Clinicians and laypeople assessment of facial attractiveness in patients with cleft lip and palate treated with LeFort I surgery or late maxillary protraction

Primary Rhinoplasty for Unilateral Cleft Lip: A Long-Term Cohort Assessment of Aesthetic and Anthropometric Outcomes

The decision to undertake rhinoplasty maneuvers during cleft lip repair remains controversial. Little data compare long-term outcomes with and without primary rhinoplasty (PR). This study compared nasolabial outcomes in cohorts with unilateral cleft lip (UCL) treated with and without PR at the Children's Hospital of Philadelphia using standardized aesthetic and anthropometric assessments.

Retrospective cohort study.

Tertiary care pediatric hospital.

Patients who underwent lip repair for UCL.

Cleft lip repair with and without PR.

Anthropometric analyses and crowdsourced aesthetic assessments using Americleft nasolabial appearance reference scales and pairwise comparisons.

Among 208 patients, 155 (74.5%) and 53 (25.5%) underwent lip repair with and without PR at 4.5 ± 1.1 months. Primary rhinoplasty (β = 0.345, P = .037) and a lower Cleft Lip Severity Index (β = -0.341, P < .001) predicted superior pairwise rank at 4.9 ± 1.9 years of age. History of PR predicted decreased columellar deviation angle (CDA) (β = -2.375, P = .019) and improved nostril symmetry (β = 0.111, P = .038). Increased columellar-labial angle (r = 0.27, P = .002), improved nostril symmetry (r = -0.23, P = .01), and decreased CDA (r = -0.45, P < .001) correlated with superior ratings. Patients with ˂20 days of postoperative nasal stenting had inferior lateral ratings (2.4 ± 0.6 vs 2.1 ± 0.5, P = .005). Those who underwent surgery at ˂5.3 months had inferior nasal projection (Goode's ratio 0.56 ± 0.09 vs 0.62 ± 0.08, P = .006).

Primary rhinoplasty for UCL offers superior aesthetic results in early childhood by layperson and anthropometric assessments. Specific improved characteristics from PR-CDA and nostril symmetry-most greatly influence layperson perception of nasal appearance. Older age at surgery predicted increased nasal projection, while prolonged nasal stenting predicted superior profile appearance.

Interpersonal impressions of cleft and non-cleft adolescents: A panel assessment study of peers, laypersons, and clinicians using 3dMD images

BACKGROUND

Patients with cleft lip and palate anomalies suffer from associated negative psychosocial effects despite undergoing reconstructive surgeries. Discrimination from others may be a contributing factor. We aim to understand whether people react differently to cleft and non-cleft subjects in questions regarding aesthetic appraisal and interpersonal impressions, as well as whether diverging opinions exist between people of different backgrounds.

MATERIALS AND METHODS

Using the 3dMD system, three-dimensional craniofacial images of cleft (n = 20) and non-cleft (n = 5) pediatric individuals were obtained and used to create a Likert scale-based questionnaire. Participants from three different backgrounds, including adolescent peers, adult laypersons, and plastic surgeons, were recruited to complete the assessment. The resulting data were transferred to a bar graph and analyzed with the item response theory-graded response model to estimate the latent traits and capability of each subject.

RESULTS

Non-cleft images obtained more positive responses than cleft images in questions of both aesthetic appraisal and interpersonal impressions. However, some of the cleft images were rated similarly, or even superior, to non-cleft images in questions regarding interpersonal impressions. Surgeons showed the greatest latent capability in differentiating between cleft and non-cleft images, followed by adult laypersons, and then adolescent peers.

CONCLUSIONS

Despite cleft patients experiencing drastic improvements in appearance post-repair, all subject groups responded differently to questions concerning aesthetic and social impressions of pediatric cleft and non-cleft images. Plastic surgeons were more critical than others. These findings may offer further insight to clinicians, educators, and caregivers into the social challenges faced by cleft individuals.

Long-term profile attractiveness of patients with Class I and II malocclusion treated with and without extractions: A 35-year follow-up

INTRODUCTION

The objective of this study was to compare the profile attractiveness in subjects treated with and without extractions after the long-term 35-year follow-up, according to laypeople, dentists, and orthodontists.

