Validity of Subjective Evaluations for the Assessment of Lip Scarring and Impairment

Objective: In patients with cleft lip and palate, the aim of the study was (1) to determine and compare the level of agreement among examiners’ subjective evaluations of static and dynamic lip form; (2) assess possible bias of examiners’ subjective evaluations; and (3) determine the impact of lip scarring on an examiner’s subjective assessment of dynamic lip form. Setting: Patients and subjects were recruited from the University of North Carolina Cleft Lip and Palate Center and School of Dentistry. Patients, Participants: Thirteen patients with unilateral cleft lip and palate and varying degrees of cleft scar severity were selected and one subject without cleft who wore artificial scars of varying severity. Interventions: For the patients with cleft, a previously repaired complete cleft lip and palate. Photographs and videotape recordings were made of the patients with cleft and the subject without cleft, with and without the artifical scars, at rest and smiling. Main Outcome Measure(s): Rankings of cleft scar severity and impairment on a 6-point Likert scale by a lay and professional panel. Results: Intraand interexaminer reliability was good for the lower facial regions at rest but not during movement. Professionals gave ratings of greater severity and impairment than laypersons, and professionals agreed when rating the lower faces at rest more so than during movement. Lip scarring affected perceptions of impairment during movement by viewers in both panels. Conclusions: Subjective assessments can be affected by methodological approaches, professional experience, and stimulus type. Future research should focus on establishing objective methods to evaluate patients with cleft lip and palate at rest and during function.