title: Functional outcomes of cleft lip surgery. Part I: Study design and surgeon ratings of lip disability and need for lip revision.
abstract: OBJECTIVE
  Children with a cleft of the upper lip exhibit obvious facial disfigurement. Many require multiple lip surgeries for an optimal esthetic result. However, because the decision for lip revision is based on subjective clinical criteria, clinicians may disagree on whether these surgeries should be performed. To establish more reliable, functionally relevant outcome criteria for evaluation and treatment planning, a clinical trial currently is in progress. In this article, the design of the clinical trial is described and results of a study on subjective evaluations of facial form by surgeons for or against the need for lip revision surgery are presented.
  
  
  METHODS
  Parallel, three-group, nonrandomized clinical trial and subjective evaluations/ratings of facial views by surgeons.
  
  
  METHODS
  For the clinical trial, children with repaired cleft lip and palate scheduled for a secondary lip revision, children with repaired cleft lip and palate who did not have lip revision, and noncleft children. For the subjective evaluations, surgeons' facial ratings of 21 children with repaired cleft lip.
  
  
  METHODS
  Descriptive and Kappa statistics assessing the concordance of surgeons' ratings of (a) repeated facial views and (b) a recommendation of revision on viewing the prerevision and postrevision views.
  
  
  RESULTS
  The surgeons' consistency in rating repeated views was moderate to excellent; however, agreement among the surgeons when rating individual participants was low to moderate.
  
  
  CONCLUSIONS
  The findings suggest that the agreement among surgeons was poor and support the need for more objective measures to assess the need for revision surgery.
authors.affiliation: Department of Orthodontics, University of North Carolina at Chapel Hill 27599-7450, USA. carroll-ann_trotman@dentistry.unc.edu
authors.forename: Carroll-Ann
authors.initials: CA
authors.lastname: Trotman
authors.forename: Ceib
authors.initials: C
authors.lastname: Phillips
authors.forename: Greg K
authors.initials: GK
authors.lastname: Essick
authors.forename: Julian J
authors.initials: JJ
authors.lastname: Faraway
authors.forename: Steven M
authors.initials: SM
authors.lastname: Barlow
authors.forename: H Wolfgang
authors.initials: HW
authors.lastname: Losken
authors.forename: John
authors.initials: J
authors.lastname: van Aalst
authors.forename: Lyna
authors.initials: L
authors.lastname: Rogers
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000503:physiopathology* / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D015588:Observer Variation; D019239:Practice Patterns, Dentists'; D012086:Reoperation; D012107:Research Design; D016896:Treatment Outcome