METHODS

A total of 40 patients with Class I and II malocclusion were divided into 2 groups, according to the treatment protocol: extraction (E) group, extractions of 4 premolars (n = 24), with mean pretreatment (T1), posttreatment (T2), and long-term posttreatment (T3) ages of 13.13, 15.50 and 49.56 years, respectively. The mean treatment time (T2 - T1) was 2.37 years, and the long-term follow-up (T3 - T2) was 34.19. Nonextraction (NE) group (n = 16), with mean ages at T1, T2, and T3 of 13.21, 15.07, and 50.32 years, respectively. The mean (T2 - T1) was 1.86 years, and the (T3 - T2) was 35.25 years. Lateral cephalograms were used to perform profile facial silhouettes, and an online evaluation was performed by 72 laypeople, 63 dentists, and 65 orthodontists, rating the attractiveness from 1 (least attractive) to 10 (most attractive). The intragroup comparison was performed with the repeated measures analysis of variance and Tukey tests. Intergroup comparison was performed with t tests, 1-way analysis of variance, and Tukey tests.

RESULTS

The E group had a longer treatment time than that of the NE group. In the pretreatment, posttreatment, and long-term posttreatment stages, the E and NE groups showed similar profile attractiveness. Laypersons and dentists were more critical than orthodontists.

CONCLUSIONS

At long-term posttreatment follow-up, profile attractiveness was similar in patients treated with and without extractions.

Comparative evaluation of nasolabial appearance of unilateral cleft lip and palate patients by professional, patient and layperson using 2 aesthetic scoring systems: A cross sectional study

OBJECTIVE

To compare the perspective of healthcare providers (orthodontists), cleft patients and laypersons in judging nasolabial aesthetics in patients with complete unilateral cleft lip, with or without cleft palate (UCL ± P) using 2 scoring systems.

DESIGN

This cross-sectional study was conducted in a tertiary care government hospital.

PATIENTS

Photographic records of 100 patients with complete UCL ± P from the age group of 5-18 years (mean age-12.2 ± 3.93 years) were included in this study.

METHOD

Photographic records of 100 patients with complete UCL ± P from the age group of 5-18 years were included. A panel of 3 orthodontists, 3 laypersons and 3 cleft patients rated nasolabial aesthetics using 2 scoring systems i.e. Asher-McDade index (AMAI) and Cleft Aesthetic Rating Scale (CARS). Spearman's split-half reliability, Intra-class correlation coefficient and Cronbach's alpha were computed to measure internal consistency and reliability. Inter-panel agreement between pair of groups was determined by means of Spearman correlation coefficient.

RESULTS

Estimated reliability of CARS for 3 raters in each panel was in moderate agreement for orthodontists and cleft patients (0.849 and 0.810). Good repeatability and agreement were recorded with moderate to high intra-panel reliability for all parameters of both AMAI and CARS. Overall inter-panel agreement was moderate for both AMAI and CARS. Pair-wise inter-panel agreement showed a moderately positive correlation in both scales (AMAI and CARS) by cleft patients and professionals.

CONCLUSION

CARS index can be reliably used for assessment of nasolabial aesthetics by cleft patients, professionals and lay persons on 2D facial photographs. Patients were more critical than clinicians and laypersons using both indices (CARS and AMAI) as they are more self-aware and conscious. Thus, a clear communication between clinician and patient regarding expectations, perception and satisfaction with surgical results is strongly recommended.

Orthognathic Surgery and Relapse: A Systematic Review

BACKGROUND

This review aimed to analyze the relapse in orthognathic surgery.

METHODS

PubMed, Scopus, and Web of Science databases were used to find papers that matched our topic dating from 1 January 2012 up to November 2022. Inclusion criteria were (1) human studies, (2) open access studies, (3) studies concerning the correlation between orthognathic surgery and relapse. Exclusion criteria were: (1) in vitro or animal studies, (2) off-topic studies, (3) reviews, (4) other languages than English.

RESULTS

A total of 482 results were obtained resulting in 323 publications after duplicate removal (158). After screening and eligibility phases 247 records were excluded: 47 reviews, 5 in animals, 35 in vitro, 180 off-topic. The authors successfully retrieved the remaining 78 papers and evaluated their eligibility. A total of 14 studies from these were ultimately included in the review.

CONCLUSION

Using cephalometric examinations and digital study models, these studies reveal that the relapse after orthognathic surgery is an event that occurs in most of the cases. The limitation of our research is that most of the studies are retrospective and use small sample sizes. A future research goal should be to conduct long-term clinical trials with larger numbers of samples.

