Defining the Aesthetic Range of Normal Symmetry for Lip and Nose Features in 5-Year-Old Children Using the Computer-Based Program SymNose.

OBJECTIVE: To provide a normal comparison group against which to judge symmetry results after cleft surgery and to introduce the thin lip correction (TLC) feature in SymNose. A lip-aspect ratio algorithm has been added to the latest version of SymNose to compensate for the higher degree of overlap in thicker lips when compared to thin lips. DESIGN: Retrospective analysis of symmetry in healthy participants, using the computer-based program SymNose on both anteroposterior (AP) and base view images. Photographs of 91 noncleft children were traced twice by 3 independent investigators experienced with SymNose. PARTICIPANTS: Five-year-old healthy participants from a local state school in Tavistock (West Devon, United Kingdom). MAIN OUTCOME MEASURE: Asymmetry expressed as the perimeter mismatch percentage for nose and lip features on AP view images and for nose features on base view images. RESULTS: The perimeter mismatch reference range for the nose (AP view) was 2.65% to 30.91%, for the lip 2.13% to 15.44%, for the nose (base view) 1.69% to 14.84%, for the nostrils 4.68% to 26.6%, and for the width-height ratio 1.15% to 1.80%. The perimeter mismatch percentage for the lip without TLC was significantly higher compared to the perimeter mismatch percentage with TLC (P < .001). CONCLUSION: This article provides a noncleft reference range for all perimeters drawn from SymNose against which to compare results after cleft surgery at 5 years of age. Furthermore, it shows the importance of correcting for variance in lip volume per child.

Facial Aesthetic Outcomes of Cleft Surgery: Assessment of Discrete Lip and Nose Images Compared with Digital Symmetry Analysis.

BACKGROUND: High-quality aesthetic outcomes are of paramount importance to children growing up after cleft lip and palate surgery. Establishing a validated and reliable assessment tool for cleft professionals and families will facilitate cleft units, surgeons, techniques, and protocols to be audited and compared with greater confidence. This study used exemplar images across a five-point aesthetic scale, identified in a pilot project, to score lips and noses as separate units and compared these human scores with computer-based SymNose symmetry scores. METHODS: Forty-five assessors (17 cleft surgeons nationally and 28 other cleft professionals from the UK South West Tri-centre units), scored 25 standardized photographs, uploaded randomly onto a Web-based platform, twice. Each photograph was shown in three forms: lip and nose together, and separately cropped images of nose only and lip only. The same images were analyzed using the SymNose software program. RESULTS: Scoring lips gave the best intrarater and interrater reliabilities. Nose scores were more variable. Lip scoring associated most closely with the whole-image score. SymNose ranking of the lip images related highly to the same ranking by humans (p = 0.001). The exemplar images maintained their established previous ranking. CONCLUSIONS: Images illustrating the aesthetic outcome grades are confirmed. The lip score is reliable and seems to dominate in the whole-image score. Noses are much harder to score reliably. It appears that SymNose can score lip images very effectively by symmetry. Further use of SymNose will be investigated, and families of children with cleft will trial the scoring system. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

The influence of deceased donor age and old-for-old allocation on kidney transplant outcome.

BACKGROUND: Transplantation of older deceased donor kidneys is gaining wide acceptance in most countries. Many previous studies have concluded that advanced donor age negatively impacts posttransplant outcome, but detailed data on the extent to which a few years increase in donor age will influence early graft function and graft survival are scarce. METHODS: We used the Organ Procurement and Transplantation Network database (cohort 1994-2006, n=99,860 recipients) to evaluate the effect of deceased donor age on posttransplant results and to obtain regression models which are relevant to guide clinical organ allocation policies. In addition, we simulated the effect that old-for-old allocation would have on transplant outcome. RESULTS: In the context of other risk factors, donor age increased the risk of delayed graft function and graft failure with odds and hazard ratios of 1.02 and 1.01, respectively. Absolute delayed graft function risk increased by 0.35% to 0.37%, and graft survival decreased with each year increase in donor age. Kidney discard rates in the United States increased with donor age, up to 66.9% for 65 years and older donors. In our simulation, we found that old-for-old kidney allocation would have no large impact on overall renal transplant outcome. CONCLUSIONS: This study shows that donor age strongly influences posttransplant outcome, not only in the upper extremes but also for the whole range of donor ages more than or equal to 11 years. Implementation of old-for-old kidney allocation is likely to be safe. Such a policy could reduce waiting time for aged candidates, but it will not necessarily improve overall kidney transplant outcome.