{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T23:05:07Z","timestamp":1791327907913,"version":"4.3.1"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2019,9,8]],"date-time":"2019-09-08T00:00:00Z","timestamp":1567900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Previous literature has disclosed that facial attractiveness affects the esthetic evaluation of nose and lip deformity on frontal and lateral photographs. However, it has never been debated if the removal of the external facial features on three-dimensional (3D) models (\u201ccropped assessment bias\u201d) could provide a considerable usefulness in the interpretation and comparison of the results. Additionally, it has been assumed on two-dimensional (2D) studies that esthetic assessment biases with respect to observer gender, and it is not acknowledged if and to the extent that \u201cgender assessment bias\u201d may be influenced by a three-dimensional layout. The aim of this study is to investigate if facial traits and observers\u2019 gender may affect the esthetic ratings of unilateral cleft lip and palate (UCLP) patients after soft tissue reconstruction. Materials and Methods: Three-dimensional images of ten UCLP patients\u2019 images were acquired before the intervention (T0), one-month (T1) and six-months (T2) postoperative. Geomagic\u00ae software (version 2014; 3D Systems, Rock Hill, SC, USA) was used to remove the external facial features of 3D surface models. Five-point scale developed by Asher-McDade et al. was used to rate both nasolabial attractiveness and impairment for full-face (FF) and cropped-face (CF) 3D images. Forty-three judges (21 males, 22 females) were enrolled for the esthetic evaluation. Intraclass correlation coefficient (ICC) was used to test intra- and inter-examiner reliability; a value of 0.7 was set as the minimum acceptable level of reliability. Results: When comparing the 2 sets of observations (FF and CF), the ICC ranged from 0.654 to 0.823. Concerning gender assessment bias, the ICC ranged from 0.438 to 0.686 and from 0.722 to 0.788 for males and females, respectively. Concerning inter-examiner reliability, ICC for questions 2\u20137 ranged from 0.448 to 0.644 and from 0.659 to 0.817 at T0 and T2, respectively. Conclusions: The removal of external facial features provides subtle differences on the esthetic assessment of UCLP patients. Moreover, based on our data, examiners\u2019 gender differences may affect esthetic assessment of UCLP patients. Despite the subjectivity of esthetic judgments, a reliable, validated and reproducible scoring protocol should consider the influence of gender differences on 3D esthetic assessment of UCLP patients.<\/jats:p>","DOI":"10.3390\/medicina55090576","type":"journal-article","created":{"date-parts":[[2019,9,9]],"date-time":"2019-09-09T04:12:40Z","timestamp":1568002360000},"page":"576","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Lay People Esthetic Evaluation of Primary Surgical Repair on Three-Dimensional Images of Cleft Lip and Palate Patients"],"prefix":"10.3390","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1339-9172","authenticated-orcid":false,"given":"Edoardo","family":"Staderini","sequence":"first","affiliation":[{"name":"Institute of Dentistry and Maxillo-Facial Surgery, IRCCS Fondazione Policlinico \u201cA. Gemelli\u201d, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilisa","family":"De Luca","sequence":"additional","affiliation":[{"name":"Institute of Dentistry and Maxillo-Facial Surgery, IRCCS Fondazione Policlinico \u201cA. Gemelli\u201d, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ettore","family":"Candida","sequence":"additional","affiliation":[{"name":"Institute of Dentistry and Maxillo-Facial Surgery, IRCCS Fondazione Policlinico \u201cA. Gemelli\u201d, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Ida","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Craniofacial Centre-Plastic and Maxillofacial Surgery Unit of the Children\u2019s Hospital Bambino Ges\u00f9, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriana","family":"Rajabtork Zadeh","sequence":"additional","affiliation":[{"name":"Craniofacial Centre-Plastic and Maxillofacial Surgery Unit of the Children\u2019s Hospital Bambino Ges\u00f9, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daria","family":"Bucci","sequence":"additional","affiliation":[{"name":"Craniofacial Centre-Plastic and Maxillofacial Surgery Unit of the Children\u2019s Hospital Bambino Ges\u00f9, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Zama","sequence":"additional","affiliation":[{"name":"Craniofacial Centre-Plastic and Maxillofacial Surgery Unit of the Children\u2019s Hospital Bambino Ges\u00f9, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4663-9734","authenticated-orcid":false,"given":"Carlo","family":"Lajolo","sequence":"additional","affiliation":[{"name":"Institute of Dentistry and Maxillo-Facial Surgery, IRCCS Fondazione Policlinico \u201cA. Gemelli\u201d, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Cordaro","sequence":"additional","affiliation":[{"name":"Institute of Dentistry and Maxillo-Facial Surgery, IRCCS Fondazione Policlinico \u201cA. Gemelli\u201d, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Gallenzi","sequence":"additional","affiliation":[{"name":"Institute of Dentistry and Maxillo-Facial Surgery, IRCCS Fondazione Policlinico \u201cA. Gemelli\u201d, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"85","DOI":"10.3390\/medicina47020011","article-title":"The comparison of different surgical techniques used for repair of complete unilateral cleft lip","volume":"47","author":"Zaleckas","year":"2011","journal-title":"Medicina"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1016\/j.jcms.2012.11.034","article-title":"Aesthetic outcome of cleft lip and palate treatment. Perceptions of patients, families, and health professionals compared to the general public","volume":"41","author":"Gkantidis","year":"2013","journal-title":"J. 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