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Xu Y, Yao M, Shi B, Li J, Zheng Q, Zeng N. Three-dimensional Assessment of Longitudinal Surgical Outcome in Patients with Unilateral Cleft Lip and Palate: A Modified Rotation Advancement Technique. Clin Oral Investig 2024; 28:539. [PMID: 39304571 DOI: 10.1007/s00784-024-05928-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Optimization of a modified rotation advancement technique is hampered by lack of objective measures to quantify the longitudinal surgical outcome. METHODS We collected and assessed facial 3D images of 115 consecutive patients who underwent primary repair between 2017 and 2019. Photogrammetry was performed preoperatively, immediately postoperatively and at a first and second follow-up interval, occurring at an average year of 0.6 and 5.3 years, respectively. 10 additional age-matched noncleft control subjects were also included. RESULTS Growth lag in cleft side lateral lip and gradual elongation of medial lip height on the cleft side caused continuous deviation of philtrum towards the cleft side. The columellar length on the cleft side continued to grow slower, accompanied by a persistent widening of alar base width on the cleft side, leading to in the gradual deviation of columella towards the cleft side. The pre-operative and post-operative nasolabial asymmetry would increase with greater degree of postoperative deficiencies. Right clefts presented with greater degrees of deficiencies in lateral lip height in preoperative measurement, but this discrepancy of the laterality of clefts was not observed in the two follow-up periods. CONCLUSION The surgical outcome of this modified rotational advancement technique in unilateral cleft lip primary repair is promising. Growth lag in lateral lip and lateral displacement of alar base cause continuous deviation of philtrum towards the cleft side. Pre-operative severity does predict post-operative outcomes. Laterality of oral clefts does not significantly affect the long-term outcomes of surgery. PRACTICAL IMPLICATION This surgical technique meets the current trend of cleft lip and palate primary repair and is worth promoting.
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Affiliation(s)
- Yulang Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cleft Lip and Palate Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, The People's Republic of China
| | - Meilin Yao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cleft Lip and Palate Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, The People's Republic of China
| | - Bing Shi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cleft Lip and Palate Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, The People's Republic of China
| | - Jingtao Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cleft Lip and Palate Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, The People's Republic of China
| | - Qian Zheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cleft Lip and Palate Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, The People's Republic of China
| | - Ni Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cleft Lip and Palate Surgery, West China School of Stomatology, Sichuan University, Chengdu, 610041, The People's Republic of China.
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Kauffmann P, Kolle J, Quast A, Wolfer S, Schminke B, Meyer-Marcotty P, Schliephake H. Effect of facial and nasolabial asymmetry on perceived facial esthetics in children with non-syndromic cleft lip and palate. Clin Oral Investig 2024; 28:449. [PMID: 39060480 PMCID: PMC11281991 DOI: 10.1007/s00784-024-05839-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
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.
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Affiliation(s)
- Philipp Kauffmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany.
| | - Johanna Kolle
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Anja Quast
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Susanne Wolfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Boris Schminke
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Meyer-Marcotty
- Department of Orthodontics, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Goettingen, Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
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Pan X, Huang L, Yang L, Gong Y, Liang Z, Gu M, Hu Z. Three-dimensional nasal asymmetry analysis between adolescence and adulthood in postoperative patients with unilateral cleft lip and palate using computed tomography. Odontology 2024; 112:630-639. [PMID: 37814147 DOI: 10.1007/s10266-023-00855-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023]
Abstract
AIM To investigate the differences of the nasal soft and hard tissue asymmetry in postoperative patients with unilateral cleft lip and palate (UCLP) between adolescence and adulthood, and to explore the correlation of nasal soft and hard tissue asymmetry. METHODS CT data from 47 repaired UCLP patients were included and divided into two groups:1. adolescent group: 23 patients (15 males, 8 females; age: 10-12 years old). 2. adult group: 24 patients (16 males, 8 females; age:18-32 years old). The three-dimensional asymmetry in nasal soft and hard tissues was analyzed. Additionally, the correlation between nasal soft and hard tissue asymmetry was also analyzed. RESULTS Both the adolescent group and adult group showed asymmetries in nasal soft and hard tissues. Compared to the adolescent group, the adult group had a significantly increased horizontal asymmetry of nasal soft tissues Sbal (P < 0.05). Furthermore, the sagittal asymmetry of soft tissue Glat (P < 0.05), Sbal (P < 0.001), Sni (P < 0.001) and hard tissue LPA (P < 0.05) also increased significantly. In the adult group, there were more landmarks with a correlation between the asymmetry of nasal hard tissue and soft tissue compared to the adolescent group. There were moderate to strong correlations between nasal hard and soft tissue symmetries in the horizontal and sagittal directions (0.444 < r < 764), but no correlation in the vertical direction in the adult group (P > 0.05). CONCLUSIONS The asymmetry of nasal soft and hard tissues in patients with repaired UCLP becomes more apparent in the horizontal and sagittal dimensions from adolescence to adulthood. The correlation between the asymmetry of nasal hard tissue and soft tissue becomes stronger in the horizontal and sagittal dimensions. These factors should be taken into account when performing treatment for repaired UCLP patients in adolescence and adulthood.
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Affiliation(s)
- Xuhong Pan
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China
| | - Le Huang
- Department of Stomatology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, China
| | - Liang Yang
- Department of Stomatology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yingyu Gong
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China
| | - Zhigang Liang
- Department of Stomatology, Shenzhen Second People's Hospital, Shenzhen, China.
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - Ziyang Hu
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China.
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Al-Rudainy D, Adel Al-Lami H, Yang L. Validity and reliability of three-dimensional modeling of orthodontic dental casts using smartphone-based photogrammetric technology. J World Fed Orthod 2023; 12:9-14. [PMID: 36528481 DOI: 10.1016/j.ejwf.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/10/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The development of intraoral scanning technology has effectively enhanced the digital documentation of orthodontic dental casts. Albeit, the expense of this technology is the main limitation. The purpose of the present study was to assess the validity and reliability of virtual three-dimensional (3D) models of orthodontic dental casts, which were constructed using smartphone-based 3D photogrammetry. METHODS A smartphone was used to capture a set of two-dimensional images for 30 orthodontic dental casts. The captured images were processed to construct 3D virtual images using Agisoft and 3DF Zephyr software programs. To evaluate the accuracy of the virtual 3D models obtained by the two software programs, the virtual 3D models were compared with cone-beam computed tomography scans of the 30 dental casts. Colored maps were used to express the absolute distances between the points of each compared two surfaces; then, the means of the 100%, 95th, and 90th of the absolute distances were calculated. A Wilcoxon signed-rank test was applied to detect any significant differences. RESULTS The differences between the constructed 3D images and the cone-beam computed tomography scans were not statistically significant and were accepted clinically. The deviations were mostly in the interproximal areas and in the occlusal details (sharp cusps and deep pits and fissures). CONCLUSIONS This study found that smartphone-based stereophotogrammetry is an accurate and reliable method for 3D modeling of orthodontic dental casts, with errors less than the accepted clinically detectable error of 0.5 mm. Smartphone photogrammetry succeeded in presenting occlusal details, but it was difficult to accurately reproduce interproximal areas.
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Affiliation(s)
- Dhelal Al-Rudainy
- Orthodontic Department, College of Dentistry, University of Baghdad, Baghdad, Iraq.
| | - Hadeel Adel Al-Lami
- Orthodontic Department, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Liu Yang
- Departmet of Stomatology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China.
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Xu Y, Zeng N, Li J, Zheng Q, Shi B. Growth patterns of the nasolabial region following unilateral cleft lip primary repair. Front Pediatr 2023; 11:1136467. [PMID: 36994436 PMCID: PMC10040551 DOI: 10.3389/fped.2023.1136467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/16/2023] [Indexed: 03/31/2023] Open
Abstract
Surgical correction is the optimal way of repairing a congenital cleft lip. Patients with this condition often undergo initial surgical treatment at an early age and achieve an acceptable outcome. However, their levels of satisfaction will decrease in later stages of life as facial growth and development will inevitably cause changes in long-term outcomes, especially in the nasolabial region. Therefore, it is important for surgeons to understand nasolabial development after primary treatment and tailor their surgical techniques appropriately. This review focuses on the growth patterns of the nasolabial region after primary repair, so as to provide references for operative strategy.
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Vissarionov VA, Mustafaev MS, Mustafaeva SM, Karyakina IA, Kuzhonov DT, Mustafaev MS. Reconstruction of the Nose After Unilateral Cheilouranoplasty. Cleft Palate Craniofac J 2022:10556656221099816. [PMID: 35769046 DOI: 10.1177/10556656221099816] [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: 11/16/2022] Open
Abstract
Congenital clefts of the maxillofacial area still remain of current interest in reconstructive facial surgery. While their frequency grows up, the issues of effective surgical primary and secondary interventions are not completely solved yet. The article presents the main problems associated with the elimination of the deformations and our modifications of methods for their correction. The study was conducted based on the Centre [2] and the University [1], Russian Federation. The project was carried out within the framework of the state assignment of the Ministry of Science and Higher Education of the Russian Federation, mnemocode 0669-2020-0008. The research is based on the results of complex treatment of 112 patients with unilateral clefts of the upper lip and palate from the age of 5 to 34 years, 68 patients of them also carried out secondary surgeries. The methods of performing rhinocheiloplasty by moving a "sliding" flap, of eliminating a ctenoid plica appearing after primary surgeries are presented, described, explained, and substantiated in the article. The proposed methods gave a good or satisfactory result in 92.8% of the operated patients, which allows them to be considered effective for eliminating congenital and postoperative nasal deformities in patients with facial clefts. : The surgical methods of eliminating congenital and postoperative deformities of the nose in patients with facial clefts should be modified in accordance with the nature of the most frequently arising shortcomings of the surgical stages of correction.
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Affiliation(s)
- Vladimir A Vissarionov
- 64919Kabardino-Balkarian State University named after Kh.M. Berbekov, Institution of Dentistry and Maxillo-Facial Surgery, Russian Federation.,North-Caucasian Scientific and Practical Centre for Maxillo-Facial, Plastic Surgery and Dentistry, Nalchik, Russian Federation
| | - Magomet Sh Mustafaev
- 64919Kabardino-Balkarian State University named after Kh.M. Berbekov, Institution of Dentistry and Maxillo-Facial Surgery, Russian Federation.,North-Caucasian Scientific and Practical Centre for Maxillo-Facial, Plastic Surgery and Dentistry, Nalchik, Russian Federation
| | - Sofiyat M Mustafaeva
- 64919Kabardino-Balkarian State University named after Kh.M. Berbekov, Institution of Dentistry and Maxillo-Facial Surgery, Russian Federation.,North-Caucasian Scientific and Practical Centre for Maxillo-Facial, Plastic Surgery and Dentistry, Nalchik, Russian Federation
| | - Irina A Karyakina
- State Budgetary Institution of Health Care of the City of Moscow "Morozovskaya Children's City Clinical Hospital of Healthcare of the City of Moscow", Russian Federation
| | - Dzhambulat T Kuzhonov
- 64919Kabardino-Balkarian State University named after Kh.M. Berbekov, Institution of Dentistry and Maxillo-Facial Surgery, Russian Federation.,North-Caucasian Scientific and Practical Centre for Maxillo-Facial, Plastic Surgery and Dentistry, Nalchik, Russian Federation
| | - Muslim Sh Mustafaev
- 64919Kabardino-Balkarian State University named after Kh.M. Berbekov, Institution of Dentistry and Maxillo-Facial Surgery, Russian Federation
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Pedersoli L, Dalessandri D, Tonni I, Bindi M, Isola G, Oliva B, Visconti L, Bonetti S. Facial Asymmetry Detected with 3D Methods in Orthodontics: A Systematic Review. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2111251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Historically, the development of two-dimensional (2D) imaging techniquesforerun that of three-dimensional (3D) ones. Some 2D methods are still considered valid and effective to diagnose facial asymmetry but 3D techniques may provide more precise and accurate measurements.
Objective:
The aim of this work is to analyze the accuracy and reliability of the imaging techniques available for the diagnosis of facial asymmetry in orthodontics and find the most reliable.
Methods:
A search strategy was implemented using PubMed (National Library of Medicine, NCBI).
Results:
A total of 3201 papers were identified in electronic searches. 90 articles, available in full text, were included in the qualitative synthesis consisting of 8 reviews on the diagnosis of facial asymmetry, 22 in vivo and in vitro studies on 2D methods and 60 in vivo and in vitro studies on 3D methods to quantify the asymmetry.
Conclusion:
2D techniques include X-ray techniques such as posterior-anterior cephalogram, which still represents the first level exam in the diagnosis of facial asymmetry. 3D techniques represent the second level exam in the diagnosis of facial asymmetry. The most current used techniques are CBCT, stereophotogrammetry, laser scanning, 3D optical sensors and contact digitization. The comparison between bilateral parameters (linear distances, angles, areas, volumes and contours) and the calculation of an asymmetry index represent the best choices for clinicians who use CBCT. The creation of a color-coded distance map seems to represent the most accurate, reliable and validated methods for clinicians who use stereophotogrammetry, laser scanning and 3D optical sensors.
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Yin J, Zhang S, Huang N, Shi B, Zheng Q, Yang C. Short-term surgical outcomes in patients with unilateral complete cleft lip and palate after presurgical nasoalveolar molding therapy: A three-dimensional anthropometric study. Front Pediatr 2022; 10:1101184. [PMID: 36644403 PMCID: PMC9837100 DOI: 10.3389/fped.2022.1101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This brief research report aimed to evaluate the short-term efficacy of presurgical nasoalveolar molding (PNAM) therapy on the nasolabial morphology three dimensionally in patients with non-syndromic complete unilateral cleft lip and palate (UCLP). METHODS Thirty-six patients with non-syndromic complete unilateral complete cleft lip and palate were enrolled retrospectively and categorized into 2 groups: 18 patients who had received PNAM treatment (PNAM group) and 18 age-matched patients who have not receive PNAM treatment (no PNAM group) from 2017 to 2021. The average starting age for PNAM therapy was 18.33 days, and the average PNAM treatment duration was 99.08 days. Twelve nasolabial parameters were measured to compare the postsurgical outcomes of two groups. RESULTS In PNAM groups, cleft width, vertical distance between double Crista philtri and columellar deviation were reduced compared to that in no PNAM group. And nostril height was larger than that in no PNAM group. The differences between two groups were statistically significant (p < .05). There were no statistical differences in columellar length, nostril width and bi-alar width between two groups. However, the nostril width on cleft side in PNAM group was decreased by an average of 1.1 mm. CONCLUSION Our result indicated that PNAM therapy decreased cleft width and vertical distance between Crista philtri. It also increased nasal symmetry by decreasing columellar deviation, increasing nostril height.
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Affiliation(s)
- Jiayi Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shiming Zhang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ning Huang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qian Zheng
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chao Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Lips and noses in 10-year old patients with repaired complete unilateral clefts of lip, alveolus, and palate. A prospective three-centre study of the Baltic Cleft Network. J Craniomaxillofac Surg 2021; 50:246-253. [PMID: 34961665 DOI: 10.1016/j.jcms.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/06/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022] Open
Abstract
This multicenter study aimed at comparing different techniques of lip and nose repair with or without NAM and primary anterior rhinoplasty in pre-adolescent children. Patients with unilateral clefts of lip, alveolus, and palate who had undergone cleft lip and nose repair were evaluated in a prospective three-centre study using standardized monochromatic, cropped photographs. Four cleft surgeons evaluated the aesthetics of the central part of the face when the patients had reached age ten years. Seventy-six sets of photographs out of 87 patients were evaluated. The overall ratings of lips and noses did not differ much between centres. However, noses of centres 1 (mean 0.74; SD 0.57) and 2 (mean 0.76; SD 0.60) had been rated better than centre 3 (mean 1.32; SD 0.78; p = 0.0078), especially "Deformation of upper part of nostril rim or poor position of alar cartilage". Centre 3 had produced better looking scars (mean 0.33; SD 0.48); p = 0.0036. Within the limitations of the study it seems that NAM and primary anterior rhinoplasty including postoperative nasal stents should be performed whenever possible in order to achieve a favorable shape of the nose and to reduce the need for secondary corrective surgery.
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Dissaux C, Diop V, Wagner D, Talmant JC, Morand B, Bruant-Rodier C, Ruffenach L, Grollemund B. Aesthetic and psychosocial impact of dentofacial appearance after primary rhinoplasty for cleft lip and palate. J Craniomaxillofac Surg 2021; 49:914-922. [PMID: 34187731 DOI: 10.1016/j.jcms.2021.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 04/23/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022] Open
Abstract
The primary aim of this study was to demonstrate whether primary rhinoplasty shows aesthetic and psychosocial advantages for children with a complete unilateral cleft lip and palate. The second aim was to determine the satisfaction levels concerning the dentofacial appearance. Group A corresponded to patients from a center specialised in primary cheilo-rhinoplasty with 20 years' experience and Group B to patients who did not benefit from primary rhinoplasty. Children and their parents filled in a custom-designed satisfaction questionnaire on dentofacial appearance and its psychosocial impact. The variables studied were the main criterion (the nose) and secondary criteria (the upper lip, the smile, the profile and the face as a whole). 56 families consented to be involved in the study. The children did not rate statistically differently their social relationships if they had primary rhinoplasty or not. Parents however expressed very different views. They considered the nasal appearance of the children who had primary rhinoplasty as statistically more attractive and evaluated their psychosocial experience as significantly better. For the other parts of the face, in both groups, satisfaction levels of dentofacial appearance and psychosocial comfort were good (scores above 80/100). Yet, 44% of the families would go for further interventions, especially concerning the nose (13% of whom were in Group A and 42% in Group B). Within the limitations of this study, primary rhinoplasty seems to improve the patient's well-being and social life and, therefore, should be considered whenever appropriate.
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Affiliation(s)
- Caroline Dissaux
- Cleft Competence Center, Maxillofacial and Plastic Surgery Department, Strasbourg University Hospital, Site Hautepierre 2, Av Molière, Strasbourg 67091, France.
| | - Valérie Diop
- Département d'Orthopédie Dento-Faciale, Pôle de médecine et chirurgie buccodentaires, Strasbourg University Hospital, Place de l'Hôpital 1, Strasbourg 67000, France
| | - Delphine Wagner
- Cleft Competence Center, Maxillofacial and Plastic Surgery Department, Strasbourg University Hospital, Site Hautepierre 2, Av Molière, Strasbourg 67091, France; Département d'Orthopédie Dento-Faciale, Pôle de médecine et chirurgie buccodentaires, Strasbourg University Hospital, Place de l'Hôpital 1, Strasbourg 67000, France
| | - Jean-Claude Talmant
- Centre de compétence des fentes labio-palatines des Pays de la Loire, Clinique Jules Verne, Nantes, France
| | - Béatrice Morand
- Centre de compétence des fentes labio-palatines de Grenoble, CHU Michallon, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Catherine Bruant-Rodier
- Cleft Competence Center, Maxillofacial and Plastic Surgery Department, Strasbourg University Hospital, Site Hautepierre 2, Av Molière, Strasbourg 67091, France
| | - Laeticia Ruffenach
- Cleft Competence Center, Maxillofacial and Plastic Surgery Department, Strasbourg University Hospital, Site Hautepierre 2, Av Molière, Strasbourg 67091, France
| | - Bruno Grollemund
- Cleft Competence Center, Maxillofacial and Plastic Surgery Department, Strasbourg University Hospital, Site Hautepierre 2, Av Molière, Strasbourg 67091, France
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Assessment of facial symmetry by three-dimensional stereophotogrammetry after mandibular reconstruction: A comparison with subjective assessment. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:56-61. [DOI: 10.1016/j.jormas.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/27/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
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Leonardi R, Muraglie S, Lo Giudice A, Aboulazm KS, Nucera R. Evaluation of mandibular symmetry and morphology in adult patients with unilateral posterior crossbite: a CBCT study using a surface-to-surface matching technique. Eur J Orthod 2020; 42:650-657. [PMID: 31995170 DOI: 10.1093/ejo/cjz106] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate mandibular morphology in adults affected by posterior unilateral crossbite (PUXB) and to evaluate the hemi mandibular volumes from the crossbite (CB) and non-CB sides of the same patients. METHODS Thirty-eight cone beam computed tomography (CBCT) images were consecutively recruited and the Digital Imaging and Communications in Medicine (DICOM)-formatted scans were volume rendered into a surface three-dimensional (3D) mesh model and volumes to obtain the 3D model of the mandibular bone. To achieve the surface point-to-point analysis of the mandibular models, a reverse engineering software was used. The same procedure was performed for an age-matched control group (19 CBCT images). RESULTS Total mandibular volume showed a difference of 2.46 cm3 between patients and controls, which was not statistically significant. A mean difference of 1.53 cm3 was found comparing the hemi mandibular volumes from the CB and non-CB sides of PUXB patients, this difference was statistically significant (P ≤ 0.01). Findings for the surface-to-surface deviation analysis, demonstrated a higher percentage of mismatch in patients PUXB, over 10% at 0.5 mm tolerance level. LIMITATIONS Limitations are related to the intrinsic surfaces matching methodology, that make difficult to evaluate discrepancies among different mandibular anatomical units. CONCLUSION Adult patients affected by PUXB show a greater mandibular structural asymmetry compared to controls because of a lower matching percentage obtained from the surface-to-surface matching technique. IMPLICATIONS Treatment of adult patients affected by PUXB should take into consideration the possibility of a mild mandibular asymmetry mainly localized at the condyle and gonial angle levels.
