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Awarun B, Blok J, Pauwels R, Politis C, Jacobs R. Three-dimensional imaging methods to quantify soft and hard tissues change after cleft-related treatment during growth in patients with cleft lip and/or cleft palate: a systematic review. Dentomaxillofac Radiol 2018; 48:20180084. [PMID: 30160533 DOI: 10.1259/dmfr.20180084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES: To assess the use of three-dimensional (3D) imaging methods to quantify the changes in soft- and hard-tissues in cleft patients after cleft-related treatment during growth. METHODS: PubMed, EMBASE, Web of Science and the Cochrane Library were searched up to 1 June 2018. Included publications were those using 3D imaging to quantify soft- and hard-tissue changes after cleft-related treatments in patients with any type of cleft, during growth. Data extraction and qualitative analysis were performed by two reviewers. The methodological quality of each study was reviewed using the QUADAS-2 tool. RESULTS: From 4 databases, 2315 articles were found. Full texts of 422 articles were analyzed and finally 12 articles were included for qualitative analysis. CT was performed in the majority of studies for hard-tissue quantification. Stereophotogrammetry, Laser scanner and 3D digitizer were identified as viable methods to quantify both soft- and hard-tissue changes, depending on whether the scan was made of the facial surface or the cast surface. Most studies conducted imaging analysis without registration between multitemporal images, which is the reason why they did not fulfil the inclusion criteria. CONCLUSIONS: Although several imaging modalities have the potential to quantify cleft-related treatment follow-up, there is an urgent need to assess the imaging methods and related analyses allowing to standardise a 3D imaging protocol to quantify hard- and soft-tissue treatment follow-up.
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Affiliation(s)
- Bennaree Awarun
- 1 Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium
| | - Jorden Blok
- 1 Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium
| | - Ruben Pauwels
- 1 Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium.,2 Department of Radiology, Faculty of Dentistry, Chulalongkorn University , Bangkok , Thailand.,3 Department of Mechanical Engineering, KU Leuven , Leuven , Belgium
| | - Constantinus Politis
- 1 Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium
| | - Reinhilde Jacobs
- 1 Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven , Leuven , Belgium.,4 Department Dental Medicine, Karolinksa Institutet , Stockholm , Sweden
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2
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Howe BJ, Cooper ME, Wehby GL, Resick JM, Nidey NL, Valencia-Ramirez LC, Lopez-Palacio AM, Rivera D, Vieira AR, Weinberg SM, Marazita ML, Moreno Uribe LM. Dental Decay Phenotype in Nonsyndromic Orofacial Clefting. J Dent Res 2017; 96:1106-1114. [PMID: 28535364 DOI: 10.1177/0022034517709961] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although children with oral clefts have a higher risk for dental anomalies when compared with the general population, prior studies have shown conflicting results regarding their dental decay risk. Also, few studies have assessed dental decay risk in unaffected relatives of children with clefts. Thus, the question of increased risk of dental decay in individuals with oral clefts or their unaffected relatives is still open for empirical investigation. This study characterizes dental decay in the largest international cohort to date of children with nonsyndromic clefts and their relatives, as compared with controls, and it addresses whether families with oral clefts have a significantly increased risk for dental decay versus the general population. A total of 3,326 subjects were included: 639 case probands, 1,549 unaffected relatives, and 1,138 controls. Decay was identified from in-person dental examinations or intraoral photographs. Case-control differences were tested with regression analysis. No significant differences were shown in percentage decayed and filled teeth and decayed teeth in the primary dentition (dft, dt) and permanent dentition (DFT, DT) in cases versus controls. In the cleft region, no significant differences were seen in primary or permanent decay (dt, DT) when compared with controls. No difference was found with regard to cleft type and percentage dft, dt, DFT, and DT in case probands. Nonsignificant differences were found in unaffected siblings and parents versus controls (primary and permanent dentitions). Collectively, these findings indicate that individuals with nonsyndromic oral clefts and their families do not have a higher dental decay risk as compared with the general population. These results suggest that either genetic or environmental factors underlying a higher susceptibility for dental anomalies do not increase caries risk or that the seemingly higher risk for dental decay associated with increased dental anomalies in case probands may be superseded by possible greater access to dental care.