The Use of Eye-Tracking Technology in Pediatric Orofacial Clefts: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis assessed the quality of the peer-reviewed literature and evaluated the usefulness of eye-tracking technology in evaluating observers' perceptions of pediatric patients with orofacial clefts. PubMed, Science Direct, Wiley, and Web of Science were searched. Articles were screened in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, and their methodological quality was assessed. Of the 10,254 identified studies, 12 were included. Eleven studies were cross-sectional, and one was a prospective cohort study. The main areas of interest analyzed were the eyes, nose, and mouth. Nine studies used assessment scales to analyze the link between perceived attractiveness and visualization patterns and measures. For the fixation duration outcome, six studies were eligible for inclusion in the meta-analysis. All studies reported on fixation duration in milliseconds and reported on a standard deviation. The meta-analysis demonstrated a significant difference in the measurements between the control groups and the patients with orofacial clefts. This might indicate the usefulness of eye-tracking technology as a metric for assessing the success of cleft repairs based on the perceptions of different populations. Future studies should be comprehensively reported on for comparability and reproducibility purposes.

Visual perception of repaired cleft lip scarring face associated with different malocclusions via eye-tracking

Background. This study aimed to evaluate the visual facial perception in response to scars associated with repaired cleft lip (CL) on a male adolescent patient, as assessed via eye-tracking. Methods. Index of orthodontic treatment need (IOTN) malocclusions, grades 1, 5, and 8 were added to the frontal view facial image of an adolescent male model showing asymmetries of the nose and upper lip after CL surgery using the software Photoshop CS5® software. The eye movements of 91 laypeople observers were tracked by an Eye Tribe infrared sensor connected to OGAMA© software. A Kruskal–Wallis test was used to identify differences in total fixation time and time until the first fixation for the areas of interest. A visual analog scale (VAS) of attractiveness was also used in the study. Statistical analysis was performed adopting a significance level of P<0.05. Results. The area of interest (AOI) were found to be the mouth and teeth, which were more focused on gazed at than any other area, regardless of the grade of IOTN. For observers of different ages, there were significant differences in the time until the first fixation on the scar of the repaired CL region for IOTN grade 1 (P=0.007). Images showing IOTN grade 1 repaired CL regions received the highest VAS scores. The older the age, the greater the tendency to give a higher VAS score for the same malocclusion. Conclusion. The presence of a CL scar on the upper lip did not attract the eye of laypeople observers of different ages, regardless of the degree of malocclusion in the non-smile image. The age of the observers did influence the perception of attractiveness, with older observers giving higher scores than younger ones. As the severity of the malocclusion increased, they were found to be less attractive.

Comparison of Profile Attractiveness between Class III Orthodontic Camouflage and Predictive Tracing of Orthognathic Surgery

Objective

The aim of this study was to compare the profile attractiveness between orthodontic camouflage of the Class III malocclusion and the predictive tracing simulating orthognathic surgery evaluated by dentists and laypeople. Settings and sample population. The sample consisted of 21 patients (9 male; 12 female) with Class III malocclusion treated with orthodontic camouflage and Class III intermaxillary elastics. Material and Methods. The mean initial age of the patients was 24.38 years (SD 3.32), and the mean ANB angle was −1.91° (SD 0.83°). Patients presented skeletal Class III and normal growth patterns. Initial and final lateral cephalograms of each patient were used. The initial cephalogram was used to perform the treatment simulation of orthognathic surgery, and its silhouette was compared to the silhouette obtained from the final cephalogram after Class III orthodontic camouflage. A subjective analysis of profile attractiveness was performed by 47 laypeople and 60 dentists, with scores from 1 (less attractive) to 10 (most attractive). Mann–Whitney tests were used to compare profile attractiveness between the orthodontic treatment and the predictive tracing groups and between dentists and laypeople.

Results

The predictive tracing of orthognathic surgery showed to be statistically significantly more attractive (mean score 4.57, SD 2.47) than that of the Class III camouflage orthodontic treatment (mean score 4.22, SD 2.40), with a mean numerical but significant difference of 0.35 (SD 2.01) (P < 0.001). Laypeople were more critical than dentists in evaluating profile attractiveness, but numerical difference between the groups was also small.

Conclusion

The profile silhouette of predictive tracing simulating orthognathic surgery showed to be more attractive than that of Class III camouflage orthodontic treatment; however, differences were small but statistically significant. Laypeople showed to be more critical than dentists.

Does the Nostril Shape Change After Le Fort I Advancement in Patients With Unilateral Complete Cleft Lip?

PURPOSE

Patients with unilateral cleft lip and palate (UCLP) may require Le Fort I advancement to correct maxillary hypoplasia after reaching skeletal maturity. The underlying cleft anatomy, previous operations, and scarring can affect nostril changes after maxillary advancement. The purpose of the present study was to determine whether Le Fort I advancement affects the nostril configuration (ie, width, axis, shape) in patients with UCLP. The specific aims were to (1) compare cleft and noncleft nostrils in patients with UCLP after maxillary advancement and (2) compare the changes in nostril configuration in patients with UCLP with those in noncleft controls after Le Fort advancement.

PATIENTS AND METHODS

A retrospective case-control study of nonsyndromic, skeletally mature patients with UCLP and a case-matched control group without UCLP who had undergone single-piece Le Fort I advancement with alar cinch suture from 2010 to 2014. Patients were included if they had undergone pre- and postoperative 3-dimensional photogrammetry without intervening nasal revision. Three-dimensional anthropometry was used to evaluate changes in nostril axis and width, soft triangle angle, columellar show, and nasal width after orthognathic correction.

RESULTS

The present study included 19 patients with UCLP (11 males; mean age, 18.0 years) and 19 noncleft controls (11 males; mean age, 18.7 years; P = .276). The mean sagittal advancement in the patients with UCLP and noncleft controls was 7.5 mm and 6.3 mm, respectively (P = .143). On average, the nostrils widened, the soft triangles flattened, and the columellar show increased. No significant difference was found in the changes to the nostril configuration between the cleft and noncleft sides in the patients with UCLP. No significant differences were found in the nostril changes between patients with UCLP and noncleft controls.

CONCLUSIONS

Baseline nostril asymmetry is not altered by Le Fort osteotomy in patients with UCLP because both nostrils respond similarly to the deforming forces of maxillary advancement. Similarly, no differences were found in the nostril changes between the cleft and noncleft controls. These findings can aid proper surgical planning for cleft nasal revisions.

Comparison of professional and laypeople evaluation of nasolabial esthetics following unilateral cleft lip repair

Objectives:

The objective is to know the extent of agreement of clinicians’ perception of nasolabial esthetic compared to that of laypeople (parents).

Materials and Methods:

This was a prospective study of comparison of clinician's perception of nasolabial esthetics with that of laypeople following surgical repair of UCL. Participants were recruited from the Cleft Clinic of the Lagos University Teaching Hospital, and surgical repair of the cleft was performed under general anesthesia. Surgical evaluation was done through direct clinical evaluation using the modified form of the Christofides’ criteria by laypeople and professionals.

Results:

A total of 48 cleft participants were enrolled in the study. The evaluation of the lip by both the laypeople and professionals was similar, and there was no difference (0.588) in their rating. However, there was a significant disagreement (P = 0.001) between them in the nose assessment.

Conclusion:

Neither the solitary opinion of the professionals nor that of the laypeople is satisfactory in the evaluation of facial esthetics; both are equally important, especially in the assessment of nasal esthetics. However, opinion of either the laypeople or the professional might be enough in the evaluation of the lip esthetics.

Developing an Eye-Tracking Protocol to Determine Children’s Visual Perception of Secondary Cleft Lip Deformity

Objective:

To develop a protocol that will be used to measure children’s perception of secondary cleft lip deformity (SCLD) using objective eye-tracking technology.

Design:

Cross-sectional study. Data collection May and June of 2018.

Setting:

Single tertiary care pediatric hospital with a well-established cleft team.

Participants:

Participants were recruited from a general pediatric otolaryngology clinic. Sixty participants from 4 age groups (5-6, 10, 13, and 16 years) were enrolled on a voluntary basis.

Intervention:

Pediatric participants viewed images of children’s faces while wearing eye-tracking glasses. Ten images with unilateral SCLD and 2 control images with no facial scarring were viewed as gaze was assessed.

Main Outcome and Measure:

Successful gaze fixation was recorded across all age groups.

Results:

This article illustrates the types of data generated from glasses-based eye tracking in children. All children, regardless of age, spent more time with their gaze on a SCLD images (mean = 4.23 seconds; standard deviation [SD] = 1.41 seconds) compared to control images (mean = 3.97 seconds; SD = 1.42). Younger age groups spent less time looking at specific areas of interest in SCLD images.

Conclusion:

In this pilot study, we were able to successfully use eye-tracking technology in children to demonstrate gaze preference and a trend toward visual perception of SCLD changing with age. This protocol will allow for a future study, with larger and more diverse populations. Better understanding of how SCLD is perceived among children and adolescents has the potential to guide future interventions for SCLD and other facial deformities in pediatric patients.

Evaluation of facial appearance in patients with repaired cleft lip and palate: comparing the assessment of laypeople and healthcare professionals

Background

The present study aimed to determine whether laypeople and professionals rate the facial appearance of individuals with repaired complete unilateral or bilateral cleft lip and palate (UCLP, BCLP) similarly based on viewing full facial images.

Methods

The study followed a cross-sectional analytical design where five young patients aged 10 to 14 years, who had completed all stages of their unilateral or bilateral cleft lip and palate treatment (bilateral: three, unilateral: two), were evaluated by two groups. The assessment was done by laypeople and 97 qualified professionals (33 orthodontists, 32 plastic surgeons, and 32 oral and maxillofacial surgeons). Professionals were not involved in any stage of the patients’ treatment.

Results

The facial appearance assessment of the professional groups on different facial aesthetics was significantly lower than that of laypeople, and they had higher perceived need for further treatment. On the other hand, laypeople had higher aesthetic ratings and lower perceived need for further treatment. Differences were also observed between the assessments of the professional groups. Participants who had lower aesthetic assessments of the repair tended to report a higher influence of cleft lip and palate on social activities and professional life.

Conclusion

Differences in perception exist between healthcare professionals and laypeople. The discrepancies between the professional groups could be attributed to different treatment modalities and protocols.

Aesthetic Assessment of Infants With Different Cleft Types Before, During, and After Orthopedic Treatment

OBJECTIVE

The aim of the present study is to compare the aesthetic assessments of infants with different types of cleft before (T1), during (T2), and after (T3) orthopedic therapy (OT) by orthodontists, dentists, and laypersons.

METHODS

Photographs of 3 patients (incomplete lip [C1], complete unilateral [C2], and complete bilateral cleft [C3]) at T1 (C1, C2, C3 chronologic age: 5, 2, 2 days), T2 (C1, C2, C3 chronologic age: 32, 28, 35 days; using forehead anchoraged nasal stent or conventional nasoalveolar therapy plates), and T3 (C1, C2, C3 chronologic age: 80, 91, 105 days) were collected from the archive. The nasolabial region at stage T3 were masked and also added to the evaluation form (T4). Fifty-one evaluators (17 orthodontists, 17 dentists, and 17 laypersons; mean age = 30.1 ± 3.63) assessed 21 frontal photographs using Asher-McDade et al's 5-point scale.

RESULTS

The scores of the orthodontists for T1 photographs were statistically lower than the dentists and laypersons (P < 0.05). The scores of T3 and T4 were similar in all groups (P > 0.05). The assessment scores progressively decreased from T1 to T3 (P > 0.05). The scores of both treatment methods were similar in the orthodontist group (P > 0.05), whereas the scores were lower for forehead anchored nasal stent in the other groups (P < 0.05).

CONCLUSION

Orthodontists are familiar with cleft patients. Therefore, the aesthetic of infants at any therapy stage with different treatment methods was not categorized as poor. The enhanced scores at post-OT stage and the similar scores of masked and nonmasked post-OT photographs may underline the recognition of the rehabilitation period by not only specialists but also laypersons.

Applying artificial intelligence to assess the impact of orthognathic treatment on facial attractiveness and estimated age

This observational study aimed to use artificial intelligence to describe the impact of orthognathic treatment on facial attractiveness and age appearance. Pre- and post-treatment photographs (n=2164) of 146 consecutive orthognathic patients were collected for this longitudinal retrospective single-centre study. Every image was annotated with patient-related data (age; sex; malocclusion; performed surgery). For every image, facial attractiveness (score: 0-100) and apparent age were established with dedicated convolutional neural networks trained on >0.5million images for age estimation and with >17million ratings for attractiveness. Results for pre- and post-treatment photographs were averaged for every patient separately, and apparent age compared to real age (appearance). Changes in appearance and facial attractiveness were statistically examined. Analyses were performed on the entire sample and subgroups (sex; malocclusion; performed surgery). According to the algorithms, most patients' appearance improved with treatment (66.4%), resulting in younger appearance of nearly 1year [mean change: -0.93years (95% confidence interval (CI): -1.50; -0.36); p=0.002), especially after profile-altering surgery. Orthognathic treatment had similarly a beneficial effect on attractiveness in 74.7% [mean difference: 1.22 (95% CI: 0.81; 1.63); p<0.001], especially after lower jaw surgery. This investigation illustrates that artificial intelligence might be considered to score facial attractiveness and apparent age in orthognathic patients.

