Association between subjective and objective measures of lip form and function: An exploratory analysis

Objective: In patients with cleft lip and palate, the aims of this study were to generate objective measures of different attributes of lip movement and to explore the utility of these objective measures by examining the association between examiners' subjective assessments with the objective measures. Patients and Participants: Thirteen patients with unilateral cleft lip and palate with varying degrees of cleft scar severity were selected. All patients had a previously repaired complete unilateral cleft lip and palate. Interventions: Photographs and videotape recordings were made of the patients with cleft at rest and during smiling. Measurements of lip movement were obtained by means of a motion analysis system. Main Outcome Measures: The study sought to obtain rankings of cleft scar severity and impairment on a 6-point Likert scale by a lay and professional panel and measurements of displacement, asymmetry, speed, and velocity of upper lip during smiling. Results: Displacement was the most consistent and valid objective measurement. An objective analysis of the entire upper lip provided the most information. In general, there was a decrease in the objective measures of upper lip movement as examiners' perceptions of facial appearance or disfigurement at rest and impairment during movement became worse. This relationship was stronger for the at-rest perceptions, implying that subjective assessments should be made with the face at rest. Conclusions: Objective measures provided the promise for differentiation of the components of movement and should be used to supplement subjective evaluations of lip appearance at rest and during movement.