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Affiliation(s)
- B J Howe
- 1 Department of Family Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA.,2 The Iowa Institute for Oral Health Research, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - M E Cooper
- 3 Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - G L Wehby
- 4 Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - J M Resick
- 3 Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - N L Nidey
- 5 Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - A M Lopez-Palacio
- 7 Department of Basic Integrated Studies, College of Dentistry, University of Antioquia, Medellin, Colombia
| | - D Rivera
- 8 Population Genetics and Mutacarcinogenesis Group, University of Antioquia, Medellin, Colombia
| | - A R Vieira
- 3 Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,9 Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - S M Weinberg
- 3 Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - M L Marazita
- 3 Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,9 Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - L M Moreno Uribe
- 2 The Iowa Institute for Oral Health Research, College of Dentistry, University of Iowa, Iowa City, IA, USA.,10 Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, IA, USA
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A Bidimensional System of Facial Movement Analysis Conception and Reliability in Adults. BIOMED RESEARCH INTERNATIONAL 2015; 2015:812961. [PMID: 26161415 PMCID: PMC4486482 DOI: 10.1155/2015/812961] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 04/22/2015] [Accepted: 04/29/2015] [Indexed: 11/17/2022]
Abstract
Objective. To design a bidimensional facial movement measuring tool and study its reliability. Methods. We utilized the free video-analysis software Kinovea that can track preselected points during movements and measure two-point distances off-line. Three raters positioned facial markers on 10 healthy individuals and video-taped them during maximal bilateral contractions of frontalis, corrugator, orbicularis oculi, zygomaticus, orbicularis oris, and buccinator, on two occasions. Each rater also analyzed the first video twice, one week apart. For each muscle, intrarater reliability was measured by percent agreements (PA) and intraclass correlation coefficients (ICC) between two assessments of the same video one week apart and between assessments of two videos collected one week apart. Interrater reliability was measured by PA, ICC, and coefficients of variation (CV) between assessments of the first video-recording by the three raters. Results. Intrarater and interrater reliabilities were good to excellent for frontalis (PA and ICC > 70%; CV < 15%), moderate for orbicularis oculi, zygomaticus, and orbicularis oris, and poor for corrugator and buccinators. Discussion. Without formal prior training, the proposed method was reliable for frontalis in healthy subjects. Improved marker selection, training sessions, and testing reliability in patients with facial paresis may enhance reliability for orbicularis oculi, zygomaticus, and orbicularis oris.
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Kuijpers MAR, Chiu YT, Nada RM, Carels CEL, Fudalej PS. Three-dimensional imaging methods for quantitative analysis of facial soft tissues and skeletal morphology in patients with orofacial clefts: a systematic review. PLoS One 2014; 9:e93442. [PMID: 24710215 PMCID: PMC3977868 DOI: 10.1371/journal.pone.0093442] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/04/2014] [Indexed: 01/11/2023] Open
Abstract
Background Current guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising. Objective To identify 3D imaging methods for quantitative assessment of soft tissue and skeletal morphology in patients with cleft lip and palate. Data sources Literature was searched using PubMed (1948–2012), EMBASE (1980–2012), Scopus (2004–2012), Web of Science (1945–2012), and the Cochrane Library. The last search was performed September 30, 2012. Reference lists were hand searched for potentially eligible studies. There was no language restriction. Study selection We included publications using 3D imaging techniques to assess facial soft tissue or skeletal morphology in patients older than 5 years with a cleft lip with/or without cleft palate. We reviewed studies involving the facial region when at least 10 subjects in the sample size had at least one cleft type. Only primary publications were included. Data extraction Independent extraction of data and quality assessments were performed by two observers. Results Five hundred full text publications were retrieved, 144 met the inclusion criteria, with 63 high quality studies. There were differences in study designs, topics studied, patient characteristics, and success measurements; therefore, only a systematic review could be conducted. Main 3D-techniques that are used in cleft lip and palate patients are CT, CBCT, MRI, stereophotogrammetry, and laser surface scanning. These techniques are mainly used for soft tissue analysis, evaluation of bone grafting, and changes in the craniofacial skeleton. Digital dental casts are used to evaluate treatment and changes over time. Conclusion Available evidence implies that 3D imaging methods can be used for documentation of CLP patients. No data are available yet showing that 3D methods are more informative than conventional 2D methods. Further research is warranted to elucidate it. Systematic review registration International Prospective Register of Systematic Reviews, PROSPERO CRD42012002041
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Affiliation(s)
- Mette A. R. Kuijpers
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Cleft Palate Craniofacial Unit, Radboud University Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - Yu-Ting Chiu
- Department of Dentistry and Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Rania M. Nada
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carine E. L. Carels
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Cleft Palate Craniofacial Unit, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Piotr S. Fudalej
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern Switzerland
- Department of Orthodontics, Palacky University Olomouc, Olomouc, Czech Republic
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Trotman CA, Phillips C, Faraway JJ, Hartman T, van Aalst JA. Influence of objective three-dimensional measures and movement images on surgeon treatment planning for lip revision surgery. Cleft Palate Craniofac J 2013; 50:684-95. [PMID: 23855676 DOI: 10.1597/12-191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : To determine whether a systematic evaluation of facial soft tissues of patients with cleft lip and palate, using facial video images and objective three-dimensional measurements of movement, change surgeons' treatment plans for lip revision surgery. Design : Prospective longitudinal study. Setting : The University of North Carolina School of Dentistry. Patients, Participants : A group of patients with repaired cleft lip and palate (n = 21), a noncleft control group (n = 37), and surgeons experienced in cleft care. Interventions : Lip revision. Main Outcome Measures : (1) facial photographic images; (2) facial video images during animations; (3) objective three-dimensional measurements of upper lip movement based on z scores; and (4) objective dynamic and visual three-dimensional measurement of facial soft tissue movement. Results : With the use of the video images plus objective three-dimensional measures, the operating surgeon changed the problem list of the surgical treatment plan for 86% of the patients (95% confidence interval, 0.64 to 0.97) and the surgical goals for 71% of the patients (95% confidence interval, 0.48 to 0.89). The surgeon group varied in the percentage of patients for whom the problem list was modified, ranging from 24% (95% confidence interval, 8% to 47%) to 48% (95% confidence interval, 26% to 70%) of patients, and the percentage for whom the surgical goals were modified, ranging from 14% (94% confidence interval, 3% to 36%) to 48% (95% confidence interval, 26% to 70%) of patients. Conclusions : For all surgeons, the additional assessment components of the systematic valuation resulted in a change in clinical decision making for some patients.
