Dental arch relationships after two-flap palatoplasty in Taiwanese patients with unilateral cleft lip and palate

The authors evaluated the dental arch relationships of patients with unilateral cleft lip and palate treated with two-flap palatoplasty at the Chang Gung Craniofacial Center, Taipei, Taiwan, and compared them with the 6 centers from the Eurocleft study. Intraoral dental photographs of 60 consecutively treated Taiwanese patients with complete unilateral cleft lip and palate were used. The dental arch relationships were rated with the Goslon yardstick and compared with the Goslon outcome of the 6 center Eurocleft study. The strength of agreement of rating was assessed with quadratic-weighted kappa statistics. Inter- and intra-examiner agreements were high. 75% of patients were classified into poor or very poor categories, and the mean Goslon score was 3.92. These results showed no significant difference with Eurocleft center D, which had relatively poor treatment outcome. These data suggest that intraoral dental photographs provide a reliable method for rating dental arch relationships. Dental arch relationships in patients with unilateral cleft lip and palate at Chang Gung Craniofacial Center were unfavorable. This seemed to be attributable to the surgical procedures and racial differences in craniofacial morphology.     

单侧完全性唇腭裂上下牙弓关系评价研究

目的　评价单侧完全性唇腭裂（UCLP）患者上、下颌牙弓关系的协调性,并与亚洲和欧洲几大著名唇腭裂治疗中心的研究结果进行比较,为唇腭裂继发牙牙合畸形的诊断、矫治设计和序列治疗提供依据。方法　回顾性分析2013年3月至2014年3月于青岛大学附属医院口腔正畸科就诊的52例UCLP患者治疗前的记存模型,按照Goslon Yardstick 评价系统和Eurocleft三分类法进行牙弓协调性评价。与中国台湾长庚医院、日本东京大学医院及欧洲6所唇腭裂治疗中心（A～F）的同类研究结果相比较,并进行统计学分析。结果　本中心UCLP患者Goslon Yardstick平均等级为3.75 ± 0.93,Goslon Yardstick等级为4的患者最多,占36.5%,59.6%患者属于差及较差的等级。与台湾长庚医院、东京大学医院及欧洲唇腭裂D治疗中心的结果相接近（P＞0.05）,比其他5所欧洲唇腭裂治疗中心患者的牙弓协调性差（P＜0.05）。结论　UCLP患者上、下牙弓协调性差。青岛大学附属医院接受正畸治疗的UCLP患者,上下牙弓协调性与台湾长庚医院、东京大学医院、欧洲唇腭裂D治疗中心接近,比其他5所欧洲唇腭裂治疗中心牙弓协调性差。     

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??Objective    To evaluate the dental arch relationship of patients with unilateral complete cleft lip palate??UCLP??by comparing them with previous study and to provide theoretical basis on diagnosis??treatment plan design and team approach for patients with UCLP. Methods??Totally 52 UCLP patients treated in the Department of Orthodontics in the Affiliated Hospital of Qingdao University during March 2013 to March 2014 were selected. The dental models of UCLP patients were categorized using Great Ormond Street??London and Oslo Yardstick??Goslon Yardstick??index. Compare the results with the Goslon Yardstick scores of Chang Gung Craniofacial Center??Hospital of Tokyo University and 6 Eurocleft centers reported in previous studies and make statistical analysis. Results??Mean Goslon Yardstick score of UCLP treated in Affiliated Hospital of Qingdao University was 3.75±0.93??36.5% patients had a Goslon Score of 4??and 59.6% patients were classified into poor and very poor categories. The results of our center showed significant differences from those of Eurocleft centers A??B??C??E and F??P < 0.05????but did not differ significantly from those of Eurocleft center D??Chang Gung center or Hospital of Tokyo University??P > 0.05??. Conclusion??Dental arch relationship in patients with UCLP in the Affiliated Hospital of Qingdao University is poor??which is similar to that in Chang Gung Craniofacial Center??Hospital of Tokyo University and Eurocleft center D??but is poorer than the other fove Eurocleft centers.     

Photographs of study casts: an alternative medium for rating dental arch relationships in unilateral cleft lip and palate.

