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Ronde EM, Nolte JW, Becking AG, Breugem CC. Interrater Reliability for Classifying Craniofacial Microsomia Severity: A Call for Objective Evaluation. Cleft Palate Craniofac J 2023:10556656231216557. [PMID: 37993999 DOI: 10.1177/10556656231216557] [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: 11/24/2023] Open
Abstract
OBJECTIVE The severity of craniofacial microsomia (CFM) is generally classified using the Orbit, Mandible, Ear, Soft tissue, Nerve (OMENS) classification score. The global assessment of the Phenotypic Assessment Tool for Craniofacial Microsomia (PAT-CFM), is a pictorial modification of the OMENS classification. The aim of this study was to assess the interrater reliability of the PAT-CFM global assessment score. DESIGN In this prospective cohort study, three clinicians completed the global assessment form of the PAT-CFM. The mandible was classified based on orthopantomogram- and/or computed tomography images. PARTICIPANTS Consecutive patients with CFM or microtia. Interrater agreement was calculated using the weighted Krippendorff alpha (α), with 95% confidence intervals (CI). RESULTS In total, 53 patients were included (106 hemifaces). The reliabilities of the main classification components ranged from high for the mandible (α = 0.904 [95% CI 0.860-0.948]) and ear (α = 0.958 [95% CI 0.934-0.983]) subscales, to tentative for the orbital summary score (α = 0.682 [0.542-0.821]), and nerve summary score (α = 0.782 [0.666-0.900]) subscales. CONCLUSIONS The reliability of the ear and radiographic mandible scales of the PAT-CFM global classification were high, while the orbit, facial nerve and soft tissue subscales may have limited reliability. Research focusing on radiographic severity scores for hypoplasia of the orbits and soft tissues, as well as objective measures for overall facial hypoplasia using non-ionizing forms of imaging for early classification, are warranted.
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Affiliation(s)
- Elsa M Ronde
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, the Netherlands
- Amsterdam UMC Expert Center for Cleft, Craniofacial and Airway Disorders, Amsterdam, the Netherlands
| | - Jitske W Nolte
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC Expert Center for Cleft, Craniofacial and Airway Disorders, Amsterdam, the Netherlands
| | - Alfred G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, the Netherlands
- Amsterdam UMC Expert Center for Cleft, Craniofacial and Airway Disorders, Amsterdam, the Netherlands
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, the Netherlands
- Amsterdam UMC Expert Center for Cleft, Craniofacial and Airway Disorders, Amsterdam, the Netherlands
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Fan W, Rokohl AC, Maus J, Guo Y, Ju X, Li X, Wawer Matos PA, Heindl LM. Evaluation of the Portable Next-Generation VECTRA H2 3D Imaging System for Measuring Upper Eyelid Area and Volume. Aesthet Surg J 2023; 43:1114-1123. [PMID: 37157856 DOI: 10.1093/asj/sjad136] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Although a portable 3-dimensional (3D) imaging system has been used for periocular measurement analysis, this system has yet to be tested and validated for periocular area and volume measurements. OBJECTIVES The aim of this study was to define the upper eyelid and upper eyelid fold region through a modified landmark strategy and validate a portable 3D imaging system for area and volume measurements in this periocular region. METHODS Eighty-one healthy adult Caucasians underwent 3D facial imaging with the VECTRA M3 (static) and VECTRA H2 (portable) 3D imaging systems (Canfield Scientific, Inc., Parsippany, NJ). Subsequently, the upper eyelid and upper eyelid fold regions were selected according to a modified landmark localization strategy. Direct measurements of area and volume were performed to assess intrarater, interrater, intramethod, and intermethod reliability, and to compare the agreement between the 2 devices. RESULTS The VECTRA M3 and H2 showed high reliability on upper eyelid area measurements. Excellent intra-, inter-, and intramethod reliability agreements were observed in intraclass correlation coefficient; very good agreement in intrarater reliability was observed in the relative error of measurement (REM) and relative technical error of measurement (rTEM); and good inter- and intramethod reliability were observed in the REM and rTEM. For area measurement of the upper eyelid fold, the intrarater, interrater, and intramethod reliability of the M3 was lower than that of the H2. Both systems had poor intrarater, interrater, and intramethod reliability for volume measurements in the upper eyelid and upper eyelid fold region. CONCLUSIONS This new portable 3D imaging system achieved excellent or very good reliability values for standardized direct measurements of the upper eyelid and upper eyelid fold region, although volume measurements seem less reliable.
