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Americleft Methods: Is the Q-SORT Method Equivalent with 2D Photos and 3D Surface Imaging?
Christine M. Jones, MD1, Thomas D. Samson, MD1, Ana M. Mercado, DMD, PhD2, Kathy A. Russell, DDS, MSc3, John Daskalogiannakis, DDS, MSc4, Ronald R. Hathaway, DDS, MS5, Ross E. Long, Jr., DMD, MS, PhD6.
1Penn State Hershey Medical Center, Hershey, PA, USA, 2Ohio State University, Columbus, OH, USA, 3Dalhousie University/IWK Health Centre, Halifax, NS, Canada, 4The Hospital for Sick Children, Toronto, ON, Canada, 5Peyton Manning Children's Hospital at St. Vincent, Indianapolis, IN, USA, 6Lancaster Cleft Palate Clinic, Lancaster, PA, USA.

BACKGROUND: Comparing outcomes in the repair of cleft lip and palate between centers allows the clinical differences between treatment methods to be quantified. The best measurement would achieve a balance between practicality of use and similarity to a live patient evaluation. Photographs are widely available, inexpensive, and easily shared; however, the detail of evaluation is limited by the number of projections. Three-dimensional imaging more closely mimics a patient encounter but may be more cumbersome and limited by cost. This study measured the relationship between photographic and 3D surface imaging ratings.
METHODS: Patients with repaired complete unilateral cleft lip and palate who were consecutively treated at one center and had complete 2D and 3D photographic documentation were included. Frontal, profile, and three-dimensional digital images were cropped to show the nose and upper lip and coded. Nasolabial profile, nasolabial form, and vermillion border aesthetics were rated using the 5-point scale described by Asher-McDade. Intrarater and interrater reliabilities were calculated using weighted kappa statistics. Correlation of 2D and 3D ratings was determined using Bland-Altman plots.
RESULTS: Twenty seven patients were included. Interrater reliability scores were good for 2D and fair to good for 3D imaging. Intrarater reliability was good to very good for 2D and moderate to good for 3D imaging. Bland-Altman analysis showed good agreement of 2D and 3D scores for nasolabial profile and nasolabial form, but there was more systematic error in the assessment of vermillion border.
CONCLUSIONS: Although three-dimensional images may be perceived as more representative of a direct clinical facial evaluation, their use for subjective rating of nasolabial esthetics is not more reliable than two-dimensional images. Conventional 2D images provide acceptable reliability while being readily accessible for most cleft palate centers.


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