Validity and reproducibility of the 3D VECTRA photogrammetric surface imaging system for the maxillofacial anthropometric measurement on cleft patients

Smartphone-generated 3D facial images: reliable for routine assessment of the oronasal region of patients with cleft or mere convenience? A validation study

OBJECTIVES

To evaluate the validity and reliability of smartphone-generated three-dimensional (3D) facial images for routine evaluation of the oronasal region of patients with cleft by comparing their accuracy to that of direct anthropometry (DA) and 3dMD.

MATERIALS AND METHODS

Eighteen soft-tissue facial landmarks were manually labelled on each of the 17 (9 males and 8 females; mean age 23.3 ± 5.4 years) cleft lip and palate (CLP) patients' faces. Two surface imaging systems, 3dMDface and Bellus3D FaceApp, were used to perform two imaging operations on each labelled face. Subsequently, 32 inter-landmark facial measurements were directly measured on the labelled faces and digitally measured on the 3D facial images. Statistical comparisons were made between smartphone-generated 3D facial images (SGI), DA, and 3dMD measurements.

RESULTS

The SGI measurements were slightly higher than those from DA and 3dMD, but the mean differences between inter-landmark measurements were not statistically significant across all three methods. In terms of clinical acceptability, 16% and 59% of measures showed differences of ≤ 3 mm or ≤ 5º, with good agreement between DA and SGI and 3dMD and SGI, respectively. A small systematic bias of ± 0.2 mm was observed generally among the three methods. Additionally, the mean absolute difference between the DA and SGI methods was the highest for linear measurements (1.31 ± 0.34 mm) and angular measurements (4.11 ± 0.76º).

CONCLUSIONS

SGI displayed fair trueness compared to DA and 3dMD. It exhibited high accuracy in the orolabial area and specific central and flat areas within the oronasal region. Notwithstanding this, it has limited clinical applicability for assessing the entire oronasal region of patients with CLP. From a clinical application perspective, SGI should accurately encompass the entire oronasal region for optimal clinical use.

CLINICAL RELEVANCE

SGI can be considered for macroscopic oronasal analysis or for patient education where accuracy within 3 mm and 5º may not be critical.

Accuracy of Smartphone-Based Three-Dimensional Facial Scanning System: A Systematic Review

BACKGROUND

Recently, the integration of 3D face scanning into smartphones has raised vast interest in plastic surgery. With the release of smartphones featuring 3D face scanning technology, users now can capture detailed 3D models of their faces using their smartphones. However, trueness and precision of this system is less well established.

METHODS

PubMed, Cochrane Library, Embase, ScienceDirect, Scopus, and Web of Science databases were searched for studies evaluating 3D scanning of smartphone devices and conventional 3D imaging systems from January 1, 2017, to June 1, 2023. A qualitative systematic review was conducted by two review authors after independently selecting studies, extracting data, and assessing the risk of bias of included studies.

RESULTS

A total of 11 studies were included, all focusing on the accuracy of smartphone 3D facial scanning. The results show that although smartphones perform poorly on deep and irregular surfaces, they are accurate enough for clinical applications and have the advantage of being economical and portable.

CONCLUSIONS

Smartphone-based 3D facial scanning has been basically validated for clinical application, showing broad clinical application prospects in plastic surgery.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Quantitative Assessment of Lip Morphology in Patients With and Without Cleft Lip and Palate Using 3-Dimensional Stereophotogrammetry

This study aimed to assess and quantify the morphologic characteristics of the lips and the lower third of the face in cleft and noncleft patients, utilizing three-dimensional (3D) stereophotogrammetry. Sixty patients were included in the study, comprising 30 unilateral cleft lip and palate patients (G1, 24 female, 6 male; aged 20 to 60 y, mean age 44.0±12.0 y) and 30 noncleft patients (G2, 23 female, 7 male; aged 20 to 59 y, mean age 43.5±12.0 y). Anthropometric landmarks were identified on the facial surface. Three-dimensional stereophotogrammetry was employed to capture images. Statistical analysis was conducted to compare the groups, with a significance level set at 0.05. The comparative analysis revealed statistically significant differences in 5 linear and 6 angular measurements. Linear measurements such as philtrum width, upper and lower cutaneous lip height, mandibular ramus length, and midfacial depth exhibited significant differences between cleft and noncleft patients. Similarly, angular measurements, including upper lip angle, Cupid's bow angle, lower/medium face convexity, lip seal, nasolabial angle, and left gonial angle, displayed statistically significant disparities. These findings underscore the ongoing surgical challenges in the comprehensive rehabilitation of patients with clefts, highlighting the critical need for continued advancements in treatment strategies.