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Affiliation(s)
- Rosalia Leonardi
- Department of Orthodontics, School of Dentistry, University of Catania, Italy
| | - Simone Muraglie
- Department of Orthodontics, School of Dentistry, University of Catania, Italy
| | - Antonino Lo Giudice
- Department of Orthodontics, School of Dentistry, University of Catania, Italy
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, University of Messina, Italy
| | - K S Aboulazm
- Department of Orthodontics, School of Dentistry, Pharos University, Alexandria, Egypt
| | - R Nucera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, University of Messina, Italy
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13
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Fishman Z, Whyne CM, Hope A, Fialkov JA. Modeling and measuring average nasal asymmetry by dorsum midline and nose tip lateral deviation. J Plast Reconstr Aesthet Surg 2020; 74:857-865. [PMID: 33199224 DOI: 10.1016/j.bjps.2020.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/30/2020] [Accepted: 10/10/2020] [Indexed: 01/13/2023]
Abstract
In rhinoplasty and nasal reconstruction, achieving symmetry is critical for optimal patient outcomes and reducing re-operation rates. Assessing nasal asymmetry is challenging, both pre- and intra-operatively, if based on only a surgeons' visual perception to assess and adjust the small distances important to cosmesis (<2-3 mm). To measure nasal symmetry, we first developed an algorithm to analyze lateral nasal deviation on facial three-dimensional (3D) scans captured by external surface scanning. In this, nasal deviation is measured by first registering a 3D facial scan to orthogonal axes in order to remove tilt. The lateral position of the nasal midline is then found across transverse planes along the dorsum and nasal tip regions by probing midpoints 1 and 2 mm back from the local maximum projection. The nasal deviation measurement algorithm was validated on a simulated asymmetrical nose model with known nasal deviation. Simulated deviations were applied to the symmetrical average nose using an exponential twist away from the face, with control of the maximum deviation and degree of curvature. Modeled deviations were evaluated with the algorithm at clinically negligible (0.02-0.06 mm) average differences and for small lateral deviations (1-5 mm). Nasal deviation using the algorithms was then measured for the 100 multi-ethnic subjects in the Binghamton University 3D Facial Expression database. Average values for maximum lateral deviation, deviation across the whole nose, and deviation at the nose tip were measured to provide context to deviation measurements in surgical planning. This research presents a new nasal assessment tool that can be useful in improving symmetry in rhinoplasty and reconstruction.
