title: Nasolabial esthetics in children with complete unilateral cleft lip and palate after 1- versus 3-stage treatment protocols.
abstract: OBJECTIVE
  Facial esthetics play an important role in social interactions. However, children with a repaired complete unilateral cleft lip and palate usually show some disfigurement of the nasolabial area. To date, few studies have assessed the nasolabial appearance after different treatment protocols. The aim of the present study was to compare the nasolabial esthetics after 1- and 3-stage treatment protocols.
  
  
  METHODS
  Four components of the nasolabial appearance (nasal form, nasal deviation, mucocutaneous junction, and profile view) were assessed by 4 raters in 108 consecutively treated children who had undergone either 1-stage closure (Warsaw group, 41 boys and 19 girls, mean age 10.8 years, SD 2.0) or 3-stage (Nijmegen group, 30 boys and 18 girls, mean age 8.9 years, SD 0.7). A 5-grade esthetic index of Asher-McDade was used, in which grade 1 indicates the most esthetic and grade 5 the least esthetic outcome.
  
  
  RESULTS
  The nasal form was judged the least esthetic in both groups and graded 3.1 (SD 1.1) and 3.2 (SD 1.1). The nasal deviation, mucocutaneous junction, and profile view were scored from 2.1 (SD 0.8) to 2.3 (SD 1.0) in both groups. The treatment outcome after the Warsaw and Nijmegen protocols was comparable. Neither overall nor any of the 4 components of the nasolabial appearance showed intercenter differences (P > .1).
  
  
  CONCLUSIONS
  The nasolabial appearance after the Warsaw (1-stage) and Nijmegen (3-stage) protocols was comparable. The technique of lip repair (triangular flap in Warsaw and Millard rotation advancement in Nijmegen) gave comparable results for the esthetics of the nasolabial area.
authors.affiliation: Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland. pfudalej@gmail.com
authors.forename: Piotr
authors.initials: P
authors.lastname: Fudalej
authors.forename: Christos
authors.initials: C
authors.lastname: Katsaros
authors.forename: Catharina
authors.initials: C
authors.lastname: Bongaarts
authors.forename: Zofia
authors.initials: Z
authors.lastname: Dudkiewicz
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Kuijpers-Jagtman
mesh_terms: D000367:Age Factors; D002648:Child; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D002985:Clinical Protocols; D004954:Esthetics; D005260:Female; D006801:Humans; D008046:Lip / Q000473:pathology* / Q000601:surgery; D008297:Male; D009666:Nose / Q000473:pathology* / Q000601:surgery; D010156:Palatal Muscles / Q000601:surgery; D010158:Palatal Obturators; D021362:Palate, Hard / Q000601:surgery; D010160:Palate, Soft / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome