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Ashoori M, Zoroofi RA, Sadeghi M. An Automatic Framework for Nasal Esthetic Assessment by ResNet Convolutional Neural Network. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:455-470. [PMID: 38343266 PMCID: PMC11031543 DOI: 10.1007/s10278-024-00973-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 04/20/2024]
Abstract
Nasal base aesthetics is an interesting and challenging issue that attracts the attention of researchers in recent years. With that insight, in this study, we propose a novel automatic framework (AF) for evaluating the nasal base which can be useful to improve the symmetry in rhinoplasty and reconstruction. The introduced AF includes a hybrid model for nasal base landmarks recognition and a combined model for predicting nasal base symmetry. The proposed state-of-the-art nasal base landmark detection model is trained on the nasal base images for comprehensive qualitative and quantitative assessments. Then, the deep convolutional neural networks (CNN) and multi-layer perceptron neural network (MLP) models are integrated by concatenating their last hidden layer to evaluate the nasal base symmetry based on geometry features and tiled images of the nasal base. This study explores the concept of data augmentation by applying the methods motivated via commonly used image augmentation techniques. According to the experimental findings, the results of the AF are closely related to the otolaryngologists' ratings and are useful for preoperative planning, intraoperative decision-making, and postoperative assessment. Furthermore, the visualization indicates that the proposed AF is capable of predicting the nasal base symmetry and capturing asymmetry areas to facilitate semantic predictions. The codes are accessible at https://github.com/AshooriMaryam/Nasal-Aesthetic-Assessment-Deep-learning .
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Affiliation(s)
- Maryam Ashoori
- Control and Intelligent Processing Center of Excellence, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran.
| | - Reza A Zoroofi
- Control and Intelligent Processing Center of Excellence, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mohammad Sadeghi
- Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tehran, Iran
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Tse RW, Sitzman TJ, Allori AC, Ettinger RE, Fisher DM, Bezuhly M, Samson TD, Beals SP, Matic DB, Mercan E. Measuring the Unilateral Cleft Lip Nasal Deformity: Lateral Deviation of Subnasale Is a Clinical and Morphologic Index of Unrepaired Severity. Cleft Palate Craniofac J 2023:10556656231202173. [PMID: 37787163 DOI: 10.1177/10556656231202173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
OBJECTIVE Objective measurement of pre-operative severity is important to optimize evidence-based practices given that the wide spectrum of presentation likely influences outcomes. The purpose of this study was to determine the correlation of objective measures of form with a subjective standard of cleft severity. DESIGN 3D images were ranked according to severity of nasal deformity by 7 cleft surgeons so that the mean rank could be used as the severity standard. PATIENTS 45 patients with unilateral cleft lip and 5 normal control subjects. INTERVENTIONS Each image was assessed using traditional anthropometric analysis, 3D landmark displacements, and shape-based analysis to produce 81 indices for each subject. MAIN OUTCOME The correlation of objective measurements with the clinical severity standard. RESULTS Lateral deviation of subnasale from midline was the best predictor of severity (0.86). Other strongly-correlated anthropometric measurements included columellar angle, nostril width ratio, and lateral lip height ratio (0.72, 0.80, 0.79). Almost all shape-based measurements had tight correlation with the severity standard, however, dorsum deviation and point difference nasolabial symmetry were the most predictive (0.84, 0.82). CONCLUSIONS Quantitative measures of severity transcend cleft type and can be used to grade clinical severity. Lateral deviation of subnasale was the best measure of severity and may be used as a surrogate of uncoupled premaxillary growth; it should be recorded as an index of pre-operative severity with every cleft lip repair. The correlation of other measures evaluated clarify treatment priorities and could potentially be used to grade outcomes.