Clinical effectiveness of late maxillary protraction in cleft lip and palate: A methods paper

OBJECTIVES

A prospective parallel cohort trial was conducted to compare outcomes of patients treated with maxillary protraction vs LeFort 1 maxillary advancement surgery.

SETTING AND SAMPLE POPULATION

The primary site for the clinical trial is Children's Hospital Los Angeles; the satellite test site is Seattle Children's Hospital. All patients have isolated cleft lip and palate and a skeletal Class III malocclusion.

MATERIAL AND METHODS

A total of 50 patients, ages 11-14, will be recruited for the maxillary protraction cohort. The maxillary surgery cohort consists of 50 patients, ages 16-21, who will undergo LeFort 1 maxillary advancement surgery. Patients with additional medical or cognitive handicaps were excluded from the study.

RESULTS

Current recruitment of patients is on track to complete the study within the proposed recruitment period.

CONCLUSION

This observational trial is collecting information that will examine dental, skeletal, financial and quality-of-life issues from both research cohorts.

Female Facial Attractiveness Assessed from Three-Dimensional Contour Lines by University Students

BACKGROUND

Three-dimensional (3D) images could provide more accurate evaluation for facial attractiveness than two-dimensional (2D) images. The 3D facial image could be simplified into gray scale 3D contour lines. Whether female facial attractiveness could be perceived in these simplified 3D facial contour lines should be determined.

METHODS

A series of 100 2D photographs (one frontal and two lateral views) and 3D contour lines extracted from 3D facial images of females were projected onto a screen. Each image presentation lasted 5 s, and the evaluators marked their impression of each image's facial attractiveness on a five-point Likert scale within 3 s of its presentation. The evaluation of the 3D contour lines was performed twice, 2 weeks apart. The evaluators were university students.

RESULTS

High consistency (r = 0.92) was found for the first and second evaluation of 3D facial contour lines for female facial attractiveness. The judgments of unattractive face were more consistent than the judgments of attractive face. Male students tended to give lower scores than female students in the evaluation of female facial attractiveness.

CONCLUSIONS

Female facial attractiveness could be evaluated by 3D facial contour lines. 3D facial contour lines should be one of the key factors of facial attractiveness.

Evaluation of Facial Appearance in Patients with Cleft Lip and Palate by Laypeople and Professionals: A Systematic Literature Review

Objective

To identify whether laypeople and professionals rate the facial appearance of patients with cleft lip and palate (CLP) similarly based on viewing full facial images.

Design

Several electronic databases were searched. A hand search was performed among reference lists and relevant journals. Studies that assessed the full facial appearance of patients with CLP based on two-dimensional (2D) photographs, 3D images, or clinical examination by laypeople and professionals using a visual analog scale (VAS) or a categorical rating scale were included. Two authors independently assessed articles using methodologic-quality scoring protocol.

Result

Eleven articles were included in qualitative synthesis, including four high-level and seven moderate-level papers. Three studies found that laypeople were more critical than professionals, three found there was no significant difference between laypeople and professionals, and five reported that professionals were more critical than laypeople when assessing facial appearance of patients with CLP.

Conclusions

It still remains unknown whether laypeople are more or less critical than professionals when rating facial appearance of patients with repaired CLP. Professionals are more familiar with the esthetic outcomes and difficulties of treating patients. The opposite maybe true for laypeople; this disparity between what is achievable by professionals and what is expected by laypeople may be a source of dissatisfaction in facial appearance outcome. Further well-designed studies should be carried out to address this question and the clinical significance of the difference in rating scores for patients with CLP.

Comparison of esthetics perception and satisfaction of facial profile among male adolescents and adults with different profiles

Objective:

To evaluate esthetics perception and satisfaction of the facial profile among Iranian male adolescents and adults.

Materials and Methods:

In this cross-sectional study, male subjects referred to Orthodontic Department of Mashhad Dental School were enrolled (n = 84) and were divided into two groups: Adolescents (n = 39), and adults (n = 45). They were also assigned to straight, convex, or concave profile groups based on the facial profile angle (G-Sn-Pog’). An ideal silhouette of the lower facial profile was designed in Adobe® Photoshop® CS2 software (Kansas, USA). Then, eight other silhouettes representing different relations of the maxilla and mandible were constructed. Patients were asked to use numbers 1–10 to rank the facial profiles in the order of the attractiveness, and choose a silhouette that best closely resembled their own profile. Moreover, using a questionnaire patients were asked to rank their satisfaction with their profile, and asked to assign a number (1–5) to each question as follows; one represented the least satisfaction, while five reflected the highest satisfaction.