Effect of facial and nasolabial asymmetry on perceived facial esthetics in children with non-syndromic cleft lip and palate

OBJECTIVE

The aim of the present study was to objectively assess the degree of residual facial asymmetry after primary treatment of non-syndromic unilateral cleft lip and palate (UCLP) in children and to correlate it with subjective ratings of facial appearance.

MATERIALS AND METHODS

Stereophotometry was used to record the faces of 89 children with UCLP for comparison of cleft and non-cleft sides up to 5 years after primary cleft closure. Root mean square values were calculated to measure the difference between the shape of cleft and non-cleft sides of the face and were compared to controls without a cleft lip. The Asher-McDade Aesthetic Index (AMAI) was used for subjective rating of the nasolabial area through 12 laypersons.

RESULTS

Children with a cleft lip (CL) showed no significant difference in RMS values compared to controls. Significant differences occurred when the evaluation was limited to the nasolabial area, however only in patients with cleft lip alveolus (CLA) and cleft lip palate (CLAP)(p < 0.001). In contrast, subjective ratings showed significantly higher values for all three cleft severity groups (CL, CLA, CLAP) compared to controls (p < 0.001). There was a non-linear correlation between the RMS (root mean square) values and the AMAI score.

CONCLUSIONS

Even non-significant discrete objective deviations from facial symmetry in children after primary closure of UCLP are vigilantly registered in subjective ratings and implemented in the judgement of facial appearance.

CLINICAL RELEVANCE

3D stereophotometry is a usefull tool in monitoring asymmetry in patients with a cleft.

Automated facial landmark measurement using machine learning: A feasibility study

STATEMENT OF PROBLEM

Information regarding facial landmark measurement using machine learning (ML) techniques in prosthodontics is lacking.

PURPOSE

The objective of this study was to evaluate and compare the reliability, validity, and accuracy of facial anthropological measurements using both manual and ML landmark detection techniques.

MATERIAL AND METHODS

Two-dimensional (2D) frontal full-face photographs of 50 men and 50 women were made. The interpupillary width (IPW), interlateral canthus width (LCW), intermedial canthus width (MCW), interalar width (IAW), and intercommissural width (ICW) were measured on 2D digital images using manual and ML methods. The automated measurements were recorded using a programming language (Python), and a convolutional neural network (CNN) model was trained to detect human facial landmarks. The obtained data from the manual and ML methods were analyzed using intraclass correlation coefficients (ICCs), the paired sample t test, Bland-Altman plots, and the Pearson correlation analysis (α=.05).

RESULTS

Intrarater and interrater reliability values were greater than 0.90, indicating excellent reliability. The mean difference between the manual and ML measurements of IPW, MCW, IAW, and ICW was 0.02 mm, while it was 0.01 mm for LCW. No statistically significant differences were found between the measurements obtained by the manual and ML methods (P>.05). Highly significant positive correlations (P<.001) were obtained between the results of the manual and ML methods: (r=0.996[IPW], r=0.977[LCW], r=0.944[MCW], r=0.965[IAW], and r=0.997[ICW]).

CONCLUSIONS

In the field of prosthodontics, the use of ML methods provides a reliable alternative to manual digital techniques for carrying out facial anthropometric measurements.

A New Algorithm for Secondary Repair of Unilateral Cleft Lip Nasal Deformity

OBJECTIVES

Following primary surgery for unilateral cleft lip palate (UCLP), cleft lip nasal deformities (CLNDs) (nasal asymmetry, collapsed nasal alae, and a widened alar base) are generally inevitable and often require secondary rhinoplasty. However, reconstructing a cleft nose with an alar tissue deficiency remains challenging for rhinoplasty surgeons.

METHODS

The manifestations of common deformities are described herein, and a secondary rhinoplasty technique for unilateral CLNDs using a nasolabial flap (NLF) has been proposed for patients with alar tissue deficiency. Secondary rhinoplasties were performed in 12 patients with unilateral CLNDs between 2020 and 2021 using a NLF. Photogrammetric measurements were performed preoperatively and postoperatively. A total of 12 flaps were successfully transferred. Ten patients were followed up for >1 year.

RESULTS

Significant postoperative decreases in nasal alar width were measured in both the base view (p < 0.050) and the frontal view (p < 0.050). Despite the additional facial scars that occurred in some cases, all patients were satisfied with the aesthetic effects.

CONCLUSIONS

The NLF achieved satisfactory results in secondary rhinoplasty of unilateral CLND for patients with nasal tissue deficiencies in whom the surgeon weighed the potential benefits over postoperative scarring.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:1648-1655, 2024.

"Utility of Smartphone-based Three-dimensional Surface Imaging for Digital Facial Anthropometry"

Background

The utilization of three-dimensional (3D) surface imaging for facial anthropometry is a significant asset for patients undergoing maxillofacial surgery. Notably, there have been recent advancements in smartphone technology that enable 3D surface imaging.In this study, anthropometric assessments of the face were performed using a smartphone and a sophisticated 3D surface imaging system.