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Fan W, Guo Y, Hou X, Liu J, Li S, Ju S, Matos PAW, Simon M, Rokohl AC, Heindl LM. Validation of the Portable Next-Generation VECTRA H2 3D Imaging System for Periocular Anthropometry. Front Med (Lausanne) 2022; 9:833487. [PMID: 35360740 PMCID: PMC8962622 DOI: 10.3389/fmed.2022.833487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Portable three-dimensional imaging systems are becoming increasingly common for facial measurement analysis. However, the reliability of portable devices may be affected by the necessity to take three pictures at three time points. The purpose of this study was to evaluate the effectiveness of portable devices for assessing the periocular region. Methods In 60 Caucasian volunteers (120 eyes), four facial scans (twice for each instrument) using the portable VECTRA H2 and static VECTRA M3 devices were performed; patients' heads were kept straight, looking ahead, with a neutral facial expression. One assessor set 52 periocular landmarks in the periocular area of each image and subsequently assessed intra- and inter-device reliability by comparing two within-device measurements and one between-device measurement, respectively. Results The mean absolute difference (MAD) (0.13 and 0.12 units), relative error of measurement (REM) (0.61 and 0.68%), technical error of measurement (TEM)(1.02 and 0.80 units), relative TEM (rTEM) (5.51 and 4.43%), and intraclass correlation coefficient (ICC) (0.89, 0.89) showed good intra-device reliability for M3 and H2; MAD (0.63, 0.62 units), REM (2.83, 2.69%), TEM (1.31, 1.10 units), rTEM (7.62, 5.57%), and ICC (0.79, 0.83) indicated that inter-device reliability deteriorated compared to intra-device reliability and that the inter-device reliability of the first scan (moderate) was lower than that of the average of the two scans (good). Conclusions The portable VECTRA H2 device proved reliable in assessing most periocular linear distances, curve distances, and angles; some improvement in inter-device reliability can be achieved by using the average of two scans.
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Affiliation(s)
- Wanlin Fan
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Yongwei Guo
- Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyi Hou
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jinhua Liu
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Senmao Li
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sitong Ju
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philomena Alice Wawer Matos
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Simon
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander C. Rokohl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- *Correspondence: Alexander C. Rokohl
| | - Ludwig M. Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
- Ludwig M. Heindl
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Aleixo F, O’Callaghan SA, Ducla Soares L, Nunes P, Prieto R. AragoJ: A free, open‐source software to aid single camera photogrammetry studies. Methods Ecol Evol 2020. [DOI: 10.1111/2041-210x.13376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Luís Ducla Soares
- Instituto de Telecomunicações Instituto Universitário de Lisboa (ISCTE‐IUL) Lisbon Portugal
| | - Paulo Nunes
- Instituto de Telecomunicações Instituto Universitário de Lisboa (ISCTE‐IUL) Lisbon Portugal
| | - Rui Prieto
- MARE—Marine and Environmental Sciences Centre Lisbon Portugal
- OKEANOS and IMAR Centre at the University of the Azores Ponta Delgada Portugal
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Ritschl LM, Wolff KD, Erben P, Grill FD. Simultaneous, radiation-free registration of the dentoalveolar position and the face by combining 3D photography with a portable scanner and impression-taking. Head Face Med 2019; 15:28. [PMID: 31767030 PMCID: PMC6876115 DOI: 10.1186/s13005-019-0212-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022] Open
Abstract
Objectives Simultaneous, radiation-free registration of the teeth and the upper and lower jaw positions in relation to the extraoral soft tissue could improve treatment planning and documentation. The purpose of this study is to describe a workflow to solve this form of registration and surface acquisition with a mobile device. Methods Facial scans of ten healthy participants were taken using a blue-light LED 3D scanner (Artec® Space Spider; Artec® Group; Luxembourg). An impression of the maxillary dentoalveolar arch was taken simultaneously to the 3D photo using a modified impression tray with two different extraoral registration geometries (sphere vs. cross). Following, an impression of the mandibular dentoalveolar arch was taken once. Both impressions were scanned with the 3D scanner. All resulting standard tesselation language (.stl) files of the geometries were compared to the original, virtual .stl files and the root mean square errors (RMSE) were calculated for each surface (Artec Studio 13 Professional × 64; Artec® Group; Luxembourg) to determine which geometry serves as a better reference for intra-extraoral registration. Results The RMSE between the original geometries and the scanned counterfeits were statistically lower for spherical geometries (p < 0.008). Once scanned and aligned, both geometries enabled an alignment of the intra- and extraoral scan. However, the spherical geometries showed virtually better results without significance (p = 0.70). Conclusions The presented study provides a radiation-free solution for simultaneous dentoalveolar correlations in relation to the extraoral soft tissue. Spherical geometries achieved more precise and easier intra-extraoral alignments using the applied mobile 3D scanner and workflow.
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Collett BR, Chapman K, Wallace ER, Kinter SL, Heike CL, Speltz ML, Werler M. Speech, Language, and Communication Skills of Adolescents With Craniofacial Microsomia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1571-1581. [PMID: 31580699 PMCID: PMC7251598 DOI: 10.1044/2019_ajslp-19-0089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
Purpose Youth with craniofacial microsomia (CFM) have anomalies and comorbidities that increase their risk for speech, language, and communication deficits. We examined these outcomes in youth with and without CFM and explored differences as a function of CFM phenotype and hearing status. Method Participants included youth ages 11-17 years with CFM (n = 107) and demographically similar controls (n = 306). We assessed speech intelligibility, articulation, receptive and expressive language, and parent and teacher report measures of communication. Hearing status was also screened at the study visit. Group differences were estimated using linear regression analyses with standardized effect sizes (ES) adjusted for demographic characteristics (adjusted ES) or negative binomial regression. Results Youth with CFM scored lower than unaffected peers on most measures of intelligibility, articulation, expressive language, and parent- and-teacher-rated communication. Differences were most pronounced among participants with CFM who had mandibular hypoplasia plus microtia (adjusted ES = -1.15 to -0.18). Group differences were larger in youth with CFM who failed the hearing screen (adjusted ES = -0.73 to 0.07) than in those who passed the hearing screen (adjusted ES = -0.34 to 0.27). Conclusions Youth with CFM, particularly those with mandibular hypoplasia plus microtia and/or hearing loss, should be closely monitored for speech and language concerns. Further research is needed to identify the specific needs of youth with CFM as well as to document the course of speech and language development in children with CFM.
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Affiliation(s)
- Brent R Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, WA
| | - Kathy Chapman
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Erin R Wallace
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | | | | | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, WA
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Ritschl LM, Grill FD, Mittermeier F, Lonic D, Wolff KD, Roth M, Loeffelbein DJ. Evaluation of a portable low-budget three-dimensional stereophotogrammetry system for nasal analysis. J Craniomaxillofac Surg 2018; 46:2008-2016. [PMID: 30322779 DOI: 10.1016/j.jcms.2018.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/28/2018] [Accepted: 04/25/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) photogrammetry has reached high standards and accuracy but is mainly conducted with stationary and expensive systems. The purpose of this study was to evaluate the accuracy of a low-budget portable system with special regard to the gracile and challenging nasal region. MATERIAL AND METHODS 3D models of the perinasal area were acquired by impression-taking and the scanning of the generated plaster models (3Shape D500) or with a portable low-budget 3D stereophotogrammetry (FUEL3D® SCANIFY®) system. Four examiners analysed defined landmarks of the generated Standard Tessellation Language files with regard to accuracy and interobserver reliability by using 3dMDvultus™ software. A semi-automatic 3D best-fit analysis of both models was performed by using Geomagic® and the Root Mean Squared (RMS) errors were calculated. RESULTS 41 volunteers were included, with 22 perinasal and perioral landmarks, 15 3D distances and eight 3D angles being analysed per data set. In a point-based analysis the mean spreads were partially smaller in the plaster model scans. Most measurements showed very high (>0.8) to excellent (>0.9) intraclass correlation coefficients, the lowest being found for columella length (0.686) and left nostril width (0.636). Overall, the mean RMS error between the superimposed surfaces was 0.89 ± 0.22 mm in the best-fit analysis. CONCLUSIONS The corresponding software program was operator-friendly. The findings indicate that the analysed, affordable and portable system is a feasible solution for 3D image acquisition with comparable accuracy reported in the literature. Further studies will analyse the feasibility in neonates.
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Affiliation(s)
- Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
| | - Florian D Grill
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Fabienna Mittermeier
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Daniel Lonic
- Department of Plastic and Reconstructive Surgery, Helios Klinikum München West, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Maximilian Roth
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany; Department of Oral and Maxillofacial Surgery, Helios Klinikum München West, Germany
| | - Denys J Loeffelbein
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany; Department of Oral and Maxillofacial Surgery, Helios Klinikum München West, Germany
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Lewyllie A, Cadenas De Llano-Pérula M, Verdonck A, Willems G. Three-dimensional imaging of soft and hard facial tissues in patients with craniofacial syndromes: a systematic review of methodological quality. Dentomaxillofac Radiol 2017; 47:20170154. [PMID: 29168926 DOI: 10.1259/dmfr.20170154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To systematically review the methodological quality of three-dimensional imaging studies of patients with craniofacial syndromes and to propose recommendations for future research. METHODS PubMed, Embase and Cochrane databases as well as Grey literature were electronically searched. Inclusion criteria were patients with genetic syndromes with craniofacial manifestations and three-dimensional imaging of facial soft and/or hard tissues. Exclusion criteria consisted of non-syndromic conditions or conditions owing to environmental causes, injury or trauma, facial soft and hard tissues not included in the image analysis, case reports, reviews, opinion articles. No restrictions were made for patients' ethnicity nor age, publication language or publication date. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS The search yielded 2228 citations of which 116 were assessed in detail and 60 were eventually included in this review. Studies showed a large heterogeneity in study design, sample size and patient age. An increase was observed in the amount of studies with time, and the imaging method most often used was CT. The most studied craniofacial syndromes were Treacher Collins, Crouzon and Apert syndrome. The articles could be divided into three main groups: diagnostic studies (34/60, 57%), evaluation of surgical outcomes (21/60, 35%) and evaluation of imaging techniques (5/60, 8%). For comparative studies, the median MINORS score was 13 (12-15, 25-75th percentile), and for non-comparative studies, the median MINORS score was 8 (7-9, 25-75th percentile). CONCLUSIONS The median MINORS scores were only 50 and 54% of the maximum scores and there was a lack of prospective, controlled trials with sufficiently large study groups. To improve the quality of future studies in this domain and given the low incidence of craniofacial syndromes, more prospective multicentre controlled trials should be set up.
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Affiliation(s)
- Arianne Lewyllie
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Maria Cadenas De Llano-Pérula
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Anna Verdonck
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Guy Willems
- Department of Oral Health Sciences - Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven , Leuven , Belgium
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Mitchell RM, Saltzman BS, Norton SJ, Harrison RG, Heike CL, Luquetti DV, Sie KC. Hearing Loss in Children with Craniofacial Microsomia. Cleft Palate Craniofac J 2017; 54:656-663. [DOI: 10.1597/15-348] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the association between craniofacial phenotype and hearing loss in children with craniofacial microsomia. Design Retrospective cohort study. Setting Tertiary care children's hospital. Patients Individuals with craniofacial microsomia. Main Outcome Measures Ear-specific audiograms and standardized phenotypic classification of facial characteristics. Results A total of 79 participants were included in the study. The mean age was 9 years (range, 1 to 23 years) and approximately 60% were boys. