Quantifying normal head form and craniofacial asymmetry of elementary school students in Taiwan

Exploring Progression and Differences in Facial Asymmetry for Hemifacial Microsomia and Isolated Microtia: Insights from Extensive 3D Analysis

BACKGROUND

Aiming to measure and compare asymmetry of facial hard and soft tissues in patients with HFM and isolated microtia, examining how it evolves.

METHODS

This cross-sectional study assessed facial asymmetry in male East Asian patients aged 5-12 diagnosed with unilateral hemifacial microsomia (Pruzansky-Kaban types I and IIA) or isolated microtia. Using 3D imaging of computed tomography scans, it measured root-mean-square (RMS) values for surface deviations across facial regions. Statistical analyses explored differences between conditions and the relationship of age with facial asymmetry.

RESULTS

A total of 120 patients were categorized into four groups by condition (HFM or isolated microtia) and age (5-7 and 8-12 years). Patients with HFM exhibited the greatest asymmetry in the lower cheek, while those with isolated microtia showed primarily upper face asymmetry. Significant differences, except in the forehead and nasal soft tissue, were noted between the groups across age categories. Notable distinctions in hard tissue were found between age groups in the nasal and mid-cheek areas for patients with HFM (median RMS (mm) 0.9 vs. 1.1, P = 0.02; 1.5 vs. 1.7, P = 0.03) and in the nasal and upper lip areas for patients with isolated microtia (median RMS (mm) 0.8 vs. 0.9, P = 0.002; 0.8 vs. 1.0, P = 0.002). Besides these areas for HFM, no significant age-asymmetry correlation was detected.

CONCLUSIONS

Significant differences in facial asymmetry were observed between HFM and isolated microtia, with the asymmetry in specific area evolving over time.

LEVEL OF EVIDENCE IV

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Measuring asymmetry in facial morphea via 3-dimensional stereophotogrammetry

BACKGROUND

Objectively determining tissue loss in craniofacial morphea is challenging. However, 3-dimensional (3D) stereophotogrammetry is a noninvasive modality that may be a useful adjunct.

OBJECTIVE

To prospectively evaluate 3D stereophotogrammetry in the assessment of craniofacial linear morphea.

METHODS

Participants underwent clinical, quality-of-life, and 3D-stereophotogrammetry assessments. Traditional photographs and 3D-stereophotogrammetry images were rated as mild, moderate, or severe by 2 experts and 2 nonexperts. In addition, interrater and intrarater reliability (on delayed rescoring) were calculated.

RESULTS

Of 23 patients with craniofacial morphea, 3D stereophotogrammetry detected pathologic asymmetry in 14 (20.6%) patients. Providers rated patients as more severely affected when using 3D stereophotogrammetry versus when using traditional photographs (19% severe on 3D stereophotogrammetry vs 0% severe on traditional photographs, P = .004). Qualitative ratings of both traditional and 3D images showed high inter- and intrarater reliability between experts and nonexperts alike. Physicians' Global Assessment of Damage scores correlated with mouth asymmetry (P = .0021), cheek asymmetry (P = .04), and 3D-stereophotogrammetry ratings (median, mild: 27.5 vs moderate: 46.5 vs severe: 64, P = .0152). Lower face asymmetry correlated with worse quality-of-life scores (P = .013).

LIMITATIONS

Small sample size and cross-sectional design.

CONCLUSION

3D stereophotogrammetry can reliably detect and quantify asymmetry in craniofacial morphea with greater sensitivity than that observed with traditional assessment alone. 3D stereophotogrammetry may be a useful adjunct to clinical examination.

Craniofacial Growth and Asymmetry in Newborns: A Longitudinal 3D Assessment

OBJECTIVE

To evaluate the development of the craniofacial region in healthy infants and analyze the asymmetry pattern in the first year of life.

METHODS

The participants were grouped by sex and age (1, 2, 4, 6, 9, and 12 months) to receive three-dimensional (3D) photographs. Stereoscopic craniofacial photos were captured and transformed into a series of craniofacial meshes in each group. The growth patterns of the anthropometric indices and the degree of craniofacial asymmetry were measured, and average craniofacial meshes and color-asymmetry maps with craniofacial asymmetry scores were calculated.

RESULTS

A total of 373 photographs from 66 infants were obtained. In both genders, the highest and lowest growth rates for all anthropometric indices were noted between 1 and 2 months and between 9 and 12 months, respectively. Overall, male infants had higher anthropometric indices, head volume, and head circumference than female infants. The craniofacial asymmetry score was presented with a descending pattern from 1 to 12 months of age in both sex groups. Both sex groups showed decreased left-sided laterality in the temporal-parietal-occipital region between 1 and 4 months of age and increased right frontal-temporal prominence between 6 and 12 months of age.

CONCLUSIONS

A longitudinal evaluation of the craniofacial growth of healthy infants during their first year of life was presented.

Longitudinal composite 3D faces and facial growth trends in children 6-11 years of age using 3D cephalometric surface imaging

BACKGROUND

Normative craniofacial anthropometry provides clinically important reference values used in the treatment of craniofacial conditions. Few objective datasets of normative data exist for children.

AIM

To establish normative data regarding craniofacial morphology changes with growth in children.

SUBJECTS AND METHODS

3D surface images of the same group of healthy children aged 6 - 11 years old recruited from a Dallas school were taken annually between the years 2015 - 2020. Composite 3D cephalometric faces were created for boys and girls of each age. General and craniofacial anthropometric measurements were compared.

RESULTS

Seven hundred ninety one individual stereophotogrammetric acquisitions were used (400 boys, 391 girls) taken from 180 children. Linear facial, orbital, nasal, and oral anthropometric measurements revealed a consistent increase in magnitude with age. Composite 3D face comparisons revealed prominent vertical and anteroposterior growth trends in the lower and upper facial regions.

CONCLUSION

This study presents a longitudinal 3D control dataset of the same group of children over a 6-year period that can serve as reference norms for facial growth values and trends in children aged 6-11 years. The composite 3D normative faces are available for clinical and research purposes upon request, which may be interrogated and measured according to user need and preference.

Implications of Applying New Technology in Cosmetic and Reconstructive Facial Plastic Surgery

The field of facial plastic and reconstructive surgery is privy to a myriad of technological advancements. As innovation in areas such as imaging, computer applications, and biomaterials progresses at breakneck speed, the potential for clinical application is endless. This review of recent progress in the implementation of new technologies in facial plastic surgery highlights some of the most innovative and impactful developments in the past few years of literature. Patient-specific surgical modeling has become the gold standard for oncologic and posttraumatic reconstructive surgery, with demonstrated improvements in operative times, restoration of anatomical structure, and patient satisfaction. Similarly, reductions in revision rates with improvements in learner technical proficiency have been noted with the use of patient-specific models in free flap reconstruction. In the cosmetic realm, simulation-based rhinoplasty implants have drastically reduced operative times while concurrently raising patient postoperative ratings of cosmetic appearance. Intraoperative imaging has also seen recent expansion in its adoption driven largely by reports of eradication of postoperative imaging and secondary-often complicated-revision reconstructions. A burgeoning area likely to deliver many advances in years to come is the integration of bioprinting into reconstructive surgery. Although yet to clearly make the translational leap, the implications of easily generatable induced pluripotent stem cells in replacing autologous, cadaveric, or synthetic tissues in surgical reconstruction are remarkable.