Methods

30 healthy volunteers (15 females and 15 males) were included in the study. An iPhone 14 Pro (Apple Inc., USA) using the application 3D Scanner App (Laan Consulting Corp., USA) and the Vectra M5 (Canfield Scientific, USA) were employed to create 3D surface models. For each participant, 19 anthropometric measurements were conducted on the 3D surface models. Subsequently, the anthropometric measurements generated by the two approaches were compared. The statistical techniques employed included the paired t-test, paired Wilcoxon signed-rank test, Bland-Altman analysis, and calculation of the intraclass correlation coefficient (ICC).

Results

All measurements showed excellent agreement between smartphone-based and Vectra M5-based measurements (ICC between 0.85 and 0.97). Statistical analysis revealed no statistically significant differences in the central tendencies for 17 of the 19 linear measurements. Despite the excellent agreement found, Bland-Altman analysis revealed that the 95% limits of agreement between the two methods exceeded ±3 mm for the majority of measurements.

Conclusion

Digital facial anthropometry using smartphones can serve as a valuable supplementary tool for surgeons, enhancing their communication with patients. However, the proposed data suggest that digital facial anthropometry using smartphones may not yet be suitable for certain diagnostic purposes that require high accuracy.

Efficacy of Cranial Orthosis for Plagiocephaly Based on 2D and 3D Evaluation

Background  With the advent of cranial orthoses as therapeutic medical devices for the treatment of severe positional head deformities in Japan, an increasing number of patients are being treated with them. However, assessing the effectiveness of a treatment is often difficult due to the use of different metrics. This study aimed to evaluate the effectiveness of cranial orthoses for deformational plagiocephaly using two- (2D) and three-dimensional (3D) evaluation metrics. Methods  We conducted a retrospective study of infant patients with deformational plagiocephaly who underwent cranial orthosis treatment. We evaluated the severity of deformational plagiocephaly using cranial asymmetry (CA) and the cranial vault asymmetry index (CVAI) as 2D metrics, and anterior and posterior symmetry ratios as 3D metrics. The patients were divided into 24 subgroups based on the initial severity of each outcome and their age at the start of treatment. We analyzed the changes in outcomes and correlations within improvements across the age and severity categories. Results  Overall, 1,038 infants were included in this study. The mean CA, CVAI, and anterior and posterior symmetry ratios improved significantly after cranial orthosis treatment. The improvement in each score was greater in patients with more severe initial deformities and in those who underwent treatment at a younger age. Conclusion  Cranial orthosis treatment was effective in correcting deformational plagiocephaly in infants, as demonstrated by improvements in both 2D and 3D metrics. Patients with more severe initial deformities and those who underwent treatment at a younger age showed greater improvement.

Facial Analysis of Patients with Unilateral or Bilateral Cleft Lip and Palate Using 3D Stereophotogrammetry

OBJECTIVES

To evaluate the quantitative values of linear and angular facial anthropometrics in patients with unilateral cleft lip and palate (UCLP) and compare them with those of patients with bilateral cleft lip and palate (BCLP) using three-dimensional (3D) facial imaging.

DESIGN

Retrospective, observational, and cross-sectional study.

SETTING

Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP).

PATIENTS/ PARTICIPANTS

In total, 61 non-syndromic patients with CLP who underwent multidisciplinary treatment and rehabilitated with a prosthesis were enrolled and divided into those with UCLP (G1; n = 31) and those with BCLP (G2; n = 30).

INTERVENTION

Facial images were captured using a 3D camera after landmarks were marked on each patient's face. The software evaluated linear and angular parameters. Statistical tests were applied. Significance was determined as P < 0.05.

MAIN OUTCOME MEASUREMENTS

Overall, 22 linear and 13 angular measurements were evaluated.

RESULTS

The nasal length (P = 0.08), middle third of the face (P = 0.06), base nose width (P < 0.001), nasal root width (P < 0.001), nasal tip angle (P = 0.018), philtrum width (P < 0.001), lower face width (P = 0.039) and midfacial depth (P = 0.040) were significantly higher in G2; the upper cutaneous lip height was significantly higher in G1. Sexual dimorphism was observed except for linear measurements (linear distance between the labiale superius and labiale inferius landmarks, nasal root width, and upper cutaneous lip length) and angular measurements.

CONCLUSIONS

G2 had a greater length and width of nose and nasal root, nasal tip angle, philtrum width, and lower face width, midfacial depth, and midface third than G1. These findings also revealed the presence of sexual dimorphism.

Current status of optical scanning in facial prosthetics: A systematic review and meta-analysis

Purpose To assess the accuracy of scanning technologies for constructing facial prostheses on human faces.Study selection Our systematic search was performed on five databases. Studies reporting on human volunteers (P) whose faces were scanned with a scanning technology were eligible. The anthropometrical interlandmark distances (ILDs) were used as indicators of accuracy; the ILDs are measured on the virtual models (I) and directly on the faces (C). The virtual models deviated from their true values (O). Studies reporting the measurements on patients with or without facial deformities were included, but cadavers or inanimate objects were reasons for exclusion. We performed a mean difference (MD) / standardized MD analysis with a random effect model. The difficulties regarding the scanning procedure mentioned in the articles were also assessed.Results We found 3723 records after duplicate removal. Twenty five articles were eligible for the qualitative review, and ten articles were included in the quantitative synthesis. Eight different ILDs were compared in MD analyses. The differences were between -0.54-0.43 mm. We also performed a regional three-dimensional analysis to compare scanning technologies in each major region. No significant differences were found in any of the regions and axes. The most mentioned difficulties were artifacts due to motion or blinking.Conclusions The results suggest no systematic skew in linear dimensions neither between direct caliper measurements nor between measurements on the scanned models, scanning technologies, or facial regions.

Development and Validation of a Comprehensive Perioral Evaluation Method Using Three-Dimensional Stereophotogrammetry

BACKGROUND

The non-invasive three-dimensional (3D) stereophotogrammetry is widely used in anthropometry for medical purpose. Yet, few studies have assessed its reliability on measuring the perioral region.

OBJECTIVES

This study aimed to provide a standardized 3D anthropometric protocol for the perioral region.

METHODS

38 female and 12 male Asians were recruited (mean age 31.6 ± 9.6 years). Two sets of 3D images using the VECTRA 3D imaging system were acquired for each subject, and two measurement sessions for each image were performed independently by two raters. 25 landmarks were identified, and 28 linear, 2 curvilinear, 9 angular and 4 areal measurements were evaluated for intrarater, interrater, and intramethod reliability.

RESULTS

Our results showed high reliability of 3D imaging-based perioral anthropometry by mean absolute difference (0.57 and 0.57 unit), technical error measurement (0.51 and 0.55 unit), relative error of measurement (2.18% and 2.44%), relative technical error of measurement (2.02% and 2.34%), and intraclass correlation coefficient (0.98 and 0.98) for intrarater 1 and intrarater 2 reliability; respectively 0.78 unit, 0.74 unit, 3.26%, 3.06% and 0.97 for interrater reliability; and respectively 1.01 unit, 0.97 unit, 4.74%, 4.57% and 0.95 for intramethod reliability.

CONCLUSIONS

This standardized protocol utilizing 3D surface imaging technologies are feasible and highly reliable in perioral assessment. It could be further applied for diagnostic purpose, surgical planning and therapeutic effect evaluation in clinical practice in relation to perioral morphologies.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Three-dimensional evaluation of symmetry in facial palsy reanimation using stereophotogrammetric devices: A series of 15 cases

Facial palsy can severely compromise quality of life, significantly altering the harmony and symmetry of the face, which can be restored by surgical rehabilitation. The aim of the study was the quantification of facial symmetry following facial reanimation. Fifteen consecutive adult patients were surgically treated through triple innervation for reanimation of flaccid unilateral facial paralysis (contralateral facial nerve, masseteric nerve, and hypoglossal nerve) and fascia lata graft for definition of the nasolabial sulcus. In the preoperative stage and at least 11 months after the surgical treatment, three-dimensional facial images were recorded through stereophotogrammetry in a neutral (rest) position, and with Mona Lisa and full-denture (maximum) smiles. Labial commissure inclination relative to the interpupillary axis, and a surface assessment of local facial asymmetry at rest and while smiling were obtained for the upper, middle, and lower facial thirds. The angle between the interpupillary axis and the labial commissure significantly improved in post-surgical acquisitions, regaining symmetry at rest (t-test; p < 0.001). Facial symmetry increased significantly when passing from pre-to postsurgical facial scans, from the lower to the upper facial third, and from the full smile to the rest position (ANOVA; p < 0.001). After treatment, the full smile recovered more symmetry than the other two expressions. In summary, surgical treatment significantly reduced facial asymmetry, but this reduction differed significantly among the various animations and facial thirds. The results of this study confirmed clinical findings of significant static and dynamic improvements in facial symmetry after triple innervation reanimation surgery.

Can smartphones be used for routine dental clinical application? A validation study for using smartphone-generated 3D facial images

OBJECTIVES

To compare the accuracy of smartphone-generated three-dimensional (3D) facial images to that of direct anthropometry (DA) and 3dMD with the aim of assessing the validity and reliability of smartphone-generated 3D facial images for routine clinical applications.

MATERIALS AND METHODS

Twenty-five anthropometric soft-tissue facial landmarks were labelled manually on 22 orthognathic surgery patients (11 males and 11 females; mean age 26.2 ± 5.3 years). For each labelled face, two imaging operations were performed using two different surface imaging systems: 3dMDface and Bellus3D FaceApp. Next, 42 inter-landmark facial measurements amongst the identified facial landmarks were measured directly on each labelled face and also digitally on 3D facial images. The measurements obtained from smartphone-generated 3D facial images (SGI) were statistically compared with those from DA and 3dMD.

RESULTS

SGI had slightly higher measurement values than DA and 3dMD, but there was no statistically significant difference between the mean values of inter-landmark measures across the three methods. Clinically acceptable differences (≤3 mm or ≤5°) were observed for 67 % and 74 % of measurements with good agreement between DA and SGI, and 3dMD and SGI, respectively. An overall small systematic bias of ± 0.2 mm was observed between the three methods. Furthermore, the mean absolute difference between DA and SGI methods was highest for linear (1.41 ± 0.33 mm) as well as angular measurements (3.07 ± 0.73°).

CONCLUSIONS

SGI demonstrated fair trueness compared to DA and 3dMD. The central region and flat areas of the face in SGI are more accurate. Despite this, SGI have limited clinical application, and the panfacial accuracy of the SGI would be more desirable from a clinical application standpoint.

CLINICAL SIGNIFICANCE

The usage of SGI in clinical practice for region-specific macro-proportional facial assessment involving central and flat regions of the face or for patient education purposes, which does not require accuracy within 3 mm and 5° can be considered.

Gender- and Age-Related Characterization of Lip Morphology: A Three-Dimensional Analysis in a Chinese Population

BACKGROUND

Establishing facial anthropometric reference values is essential for diagnosis of deformity, assessment of aging, and planning for aesthetic and reconstructive treatment.

OBJECTIVES

This study aimed to provide detailed perioral anthropometric data in relation to sex and age in Chinese persons with a standardized 3-dimensional protocol.

METHODS

Three-dimensional facial photographs were obtained of 60 male and 64 female healthy Chinese participants ages 20 to 35 and 50 to 65 years old, as well as 2 acromegaly patients, with the VECTRA 3D camera. A standardized evaluation was performed to locate 37 perioral landmarks and generate corresponding measurements, including 26 linear distances, 5 ratios, 2 curvatures, 4 areas, and 9 angles. Measurements of different age groups and of different genders were compared, as were measurements of healthy individuals with those of acromegaly patients.

RESULTS

Sex discrepancy was noted in philtrum length, width, and area, lip width, and vermilion and cutaneous upper lip area; these were larger in Chinese males than females. However, vermilion heights were similar in both genders. With age, philtrum and cutaneous upper lip height and area, lip width, and angles related to cupid's bow significantly increased, whereas vermilion height and mouth corner angles decreased, and philtrum width, vermilion areas, and lip protrusion remained unchanged. Compared to healthy Chinese patients, acromegaly patients had a larger value for most measurements. Perioral rejuvenation based on detailed 3-dimensional anthropometry showed good results.

CONCLUSIONS

Chinese males have wider but not thicker lips than females, and aging features thin, flattened, and wide vermilions with a lengthened philtrum in both genders. These data can serve as a reference standard for disease diagnosis, aesthetic procedures, and reconstructive lip surgeries.

LEVEL OF EVIDENCE: 4

Evaluation of the Portable Next-Generation VECTRA H2 3D Imaging System for Measuring Upper Eyelid Area and Volume

BACKGROUND

Although a portable 3-dimensional (3D) imaging system has been used for periocular measurement analysis, this system has yet to be tested and validated for periocular area and volume measurements.

OBJECTIVES

The aim of this study was to define the upper eyelid and upper eyelid fold region through a modified landmark strategy and validate a portable 3D imaging system for area and volume measurements in this periocular region.

METHODS

Eighty-one healthy adult Caucasians underwent 3D facial imaging with the VECTRA M3 (static) and VECTRA H2 (portable) 3D imaging systems (Canfield Scientific, Inc., Parsippany, NJ). Subsequently, the upper eyelid and upper eyelid fold regions were selected according to a modified landmark localization strategy. Direct measurements of area and volume were performed to assess intrarater, interrater, intramethod, and intermethod reliability, and to compare the agreement between the 2 devices.