OBJECTIVE: To investigate the reliability of using photographs of study casts as an alternative to casts for rating dental arch relationships. DESIGN: Repeated-measures study. SETTING: Cleft Palate Center of the University Medical Center Nijmegen, Nijmegen, The Netherlands. PATIENTS: Records of children with complete unilateral cleft lip and palate (UCLP) (n = 49) at the age of 9 years were included. MEAN OUTCOME MEASURE(S): Statistics of intra- and interexaminer agreement. RESULTS: No significant differences were found between the rating of dental casts and photographs of dental casts, using the Goslon Yardstick. CONCLUSIONS: Photographs of dental casts provide a consistent, reproducible method for rating dental arch relationships in patients with UCLP at the age of 9 years and provide a reliable alternative to the application of the Goslon Yardstick on dental casts.     

Dental arch relationships in Yorkshire children with unilateral cleft lip and palate.

OBJECTIVE: To assess the dental arch relationships of children with a complete unilateral cleft lip and palate (UCLP), born consecutively between 1983 and 1987, who had undergone primary cleft repair in the West Yorkshire region of the United Kingdom. The treatment outcome of this UCLP sample was then compared with the results of a previously published intercenter European study. DESIGN: A retrospective study with standardized record collection and blind assessment. SETTING: Regional dental hospital providing secondary and tertiary health care to the local population. PATIENTS: 35 UCLP patients whose primary repair had been performed within West Yorkshire. INTERVENTIONS: Dental casts obtained for each subject within 12 months of their 10th birthday. MAIN OUTCOME MEASURES: The West Yorkshire models were randomly mixed with an anonymous sample of 115 UCLP cases from other cleft centers in the U.K. The dental arch relationships of the 10-year-old models were assessed by applying the Goslon Yardstick. RESULTS: One-third of the West Yorkshire cleft sample were rated as belonging to Goslon group 2 (good result), another third to group 3 (fair result), and the remaining third to groups 4 and 5 (poor/very poor result). Numerically, the results were of a slightly higher standard than that previously published for other U.K. and European cleft centers but were inferior to the treatment outcome of two European centers. No statistically significant differences were found between the outcome results of the West Yorkshire group and the other cleft centers. CONCLUSIONS: These results provide useful baseline data against which progress in achieving improved treatment outcome for West Yorkshire UCLP children can be determined by future research.     

The Slavcleft: A three-center study of the outcome of treatment of cleft lip and palate. Part 2: Dental arch relationships

PurposeOur aim was to evaluate the dental arch relationship in a preadolescent Slavic population with unilateral cleft lip and palate (UCLP) by using the Goslon Yardstick.Materials and methodsPatients treated in Warsaw, Poland (n = 32), Prague, Czech Republic (n = 33) and Bratislava, Slovakia (n = 30) were included in this retrospective study. Each cleft center used a unique surgical protocol. Three raters scored blindly the dental arch relationship on plaster models. Intra- and inter-rater agreement were assessed with kappa statistics, and differences between the groups were evaluated with one-way analysis of variance. Intra-rater agreement was very good (k > 0.825), while inter-rater agreement was either good or very good (kappa >0.703).ResultsWe found that patients treated in Warsaw showed a more favorable dental arch relationship (Goslon score = 2.58, SD = 0.77) than patients treated in Prague (Goslon score = 3.21, SD = 1.04). Patients treated in Bratislava showed an intermediate Goslon score (3.07; SD = 0.99).ConclusionThis study showed that the dental arch relationships in patients treated in Warsaw with a one-stage repair were more favorable than in patients treated in Prague and Bratislava with a two-stage protocol and comparable to the best results obtained in the Eurocleft and Americleft studies.     

Predictors of poor dental arch relationship in young children with unilateral cleft lip and palate

The aim of this cross-sectional outcome study using retrospective data capture of treatment histories was to examine the characteristics of young children with unilateral cleft lip and palate who had poor dental arch relationship (i.e., Goslon 5). The study sample comprised 120 children born with nonsyndromic complete unilateral cleft lip and palate between 1995 and 2003, and were aged between 5.0 and 7.0 years (mean age, 5.1 years) at the time of data collection. The dental arch relationship was assessed using the Goslon yardstick from intraoral dental photographs. An independent investigator recorded treatment histories from the clinical notes. The inter- and intraexaminer agreements evaluated by weighted kappa statistics were high. There was no association between dental arch relationship and the type of presurgical orthopedics or pharyngeal flap. Dental arch relationship was associated with the initial cleft size (odds ratio, OR = 1.3; 95% confidence interval, CI = 1.1-1.5, p < 0.01), surgeon grade for palate repair (OR = 5.0, 95% CI = 1.2-19.9, p < 0.05), and primary gingivoperiosteoplasty (OR = 2.8, 95% CI = 1.0-8.1, p = 0.05). These data suggest that intraoral dental photographs provide a reliable method for rating dental arch relationship. Wide initial cleft, high-volume surgeon, and primary gingivoperiosteoplasty are predictors of poor dental arch relationship outcome in young children with unilateral cleft lip and palate. These findings may improve treatment outcome by modifying the treatment protocol for patients with unilateral cleft lip and palate.     

A comparison of craniofacial form in Northern Irish children with unilateral cleft lip and palate treated with different primary surgical techniques.

OBJECTIVE: The quality of outcomes in patients with unilateral cleft lip and palate (UCLP) was compared between two senior plastic surgeons. One surgeon carried out a one-stage Wardill-Kilner palate repair. The other surgeon employed a vomer flap hard palate repair followed by a von Langenbeck soft palate closure (Oslo protocol). DESIGN: Retrospective analysis. PATIENTS: Thirty-four children (mean age 9.7 years) born with complete skeletal UCLP in Northern Ireland from 1983 to 1991 who received primary repair surgery from one of the two surgeons. MAIN OUTCOME MEASURES: Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system. RESULTS: Twenty-nine of the 34 subjects had good or satisfactory arch relationships. Comparison between the surgeons revealed that the Wardill-Kilner group had a greater proportion of Goslon grades of greater than 3, indicating poor arch relationships. However, this difference failed to reach statistical significance. There were no significant cephalometric differences between patients treated by the two surgeons. CONCLUSIONS: Although the difference was not statistically significant, the highest proportion of patients likely to require orthognathic surgery was found in those treated using the Wardill-Kilner technique.     

Palate height: another indicator of surgical outcome in unilateral cleft lip and palate?

OBJECTIVE: To determine whether palate height and maxillary arch depth are systematically related to the surgical center at which primary repair in unilateral cleft lip and palate (UCLP) was carried out. DESIGN: A retrospective comparison based on study casts of consecutive cases of UCLP obtained at age 9 years from six different centers. The observer who conducted measurements was blinded to the source of individual records. SETTING: The patients whose records were analyzed received all their surgical care in a national health service setting in six different northern European centers and regions. PATIENTS: Patients were consecutively treated Caucasian children with non-syndromic complete UCLP born in the period 1976 to 1979. MAIN OUTCOME MEASURES: The main outcome measures for the original study were craniofacial form, dental arch relationships, nasolabial appearance, and speech. This report focuses on measurements of anterior maxillary arch depth and palate height. Results: Anterior arch depth and anterior palate height showed some variation among the centers. There was a tendency for anterior arch depth and palate height to also be reduced at centers at which patients showed unfavorable dental arch relationships. CONCLUSIONS: Anterior arch depth and palate height might be considered in future studies of surgical outcome and in their possible relationship to problems of articulation.     

A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 3. Dental arch relationships.

One hundred and forty-nine dental casts of subjects with complete unilateral clefts of the lip and palate from six European cleft palate centers were assessed by means of the Goslon Yardstick. The Yardstick proved capable of discriminating between the quality of the dental arch relationships between the six centers. Two centers showed especially poor results. Three centers obtained satisfactory results although differing surgical techniques were used in these centers. One of the centers showing satisfactory dental arch relationships employed a more complex and expensive treatment program than the other two centers, which both used simpler centralized treatment regimens.     

Assessment of dental arch relationships in Japanese patients with unilateral cleft lip and palate.

