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Original Investigation
August 22, 2019

Association of Pediatric Patient Demographic Factors and Scar Anatomic Features With Scar Outcomes After Surgical Repair of Cleft Lip

Author Affiliations
  • 1Department of Otolaryngology–Head & Neck Surgery, Medical University of South Carolina, Charleston
JAMA Facial Plast Surg. 2019;21(5):452-457. doi:10.1001/jamafacial.2019.0669
Key Points

Question  What pediatric patient demographic factors and anatomic scar features are associated with the overall cleft lip scar outcome after surgical repair?

Findings  In this case-control study of 58 pediatric patients who underwent surgical repair of cleft lip, black patients were observed to have worse overall scar outcomes than white patients, and a depressed scar height was significantly associated with overall scar appearance at both 6 and 12 months after surgical repair.

Meaning  This study’s findings suggest that black pediatric patients experience worse scar outcomes after surgical repair of cleft lip.


Importance  Scar outcomes following cleft lip repair are an important component of pediatric patient and family satisfaction and indicate the need for future surgical interventions.

Objective  To assess the association of pediatric patient demographic factors and scar anatomic features with scar outcomes following cleft lip surgical repair.

Design, Setting, and Participants  A case-control study was conducted involving 58 pediatric patients who underwent surgical repair of a cleft lip from October 31, 2008, to August 4, 2016, at a tertiary care pediatric specialty hospital. Data on patient demographic factors, cleft type, and the surgical technique used were collected and analyzed from June 11, 2009, to November 21, 2017. Scar outcomes were subjectively rated by 3 physicians at 6-month and 12-month postoperative intervals.

Main Outcomes and Measures  Overall scar outcomes at 6-month and 12-month postoperative intervals were based on rating of scar appearance, color, width, height, and alignment by using a subjective, 5-point scar-assessment scale in which 1 indicated the poorest aesthetic appearance and 5, the ideal aesthetic appearance.

Results  A total of 58 pediatric patients who underwent cleft lip repair were evaluated; mean (SD) age at time of repair, 4.8 (3.0) months. Of these, 44 (76%) were male and 14 (24%) were female, 37 (64%) were white, 11 (19%) were black, 7 (12%) were Hispanic, 2 (3%) were Asian, and 1 (2%) was of another race/ethnicity. Scores on the Cohen κ interrater test indicated either a substantial or almost perfect strength of agreement among the physicians grading the scar outcomes. At 12 months, patients with black skin type had worse overall scar outcomes than patients with white skin type (odds ratio [OR], −0.31; 95% CI, −1.15 to −0.14; P = .03). A depressed scar height (OR, −0.54; 95% CI, −1.32 to −0.49; P < .001), and hypopigmented scar color (OR, −0.45; 95% CI, −1.34 to −0.32; P = .002) were associated with worse scar outcomes at 12 months following surgery. The overall median lip scar outcome significantly improved between the 6-month and 12-month follow-up assessments (scar-assessment scale score, 3.3; interquartile range [IQR], 2.7-4.0 vs 4.0; IQR, 3.3-4.3; P < .001). No association was observed between the anatomic type and severity of the cleft lip and scar outcomes (unilateral vs bilateral cleft, complete vs incomplete or microform cleft, and lip height ratio of the unilateral noncleft to cleft lip).

Conclusions and Relevance  This study’s findings suggest that, compared with white pediatric patients, black pediatric patients exhibited worse overall scar outcomes. A depressed scar and a hypopigmented scar also were associated with overall worse scar appearance after surgical repair. Cleft lip scar outcomes were not significantly associated with the type and severity of the cleft lip.