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Trotman CAE, Faraway J, Soltmann R, Hartman T, van Aalst J. Facial soft tissue dynamics before and after primary lip repair. Cleft Palate Craniofac J 2012; 50:315-22. [PMID: 23050657 DOI: 10.1597/12-080] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives : (1) To collect three-dimensional, dynamic facial images from two groups of infants: one group born with cleft lip and palate slated to have a primary lip repair and a second, age-matched, noncleft control group. (2) To develop analyses to determine differences in facial movement between infants with cleft lip with or without palate (CL±P) and noncleft control infants and to determine changes in facial movement before and after primary lip repair. Design : Longitudinal, prospective case-control study. Setting : Facial Animation Laboratory at the University of North Carolina School of Dentistry. Participants : Two groups of infants: one group with unrepaired CL±P slated to have primary lip repair (n = 15) and a second group of age-matched, noncleft controls (n = 15). Interventions : Movement testing before and 4 months after primary lip repair in infants with CL±P and at similar time points in noncleft infants. Main Outcome Measures : Seven measures of facial movement. Results : The range of facial movements increased by 17% for all infants during the 4-month period. Compared with the noncleft group (1) infants with unilateral CL±P had 50% less nasolabial movement, and this difference did not change due to the lip repair; and (2) infants with unilateral or bilateral CL±P had 58% and 118% greater lateral upper lip movement, respectively, and 3.67 and 3.56 times greater asymmetry of movement, respectively, before lip repair. The procedure almost entirely removed the hypermobility and decreased the asymmetry. Conclusions : Primary surgical lip repair decreased hypermobility and improved asymmetry of upper lip movement.
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Liu J, Zhou H, Weir MD, Xu HHK, Chen Q, Trotman CA. Fast-degradable microbeads encapsulating human umbilical cord stem cells in alginate for muscle tissue engineering. Tissue Eng Part A 2012; 18:2303-14. [PMID: 22697426 DOI: 10.1089/ten.tea.2011.0658] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Human umbilical cord mesenchymal stem cells (hUCMSCs) are inexhaustible and can be obtained without an invasive surgery. To date, there has been no report on seeding hUCMSCs in three-dimensional scaffolds for muscle tissue engineering. The objectives of this study were to (1) investigate hUCMSC seeding in a scaffold for muscle engineering and (2) develop a novel construct consisting of hUCMSC-encapsulating and fast-degradable microbeads inside a hydrogel matrix. The rationale was that the hydrogel matrix would maintain the defect volume, while the microbeads would degrade to release the cells and concomitantly create macropores in the matrix. hUCMSCs were encapsulated in alginate-fibrin microbeads, which were packed in an Arg-Gly-Asp (RGD)-modified alginate matrix (AM). This construct is referred to as hUCMSC-microbead-AM. The control consisted of the usual cell encapsulation in AM without microbeads (referred to as hUCMSC-AM). In the hUCMSC-AM construct, the hUCMSCs showed as round dots with no spreading at 1-14 days. In contrast, cells in the hUCMSC-microbead-AM construct had a healthy spreading and elongated morphology. The microbeads successfully degraded and released the cells at 8 days. Myogenic expressions for hUCMSC-microbead-AM were more than threefold those of hUCMSC-AM (p<0.05). Immunofluorescence for myogenic markers was much stronger for hUCMSC-microbead-AM than hUCMSC-AM. Muscle creatine kinase of hUCMSC-microbead-AM at 14 days was twofold that of hUCMSC-AM (p<0.05). In conclusion, hUCMSC encapsulation in novel fast-degradable microbeads inside a hydrogel matrix was investigated for muscle engineering. Compared to the usual method of seeding cells in a hydrogel matrix, hUCMSC-microbead-AM construct had greatly improved cell viability and myogenic differentiation, and hence, is promising to enhance muscle regeneration.
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Affiliation(s)
- Jun Liu
- Biomaterials and Tissue Engineering Division, Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland Dental School, Baltimore, Maryland 21201, USA
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Sharma VP, Bella H, Cadier MM, Pigott RW, Goodacre TEE, Richard BM. Outcomes in facial aesthetics in cleft lip and palate surgery: a systematic review. J Plast Reconstr Aesthet Surg 2012; 65:1233-45. [PMID: 22591614 DOI: 10.1016/j.bjps.2012.04.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/03/2012] [Accepted: 04/02/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND While there are internationally validated outcome measures for speech and facial growth in cleft lip and palate patients, there is no such internationally accepted system for assessing outcomes in facial aesthetics. METHOD A systematic critical review of the scientific literature from the last 30 years using PUBMED, Medline and Google Scholar was conducted in-line with the PRISMA statement recommendations. This encompassed the most relevant manuscripts on aesthetic outcomes in cleft surgery in the English language. RESULTS Fifty-three articles were reviewed. Four main means of determining outcome measures were found: direct clinical assessment, clinical photograph evaluation, clinical videographic assessment and three-dimensional evaluation. Cropped photographs were more representative than full face. Most techniques were based on a 5-point scale, evolving from the Asher-McDade system. Multiple panel-based assessments compared scores from lay or professional raters, the results of which were not statistically significant. Various reports based on cohorts were poorly matched for gender, age, clinical condition and ethnicity, making their results difficult to reproduce. CONCLUSIONS The large number of outcome measure rating systems identified, suggests a lack of consensus and confidence as to a reliable, validated and reproducible scoring system for facial aesthetics in cleft patients. Many template and lay panel scoring systems are described, yet never fully validated. Advanced 3D imaging technologies may produce validated outcome measures in the future, but presently there remains a need to develop a robust method of facial aesthetic evaluation based on standardised patient photographs. We make recommendations for the development of such a system.
