title: Developing a visual rating chart for the esthetic outcome of unilateral cleft lip and palate repair.
abstract: BACKGROUND
  Aesthetic impairment is a major concern for the cleft lip/palate patient. Thus, auditing of postsurgical esthetic outcome needs to be further explored as till date no universally accepted protocol exists. The study objective was to propose a new visual rating chart (VRC) for the aesthetic outcome of cleft lip and palate (CLP) surgery.
  
  
  METHODS
  In a retrospective review of 200 repaired clefts, the common esthetic deficiencies were identified, categorized and ranked in the order of severity. A chart of the illustrative diagram with textual description of the defects was produced and used as a basis for rating outcome by two groups of raters (familiar raters and recruited raters). Intra- and inter-raters reliability was estimated using Cohen's kappa statistics and intra-class correlation coefficient (ICC). Comparison between mean group coefficient was achieved with Kendall's correlation coefficient of concordance.
  
  
  RESULTS
  The intra- and inter-rater reliability for familiar raters was found to be strong with kappa values range of 0.80-0.87 (P < 0.001). Similarly, inter-raters' reliability by recruited judges was very strong using ICC at both single (0.768) and average measures (0.982).
  
  
  CONCLUSIONS
  The VRC is a reliable tool for assessing the esthetic outcome of CLP repairs.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Oyo State, Nigeria.
authors.forename: A Olusanya
authors.initials: AO
authors.lastname: Adeola
authors.affiliation: Faculty of Dentistry, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria.
authors.forename: A Akadiri
authors.initials: AA
authors.lastname: Oladimeji
keywords: Cleft surgery; rating scale; surgical outcome