{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:57:26Z","timestamp":1790776646237,"version":"4.1.0"},"reference-count":33,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary care pediatric hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Participants<\/jats:title>\n                    <jats:p>Patients who underwent lip repair for bilateral cleft lip.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Cleft surgeons and layperson raters graded preoperative cleft severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure(s)<\/jats:title>\n                    <jats:p>Anthropometric analyses and crowdsourced aesthetic assessments using Likert scales and pairwise comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Intraclass correlation coefficient was 0.94 (95% confidence interval [CI] 0.90-0.97) among cleft surgeon raters (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20097), 0.84 (95% CI 0.73-0.92) among layperson raters (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200910), and 0.88 (95% CI 0.80-0.94) in the combined group (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200917). Among 18 patients, a higher BCLSI correlated with a greater columellar\u2013labial angle (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      \u2009=\u20090.686,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.002). BCLSI predicted pairwise rank-derived coefficients (\u03b2\u2009=\u2009\u22121.289,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.015), lateral ratings (\u03b2\u2009=\u20090.752,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), frontal ratings (\u03b2\u2009=\u20090.440,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.038), and composite ratings (\u03b2\u2009=\u20090.551,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.006) independent of age at surgery, age at postoperative photograph, history of nasoalveolar molding, lip repair technique, sex, and race. A greater columellar\u2013labial angle correlated with poor lateral (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      \u2009=\u2009.729,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001) and composite (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      \u2009=\u2009.471,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.048) ratings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The BCLSI demonstrates good interrater reliability among cleft surgeons and layperson raters. A higher BCLSI correlated with a greater columellar\u2013labial 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656251399648","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T15:05:09Z","timestamp":1764169509000},"page":"2877-2885","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Bilateral Cleft Lip Severity Index: Correlation With Long-Term Outcomes"],"prefix":"10.1177","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1180-7526","authenticated-orcid":false,"given":"Jinggang J.","family":"Ng","sequence":"first","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manisha","family":"Banala","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8570-5178","authenticated-orcid":false,"given":"Benjamin Ballard","family":"Massenburg","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan H.","family":"Sussman","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meagan","family":"Wu","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0150-4174","authenticated-orcid":false,"given":"Dominic J.","family":"Romeo","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott P.","family":"Bartlett","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7995-7256","authenticated-orcid":false,"given":"David W.","family":"Low","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7112-8114","authenticated-orcid":false,"given":"Jordan W.","family":"Swanson","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2827-5471","authenticated-orcid":false,"given":"Jesse A.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1597\/15-292"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2013.12.001"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1597\/09-186.1"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002083"},{"key":"e_1_3_3_6_2","doi-asserted-by":"crossref","unstructured":"Ng JJ Banala M Sussman JH et al. 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