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Affiliation(s)
- V P Sharma
- Birmingham Institute of Paediatric Plastic Surgery at Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 NH, UK.
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Sforza C, Guzzo M, Mapelli A, Ibba TM, Scaramellini G, Ferrario VF. Facial mimicry after conservative parotidectomy: a three-dimensional optoelectronic study. Int J Oral Maxillofac Surg 2012; 41:986-93. [PMID: 22456104 DOI: 10.1016/j.ijom.2012.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 02/23/2012] [Indexed: 11/30/2022]
Abstract
Facial nerve paralysis is one of several possible complications following conservative parotidectomy. To assess three-dimensional facial movements non-invasively in patients with unilateral facial palsy following parotidectomy for benign tumours, the three-dimensional coordinates of 21 soft-tissue facial landmarks were recorded in 32 patients (21 HB I, 5 HB II, 6 HB III-IV; 3 months post-surgery follow-up), and 40 control subjects, during the performance of facial movements (smile, 'surprise', eye closure, single eye closure). For all symmetric animations, control subjects had larger total mobility than patients; mobility progressively decreased in patients with larger clinical grades. For asymmetric eye closures, HB I patients and control subjects had similar total movements, while HB II patients had smaller movements, especially for the paretic side eye closure; smaller total movements were found in HB III-IV patients. The method allowed the quantitative detection of alterations in facial movements. Significant differences between patients and control subjects in the magnitude and asymmetry of movements were found.
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Affiliation(s)
- C Sforza
- Functional Anatomy Research Center, Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico, Laboratorio di Anatomia Funzionale dell'Apparato Locomotore, Dipartimento di Morfologia Umana e Scienze Biomediche Città Studi, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milano, Italy.
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Faces in 4 dimensions: Why do we care, and why the fourth dimension? Am J Orthod Dentofacial Orthop 2012; 140:895-9. [PMID: 22133956 DOI: 10.1016/j.ajodo.2011.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 07/01/2011] [Accepted: 07/01/2011] [Indexed: 11/21/2022]
Abstract
The purpose of this article is to describe a dynamic approach for 3-dimensional analyses of facial soft-tissue movements. The method and analysis have numerous applications but, most specifically, are used to assess diagnostic and treatment outcomes of soft-tissue surgery in patients with repaired cleft lip and palate.
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Analysis of lip motion using principal component analyses. J Craniomaxillofac Surg 2011; 39:232-6. [DOI: 10.1016/j.jcms.2010.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 04/09/2010] [Accepted: 04/09/2010] [Indexed: 11/17/2022] Open
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Barlow SM, Trotman CA, Chu SY, Lee J. Modification of perioral stiffness in patients with repaired cleft lip and palate. Cleft Palate Craniofac J 2011; 49:524-9. [PMID: 21247345 DOI: 10.1597/10-092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To measure and compare the perioral stiffness among three groups of pediatric subjects: a group of patients with a repaired cleft lip (and palate) who had a secondary lip revision surgery (revision), another group of patients with repaired cleft lip (and palate) who did not have secondary surgery (nonrevision), and a group of noncleft "normal" patients (noncleft). DESIGN A parallel, three-group, nonrandomized clinical trial. PARTICIPANTS A total of 16 patients with repaired cleft lip/palate who did not have lip revision, 13 patients with repaired cleft lip/palate who had lip revision surgery and were tested at 18 to 24 months postsurgery, and 27 noncleft patients. ANALYSIS Nonparticipatory perioral stiffness was sampled using a recently developed face-referenced measurement technology known as OroSTIFF. Perioral stiffness, derived as a quotient from resultant force and interangle lip span, was modeled with multilevel regression techniques. Real-time calculation of the perioral stiffness function demonstrated a significant quadratic relation between imposed interangle stretch and resultant force for each of the three groups. RESULTS This nonlinear stiffness growth function was significantly elevated in the nonrevision patients compared with the noncleft controls and is likely due to the presence of scar tissue in the upper lip; it was significantly lower among patients with cleft lip/palate who completed lip revision surgery. CONCLUSION This study demonstrates the efficacy of applying an objective measurement to map differences in perioral tissue biomechanics among patients born with orofacial clefts.
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Affiliation(s)
- Steven M Barlow
- Department of Speech-Language-Hearing, Neuroscience, Human Biology, and Bioengineering, University of Kansas, Lawrence, KS 66045-7555, USA.
