Predictive Capabilities of the Asher-McDade Esthetic Index for Nasolabial Revision Surgery: A Pilot Study

ObjectiveThis pilot study explored the predictive capabilities of individual components and composite scores of the Asher-McDade Esthetic Index (AMEI) for determining the need for nasolabial revision surgery in patients with repaired complete unilateral cleft lip and palate (UCLP). Receiver operating characteristic (ROC) analysis and Youden's index were employed to assess predictive power and identify optimal thresholds, respectively.DesignSingle-center retrospective cross-sectional pilot studySettingCleft and craniofacial centerParticipantsThirty-two pre-adolescent patients with complete UCLP who underwent primary repair.InterventionsStandardized frontal and lateral facial photographs were rated by three calibrated plastic surgeons using the AMEI. Components assessed included nasal form, nasal symmetry, vermilion border, and nasolabial profile. A separate panel of three plastic surgeons determined the need for nose and/or lip surgical revision by majority vote, based on the same photographs. ROC analysis evaluated the predictive ability of individual AMEI components and composite scores, with cutoffs identified via Youden's Index.Main Outcome MeasuresThe predictive ability of AMEI for determining the need for nasolabial revision, using ROC analysis and Youden's Index.ResultsNasal symmetry demonstrated the highest predictive accuracy for nose revision, and vermilion border was the strongest predictor for lip revision. Although composite scores showed promising predictive potential, they did not surpass the predictive power of the strongest individual AMEI components.ConclusionThis pilot study provides preliminary evidence that the AMEI can serve as a useful objective tool to predict the need for revision surgery in patients with repaired UCLP.