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Affiliation(s)
- Raymond W Tse
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Thomas J Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Alexander C Allori
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Hospital, Durham, NC, USA
| | - Russell E Ettinger
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - David M Fisher
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Bezuhly
- Division of Plastic Surgery, IWK Health Center, Halifax, NS, Canada
| | - Thomas D Samson
- Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Stephen P Beals
- Phoenix Children's Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - Damir B Matic
- Division of Plastic Surgery, London Health Sciences Centre, Western University, London, ON, Canada
| | - Ezgi Mercan
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
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3D Surface Imaging Technology for Objective Automated Assessment of Facial Interventions: a Systematic Review. J Plast Reconstr Aesthet Surg 2022; 75:4264-4272. [DOI: 10.1016/j.bjps.2022.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/22/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022]
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Tse RW, Ettinger RE, Sitzman TJ, Mercan E. Revisiting the unrepaired unilateral cleft lip and nasal deformity using 3D surface image analysis: A data-driven model and its implications. J Plast Reconstr Aesthet Surg 2021; 74:2694-2704. [PMID: 33941472 DOI: 10.1016/j.bjps.2021.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/04/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Current descriptions of the unilateral cleft lip and nasal deformity (uCLND) are based upon limited sample sets and subjective observations. While those descriptions are inconsistent and contradictory, theoretical models, including Hogan's "tilted tripod" and Fisher's "nasal arch forms", have never been tested. Given that favorable outcomes of treatment remain elusive, detailed study of the deformity is critical in devising better treatments. The purpose of this study was to develop a data-driven three-dimensional (3D) model of uCLND that spans the spectrum of presentation and involves a pervasive underlying mechanism. METHODS We studied 3D images of 100 infants with unrepaired cleft lip at 6 months of age. Objective assessment included the landmark positions, anthropometric dimensions, and shape-based measures. Cleft severity was stratified by the lateral displacement of subnasale, so that a model could be developed using linear regression. RESULTS With progressive deviation of subnasale, the non-cleft alar base moved lateral, the cleft alar base was left posterior, and the nasal dorsum followed the caudal septum (deviating towards the non-cleft side). The "twist" resulted in opposing cleft alar dome collapse, non-cleft alar ring constriction (the non-cleft nasal sill narrowed, lateral genu rose, and alar-cheek junction became more acute), and displacement of the philtrum from midline. CONCLUSIONS Our study not only supports theoretical models of uCLND but also clarifies vectors of change and reveals significant non-cleft side alterations. On the basis of our findings, the objectives of treatment should involve centralization of the columella and philtrum and rebalancing the nose by untwisting the orthogonal displacement of the alar bases.
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Affiliation(s)
- Raymond W Tse
- Division of Craniofacial and Plastic Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, WA, USA; Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA.
| | - Russell E Ettinger
- Division of Craniofacial and Plastic Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, WA, USA; Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Thomas J Sitzman
- Division of Plastic Surgery, Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Ezgi Mercan
- Division of Craniofacial and Plastic Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, WA, USA
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Seo HJ, Denadai R, Vamvanij N, Chinpaisarn C, Lo LJ. Primary Rhinoplasty Does Not Interfere with Nasal Growth: A Long-Term Three-Dimensional Morphometric Outcome Study in Patients with Unilateral Cleft. Plast Reconstr Surg 2020; 145:1223-1236. [PMID: 32332542 DOI: 10.1097/prs.0000000000006744] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary rhinoplasty has not been universally adopted because the potential for nasal growth impairment remains an unsolved issue in cleft care. This study's purpose was to assess the long-term effects of primary rhinoplasty performed by a single surgeon in a cohort of patients with a unilateral cleft lip nose deformity. METHODS Three-dimensional nasal morphometric measurements (linear, angular, proportional, surface area, and volume) were collected from consecutive patients (cleft group, n = 52; mean age, 19 ± 1 year) who had undergone primary rhinoplasty with the use of the Noordhoff approach between 1995 and 2002 and reached skeletal maturity. Normal age-, sex-, and ethnicity-matched subjects (control group, n = 52) were identified for comparative analyses. RESULTS No significant differences (all p > 0.05) were observed for most measures, including nasal height, alar width, nasal dorsum angle, columellar angle, columellar-labial angle, nasal tip/height ratio, nasal index, alar width/intercanthal distance ratio, nasal surface area, and nasal volume. The cleft group displayed significantly (all p < 0.05) lower nasal bridge length and nasal tip projection, and greater nasal protrusion, tip/midline deviation, nasal tip angle, nasal tip protrusion width index, and alar width/mouth ratio values than the control group. CONCLUSIONS Primary rhinoplasty does not interfere with nasal growth as measured by three-dimensional photogrammetric analysis. Further imaging studies are required for the assessment of development in other anatomical nasal structures. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Hyung Joon Seo