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Distances between facial landmarks can be measured accurately with a new digital 3-dimensional video system. Am J Orthod Dentofacial Orthop 2010; 137:580.e1-580.e10; discussion 580-1. [PMID: 20451768 DOI: 10.1016/j.ajodo.2009.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Revised: 03/01/2009] [Accepted: 03/01/2009] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of this study was to investigate a new digital 3-dimensional infrared video system to determine its accuracy, precision, and validity in measuring facial distances. METHODS Bench experiments were performed by measuring the vertical and diagonal distances of chessboard squares of known length to determine the system's accuracy and precision. To test the system's validity, 16 healthy volunteers participated in this study. Vertical and horizontal distances of the face were measured electronically at rest, and on posed and aggressive smiles. All measurements were repeated after 8 weeks. Direct measurements of the intercanthal distance were obtained twice with calipers. RESULTS A minor systematic error was found in the bench experiments, with the highest absolute error of 0.227 +/- 0.39 mm. The analysis with this video system showed good reproducibility of all measured distances when the mean of 2 frames was used to compare distances. Digital measurements of the intercanthal distances showed high agreement with the clinically obtained values. CONCLUSIONS This digital video system can measure geometric distances in a 3-dimensional environment with high precision. Facial distances can be measured with good accuracy and precision, allowing applications in research and clinical practice.
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Sforza C, Mapelli A, Galante D, Moriconi S, Ibba TM, Ferraro L, Ferrario VF. The effect of age and sex on facial mimicry: a three-dimensional study in healthy adults. Int J Oral Maxillofac Surg 2010; 39:990-9. [PMID: 20598508 DOI: 10.1016/j.ijom.2010.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 02/14/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
Abstract
To assess sex- and age-related characteristics in standardized facial movements, 40 healthy adults (20 men, 20 women; aged 20-50 years) performed seven standardized facial movements (maximum smile; free smile; "surprise" with closed mouth; "surprise" with open mouth; eye closure; right- and left-side eye closures). The three-dimensional coordinates of 21 soft tissue facial landmarks were recorded by a motion analyser, their movements computed, and asymmetry indices calculated. Within each movement, total facial mobility was independent from sex and age (analysis of variance, p>0.05). Asymmetry indices of the eyes and mouth were similar in both sexes (p>0.05). Age significantly influenced eye and mouth asymmetries of the right-side eye closure, and eye asymmetry of the surprise movement. On average, the asymmetry indices of the symmetric movements were always lower than 8%, and most did not deviate from the expected value of 0 (Student's t). Larger asymmetries were found for the asymmetric eye closures (eyes, up to 50%, p<0.05; mouth, up to 30%, p<0.05 only in the 20-30-year-old subjects). In conclusion, sex and age had a limited influence on total facial motion and asymmetry in normal adult men and women.
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Affiliation(s)
- C Sforza
- Functional Anatomy Research Center, Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico, Dipartimento di Morfologia Umana e Scienze Biomediche Città Studi, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, via Mangiagalli 31, Milan, Italy.
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Intraobserver reliability of the 2-dimensional analysis of facial expressions. J Oral Maxillofac Surg 2010; 68:1498-503. [PMID: 20561465 DOI: 10.1016/j.joms.2009.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Accepted: 09/01/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of our study was to develop a reliable method to identify certain facial expressions of the lower face that are easy to re-create through proper instruction and with high reproducibility. We wanted to quantitatively evaluate facial expressions in a simple, efficient, and inexpensive manner that is easily applicable in many clinical settings and in a wide variety of patients. MATERIALS AND METHODS We included 40 healthy subjects (20 women [mean age, 25.6 years] and 20 men [mean age, 27.0 years]). A digital camcorder recorded a video sequence (video 1) where the subject was verbally asked to execute several facial expressions (posed smile, spontaneous smile, aggressive smile, lip pucker, and maximum opening). Two weeks later, the video session was repeated (video 2). Frames of each expression were selected from the digitized video sequences. Horizontal and vertical distances were measured in each selected frame. RESULTS We found no statistically significant differences between the 2 videos of the expressions studied (except vertical lip changes for posed smile, lip pucker, and maximum mouth opening expression). The calculated coefficient of reliability was high and varied between 0.994 and 0.996, which confirms the reliability of the method. CONCLUSION This 2-dimensional method is an accurate means to quantitatively evaluate facial expressions in a simple, efficient, and inexpensive manner. The lip pucker, posed smile, spontaneous smile, and aggressive smile were the best and most reproducible expressions of the chosen expressions in this study.
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Okamoto H, Haraguchi S, Takada K. Laterality of Asymmetry in Movements of the Corners of the Mouth during Voluntary Smile. Angle Orthod 2010; 80:223-9. [DOI: 10.2319/021809-104.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Haruna Okamoto
- Postdoctoral, Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Suita, Japan
| | - Seiji Haraguchi
- Assistant Professor, Department of Orthodontics and Dentofacial Orthopedics, Osaka University, Suita, Japan
| | - Kenji Takada
- Professor and Chair, Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry; Adjunct Professor, Center for Advanced Medical Engineering and Informatics, Osaka University, Suita, Japan
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Sforza C, Galante D, Shirai YF, Ferrario VF. A three-dimensional study of facial mimicry in healthy young adults. J Craniomaxillofac Surg 2009; 38:409-15. [PMID: 19932974 DOI: 10.1016/j.jcms.2009.10.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 10/14/2009] [Accepted: 10/21/2009] [Indexed: 10/20/2022] Open
Abstract
To assess sex-related characteristics in facial movements, and to define a set of reference normal values, 20 healthy young adults (10 men, 10 women) performed six standardized facial movements (maximum smile; free smile; "surprise" with closed mouth; "surprise" with open mouth; right- and left-side eye closures). The three-dimensional coordinates of 21 soft-tissue facial landmarks were recorded by an optoelectronic motion analyzer, their movements computed, and standardized for facial dimensions. Asymmetry indices were calculated. The mouth area had the largest movements. Sex-related differences were found only for the superciliare landmark (men had larger movements than women, p<0.001). Asymmetries in the eyes, mouth and nose were similar in both sexes (p>0.01), with a significant effect of movement (p<0.001): eye and mouth asymmetry was larger during the asymmetric eye closures than during the symmetric movements. The right-side asymmetric movements were somewhat larger than the left-side ones. The total facial movement did not differ between sexes; the "surprise with mouth open" movement had the largest landmark displacements (p<0.001). In conclusion, normal young adult men and women had similar standardized facial movements, except in the forehead. Some individual asymmetry was found in symmetric facial animations; some synkinesis was found even in normal adults.
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Affiliation(s)
- Chiarella Sforza
- Dipartimento di Morfologia Umana e Scienze Biomediche Città Studi, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milano, Italy.
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Abstract
The aim of this research was to determine a reliable method for quantitatively evaluating the facial expressions of children and adults in order to assess their dependence on age and gender. This study evaluated 80 healthy subjects divided into four groups: 20 girls (mean age 10.6 years), 20 boys (mean age 10.8 years), 20 females (average age 25.6 years), and 20 males (average age 27.0 years). A video was used to record each individual executing three facial expressions: a rest pose, a lip pucker, and a posed smile. Representative video frames were chosen for each individual's expressions; they were digitized and then analysed with software that extracted a set of horizontal and vertical distances of the face. All distances measured in the posed smile and lip pucker were expressed as a percentage change from the rest pose. Statistical analysis with a two-way multivariate analysis of variance (MANOVA) was performed, with gender and age as the independent variables. It was evident that the ability to produce certain facial expressions differs between groups of individuals due to gender and age. Males had a greater upward vertical movement capacity in the studied facial expressions than females. Females had a more pronounced horizontal component in the posed smile. There was a trend from childhood to adulthood showing an increase in the percentage change in most vertical movements. This trend was present in both genders, though more pronounced in males. Using a robust quantitative method for collecting and analysing facial expressions, gender differences in adults were detected as well as differences between adults and children. The trend toward increasing vertical movements in adults compared with children suggests the possibility that the mimic musculature is developmentally regulated.
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Affiliation(s)
- Odyssia Houstis
- Department of Orthodontics, School of Dentistry, University of Geneva, Switzerland.
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Trotman CA, Phillips C, Essick GK, Faraway JJ, Barlow SM, Losken HW, van Aalst J, Rogers L. Functional outcomes of cleft lip surgery. Part I: Study design and surgeon ratings of lip disability and need for lip revision. Cleft Palate Craniofac J 2008; 44:598-606. [PMID: 18177192 DOI: 10.1597/06-124.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Children with a cleft of the upper lip exhibit obvious facial disfigurement. Many require multiple lip surgeries for an optimal esthetic result. However, because the decision for lip revision is based on subjective clinical criteria, clinicians may disagree on whether these surgeries should be performed. To establish more reliable, functionally relevant outcome criteria for evaluation and treatment planning, a clinical trial currently is in progress. In this article, the design of the clinical trial is described and results of a study on subjective evaluations of facial form by surgeons for or against the need for lip revision surgery are presented. DESIGN Parallel, three-group, nonrandomized clinical trial and subjective evaluations/ratings of facial views by surgeons. SUBJECTS For the clinical trial, children with repaired cleft lip and palate scheduled for a secondary lip revision, children with repaired cleft lip and palate who did not have lip revision, and noncleft children. For the subjective evaluations, surgeons' facial ratings of 21 children with repaired cleft lip. ANALYSIS Descriptive and Kappa statistics assessing the concordance of surgeons' ratings of (a) repeated facial views and (b) a recommendation of revision on viewing the prerevision and postrevision views. RESULTS The surgeons' consistency in rating repeated views was moderate to excellent; however, agreement among the surgeons when rating individual participants was low to moderate. CONCLUSIONS The findings suggest that the agreement among surgeons was poor and support the need for more objective measures to assess the need for revision surgery.
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Affiliation(s)
- Carroll-Ann Trotman
- Department of Orthodontics, University of North Carolina at Chapel Hill 27599-7450, USA.
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Trotman CA, Faraway JJ, Losken HW, van Aalst JA. Functional outcomes of cleft lip surgery. Part II: Quantification of nasolabial movement. Cleft Palate Craniofac J 2008; 44:607-16. [PMID: 18177193 DOI: 10.1597/06-125.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore nasolabial movements in participants with repaired cleft lip and palate. DESIGN A parallel, three-group, nonrandomized clinical trial. SUBJECTS Group 1=31 participants with a cleft lip slated for revision surgery (revision), group 2=32 participants with a cleft lip who did not have surgery (nonrevision), and group 3=37 noncleft control participants. METHODS Three-dimensional movements were assessed using a video-based tracking system that captured movement of 38 landmarks placed at specific sites on the face during instructed maximum smile, cheek puff, lip purse, mouth opening, and natural smile. Measurements were made at two time points at least 1 week and no greater than 3 months apart. Summary measurements were generated for the magnitude of upper lip, lower lip, and lower jaw movements and the asymmetry of upper lip movement. Separate regression models were fitted to each of the summary measurements. RESULTS Lateral movements of the upper lip were greater than vertical movements. Relative to the noncleft group, the revision and nonrevision groups demonstrated 6% to 28% less upper lip movements, with the smiles having the most restriction in movement and greater asymmetry of upper lip movement. Having an alveolar bone graft further increased the asymmetry, while a bilateral cleft lip decreased the asymmetry. Lower jaw movement caused a small increase in upper lip movement. CONCLUSIONS The objective measurement of movement may be used as an outcome measure for cleft lip surgery.
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Affiliation(s)
- Carroll-Ann Trotman
- Department of Orthodontics, University of North Carolina at Chapel Hill 27599-7450, USA.
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Trotman CA, Barlow SM, Faraway JJ. Functional outcomes of cleft lip surgery. Part III: Measurement of lip forces. Cleft Palate Craniofac J 2008; 44:617-23. [PMID: 18177195 DOI: 10.1597/06-138.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate lip force dynamics among participants with a repaired cleft of the lip and noncleft control participants. DESIGN A parallel, three-group, nonrandomized clinical trial. SUBJECTS Forty-eight participants with cleft lip and 36 noncleft participants. ANALYSIS Participants attended two separate visits. At each visit, they were instructed to produce fine motor control and maximum compression forces with each upper and lower lip in response to visual force targets. Measures of force were extracted, and the data were fit using regression techniques. RESULTS The upper and lower lips of the participants with a cleft lip demonstrated less time on target, while the lower lips had shorter rise time but higher peak forces, a higher rate of force recruitment, and increased maxima of the first derivative of force compared with the noncleft participants. For all participants, there was a learning effect for certain force variables between the two visits and with increasing age. CONCLUSION For participants with a cleft lip, force regulation of the circumoral region within the operating range presumed important for facial and speech animation is compromised because of impairments in force recruitment, gradation, fractionation, and stability. In the presence of a change in upper lip tissue mechanics due to scarring or neuromotor impairment, such as a cleft, the lower lip typically exhibits compensatory motor actions.
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Affiliation(s)
- Carroll-Ann Trotman
- Department of Orthodontics, University of North Carolina at Chapel Hill 27599-7450, USA.
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Trotman CA, Faraway JJ, Phillips C. Visual and statistical modeling of facial movement in patients with cleft lip and palate. Cleft Palate Craniofac J 2005; 42:245-54. [PMID: 15865457 PMCID: PMC3681529 DOI: 10.1597/04-010.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze and display facial movement data from noncleft subjects and from patients with cleft lip and palate by using a new dynamic approach. The hypothesis was that there are differences in facial movement between the patients with cleft lip and palate and the noncleft subjects. SETTING Subjects were recruited from the University of North Carolina School of Dentistry Orthodontic and Craniofacial Clinics. PATIENTS, PARTICIPANTS Sixteen patients with cleft lip and palate and eight noncleft "control" subjects. INTERVENTIONS Video recordings and measurements in three dimensions of facial movement. MAIN OUTCOME MEASURES Principal component (PC) scores for each of six animations or movements and dynamic modeling of mean animations. STATISTICS Multivariate statistics were used to test for significant differences in the PC mean scores between the patient groups and the noncleft groups. RESULTS No statistically significant differences were found in PC mean scores between the patient groups and the noncleft groups; however, the variability of the effect of clefting on the soft tissues during animation was noted when the noncleft data were used to establish a "normal" scale of movement. Compensatory movements were seen in some of the patients with cleft lip and palate, and the compensation was not unidirectional. CONCLUSION Measures of mean movement differences as summarized by PC scores between patients with cleft lip and palate and noncleft subjects may be misleading because of extreme variations about the mean in the patient group that may neutralize group differences. It may be more appropriate to compare patients to a noncleft normal scale of movement.
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Affiliation(s)
- Carroll-Ann Trotman
- Department of Orthodontics, School of Dentistry, University of North Carolina at Chapel Hill, 27599-7450, USA.
