[Lip, jaw, and palate clefts. Analysis of unilateral cleft lip using 3-D laser topometry]

Scoring systems of cleft-related facial deformities: a review of literature

Objective :  There is a need for an internationally agreed objective method of assessing cleft-related deformities in order to compare the results of individual surgeons and different surgical techniques or to determine the optimal timing for primary lip closure. To assess the current methods, an overview of the recent developments in postoperative scoring systems of cleft-related deformities was made. Methods :  A Medline search from June 2003 through July 2011 was conducted, and references in the selected articles were checked. This search yielded 428 articles, and after application of the inclusion and exclusion criteria, 40 articles were included in this review. Results :  Twenty-five studies used two-dimensional (2D) photographs for the assessment of cleft-related deformities. Fourteen of these studies used a subjective method for the assessment and 11 performed anthropometric measurements. Good reliability has been found for subjective assessments and measurements from 2D photographs. Fifteen studies assessed three-dimensional (3D) imaging. Conclusions :  Although there is a wide variety in study design, 3D imaging seems most reliable in assessing cleft-related facial deformities. However, scoring on 2D photographs is easier to perform and more applicable in daily practice because all cleft patients are photographed through the course of their treatment.

Development and reproducibility of a 3D stereophotogrammetric reference frame for facial soft tissue growth of babies and young children with and without orofacial clefts

The aim of this study was to develop a reference frame for three dimensional (3D) facial soft tissue growth analysis in children and to determine its reproducibility. Two observers twice placed the reference frame on 39 3D-stereophotogrammetry facial images of children with orofacial clefts and control children. The observers' performances were analyzed by calculating mean distance, distance variability, and P95 between the same facial surfaces at two different time points. Correlations between observers were analyzed with Pearson's correlation coefficient. The influence of presence of a cleft, absence of one ear in the photograph, and age on the reproducibility of the reference frame was checked using Student's t test. Results of intraobserver comparisons showed a mean distance of <0.40 mm, distance variability of <0.51 mm, and P95 of <0.80 mm. For interobserver reliability, the mean distance was <0.52 mm, distance variability was <0.53 mm, and P95 was <1.10 mm. Presence of a cleft, age, and absence of one ear on the 3D photograph did not have a significant influence on the reproducibility of placing the reference frame. The children's reference frame is a reproducible method to superimpose on 3D soft tissue stereophotogrammetry photographs of growing individuals with and without orofacial clefts.

Does abdominoplasty with liposuction of the love handles yield a shorter scar? An analysis with abdominal 3D laser scanning

The aim of this study was to evaluate the combination of abdominoplasty with liposuction of both flanks with regards to length of scar, complications, and patient's satisfaction. A retrospective analysis of 35 patients who underwent esthetic abdominoplasty at our institution between 2002 and 2004 was performed. Thirteen patients underwent abdominoplasty with liposuction of both flanks, 22 patients underwent conventional abdominoplasty. Liposuction of the flanks did not increase the rate of complications of the abdominoplasty procedures. We found a tendency toward shorter scars in patients who underwent abdominoplasty combined with liposuction of the flanks. Implementation of 3-dimensional laser surface scanning to objectify the postoperative outcomes, documented a comparable degree of flatness of the achieved body contouring in both procedures. 3-dimensional laser surface scanning can be a valuable tool to objectify assessment of postoperative results.

Quantitative 3D soft tissue analysis of symmetry prior to and after unilateral cleft lip repair compared with non-cleft persons (performed in Cambodia)

OBJECT

The aim of this study was to evaluate the clinical application of three-dimensional (3D) imaging and morphological analysis with subsequent individual therapy planning and postoperative 3D symmetry control in comparison with data from non-cleft persons.

DESIGN

This was a prospective study using a 3D surface-imaging and evaluation system in cleft patients and non-cleft persons. The pre- and postoperative 3D facial profiles were recorded from the patients using a 3D laser scanner. The preoperative 3D image was analyzed qualitatively and quantitatively for an individual therapy planning. On the basis of ratios and scores, based on empirical regions of interest, the technique of cleft repair was designed individually. The postoperative result was evaluated regarding symmetry. The surgically created soft tissue shift was defined quantitatively and visualized with vectors. The postoperative symmetry was compared with 3D data from a group of non-cleft persons of the same ethnical group.

PATIENTS

Eleven patients (mean age 13.8 years, median 13, minimum 2, maximum 41 years) with either a unilateral isolated cleft lip, a cleft lip and alveolus or a complete unilateral cleft lip, alveolus and palate and 25 non-cleft persons (8 children between 4 and 12 years, 17 adults (9 men, 8 women) between 18 and 50 years). All these persons investigated were Asians of Khmer origin.

RESULTS

The analysis permitted quantitative 3D evaluation. The 3D anthropometric data of the non-cleft Khmer persons were collected and named the gold standard of symmetry in this ethnical group. All postoperative 3D images reached symmetrical values within the range of the normal cohort. Soft tissue shifts from pre- to postoperative sites could be visualized.

CONCLUSION

A new method for registration was described enabling follow-up registration in patients when growing older. This 3D soft tissue analysis can be a useful tool in quantitative analysis and objective follow-up control in cleft patients. It offers deeper insight into the complex morphology to be treated and could contribute to individualisation of surgical procedures.