Results:

Adult and adolescent subjects with straight (adults: 12.0 ± 1.9, adolescents: 12.8 ± 1.05) and concave (adults: 10.0 ± 2.14, adolescents: 10.0 ± 2.08) profile showed the highest and the least satisfaction with their own profile, respectively. Both adult and adolescent group selected “retrognathic maxilla, prognathic mandible” as the least attractive profile. Overall, “straight” and “bimaxillary dentoalveolar retrusion” were chosen as the most attractive silhouettes in adolescent and adults, respectively. In comparison to a professional opinion (clinician ranking), 42.9% of adolescents and 22% of adults were able to correctly diagnose their own profiles type.

Conclusion:

Most of the male adolescents and especially adults diagnosis of their own profile differed with a professional assessment.

Measuring attentional bias in children with prominent ears: A prospective eye-tracking study

BACKGROUND AND AIM

When observing new faces, most people focus their attention on the central triangle of the face containing the eyes, nose and mouth. When viewing faces with prominent ears, observers may divert their attention from the central triangle. The objective of this study was to determine whether there was an objective attentional bias to prominent ears in comparison to non-prominent ears.

METHODS

A total of 24 naïve participants (13 female; mean age 22.88 years) viewed 15 photographs of children with bilateral prominent ears, unilateral prominent ears and non-prominent ears. Both pre- and post-otoplasty photographs of two patients were included. The eye movements of participants were recorded using the EyeLink 1000, a table-mounted eye-tracking device.

RESULTS

Overall, the participants spent more time looking at the ear regions for faces with prominent ears in comparison to faces without prominent ears (p = 0.007, Z = -2.688). The attentional bias to the ear region of the patient who underwent bilateral otoplasty was significantly reduced in the post-operative photograph (p = 0.011, Z = -2.534). The patient who underwent unilateral otoplasty had no significant change in fixation times towards the ear region (p = 0.594, Z = -0.533).

CONCLUSIONS

This study presents objective data to support the notion that observers show attentional bias to the ear region when viewing faces of children with prominent ears. The scope of this finding requires further research in both extent and impact.

Facial profile preferences, self-awareness and perception among groups of people in the United Arab Emirates

Objectives:

The objective of this study is to assess the differences in facial profile preference among different layers of people in the United Arab Emirates. Facial profile self-awareness among the different groups was also evaluated.

Materials and Methods:

A total sample of 222 participants (mean [standard deviation] age = 25.71 [8.3] years, almost 80% of the participants were of Arab origin and 55% were males); consisting of 60 laypersons, 60 dental students, 60 general practitioners, 16 oral surgeons, and 26 orthodontists. Facial profile photographs of a male and female adult with straight profiles and a Class I skeletal relationship were used as a baseline template. Computerized photographic image modification was carried out on the templates to obtain seven different facial profile silhouettes for each gender. To assess differences in facial profile perception, participants were asked to rank the profiles of each gender on a scale from most to least attractive (1 [highest score] and 7 [least score]). Awareness and satisfaction with the facial appearance on a profile view was assessed using questionnaires completed by the non-expert groups.

Results:

The straight facial profile was perceived to be highly attractive by all five groups. The least attractive profiles were the bimaxillary protrusion and the mandibular retrusion for the male and the female profiles, respectively. Lip protrusion was more esthetically acceptable in females. Significant differences in perception existed among groups. The female profile esthetic perception was highly correlated between the expert groups (P > 0.05). Overall agreement between the non-expert group's perceptions of their own profiles and evaluation by the expert orthodontist was 51% (κ = 0.089). Candidates who perceived themselves as having a Class III facial profile were the least satisfied with their profile.

Conclusions:

Dental professionals, dental students, and laypersons had a similar perception trends in female and male aesthetic preference. Laypersons were more tolerant to profiles with bi-maxillary retrusion. The expert group's esthetic perception was highly correlated only for the female profiles. Most of the non-experts were unable to correctly identify their facial profile.