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Rafael Denadai
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Natthacha Vamvanij
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Chatchawarn Chinpaisarn
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Lun-Jou Lo
- From the Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
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Unilateral Cleft Lip Nasal Deformity: Foundation-Based Approach to Primary Rhinoplasty. Plast Reconstr Surg 2020; 144:1138-1149. [PMID: 31688761 DOI: 10.1097/prs.0000000000006182] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cleft lip results in disruption of the nasal foundation and collapse of tip structures. Most approaches to primary rhinoplasty focus on correction of lower lateral cartilages; however, recurrent deformity is common, and secondary revision is frequently required. The authors describe an alternate approach that focuses on the foundation to "upright the nose," without any nasal tip dissection. This study assessed changes with surgery and with growth. Secondary goals were to compare methods of sidewall reconstruction and septoplasty and to identify predictors of relapse. METHODS Consecutive patients undergoing repair (n = 102) were assessed. Images were captured preoperatively, postoperatively, and at 5 years of age (when available) using three-dimensional stereophotogrammetry. Standard anthropometric and contemporary shape-based analysis (volume ratio, dorsal deviation, and alar-cheek definition) was performed to assess longitudinal changes. Images of age-matched normal control subjects were used for comparison. RESULTS Significant changes in anthropometric and morphometric measurements occurred following surgery. Postoperative form was similar to controls immediately after surgery and at 5 years. Nasal corrections were satisfactory, and only two patients have elected to undergo revision. When subjects were grouped according to cleft type, we found the same trends. When comparing different methods of nasal sidewall reconstruction or septoplasty, we found no differences. Alveolar cleft width was a significant predictor of worse preoperative and postoperative form. CONCLUSIONS Significant nasal correction can be achieved by means of reconstruction of nasal foundation, without nasal tip dissection. Preservation of tissue planes may allow for easier secondary revision, if necessary. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Seo HJ, Denadai R, Lo LJ. Long-Term Nasal Growth after Primary Rhinoplasty for Bilateral Cleft Lip Nose Deformity: A Three-Dimensional Photogrammetric Study with Comparative Analysis. J Clin Med 2019; 8:jcm8050602. [PMID: 31052470 PMCID: PMC6572392 DOI: 10.3390/jcm8050602] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 04/27/2019] [Accepted: 04/29/2019] [Indexed: 02/05/2023] Open
Abstract
Nasal deformity is associated with congenital cleft lip and palate. Primary rhinoplasty for reconstruction of the nasal deformity at the time of bilateral cleft lip repair is a controversial issue in cleft care due to traditional teaching concerning the potential impairment of nasal growth. This study assessed long-term nasal growth in patients with bilateral cleft lip and palate who underwent primary rhinoplasty by a single surgeon between 1995 and 2002 and reached skeletal maturity (n = 39; mean: 19 ± 2 years). Normal age-, gender-, and ethnicity-matched subjects (n = 52) were enrolled for comparative analyses. Three-dimensional nasal photogrammetric measurements (10 linear, 4 angular, 6 proportional, 1 surface area, and 1 volume parameter) were collected from patients with bilateral cleft lip and palate and normal subjects. Patients who underwent rhinoplasty presented with significantly (all p < 0.05) smaller nasal tip projection and nasal tip angles, but greater values for nasal dorsum length, nasal protrusion, alar width, columellar height, dome height, columellar angle, labiocolumellar angle, nasal tip height ratio, nasal index, alar width/intercanthal distance ratio, and alar width/mouth width ratio compared to normal subjects. There were no differences (all p > 0.05) in nasal height, tip/midline deviation, nasal dorsum angle, dome-to-columella ratio, columella height/alar width ratio, area surface, and volume parameters between the two groups. This study shows that primary rhinoplasty performed in patients with bilateral cleft lip and palate during infancy does not result in deficiency of the nasal dimensions relative to controls.
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Affiliation(s)
- Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
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