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Affiliation(s)
- Z Fishman
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, ON, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
| | - C M Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, ON, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - A Hope
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Toronto, ON, Canada
| | - J A Fialkov
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Plastic Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
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Gattani S, Ju X, Gillgrass T, Bell A, Ayoub A. An Innovative Assessment of the Dynamics of Facial Movements in Surgically Managed Unilateral Cleft Lip and Palate Using 4D Imaging. Cleft Palate Craniofac J 2020; 57:1125-1133. [PMID: 32419475 PMCID: PMC7594373 DOI: 10.1177/1055665620924871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Assess facial asymmetry during maximum smile in patients with surgically managed unilateral cleft lip and palate (UCLP), using a dynamic 3-dimensional (3D) imaging (4-dimensional) system. DESIGN Prospective 2 cohort comparative study. METHODS Twenty-five surgically managed UCLP cases and 75 controls at 8 to 10 years of age were recruited. Facial movements during maximum smile were recorded using video stereophotogrammetry at a rate of 60 3D facial images per second. Maximum smile took approximately 3 seconds and generated 180 3D facial images for the analysis. A generic facial mesh which consists of more than 7000 quasi landmarks was used for the assessment of facial asymmetry at 5 key 3D frames representing the pattern of maximum smile. RESULTS Statistically significant differences were seen regarding the magnitude of facial asymmetry between the UCLP group and the noncleft controls. Higher average asymmetry in the UCLP group was seen in the 3D frame midway between maximum smile and rest (frame 4) followed by the frame at peak expression of maximum smile (frame 3). The average magnitude of nasolabial asymmetry of the control group was within 0.5 mm in comparison with the UCLP cases which was about 1.8 mm. CONCLUSION This study provided for the first time, an objective tool for analysis of the dynamics of muscle movements which provided an unprecedented insight into the anatomical basis of the residual dysmorphology. The research demonstrates the limitations of the primary lip repair in achieving symmetrical results and underpins the required refinements to improve the quality of surgical repair of cleft lip.
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Affiliation(s)
- Shyam Gattani
- Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Xiangyang Ju
- Medical Devices Unit, Department of Clinical Physics and Bioengineering, National Health Service of Greater Glasgow and Clyde, United Kingdom
| | - Toby Gillgrass
- Glasgow Dental Hospital & School, Glasgow, United Kingdom
| | - Aileen Bell
- Oral Surgery, Glasgow University Dental Hospital & School, Glasgow, United Kingdom
| | - Ashraf Ayoub
- Scottish Craniofacial Research Group, Glasgow University Dental Hospital & School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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15
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Ben Bouhjar N, Kleinheinz J, Dirksen D, Berssenbrügge P, Runte C, Wermker K. Facial and midfacial symmetry in cleft patients: Comparison to non-cleft children and influence of the primary treatment concept. J Craniomaxillofac Surg 2019; 47:741-749. [PMID: 30777738 DOI: 10.1016/j.jcms.2019.01.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/12/2018] [Accepted: 01/29/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Patients with cleft lip, alveolus and palate (CLAP) may suffer from marked asymmetry with an impact on attractiveness and psychosocial aspects. The aim of this study was to assess symmetry in CLAP patients compared to non-cleft controls of similar age with regard to cleft type and treatment concept. MATERIALS AND METHODS In CLAP patients with different cleft forms and in healthy non-cleft subjects (control group) a three-dimensional stereophotogrammetric face scan was performed and an objective 3D asymmetry index (AI) was calculated for the whole face, the midface, the upper lip and the nose. RESULTS In total, 305 patients were included: 140 CLAP patients (90 male, 50 female, mean age 9.9 ± 3.6 years) and 165 controls (87 male, 78 female, mean age 8.7 ± 2.1 years). In general, CLAP patients showed significantly higher asymmetry than controls, with the most severe asymmetry found in unilateral complete CLAP. Patients treated according to an actual concept considering reconstruction of all affected muscular systems had a significant lower and more favourable AI than patients not treated according to this concept (p < 0.05). CONCLUSION An adequate treatment concept is essential to achieve better results concerning symmetry in CLAP, but symmetry values of healthy non-cleft controls are not reached.
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Affiliation(s)
| | - Johannes Kleinheinz
- University Hospital Münster, Department of Cranio-Maxillofacial Surgery, Waldeyerstraße 30, 48149, Muenster, Germany
| | - Dieter Dirksen
- University Hospital Münster, Department of Prosthetic Dentistry and Biomaterials, Waldeyerstraße 30, 48149, Muenster, Germany
| | - Philipp Berssenbrügge
- University Hospital Münster, Department of Prosthetic Dentistry and Biomaterials, Waldeyerstraße 30, 48149, Muenster, Germany
| | - Christoph Runte
- University Hospital Münster, Department of Prosthetic Dentistry and Biomaterials, Waldeyerstraße 30, 48149, Muenster, Germany
| | - Kai Wermker
- Klinikum Osnabrueck, Department of Oral and Cranio-Maxillofacial Surgery, Am Finkenhuegel 1, 49076, Osnabrueck, Germany.
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