Geometric facial gender scoring: objectivity of perception

Gender score is the cognitive judgement of the degree of masculinity or femininity of a face which is considered to be a continuum. Gender scores have long been used in psychological studies to understand the complex psychosocial relationships between people. Perceptual scores for gender and attractiveness have been employed for quality assessment and planning of cosmetic facial surgery. Various neurological disorders have been linked to the facial structure in general and the facial gender perception in particular. While, subjective gender scoring by human raters has been a tool of choice for psychological studies for many years, the process is both time and resource consuming. In this study, we investigate the geometric features used by the human cognitive system in perceiving the degree of masculinity/femininity of a 3D face. We then propose a mathematical model that can mimic the human gender perception. For our experiments, we obtained 3D face scans of 64 subjects using the 3dMDface scanner. The textureless 3D face scans of the subjects were then observed in different poses and assigned a gender score by 75 raters of a similar background. Our results suggest that the human cognitive system employs a combination of Euclidean and geodesic distances between biologically significant landmarks of the face for gender scoring. We propose a mathematical model that is able to automatically assign an objective gender score to a 3D face with a correlation of up to 0.895 with the human subjective scores.

Apriori feasibility testing of randomized clinical trial design in patients with cleft deformities and Class III malocclusion

OBJECTIVES

To assess the feasibility of randomizing treatment (surgical vs. non-surgical) for correction of a Class III malocclusion (underbite) resulting from an earlier repair of cleft lip and palate.

MATERIALS AND METHODS

Surveys about willingness to accept randomized treatment during adolescence were mailed to the parents of cleft lip and palate patients under the care of Children's Hospital Los Angeles between 2005 and 2010. The inclusion criteria were patients with cleft lip and palate, Class III malocclusion due to maxillary deficiency, and absence of medical and cognitive contraindications to treatment.

RESULTS

Out of 287 surveys, 82 (28%) were completed and returned; 47% of the subjects held a strong treatment preference (95% CI, 35-58%), while 30% were willing to accept randomization (95% CI, 20-41%). Seventy-eight percent would drop out of a randomized trial if dissatisfied with the assigned treatment (95% CI, 67-86%). The three most commonly cited reasons for being unwilling to accept random treatment assignment were 1) the desire for doctors to choose the best treatment, 2) the desire for parents to have input on treatment, and 3) the desire to correct the underbite as early as possible.

CONCLUSION

Based on this study, parents and patients would be unwilling to accept a randomly assigned treatment and would not remain in an assigned group if treatment did not meet expectations. This highlight the limitations associated with randomization trials involving surgical modalities and provide justification for other research models (e.g., cohort studies) to compare two treatment options when randomization is not feasible.

Late Maxillary Protraction in Patients with Unilateral Cleft Lip and Palate: A Retrospective Study

Objectives

This retrospective study assessed the dentoskeletal effect of late maxillary protraction (LMP; reverse-pull headgear, Class III elastics, and maxillary suturai loosening) in unilateral cleft lip and palate (UCLP) patients versus a control group of untreated UCLP patients.

Materials and Methods

Cephalograms taken at age 13 to 14 years (T1) and 17 to 18 years (T2) were used for this study. The study group comprised 18 patients (10 male and 8 female, mean age at start of LMP therapy = 13.4 [0.45] years). A control groups of 17 patients (8 male and 9 female, mean age = 13.5 [0.44] years) was used for comparison.

Results

The repeated-measures analysis of variance showed statistically significant changes across time between groups for the following variables (mean difference [T2–T1] in the study group, 95% confidence interval): SNA (°) (1.95, 0.75 to 3.15), A ┴ Na Perp (mm) (1.82, 0.86 to 2.77), CoA (mm) (2.92, 1.53 to 4.31), ANB (°) (3.13, 2.02 to 4.24), Wits (mm) (7.82, 5.01 to 10.54), Mx-Md Diff (mm) (0.62, −1.58 to 2.83), Occl P-SN (°) (-3.98, −5.99 to −1.98), overjet (mm) (8.82, 5.90 to 11.74), FMIA (°) (4.05, −0.05 to 8.15), and IMPA (°) (-5.77, −9.74 to −1.80). Late maxillary protraction created a slight open bite (0.66 mm). Trends for overeruption of mandibular incisors and an increase in lower face height ( P = .07 for both) were noted in the study group.

Conclusions

Late maxillary protraction produced a combination of skeletal changes (protraction of maxilla, improvement in the maxillo-mandibular skeletal relationship) and dental compensations (counterclockwise rotation of occlusal plane, retroclination of mandibular incisors) in patients with UCLP. Late maxillary protraction was also associated with some unwanted tooth movements (open bite tendency, mandibular incisors overeruption).