Methods of assessment of cleft-related facial deformity: a review

OBJECTIVE: To review the stimulus media, measurements and scoring system, rater's characteristics, and facial region used in assessment of the appearance of cleft-related deformity. METHODS: A review of the literature was conducted using MedLine from January 1966 to June 2003. Key orthodontic journals and The Cleft Palate-Craniofacial Journal were hand searched as well. RESULTS: Most studies used a static two-dimensional means of assessment. Direct clinical assessment, three-dimensional media, or both have been used to a lesser extent. Only one study utilized all three assessment media. Three studies, however, attempted to compare the direct clinical assessment with that obtained using two-dimensional media. Most of the studies demonstrated that appearance of the cleft-related deformity could be measured by a variety of judges. The reliability and validity of the three different media as methods of assessment have received limited attention. The facial area assessed has varied from the full face, nasolabial area, or specific features of the lip or nose. CONCLUSIONS: Wide variation exists in the study design related to assessment of cleft-related deformity. An internationally agreed objective method of assessment for this facial deformity is required. A three-dimensional, rather than a two-dimensional, means of assessment should be adopted