Validating the Asher Mc-Dade Score to assess Facial Aesthetic Outcomes in Twenty-Two Consecutive Complete Bilateral Cleft Lip Repairs

Abstract Introduction Most scoring systems used in assessing facial aesthetics in cleft patients tend to lack consistency, with no internationally agreed system, making comparisons challenging. The most widely used and validated tool is the Asher-McDade assessment. We note there are currently no reports of its use in scoring outcomes after bilateral cleft lip repair. The aim was therefore to describe the outcomes from 22 consecutive bilateral cleft lip repairs assessed using the Asher-McDade five-point scale to validate the tool for this use. Materials and methods Retrospective review was undertaken of 22 consecutive patients with bilateral cleft lip repairs performed at our centre. Each patient underwent bilateral advancement rotation repair with a vomer flap on one side at three months followed by repair of the remaining hard palate and an intravelar veloplasty three months later. Standardised photographs were taken five years following repair and cropped to isolate the nasolabial component. 11 members of the cleft multidisciplinary team were asked to rate each image on a five-point Likert scale. Statistical analysis was performed using a Two-way ANOVA test and intraclass correlation coefficient to interrogate intra & interobserver variance. Results 22 consecutive patients with complete bilateral cleft lips were photographed. There was an overall mean score for the repairs of 3.2, with a range of 4.3 to 1.8. The two-way ANOVA demonstrating that inter-rater variability accounts for just over 10% (11.23% of the total variance), p = Discussion & conclusions We demonstrate that the Asher-McDade scoring system is a valid tool to use when assessing bilateral cleft lip repairs. Variance in patients score is significantly related to a true difference in appearance with only a small percentage of variance due to intra & inter-observer variation.