RESULTS

The VECTRA M3 and H2 showed high reliability on upper eyelid area measurements. Excellent intra-, inter-, and intramethod reliability agreements were observed in intraclass correlation coefficient; very good agreement in intrarater reliability was observed in the relative error of measurement (REM) and relative technical error of measurement (rTEM); and good inter- and intramethod reliability were observed in the REM and rTEM. For area measurement of the upper eyelid fold, the intrarater, interrater, and intramethod reliability of the M3 was lower than that of the H2. Both systems had poor intrarater, interrater, and intramethod reliability for volume measurements in the upper eyelid and upper eyelid fold region.

CONCLUSIONS

This new portable 3D imaging system achieved excellent or very good reliability values for standardized direct measurements of the upper eyelid and upper eyelid fold region, although volume measurements seem less reliable.

Acquisition of Precision and Reliability of Modalities for Facial Reconstruction and Aesthetic Surgery: A Systematic Review

The foundation of reconstructive and cosmetic surgery is a confluence of advanced technologies, plethora of procedures, inventive modifications, and planned strategies. In surgical planning, the most crucial steps for treating a patient are evaluating the facial morphometry and recognizing the deviations from the baseline values of facial parameters. Various imaging and non-imaging modalities and sub-modalities contribute to diagnosis, treatment planning, and follow-up care. These techniques are an important milestone of pre-, peri-, and postoperative care in facial reconstruction. The current research aims to comprehensively explain imaging and non-imaging technologies encompassing both innovative and traditional approaches in facial reconstruction. PubMed, Scopus, and Web of Science were searched from 1990 to 2022, and systematic review was conducted in accordance with the PRISMA recommendations. Undoubtedly, various factors impact the selection of facial analysis acquisition approaches and their prospective. The surgical team must understand such modalities' potential for diagnosis and treatment. The evolution of three-dimensional imaging has been fueled because of the need for devices with high speed, small size, and several functions. Automation with more efficiency and precision is the way of the future for three-dimensional imaging. Stereophotogrammetry can clearly quantify the field of facial analysis. All the publications under consideration came to the same conclusion: Canfield's Vectra three-dimensional imaging devices can provide accurate, repeatable stereophotogrammetric pictures. Although a few minor mistakes were recorded, most examined devices are deemed reliable and accurate tools for Plastic surgeons.

Quantification of Facial Allograft Edema During Acute Rejection: A Software-Based 3-Dimensional Analysis

BACKGROUND

Acute rejection (AR) is a common complication in facial transplant (FT) patients associated with allograft edema and erythema. Our study aims to demonstrate the feasibility of using software-based 3-dimensional (3D) facial analysis to quantify edema as it resolves during/after AR treatment in an FT patient.

METHODS

Our patient is a 23-year-old man who underwent a face and bilateral hand allotransplant in August 2020. The Vectra H1 (Canfield, Fairfield, NJ) portable scanner was used to capture 3D facial images at 8 time points between postoperative day (POD) 392 and 539. The images were analyzed with the Vectra Software using a rejection-free image (POD 539) as a control.

RESULTS

Edema increased in the periorbital, lower third, and submandibular regions before AR treatment (POD 392-415). At POD 448, total facial edema was reduced to near baseline values in response to plasmapheresis and thymoglobulin (+156.94 to +28.2 mL). The fastest and most notable response to treatment was seen in the periorbital region, while some edema remained in the submandibular (+19.79 mL) and right lower third (+8.65 mL) regions. On POD 465, after the initial improvement, the edema increased but was resolved with steroid use. Facial edema did not correlate with the histopathological evaluation in our patient.

CONCLUSIONS

We demonstrated the feasibility of analyzing 3D facial images to quantify edema during/after AR treatment in an FT patient. Our analysis detected edema changes consistent with AR followed by an improvement after treatment. This technology shows promise for noninvasive monitoring of FT patients.

Surgical effects of rehabilitation protocols on dental arch occlusion of children with cleft lip and palate

Aim: to evaluate the surgical effects of two rehabilitation protocols on dental arch occlusion of 5-year-old children with or without cleft lip and palate. Methods: this is a retrospective longitudinal study the sample comprised 45 digitized dental casts divided into followed groups: Group 1 (G1) – children who underwent to cheiloplasty (Millard technique) at 3 months and to one-stage palatoplasty (von Langenbeck technique) at 12 months; Group 2 (G2) – children who underwent to cheiloplasty (Millard technique) and two-stage palatoplasty (Hans Pichler technique for hard palate closure) at 3 months and at 12 months to soft palate closure (Sommerlad technique); and Group 3 (G3) – children without craniofacial anomalies. Linear measurements, area, and occlusion were evaluated by stereophotogrammetry software. Shapiro-Wilk test was used to verify normality. ANOVA followed by posthoc Tukey test and Kruskal-Wallis followed by posthoc Dunn tests were used to compared groups. Results: For the measures intercanine distance (C-C’), anterior length of dental arch (I-CC’), and total length of the dental arch (I–MM’), there were statistical differences between G1x G3 and G2xG3, the mean was smaller for G1 and G2. No statistically significant differences occurred in the intermolar distance and in the dental arch area among groups. The occlusion analysis revealed significant difference in the comparison of the three groups (p=0.0004). Conclusion: The surgical effects of two rehabilitation protocols affected the occlusion and the development of the anterior region of the maxilla of children with oral clefts when compared to children without oral clefts.

Validation of Vectra 3D Imaging Systems: A Review

Aim: Three-dimensional facial imaging systems are a useful tool that is gradually replacing two-dimensional imaging and traditional anthropometry with calipers. In this varied and growing landscape of new devices, Canfield (Canfield Scientific, Parsippany, NJ, USA) has proposed a series of static and portable 3D imaging systems. The aim of this systematic review was to evaluate the current literature regarding the validation of Canfield’s Vectra imaging systems. Materials and Methods: A search strategy was developed on electronic databases including PubMed, Web of Science and Scopus by using specific keywords. After the study selection phase, a total of 10 articles were included in the present review. Results: A total of 10 articles were finally included in the present review. For six articles, we conducted a validation of the Vectra static devices, focusing especially on the Vectra M5, Vectra M3 and Vectra XT. For four articles, we validated the Vectra H1 portable system. Conclusions: All of the reviewed articles concluded that Canfield’s Vectra 3D imaging systems are capable of capturing accurate and reproducible stereophotogrammetric images. Minor errors were reported, particularly in the acquisition of the perioral region, but all the evaluated devices are considered to be valid and accurate tools for clinicians.

Microtia Ear Reconstruction with Patient-Specific 3D Models-A Segmentation Protocol

(1) Background: In recent years, three-dimensional (3D) templates have replaced traditional two-dimensional (2D) templates as visual guides during intra-operative carving of the autogenous cartilage framework in microtia reconstruction. This study aims to introduce a protocol of the fabrication of patient-specific, 3D printed and sterilizable auricular models for autogenous auricular reconstruction. (2) Methods: The patient's unaffected ear was captured with a high-resolution surface 3D scan (Artec Eva) and post-processed in order to obtain a clean surface model (STL format). In the next step, the ear was digitally mirrored, segmented and separated into its component auricle parts for reconstruction. It was disassembled into helix, antihelix, tragus and base and a physical model was 3D printed for each part. Following this segmentation, the cartilage was carved in the operating room, based on the models. (3) Results: This segmentation technique facilitates the modeling and carving of the scaffold, with adequate height, depth, width and thickness. This reduces both the surgical time and the amount of costal cartilage used. (4) Conclusions: This segmentation technique uses surface scanning and 3D printing to produce sterilizable and patient-specific 3D templates.

Assessment of the Orbital and Auricular Asymmetry in Italian and Sudanese Children: A Three-Dimensional Study

The evaluation of the symmetry of orbital and ear soft tissues is important for aesthetic and reconstructive surgery. However, little information is available for these facial regions, especially in children. We analyzed the orbital and auricular symmetry in 418 Italian and 206 Sudanese subadult males divided into three age groups (8–11, 12–15, and 16–19 years old). Orbital and auricular height and width were measured for calculating fluctuating and directional asymmetry indices. Differences in asymmetry indices according to ethnicity and age group were assessed through the two-way ANOVA test (p < 0.01), while differences in the prevalence of right or left asymmetry according to ethnicity were assessed through the chi-square test. On average, directional asymmetry indices ranged from −2.1% to 1.1%, while fluctuating asymmetry indices ranged between 2.9% and 5.4%, corresponding to a small effect size and to 1.06–2.34 mm actual dimensions. Sudanese subjects showed a greater asymmetry for all the indices except for the fluctuating asymmetry of orbital height (p < 0.01). The directional asymmetry of auricular width increased with age. A prevalent right-side asymmetry was found for all the orbital indices (p < 0.001) in both populations, although significantly more prevalent in Sudanese individuals (over 83% for both measures), while auricular measures showed a prevalent left asymmetry exclusively in the Sudanese but with lower percentages. Aside from the limited effect size, the results proved the ethnic variability of asymmetry of orbital and auricle regions in children and suggest the need to collect more population data.

Three-dimensional facial scanner in the hands of patients: validation of a novel application on iPad/iPhone for three-dimensional imaging

Background

Three-dimensional (3D) photography plays an important role in surgical planning and postoperative evaluation. Commercial 3D facial scanners are expensive, and they require patients to come to the clinics for 3D photography. To solve this problem, we developed an iPad/iPhone application to enable patients to capture 3D images of themselves on their own. This study aimed to evaluate the validity and reproducibility of this novel imaging system.

Methods

3D images were taken on 20 volunteers using the novel imaging system. Twenty-one anthropometric parameters were measured using calipers (direct measurement) and 3D photographs (3D photogrammetry). The results were compared to assess the accuracy and bias of 3D photogrammetry. The reproducibility was evaluated by testing intra- and interobserver reliabilities. Furthermore, 3D virtual models obtained by the novel imaging system and Vectra H1 camera were compared by performing heat map analysis.

Results

The 3D photogrammetric results showed excellent correlations with direct measurements. Most anthropometric parameters did not show statistically significant differences between the two methods. The 95% limits of agreement exceeded 2 mm in some parameters, especially those with large numbers, although their relative error measurements were very small. Intra- and interobserver reliabilities were high enough to ensure good reproducibility. The comparison of 3D models obtained by the novel imaging system and Vectra H1 camera showed that the mean distance and the mean RMS were 0.08 and 0.67 mm, respectively.

Conclusions

The novel 3D facial scanning system is validated to enable patients to take 3D images on their own. The imaging quality of the subnasale region needs further improvement. Future clinical applications include surgical planning, postoperative evaluation, and early diagnosis of diseases that affect facial appearance.

Mini-microform cleft lip with complete cleft alveolus and palate: A case report

Cleft lip and cleft alveolus are caused by incomplete fusion of the frontonasal and maxillary prominences. However, milder forms of cleft lip are rarely accompanied by cleft alveolus. Here, we report a rare case of mini-microform cleft lip with complete cleft alveolus and cleft palate. No findings suggestive of cleft lip were evident on initial examination. However, three-dimensional facial measurements confirmed the presence of cleft lip despite no evidence of orbicularis oris muscle (OOM) rupture on ultrasonography. Collapsed nostril, as observed in this case, is usually associated with OOM rupture. However, it can also be caused by skeletal abnormalities, such as cleft alveolus. Three-dimensional facial measurements and ultrasonography can assist in accurate diagnosis when visual examination is ambiguous.

Morphological Correlations in Nasolabial Formation After Primary Lip Repair for Unilateral Cleft Lip

PURPOSE

We aim to reveal postoperative morphological correlations between the nasolabial components in patients with unilateral cleft lip (UCL). The hypothetical correlations are first, a correlation between the vertical height of the cleft-side alar base and the length of the cleft-side red lip, and second, a correlation between the length of the cleft-side red lip and the vertical position of the cleft-side oral commissure. We explain how these morphological balances are controlled by surgery.

METHODS

Three-dimensional bilateral measurements of the length of the red lip, vertical height of the nasal alar base, and vertical height of the oral commissure were conducted retrospectively on 31 patients with UCL and palate (complete UCL: 26; incomplete UCL: 5) who underwent primary lip plasty at Osaka Women's and Children's Hospital from 2017 to 2019.

RESULTS

We found a statistically significant correlation between the vertical height of the cleft-side alar base and cleft-side red lip length (P = .012, r = 0.45); thus, the longer the red lip, the lower was the nasal alar base. The correlation between the cleft-side red lip length and the vertical height of the cleft-side oral commissure also showed a statistical significance (P = .00074, r = 0.57); thus, the shorter the red lip, the higher was the oral commissure.

CONCLUSIONS

The present results provided objective evidence showing basic morphological relationships between the postoperative nasolabial features of patients with UCL. The results lead to a reasonable approach to define the proposed peak of the Cupid's bow, an unsettled major controversy in cleft lip surgery.

Performing Distance Measurements in Curved Facial Regions: A Comparison between Three-Dimensional Surface Scanning and Ultrasound Imaging

Facial flap surgery depends strongly on thorough preoperative planning and precise surgical performance. To increase the dimensional accuracy of transferred facial flaps, the methods of ultrasound and three-dimensional (3D) surface scanning offer great possibilities. This study aimed to compare different methods of measuring distances in the facial region and where they can be used reliably. The study population consisted of 20 volunteers (10 males and 10 females) with a mean age of 26.7 ± 7.2 years and a mean body mass index of 22.6 ± 2.2 kg/m². Adhesives with a standardized length of 20 mm were measured in various facial regions through ultrasound and 3D surface scans, and the results were compared. Regardless of the facial region, the mean length measured through ultrasound was 18.83 mm, whereas it was 19.89 mm for 3D surface scans, with both p < 0.0001. Thus, the mean difference was 1.17 mm for ultrasound measurements and 0.11 mm for 3D surface scans. Curved facial regions show a great complexity when it comes to measuring distances due to the concavity and convexity of the face. Distance measurements through 3D surface scanning showed more accurate distances than the ultrasound measurement. Especially in "complex" facial regions (e.g., glabella region and labiomental sulcus), the 3D surface scanning showed clear advantages.