation rule part was optimized according to the analysis results of the previous step,including the optimization of the evaluation items and the introduction of reference photos.First part of the step,the 7 evaluation items were streamlined into 3 evaluation items for the nose,lip,and nasolabial region as a whole.In this part,the evaluation team used the new evaluation items to evaluate 40 sets of photos re-randomly selected from the sample pool;the reliability of the new evaluation items was statistically analyzed.The second part,to further improve the reliability of the subjective evaluation system,the evaluation reference photos were introduced into the evaluation rules.In this part,all112 groups of photos in the sample bank were evaluated by the independent evaluation team,and the reliability of the overall experimental results was analyzed by statistical methods,and 15 evaluation reference photos with 5 rating levels for 3evaluation items were selected,and the reference photos were added to the evaluation rules.In the third step,to verify the subjective evaluation system with optimized evaluation rules.Three groups to evaluate 40 randomly selected sets of photos for new items under the condition that the reference photos could be viewed at any time;the experimental results were statistically verified to analyze whether the reliability of the optimized subjective evaluation system was improved,so as to determine the final subjective evaluation system.Results:（1）Preliminary verification experiment of subjective evaluation system:There was good consistency within the evaluation groups(ICC _pro=0.858、ICC _fam=0.769、ICC _{non pro}=0.781).There was moderate consistency between evaluation groups(ICC _pro-fam=0.625,ICC _{pro-non pro}=0.511,and ICC _{fam-non pro}=0.548).Of the seven evaluated items,except philtrum,the remaining indicators had good reliability（Cronbach’sαare:nasal symmetry=0.873,nasal type=0.876,human=0.762,upper lip thickness=0.822,lip symmetry=0.844,red lip contour=0.854,and nasal lip area as a whole=0.853）.The results of six sub-evaluation items are moderately correlated with the score of overall nose and lips（r are 0.330～0.488,P<0.001）;There was no statistical difference in the scores of nasal symmetry and nasal type（P=0.684,α=0.05）.Among the four indexes of lips,the lip symmetry and the red lip contour have no statistical difference（P=1.000,α=0.05）.（2）Evaluation rule optimization experiment:in the evaluation project optimization experiment,the intra-group ICC and inter-group ICC of the evaluation team were improved compared with the first round of experiments(ICC _pro=0.920,ICC _fam=0.831,ICC _{non pro}=0.849,ICC _pro-fam=0.714,ICC _{pro-non pro}=0.689,ICC _{fam-non pro}=0.662).The reliability of the evaluation results of the three evaluation items is excellent（Cronbach’sαare 0.926,0.936,0.906）.The scores of nose and lips are still moderately correlated with the scores of overall nose and lips（r are 0.458 and 0.489,P<0.001）.In the experiment of selecting reference photos,ICC=0.898,and Cronbach’sα=0.987.（3）Verification experiment of optimized subjective evaluation system:the intra-group ICC and inter-group ICC of the evaluation team are more consistent than those of the second round experiment(ICC _pro=0.938,ICC _fam=0.863,ICC _{non pro}=0.886,ICC _pro-fam=0.741,ICC _{pro-non pro}=0.743,ICC _{fam-non pro}=0.687).The reliability of the score results of the three evaluation items is also improved compared with the second round of experiments（Cronbach’sαare 0.960,0.976,0.951）.The correlation between the scores of nose and lips and the overall score of nose and lips is still moderate（r are 0.495 and 0.520,P<0.001）.Conclusions:（1）The evaluation of postoperative appearance of CLP by three evaluation groups within the professional group,family group,and non-professional group has good reliability,but there are aesthetic differences between different groups,and the influence of group differences on the evaluation results should be faced squarely.（2）The results of the overall evaluation of nasal and lip postoperative appearance of CLP have high reliability;the introduction of evaluation reference photos in the subjective evaluation system can well improve the reliability of the evaluation system.（3）This study proposed a reliable subjective evaluation system for postoperative nasolabial area appearance of cleft lip and palate patients,in which the evaluation medium was a frontal photograph of the patient with only the nasolabial area exposed after cropping,and the evaluation group was divided into professional,family and non-professional groups according to different cognitive knowledge of CLP,and the evaluation rule was a five-point scale for the three evaluation items of nose,lip and nasolabial area in the presence of evaluation reference photos.This subjective evaluation system has good reliability and practicality.