title: The use of SymNose for quantitative assessment of lip symmetry following repair of complete bilateral cleft lip and palate.
abstract: BACKGROUND
  The SymNose computer program has been proposed as an objective method for the quantitative assessment of lip symmetry following unilateral cleft lip repair. This study aims to demonstrate the use of SymNose in patients with complete bilateral cleft lip and palate (BCLP), a group previously excluded from computer-based analysis.
  
  
  METHODS
  A retrospective cohort study compared several parameters of lip symmetry between BCLP cases and non-cleft controls. 15 BCLP cases aged 10 (±1 year) who had undergone primary repair were recruited from the patient database at the South West Cleft Unit, Frenchay Hospital. Frontal facial photographs were selected for measurement. 15 age-matched controls were recruited from a local school. Lip symmetry was expressed as: percentage mismatch of left vermillion border and upper lip area over the right, horizontal lip tilt and lateral deviation of the lip.
  
  
  RESULTS
  A significant increase in lip asymmetry was found in the BCLP group expressed as upper vermillion border mismatch across computer-defined and user-defined midlines (mean difference was 16.4% (p < 0.01) and 17.5% (p < 0.01) respectively).
  
  
  CONCLUSIONS
  The results suggest that a significant degree of lip asymmetry remains in BCLP patients even after primary repair. This challenges previous assumptions that those with bilateral defects would be relatively symmetrical.
authors.affiliation: The South West Cleft Unit (Head: Nigel Mercer ChM, FRCS, FRCPCH), Frenchay Hospital, Frenchay Park Road, Frenchay, Bristol BS16 1LE, United Kingdom. Electronic address: jr7471@bristol.ac.uk.
authors.forename: James H B
authors.initials: JH
authors.lastname: Russell
authors.affiliation: The South West Cleft Unit (Head: Nigel Mercer ChM, FRCS, FRCPCH), Frenchay Hospital, Frenchay Park Road, Frenchay, Bristol BS16 1LE, United Kingdom.
authors.forename: Harriet C
authors.initials: HC
authors.lastname: Kiddy
authors.affiliation: The South West Cleft Unit (Head: Nigel Mercer ChM, FRCS, FRCPCH), Frenchay Hospital, Frenchay Park Road, Frenchay, Bristol BS16 1LE, United Kingdom.
authors.forename: Nigel S
authors.initials: NS
authors.lastname: Mercer
mesh_terms: D016022:Case-Control Studies; D002508:Cephalometry / Q000379:methods; D002648:Child; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D015331:Cohort Studies; D005143:Eyelids / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008046:Lip / Q000473:pathology*; D009666:Nose / Q000473:pathology; D010781:Photography / Q000379:methods; D012189:Retrospective Studies; D012984:Software
keywords: Bilateral cleft lip and palate; Computer-based; Photographs; SymNose; Symmetry