Development of an automatic scoring software tool utilising artificial intelligence to measure a cleft appearance outcome for children born with a complete unilateral cleft lip

Repair of a cleft of the lip leaves a scar, and nearly always some visible difference in the appearance of the lip such as asymmetry. Such differences in appearance can cause significant distress so it is important that surgery results in the ‘best’ outcome possible.

Parents of children born with a cleft lip want to have confidence that their cleft team will do the best technical operation according to the best protocol to get the best outcome in terms of facial appearance.

However, in order to know which method of lip repair gives the best outcomes, it is necessary to have a way of measuring how good the outcome of a lip repair is. We know how to measure other important outcomes in cleft, such as psychological, speech, dental and facial growth outcomes, in a robust scientific way, yet we are unable to do the same for facial appearance. At the moment studies which look at how good the outcomes of cleft lip repair are mainly use photographs. They measure the quality of the outcome by asking viewers to rate the quality of the repair from the photograph. This is a subjective way of measuring and depends on the viewers using the same criteria as each other in their assessment. It has been shown that assessing the outcomes of lip repair surgery using these sorts of measuring tools gives unreliable results which are difficult to repeat with the same result.

The aim of this project is to develop the use of Artificial Intelligence (AI) to score facial photographs of children with a cleft lip after they have had an operation. The AI scores will be correlated directly to scores made by groups of humans to ensure that they are meaningful. The aim is to develop an easy-to-use automated software tool that can score how a person’s face looks after cleft lip surgery. If successful, this will help cleft teams assess which technical method, timing, or surgeon gets the best result.

This is a two year project funded by CLEFT and we hope to have results published at the end of 2024/ early 2025. One paper has already been written and the findings will be published at the Craniofacial Society of Great Britain and Ireland conference early next year.