Computer-assisted anthropometry for outcome assessment of cleft lip

Anthropometry, and clinical examination best evaluate the morphology of rep aired cleft lip and nose. iel original, accurate, and practical image analy sis of the lip and nose, which takes advantage of the mathematic, geometric , and organizational capabilities of public domain NIH-Image software (http ://rsb.info.nih.gov/nih-image/), has been developed and tested ol er the pa st 6 years. A modified structured physical examination form that complement s this analysis is under study. Accuracy of NIH-Image-based anthropometry was compared with direct measurem ents of 22 linear distances on the lip and nose. Twenty-five sets of direct measurements were taken, prospectively, on 15 children with repaired cleft lip ol er a 6-year period. The results were submitted to regression analys is. Then, relevant lip and nasal tip aesthetics were evaluated by the measu ring capabilities of NIH-Image to create a quantitative assessment tool. Fo r each episode, 15 possible faults were weighted, according to aesthetics a nd deformity to provide an adverse score. The sum of the 5 lip scores, 10 n ose scores, and combination gave respective grades. The analysis was modifi ed to stratify congenital deformity to relate severity of disease to outcom e. This analysis was applied to digitized images of 19 consecutive children, i mmediately prior to repair of complete unilateral cleft lip and nose, at th e time of palate repair, and annually from the age of 3 to 6 years. There w ere 19 NIH-Image-based measurements of the congenital deformity and 35 meas urements of surgical results; four children had three sets of records, eigh t had two sets, and seven had one set. Descriptive statistics were applied. Following 556 paired direct and computer-assisted measurements, exceptional linear correlation was shown with a Pearson R coefficient of 0.96. The bes t correlation was lines within the plane of the camera lens, with the avera ge difference ranging between 0.025 and 0.997 mm. Visual inspection of frontal and submental photographs of excellent, good, and poor results substantiates the ability of this analysis to quantify and grade a spectrum of relevant cleft lip and nasal anatomy. For these 19 pat ients, there was a broad range of performance scores, approximating a norma l distribution. The mean of the NIH-Image-based analysis scores, 16.91, was a (very) good grade. A single standard deviation of 6.88 extended up into excellent and down to fair. The congenital analysis indicated a range of de formity. Comparing deformity with outcome, simple regression analysis had a coefficient of determination (R-2) of 0.223, indicative of a weak positive relationship. An accurate and practical morphologic computer-assisted outcome assessment of repaired cleft lip and nasal deformity has been developed. There is a we ak direct correlation between severity of deformity and outcome. Testing in multiple clinics is warranted.