title: The use and reliability of SymNose for quantitative measurement of the nose and lip in unilateral cleft lip and palate patients.
abstract: BACKGROUND
  It is essential to have a reliable assessment method in order to compare the results of cleft lip and palate surgery. In this study the computer-based program SymNose, a method for quantitative assessment of the nose and lip, will be assessed on usability and reliability.
  
  
  METHODS
  The symmetry of the nose and lip was measured twice in 50 six-year-old complete and incomplete unilateral cleft lip and palate patients by four observers. For the frontal view the asymmetry level of the nose and upper lip were evaluated and for the basal view the asymmetry level of the nose and nostrils were evaluated.
  
  
  RESULTS
  A mean inter-observer reliability when tracing each image once or twice was 0.70 and 0.75, respectively. Tracing the photographs with 2 observers and 4 observers gave a mean inter-observer score of 0.86 and 0.92, respectively. The mean intra-observer reliability varied between 0.80 and 0.84.
  
  
  CONCLUSIONS
  SymNose is a practical and reliable tool for the retrospective assessment of large caseloads of 2D photographs of cleft patients for research purposes. Moderate to high single inter-observer reliability was found. For future research with SymNose reliable outcomes can be achieved by using the average outcomes of single tracings of two observers.
authors: Department of Plastic, Reconstructive and Hand Surgery (Head: Prof. Marco Ritt), VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: davidmosmuller@hotmail.com.
authors: David
authors: D
authors: Mosmuller
authors: Department of Plastic, Reconstructive and Hand Surgery (Head: Prof. Marco Ritt), VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: robintan100@gmail.com.
authors: Robin
authors: R
authors: Tan
authors: Department of Plastic, Reconstructive and Hand Surgery (Head: Prof. Marco Ritt), VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: f.j.mulder@student.vu.nl.
authors: Frans
authors: F
authors: Mulder
authors: Department of Plastic, Reconstructive and Hand Surgery (Head: Prof. Marco Ritt), VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: y.bachour@vumc.nl.
authors: Yara
authors: Y
authors: Bachour
authors: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, The Netherlands. Electronic address: hcw.devet@vumc.nl.
authors: Henrica
authors: H
authors: de Vet
authors: Department of Plastic, Reconstructive and Hand Surgery (Head: Prof. Marco Ritt), VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: dongriot@vumc.nl.
authors: Peter
authors: P
authors: Don Griot
mesh_terms: D002648:Child; D002971:Cleft Lip / Q000175:diagnosis* / Q000473:pathology; D002972:Cleft Palate / Q000175:diagnosis* / Q000473:pathology; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008046:Lip / Q000473:pathology*; D008297:Male; D009666:Nose / Q000473:pathology*; D015588:Observer Variation; D010781:Photography; D015203:Reproducibility of Results
keywords: Assessment; Cleft lip and palate; Nasolabial appearance; SymNose; Symmetry