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Essick GK, Dorion C, Rumley S, Rogers L, Young M, Trotman CA. Report of altered sensation in patients with cleft lip. Cleft Palate Craniofac J 2005; 42:178-84. [PMID: 15748109 PMCID: PMC3646299 DOI: 10.1597/03-124.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine whether patients with cleft lip have normal perioral sensation. DESIGN Each subject was carefully questioned about the following: sensation in the face at rest, light touch of different areas, and sensation in natural situations (e.g., exposure to cold weather) that reveal sensory abnormalities. A cotton-tip applicator stick was stroked lightly across the facial skin. The subject's descriptions of the evoked sensations were used to identify and outline areas with abnormal sensation. SETTING Data were obtained from subjects participating in a longitudinal, university-based study of the functional outcomes of lip revision surgery. PATIENTS Seventeen patients with cleft lip and 12 control subjects (aged 7 to 22 years, mean 12.9 years) participated. RESULTS In contrast to control subjects, 9 of 16 patients (56%) reported loss in sensation, described as decreased touch, scratch, tickle, or tingle intensity. Six other patients (38%) reported additional sensation, described as increased scratch, tickle, or tingle intensity. In eight patients, the altered sensation was restricted to the skin area flanking and including the visible scar, encompassing no more than 25% of the total area bound by the inferior nose, nasolabial grooves and inferior vermilion. In seven patients (unilateral cleft), the altered area extended to the contralateral, noncleft side of the upper lip or onto the philtrum. CONCLUSIONS In contrast to the literature, sensation in the upper lip of many patients with cleft lip is not normal. Loss in sensation is exhibited most commonly and limited largely to the skin overlying tissues traumatized during reconstructive surgery.
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Affiliation(s)
- Greg K Essick
- Department of Prosthodontics and Curriculum in Neurobiology, University of North Carolina, Chapel Hill, North Carolina 27599-7450, USA.
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Trotman CA, Faraway JJ. Modeling facial movement: I. A dynamic analysis of differences based on skeletal characteristics. J Oral Maxillofac Surg 2004; 62:1372-9. [PMID: 15510358 DOI: 10.1016/j.joms.2004.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To introduce a novel approach to analyze and model facial movements; and to quantify variations in facial movement caused by the extent of skeletal differences between the maxilla and mandible and the middle to lower facial heights. The hypothesis was that there are differences in facial movement related to the underlying facial skeleton which may be explained by the shape of the face rather than the pattern of movement. PATIENTS AND METHODS The study sample consisted of 43 subjects (23 men, 20 women) with a mean age of 18.5 years (SD = 11.90). Measures of the facial skeletal differences were made from lateral cephalometric radiographs, and subjects were classified as Class I and Class II, and normal to decreased lower anterior face height, respectively. Facial movements were recorded by a video-based tracking system. Descriptive and inferential statistics were performed on principal component scores generated from the movement data. A linear mixed-effects model was used to test for significant differences in movement among the different skeletal types. RESULTS A dynamic modeling of facial movements was described that has numerous potential clinical applications. Also, differences in movement were found during the lip purse movement. Specifically, skeletal Class I individuals showed greater forward and upward movement during lip purse compared with individuals with severe skeletal Class II who moved their lips straight forward with less magnitude of movement. CONCLUSION For most of the movements, apart from the lip purse, differences in motion were explained by static facial shape.
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Affiliation(s)
- Carroll-Ann Trotman
- Department of Orthodontics, University of North Carolina, School of Dentistry, Chapel Hill 27599-7450, USA
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Nooreyazdan M, Trotman CA, Faraway JJ. Modeling facial movement: II. A dynamic analysis of differences caused by orthognathic surgery. J Oral Maxillofac Surg 2004; 62:1380-6. [PMID: 15510359 PMCID: PMC4044706 DOI: 10.1016/j.joms.2004.03.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to determine the facial movement characteristics of patients who underwent orthognathic surgery. The specific aims were to determine the presurgery versus postsurgery differences in facial movements; to determine whether the presurgery facial movements were similar among patients with different dentofacial deformities; and to determine whether patients have a more similar post- than presurgery dentofacial morphology and soft tissue movement. The hypothesis was that there are differences between the pre- and postsurgery facial movements. PATIENTS AND METHODS The sample consisted of 19 patients (11 women, 8 men) with a mean age of 20.6 years (SD +/- 8.34). Facial movement and lateral cephalometric data were collected at presurgery, and at 6 and 12 months postsurgery. Measures of the facial skeletal differences were made from lateral cephalometric radiographs and facial movements were recorded by a video-based tracking system. Descriptive and inferential statistics were performed on principal component scores generated from the movement data. A linear mixed-effects model was used to test for significant differences in movement. RESULTS Differences were found between the presurgery and 12-month postsurgery visits for the instructed smile, lip purse, eye closure, grimace, and mouth opening movements as well as the natural smile. Also, there were significant differences at presurgery among the dentofacial groups for the lip purse movement but no differences were found at postsurgery for any of the movements. CONCLUSION These findings suggest that facial movements are effected by skeletal malocclusion and orthognathic surgical procedures.
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Trotman CA, Phillips C, Faraway JJ, Ritter K. Association Between Subjective and Objective Measures of Lip Form and Function: An Exploratory Analysis. Cleft Palate Craniofac J 2003. [DOI: 10.1597/1545-1569(2003)040<0241:absaom>2.0.co;2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ritter K, Trotman CA, Phillips C. Validity of Subjective Evaluations for the Assessment of Lip Scarring and Impairment. Cleft Palate Craniofac J 2002. [DOI: 10.1597/1545-1569(2002)039<0587:voseft>2.0.co;2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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