As avaliações estéticas dos resultados da reabilitação das fissuras labiopalatinas podem direcionar o planejamento de novas intervenções cirúrgicas além de auxiliar na reavaliação de protocolos de tratamento. O objetivo deste estudo foi avaliar a estética da região nasolabial em crianças com fissura labiopalatina unilateral por meio de fotografias padronizadas. O grupo estudado foi selecionado no Ambulatório da Disciplina de Prótese Bucomaxilofacial da Faculdade de Odontologia da Universidade de São Paulo, sendo constituído por 55 pacientes na faixa etária entre 6 e 12 anos, que apresentavam fissura unilateral de lábio e rebordo alveolar, com ou sem comprometimento do palato, não sindrômicos, já submetidos às cirurgias reparadoras primárias. Foram obtidas fotografias digitais padronizadas em vista frontal, perfil direito, perfil esquerdo e obliqua submental, nas quais foram avaliadas características estéticas do nariz, lábio e região nasolabial. Em um primeiro estudo, por meio da classificação de Asher-McDade, foram realizadas as análises estéticas do lábio, nariz e região nasolabial dos 55 pacientes por três avaliadores experientes no tratamento de fissurados, utilizando fotografias de face inteira e fotografias de imagem recortada da região nasolabial, quando não se observou diferença estatisticamente significante entre elas (Teste da Estatística Alfa de Cronbach). O segundo estudo foi conduzido utilizando apenas as fotografias de imagem recortada da região nasolabial, com a finalidade de verificar possíveis diferenças na avaliação de profissionais da área de saúde com e sem experiência em fissura labiopaltina. Uma nota consensual obtida dos profissionais permitiu relacionar a estética facial com as variáveis: lateralidade da fissura, gênero do paciente e hospital de origem. Na avaliação dos resultados inter-examinadores foi verificado graus elevados de confiabilidade tanto para o grupo de profissionais experientes quanto para o grupo dos não experientes, aplicando o Teste Estatístico Alfa de Cronbach. Em relação à diferença da atratividade estética do lábio, nariz e região nasolabial para os dois grupos de profissionais, observou-se pelo Teste dos Postos Sinalizados de Wilcoxon, que não houve diferença significante para lábio e nariz, no entanto, para a região nasolabial houve diferença estatisticamente significante (p= 0,002), quando o grupo de profissionais experientes apresentou maior grau de satisfação em relação aos não experientes. O teste de Mann-Whitney mostrou haver associação estatisticamente significante entre os aspectos estéticos de lábio, nariz e região nasolabial somente com a variável hospital de origem, obtendo respectivamente os valores p= 0,002, 0,034 e 0,026. Este trabalho permitiu concluir que não houve diferença na avaliação dos resultados estéticos quando da utilização de fotografias de face inteira ou de imagem recortada da região nasolabial. Os avaliadores profissionais experientes apresentaram maior satisfação com a aparência estética da região nasolabial do que os avaliadores não experientes, no entanto, para a análise isolada do lábio ou do nariz, não houve diferença. Não houve associação dos resultados estéticos em relação à lateralidade da fissura e ao gênero, mas houve em relação ao hospital de referência, o qual apresentou menores índices de satisfação. / Aesthetic evaluation of rehabilitation outcomes of the cleft lip and palate may assist in the determination of new surgical interventions and aid in re-evaluation of treatment protocols. The aim of this study was to evaluate the aesthetics of the nasolabial region in children with a unilateral cleft lip and palate using standardized photographs. The study group was selected from the Clinical Division of Maxillofacial Prosthodontics, School of Dentistry, University of São Paulo and consisted of 55 patients between 6 and 12 years of age with a unilateral cleft lip and alveolar ridge with or without the involvement of the palate, nonsyndromic, and who had already undergone primary reconstructive surgeries. Standardized digital photographs in the frontal and oblique submental views as well as in right and left profile were obtained, and the aesthetic features of the nose, lip, and nasolabial region were evaluated. In the first study, three experienced evaluators performed aesthetic analysis of the lip, nose, and nasolabial region by using the Asher-McDade esthetic index and it was compared full-face photographs and cropped images of the nasolabial region. However, no statistically significant difference was observed between the scores (Statistical Analysis Cronbach\'s alpha). The second study was conducted using only cropped photographic images of the nasolabial region in order to verify potential differences in the assessments of health professionals with and without experience in cleft lip and palate. A consensus score obtained from the assessments made by the professionals permitted the determination of a correlation between facial aesthetics and the following variables studied: laterality of the cleft, sex of the patient, and the source hospital. Evaluation of the assessments of the inter raters revealed highly reliable assessments made by the experienced professionals group as well as those made by the group of professionals without experience, where Statistical Analysis Cronbach\'s alpha was applied. By using the Wilcoxon Signed Rank Test, both the experienced professionals and without experience did not observe any statistically significant difference in the aesthetic attractiveness of the lip and nose; however a statistically significant difference was observed in the nasolabial region (p = 0.002) when the professional group revealed a higher degree of satisfaction as compared to the group of professionals without experience. The Mann-Whitneys Test revealed a statistically significant association between the aesthetics of the lip, nose, and nasolabial region only with regard to one variable i.e., the source hospital (p = 0.002, 0.034, and 0.026, respectively). The results of this study suggest that there was no difference in evaluation of the aesthetic results when full-face photographs or cropped images of the nasolabial region were used. Compared to the professionals without experience assessors, the experienced professionals evaluators showed higher satisfaction with the aesthetic appearance of the nasolabial region; however, no difference in results was observed in the analysis of the lip or nose alone. No correlation was observed between the aesthetic outcomes and the laterality of the cleft and sex of the patient. However, the source hospital was associated with the aesthetic outcome, thereby producing lower levels of outcome satisfaction.

As avaliações estéticas dos resultados da reabilitação das fissuras labiopalatinas podem direcionar o planejamento de novas intervenções cirúrgicas além de auxiliar na reavaliação de protocolos de tratamento. O objetivo deste estudo foi avaliar a estética da região nasolabial em crianças com fissura labiopalatina unilateral por meio de fotografias padronizadas. O grupo estudado foi selecionado no Ambulatório da Disciplina de Prótese Bucomaxilofacial da Faculdade de Odontologia da Universidade de São Paulo, sendo constituído por 55 pacientes na faixa etária entre 6 e 12 anos, que apresentavam fissura unilateral de lábio e rebordo alveolar, com ou sem comprometimento do palato, não sindrômicos, já submetidos às cirurgias reparadoras primárias. Foram obtidas fotografias digitais padronizadas em vista frontal, perfil direito, perfil esquerdo e obliqua submental, nas quais foram avaliadas características estéticas do nariz, lábio e região nasolabial. Em um primeiro estudo, por meio da classificação de Asher-McDade, foram realizadas as análises estéticas do lábio, nariz e região nasolabial dos 55 pacientes por três avaliadores experientes no tratamento de fissurados, utilizando fotografias de face inteira e fotografias de imagem recortada da região nasolabial, quando não se observou diferença estatisticamente significante entre elas (Teste da Estatística Alfa de Cronbach). O segundo estudo foi conduzido utilizando apenas as fotografias de imagem recortada da região nasolabial, com a finalidade de verificar possíveis diferenças na avaliação de profissionais da área de saúde com e sem experiência em fissura labiopaltina. Uma nota consensual obtida dos profissionais permitiu relacionar a estética facial com as variáveis: lateralidade da fissura, gênero do paciente e hospital de origem. Na avaliação dos resultados inter-examinadores foi verificado graus elevados de confiabilidade tanto para o grupo de profissionais experientes quanto para o grupo dos não experientes, aplicando o Teste Estatístico Alfa de Cronbach. Em relação à diferença da atratividade estética do lábio, nariz e região nasolabial para os dois grupos de profissionais, observou-se pelo Teste dos Postos Sinalizados de Wilcoxon, que não houve diferença significante para lábio e nariz, no entanto, para a região nasolabial houve diferença estatisticamente significante (p= 0,002), quando o grupo de profissionais experientes apresentou maior grau de satisfação em relação aos não experientes. O teste de Mann-Whitney mostrou haver associação estatisticamente significante entre os aspectos estéticos de lábio, nariz e região nasolabial somente com a variável hospital de origem, obtendo respectivamente os valores p= 0,002, 0,034 e 0,026. Este trabalho permitiu concluir que não houve diferença na avaliação dos resultados estéticos quando da utilização de fotografias de face inteira ou de imagem recortada da região nasolabial. Os avaliadores profissionais experientes apresentaram maior satisfação com a aparência estética da região nasolabial do que os avaliadores não experientes, no entanto, para a análise isolada do lábio ou do nariz, não houve diferença. Não houve associação dos resultados estéticos em relação à lateralidade da fissura e ao gênero, mas houve em relação ao hospital de referência, o qual apresentou menores índices de satisfação. / Aesthetic evaluation of rehabilitation outcomes of the cleft lip and palate may assist in the determination of new surgical interventions and aid in re-evaluation of treatment protocols. The aim of this study was to evaluate the aesthetics of the nasolabial region in children with a unilateral cleft lip and palate using standardized photographs. The study group was selected from the Clinical Division of Maxillofacial Prosthodontics, School of Dentistry, University of São Paulo and consisted of 55 patients between 6 and 12 years of age with a unilateral cleft lip and alveolar ridge with or without the involvement of the palate, nonsyndromic, and who had already undergone primary reconstructive surgeries. Standardized digital photographs in the frontal and oblique submental views as well as in right and left profile were obtained, and the aesthetic features of the nose, lip, and nasolabial region were evaluated. In the first study, three experienced evaluators performed aesthetic analysis of the lip, nose, and nasolabial region by using the Asher-McDade esthetic index and it was compared full-face photographs and cropped images of the nasolabial region. However, no statistically significant difference was observed between the scores (Statistical Analysis Cronbach\'s alpha). The second study was conducted using only cropped photographic images of the nasolabial region in order to verify potential differences in the assessments of health professionals with and without experience in cleft lip and palate. A consensus score obtained from the assessments made by the professionals permitted the determination of a correlation between facial aesthetics and the following variables studied: laterality of the cleft, sex of the patient, and the source hospital. Evaluation of the assessments of the inter raters revealed highly reliable assessments made by the experienced professionals group as well as those made by the group of professionals without experience, where Statistical Analysis Cronbach\'s alpha was applied. By using the Wilcoxon Signed Rank Test, both the experienced professionals and without experience did not observe any statistically significant difference in the aesthetic attractiveness of the lip and nose; however a statistically significant difference was observed in the nasolabial region (p = 0.002) when the professional group revealed a higher degree of satisfaction as compared to the group of professionals without experience. The Mann-Whitneys Test revealed a statistically significant association between the aesthetics of the lip, nose, and nasolabial region only with regard to one variable i.e., the source hospital (p = 0.002, 0.034, and 0.026, respectively). The results of this study suggest that there was no difference in evaluation of the aesthetic results when full-face photographs or cropped images of the nasolabial region were used. Compared to the professionals without experience assessors, the experienced professionals evaluators showed higher satisfaction with the aesthetic appearance of the nasolabial region; however, no difference in results was observed in the analysis of the lip or nose alone. No correlation was observed between the aesthetic outcomes and the laterality of the cleft and sex of the patient. However, the source hospital was associated with the aesthetic outcome, thereby producing lower levels of outcome satisfaction.

Objectives: Decreased volume and atrophy are hallmarks of aging facial soft tissues. In perioral region, a hallmark is deepening of nasolabial folds. It is unknown how extraction orthodontic treatment affects such tissues. This study describes nasolabial fold regional changes in premolar extraction cases. Methods: Pre- and post-treatment 3dMD images of 14 skeletal Class-I patients with 4 premolar extractions were studied for changes of tissue thickness in the nasolabial fold region. All subjects were treated at Temple University. The sample consisted of 10 females and 4 males aged 12 -26 years old and included three ethnicities: Asian, Hispanic, and African American. With the aid of 3dMD Vultus software, both qualitative and quantitative analyses were collected. Color histograms were created for qualitative analyses, and quantitative volumetric changes in cheek volume were correlated to 2-D cephalometric lip thickness, lip retraction, and incisor retraction. Data were analyzed by Spearman’s rho for lip thickness, lip retraction, and incisor retraction. Regression analyses were completed controlling for age, gender, and ethnicity. Results: In this sample of Class-I malocclusion patients with 4 premolar extraction treatment, quantitative results showed no significant correlations were found between 2-D soft tissue thickness and volumetric changes around the nasolabial fold region. Moreover, none of the other characteristics including, change in the upper lip in 2-D cephalometric measurements, age, and gender were factors that correlated with volumetric changes around the nasolabial fold. The qualitative findings showed changes in lips and commissures did not affect the soft tissues around the nasolabial fold areas. Overall, there were no significant correlations between the thickness of soft tissue, change in the lips in 2-D, age, ethnicity, and gender in volumetric changes. Conclusions: Data generated by this investigation did not imply any cause-and-effect relationship between measurements of lip thickness, lip retraction, and incisor retraction to the deepening of the nasolabial fold. / Oral Biology

The purpose of this study was to evaluate the burden of care (BOC) of two presurgical infant orthopedic (PSIO) protocols used for complete unilateral cleft lip and palate (CUCLP), and to compare aesthetic outcomes with centres not utilizing PSIO. Four samples were collected. Two from the same centre that underwent either traditional infant orthopedics (TIO) or nasoalveolar molding (NAM) and two from centres not employing PSIO. BOC data were collected for the PSIO groups and photos at age 5 were collected for ratings of nasolabial aesthetics. The BOC of NAM was found to be significantly greater than IO for number of visits (9.9 vs. 6.6, (p<0.001)) and days wearing the appliance (127 vs. 112, (p<0.05)). Significant differences in aesthetic ratings were noted amongst the three centres but not between the NAM and TIO groups. Overall, an increased burden of NAM over TIO was detected, without an observable aesthetic improvement.

The purpose of this study was to evaluate the burden of care (BOC) of two presurgical infant orthopedic (PSIO) protocols used for complete unilateral cleft lip and palate (CUCLP), and to compare aesthetic outcomes with centres not utilizing PSIO. Four samples were collected. Two from the same centre that underwent either traditional infant orthopedics (TIO) or nasoalveolar molding (NAM) and two from centres not employing PSIO. BOC data were collected for the PSIO groups and photos at age 5 were collected for ratings of nasolabial aesthetics. The BOC of NAM was found to be significantly greater than IO for number of visits (9.9 vs. 6.6, (p<0.001)) and days wearing the appliance (127 vs. 112, (p<0.05)). Significant differences in aesthetic ratings were noted amongst the three centres but not between the NAM and TIO groups. Overall, an increased burden of NAM over TIO was detected, without an observable aesthetic improvement.

El presente estudio de tipo prospectivo, comparativo, transversal y observacional; tuvo como objetivo determinar la percepción estética del ángulo nasolabial y la longitud cuello-mentón por estudiantes de la Universidad Católica Santo Toribio de Mogrovejo – Chiclayo, 2019. Se seleccionaron un total de 172 estudiantes, siendo 43 por escuela profesional: Arquitectura, Derecho, Medicina y Odontología. La evaluación consistió en calificar 07 fotografías de un perfil femenino mediante la Escala Visual Análoga (EVA), marcando según consideren ya sea el valor mínimo considerado como “Muy desagradable” hasta el valor máximo considerado como “Muy agradable”. Los resultados indican que los estudiantes de Arquitectura, Derecho, Medicina y Odontología consideran más agradable un perfil con un ángulo nasolabial de 100° y una longitud cuello-mentón de 33mm; y, menos agradable un perfil con un ángulo nasolabial entre 120 y 125° con una longitud de cuello-mentón de 39mm. No se encontró diferencia estadística significativa al comparar la percepción estética entre sexos. Se concluye que la percepción estética del ángulo nasolabial y la longitud cuello-mentón de los estudiantes de Derecho reporta los puntajes más altos según la EVA y difiere estadísticamente en comparación a los demás alumnos de la Universidad Católica Santo Toribio de Mogrovejo – Chiclayo, 2019.

Unilateral cleft lip and palate (UCLP) is a craniofacial malformation with functional and aesthetical impact on the face and the upper airways. The aims of the current thesis were to evaluate Quality of life (QoL) in adults treated for UCLP  (I), to objectively evaluate nasal form and function and to search for possible differences in residual nasal deformity and impairment of function between patients operated according to one-stage and two-stage palate closure (II) as well as to evaluate the relationship between professional and lay rating and patient satisfaction with nasolabial appearance (III) and to identify factors associated with lower levels of QoL and less satisfaction with nasal appearance among adults treated for UCLP (IV). Analyses of data from a homogenous population of UCLP patients treated at Uppsala University Hospital form the basis of this thesis. The mean follow-up time after primary surgery was 35 years (20-47 years) and participation rate was 79% (n=86). An age and gender matched control group of 68 people without clefts were evaluated according to the same protocol. The evaluation protocol included the Short Form 36 questionnaire (SF-36), rhinomanometry, acoustic rhinometry, odor test, peak nasal inspiratory flow test and photographies of faces. For the SF-36 data, age- and gender-matched norm data of 1385 people from the Swedish population were used. Unilateral cleft lip and palate affected QoL differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients in several subscales. However, except for lower values in the Mental Health subscale, QoL was similar among UCLP patients and norm data. Objectively measured nasal function was extensively affected among adults treated for UCLP. No difference in impairment of nasal function was found between one-stage and two-stage palate closure protocols on the cleft side. Judgment of nasolabial appearance differed between professionals, lay people and patients. Large infant cleft width was associated with less satisfaction with nasal appearance and male gender was associated with lower levels of mental QoL. Correlation between high nasal breathing resistance and low levels of physical QoL was found. In conclusion, this thesis provides a platform for future research for optimal evaluation of cleft treatment outcome.