Reference photographs for nasolabial appearance rating in unilateral cleft lip and palate

J Craniofac Surg. 2009 Sep;20 Suppl 2:1683-6. doi: 10.1097/SCS.0b013e3181b3ed9c.


A popular method for nasolabial rating in unilateral cleft lip and palate (UCLP) is the Asher-McDade system consisting of a 5-point ordinal scale assessing nasal form, nasal symmetry, nasal profile, and vermilion border. The aim of the current study was to identify reference photographs illustrating this scale to facilitate its use.Four observers assessed nasolabial appearance on frontal and profile photographs of the nasolabial area of 42 children of Caucasian origin with a repaired UCLP at age 9 years. Cronbachs alpha, based on the individual scores of the 4 observers, ranged from 0.73 to 0.82 for the 4 nasolabial ratings, indicating a good reliability. The reliability of the overall score (mean of the 4 component scores) was also high (Cronbachs alpha, 0.83). Both for the nasolabial component ratings and for the overall score, duplicate measurement errors were small. The reliability for the mean of the 4 observers' scores was good, Spearman rank correlation coefficients ranging from 0.56 to 0.96.Subsequently, photographs were selected that showed the highest agreement among observers. For each of the 4 components (eg, nasal form, nasal deviation, nasal profile, and shape of the vermilion border), 5 photographs were selected to illustrate the whole range of the scale (score, 1-5), resulting in the selection of 20 pictures.It was concluded that nasolabial appearance rating can be performed reliably using a panel of judges and averaging the scores of all observers. Reference photographs, as developed from this study, may facilitate the rating task.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Cleft Lip / surgery*
  • Cleft Palate / surgery*
  • Esthetics*
  • Female
  • Humans
  • Lip / pathology
  • Male
  • Nose / pathology
  • Photography*
  • Reference Values
  • Reproducibility of Results
  • White People