OBJECTIVE: Evaluation of the dental arch relationships of Japanese patients with unilateral cleft lip and palate (UCLP) from the orthodontic clinic of the University of Tokyo Hospital (UTH) compared with patients treated by the Oslo Cleft Team, Norway. DESIGN: Retrospective study and comparison with previous reports. MATERIALS: Dental models of 24 patients with UCLP in UTH taken before orthodontic treatment and before alveolar bone grafting were included. Surgeons in many hospitals performed primary surgeries. These models were matched for age and gender with 24 models from a consecutive series of patients treated by the Oslo Cleft Team as part of the Eurocran Good Practice Archive. A total of 48 models were evaluated. MAIN OUTCOME MEASURE: Dental arch relationship was rated with the Goslon Yardstick. The strength of agreement of rating was assessed with weighted kappa statistics. RESULTS: Intra- and interexaminer agreements evaluated by weighted kappa statistics were high, indicating good reproducibility. Almost 60% of the patients in UTH were classified into poor or very poor categories, and the mean Goslon score was 3.50. These results show a contrast to those in Oslo and were the poorest in comparison with previous reports. CONCLUSION: Dental arch relationships in patients with UCLP in UTH were poor. This seemed to be attributable to surgical procedures, but a factor of racial difference in the craniofacial morphology was also considered. Further intercenter research is required to clarify this point.     

单侧完全性唇腭裂患者上下颌牙弓关系的评价

目的：用Goslon Yardstick评价系统来评价替牙列期和恒牙列期单侧完全性唇腭裂患者上、下颌牙弓协调性的差异,为继发牙畸形的诊断、矫治设计和序列治疗提供依据。方法：对40例患者取牙模型并根据牙列情况分为两组,替牙列期组（n=18）和恒牙列期组（n=22）。用石膏模型,对其牙弓关系行Goslon Yardstick等级评价,并对不同牙列期组间的Yardstick等级进行统计学检验。结果：替牙列期组中,22.2%患者上下颌牙弓协调性差,属于GoslonYardstick等级4和5;Goslon Yardstick均值为2.72。恒牙列期组中,40.9%患者上下颌牙弓协调性差,属于GoslonYardstick等级4和5;Goslon Yardstick均值为3.46。结论：单侧完全性唇腭裂患者恒牙列期比替牙列期上下颌牙弓协调性差,治疗难度更大。     

The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 3: dental arch relationships.

OBJECTIVE: To compare dental arch relationships up to age 17 in individuals with complete unilateral cleft lip and palate (UCLP) treated at five European centers. DESIGN: Longitudinal cohort study, where results were previously reported at 9 years and follow-up measurements were obtained for 12 and 17 years. SETTING: Multidisciplinary cleft services in Northern Europe. SUBJECTS: 127 consecutively treated individuals with repaired UCLP. MAIN OUTCOME MEASURE: Panel rating of dental arch relationship. RESULTS: The results revealed that at 17 years of age three of the centers had better ratings in dental arch relationship (means scores: 1.7, 1.9, and 2.2, respectively) than the other two centers (3.3, 3.4) at statistically significant levels ( p < .01 to p < .001). CONCLUSION: The results confirm that systematic differences in dental arch relationships may occur between different cleft centers, but do not allow specific causal factors to be identified.     

Early assessment of dental arch development in repaired unilateral cleft lip and unilateral cleft lip and palate versus controls.

OBJECTIVE: To evaluate dental arch relationships and dimensions, relative to an age matched noncleft sample, in Caucasian 3-year-old children with repaired unilateral cleft lip (UCL) or unilateral cleft lip and palate (UCLP). DESIGN: Prospective, cross-sectional, case-control study performed in Scotland, U.K. PARTICIPANTS: Eleven children with repaired unilateral cleft lip, 16 children with repaired unilateral cleft lip and palate, and 78 children as controls. MAIN OUTCOME MEASURES: Dental arch relationships and linear arch dimensions. RESULTS: Prevalence of Class III incisor relationship was 31.3% in children with unilateral cleft lip and palate compared with 9.1% in children with unilateral cleft lip. A buccal crossbite was present in 36% of children with unilateral cleft lip, compared with 75.6% of children with unilateral cleft lip and palate.Mean linear maxillary arch dimensions did not differ significantly between children with unilateral cleft lip and the controls. Except for second intermolar width, statistically significant differences existed in mean linear maxillary arch dimensions between the unilateral cleft lip and the unilateral cleft lip and palate groups; the mean linear maxillary arch dimensions were significantly greater in the control group than in the unilateral cleft lip and palate group. The mean cleft-affected anterior quadrant length appeared to be the arch dimension with the greatest power of discrimination among the three groups. There were no significant differences in mean linear mandibular arch dimensions among the three groups. CONCLUSIONS: Anterior crossbite was almost three times more common in the unilateral cleft lip and palate group than in the unilateral cleft lip group. Mean linear maxillary arch dimensions differed significantly between the unilateral cleft lip and palate group and the control group. There were no significant differences in mean linear maxillary arch dimensions between unilateral cleft lip and controls or between mean linear mandibular arch dimensions for unilateral cleft lip, unilateral cleft lip and palate, and controls.     

Complete unilateral cleft lip and palate: validity of the five-year index and the Goslon yardstick in predicting long-term dental arch relationships.

OBJECTIVE: To assess the validity of the 5-year index by subjecting study models at the age of 5 years to both the 5-year index and the Goslon yardstick, and then relating these results to the Goslon ratings at 10 years. DESIGN: Retrospective study. SETTING: Sahlgrenska University Hospital, Gothenburg, Sweden. PATIENTS: Study models of 94 patients with unilateral cleft lip and palate (UCLP) were evaluated at the ages of 5 and 10 years. The dental arch relationships were judged and categorized by using the Goslon yardstick for the 10-year models and both the Goslon yardstick and the 5-year index for the 5-year models. RESULTS: When used for 5- and 10-year models, the Goslon yardstick showed a kappa score of 0.539 (weighted kappa = 0.579) with a moderate strength of agreement. However, 5-year index scores at 5 years compared with the Goslon scores at 10 years showed a kappa score of only 0.043 (weighted kappa = 0.090), showing poor strength of agreement. Goslon scores at 10 years showed improvement in 14 cases when graded by the same Goslon yardstick at 5 years, whereas there was improvement in 23 cases when the 5-year models were graded by the 5-year index (actual improvement in scores in UCLP cases is highly unlikely). CONCLUSIONS: Although use of the Goslon yardstick at 5 years has demonstrated some inherent flaws in its use at that age, these drawbacks are fewer than those when the 5-year index is used at 5 years of age.     

The effects of palatoplasty and pre-surgical infant orthopedic treatment on occlusion in unilateral cleft lip and palate patients

PurposeThe aim of this study was to evaluate the effect of pre-surgical infant orthopedic treatment (Hotz plate) and type of palatoplasty on the dental arch relationship and the dental arch morphology of unilateral cleft lip and palate (UCLP) patients.Materials and methodsSeventy-four children with UCLP were divided into three groups. One group had undergone one-stage palatoplasty without Hotz plate (OSP w/o H), the second had undergone one-stage palatoplasty with Hotz plate (OSP w/H), and the third had undergone two-stage palatoplasty with Hotz plate (TSP w/H). We evaluated the dental models which were taken during initial examination at our orthodontic clinic, using the Goslon Yardstick, the 5-year-old index, and dental model analysis.ResultsRegarding both indices, there were no significant differences among the three groups. However, the dental arch width between maxillary deciduous canines in OSP w/H and TSP w/H was significantly greater than that of OSP w/o H. The dental arch width at the maxillary deciduous second molars in TSP w/H was significantly greater than in OSP w/H and OSP w/o H.ConclusionDental arch relationship in UCLP patients was not influenced by the type of palatoplasty and the use of pre-surgical infant orthopedic treatment. Our results suggest that pre-surgical infant orthopedic treatment results in the increase of anterior dental width, whereas two-stage palatoplasty is significantly effective for increasing posterior dental width in UCLP patients.     

Infant orthopedics has no effect on maxillary arch dimensions in the deciduous dentition of children with complete unilateral cleft lip and palate (Dutchcleft).

OBJECTIVE: Evaluation of the effect of infant orthopedics on maxillary arch dimensions in the deciduous dentition in patients with unilateral cleft lip and palate. DESIGN: Prospective two-arm randomized controlled clinical trial with three participating cleft palate centers. SETTING: Cleft palate centers of the Radboud University Nijmegen Medical Center, Academic Center of Dentistry Amsterdam, and University Medical Center Rotterdam, the Netherlands. PATIENTS: Children with complete unilateral cleft lip and palate (n = 54) were included. INTERVENTIONS: Patients were randomly divided into two groups. Half of the patients (IO+) had a presurgical orthopedic plate until surgical closure of the soft palate at the age of 52 weeks; the other half (IO-) did not undergo presurgical orthopedics. MEAN OUTCOME MEASURES: Maxillary arch dimensions were assessed on dental casts at 4 and 6 years of age with measurements for arch width, arch depth, arch length, arch form, and the vertical position of the lesser segment. Contact and collapse were assessed also. RESULTS: There were no clinically significant differences found between IO+ and IO- for any of the variables. CONCLUSIONS: Infant orthopedics had no observable effect on the maxillary arch dimensions or on the contact and collapse scores in the deciduous dentition at the ages of 4 and 6 years. Considering the Dutchcleft results to date, there is no need to perform infant orthopedics for unilateral cleft lip and palate patients.     

Outcome of gingivoperiosteoplasty for the treatment of alveolar clefts in patients with unilateral cleft lip and palate

Gingivoperiosteoplasty (GPP) has produced inconsistent outcomes. The purpose of this prospective study was to investigate the effects of GPP on the production of bone and maxillary growth. We analysed postoperative cone-beam computed tomographic (CT) scans and intraoral dental photographs of 25 children with complete unilateral cleft lip and palate (UCLP) who were treated with GPP at the same time as their primary repair of the lip. Residual cleft defects and unsupported root ratios of central incisors adjacent to clefts were measured from scans. Dental arch relations were assessed from photographs using the Goslon (Great Ormond Street London and Oslo) yardstick. Eighteen children did not require secondary alveolar bone grafts. Residual cleft defects varied by site (20.4 mm³, 38.6 mm³, 88.2 mm³, and 135.2 mm³ for buccal coronal, palatal coronal, buccal apical, and palatal apical defects, respectively; p < 0.001). Unsupported root ratios did not differ significantly between coronal and apical central incisors adjacent to clefts. The mean (SD) Goslon score was 4.52 (0.51). Most participants (n = 18) who had a GPP did not need secondary alveolar bone grafting. GPP resulted in least bone on the palatal apical portion of the previous alveolar cleft and relatively good periodontal bony support of central incisors adjacent to the cleft. We no longer use GPP because of our concerns about maxillary growth.     

Evaluation of cheiloplasty and palatoplasty on palate surface area in children with oral clefts: longitudinal study

This study evaluated the palatal surface area in children with different oral clefts after primary surgeries and at five years of age. This longitudinal study was composed by 216 digital models: unilateral complete cleft lip (UCL), unilateral complete cleft lip and palate (UCLP), and complete cleft palate (CP). The models were analysed at four time periods: T1 (before cheiloplasty), T2 (before palatoplasty), T3 (after palatoplasty); and T4 – (at five years of age). Area of the dental arches was measured through stereophotogrammetry software. Measurements evaluated with Student’s test and ANOVA followed by the Tukey test (p<0.05) (AQ 1). In the UCL group, the palatal surface area significantly increased among phases. In the primary surgery periods, UCLP and CP significantly decreased (p<0.001). Palatal area in the UCLP group was significantly greater than the CP group. Overall, no statistically significant differences occurred among groups. At T4, the area of the palate in the UCL group was significantly greater than the UCLP group and no significant differences occurred between UCLP and CP groups. This study suggests that cheiloplasty did not inhibit the growth of the palatal surface area in children with UCL and UCLP. Palatoplasty significantly decreased the palatal area in children with UCLP and CP, demonstrating a significant negative effect of palatal repair on maxillary growth. At five years, children with UCLP and CP had a significantly smaller palate area than those with UCL.     

Nasolabial appearance in unilateral cleft lip, alveolus and palate: a comparison with Eurocleft.

OBJECTIVE: To evaluate nasolabial appearance of patients with UCLAP treated in Nijmegen and to compare them with those from six other individual centers from the Eurocleft study. Relationships between nasolabial aesthetics, dental arch relationships and cleft width at birth were also investigated. PATIENTS: Children of Caucasian origin with complete UCLAP (n=42 consecutive cases) from the Nijmegen Cleft Palate Unit, The Netherlands. METHODS: Nasolabial appearance was assessed by applying an aesthetic index and subsequently compared with the six-centre Eurocleft study. Cleft width at birth was measured on maxillary plaster casts. RESULTS: The 90% central range for the overall aesthetic rating of the 42 Nijmegen patients is 2.0-3.7 on a scale from 1 to 5 (1=very good nasolabial appearance, 5=very poor nasolabial appearance). With regard to the overall aesthetic rating, Nijmegen showed similar treatment outcomes with Eurocleft centres A, D, E and F. Nijmegen scored significantly better than Eurocleft centre C and significantly worse than Eurocleft centre B (p相似文献