A Novel Bilateral Cleft Lip Severity Index: Correlation With Long-Term Outcomes

Objective Bilateral cleft lip outcomes are heavily influenced by original anatomic deformity, but a reliable and widely accepted classification of preoperative severity has yet to emerge. This study validates the Bilateral Cleft Lip Severity Index (BCLSI) by assessing interrater reliability and the relationship between preoperative severity and aesthetic outcomes. Design Retrospective cohort study. Setting Tertiary care pediatric hospital. Patients/Participants Patients who underwent lip repair for bilateral cleft lip. Interventions Cleft surgeons and layperson raters graded preoperative cleft severity. Main Outcome Measure(s) Anthropometric analyses and crowdsourced aesthetic assessments using Likert scales and pairwise comparisons. Results Intraclass correlation coefficient was 0.94 (95% confidence interval [CI] 0.90-0.97) among cleft surgeon raters ( n = 7), 0.84 (95% CI 0.73-0.92) among layperson raters ( n = 10), and 0.88 (95% CI 0.80-0.94) in the combined group ( n = 17). Among 18 patients, a higher BCLSI correlated with a greater columellar–labial angle ( r = 0.686, P = .002). BCLSI predicted pairwise rank-derived coefficients (β = −1.289, P = .015), lateral ratings (β = 0.752, P < .001), frontal ratings (β = 0.440, P = .038), and composite ratings (β = 0.551, P = .006) independent of age at surgery, age at postoperative photograph, history of nasoalveolar molding, lip repair technique, sex, and race. A greater columellar–labial angle correlated with poor lateral ( r = .729, P < .001) and composite ( r = .471, P = .048) ratings. Conclusions The BCLSI demonstrates good interrater reliability among cleft surgeons and layperson raters. A higher BCLSI correlated with a greater columellar–labial angle and predicted poorer nasal appearance ratings by crowdsourced layperson assessments at 5 years postoperatively. The BCLSI is a simple, reliable, and informative tool that can standardize bilateral cleft lip classification and advance cleft outcomes research.