A Rating Scale for Obtaining Specific, Actionable Evaluations of Nasolabial Aesthetics After Unilateral Cleft Lip Repair

Background: Surgeons pursuing improvement in the aesthetic outcomes of their cleft lip repairs may benefit from a granular scale evaluating individual objectives of the repair. Methods: A working group of nine surgeons convened to develop an assessment scale for nasolabial aesthetics after unilateral cleft lip repair. The group identified objectives of the repair that could be evaluated using two-dimensional facial photographs. Scale items were developed to appraise success or failure in achieving each objective. Scale items were iteratively tested and refined. The scale was subsequently implemented as part of a continuing medical education course that included self-evaluation and peer-to-peer education, culminating in the formation of individual plans for improvement. Results: Twelve distinct objectives of unilateral cleft lip repair were identified, of which ten could be evaluated using photographs routinely obtained in clinical practice. A comprehensive scale was developed incorporating these ten objectives. Each scale item takes the form of a binary (yes/no) question evaluating a specific aesthetic concept, with accompanying reference images. Intra-rater reliability for each item ranged from moderate to substantial [κ = 0.57-0.81]. Inter-rater reliability ranged from fair to substantial [κ = 0.27-0.81]. When implemented in a continuing medical education course, the scale enabled surgeons to identify specific opportunities for improvement in their repair and specific surgical maneuvers to adopt in pursuit of these improvements. Conclusion: A new scale for evaluating outcomes of unilateral cleft lip repair is presented. The scale provides specific, actionable evaluations for individual objectives of the repair.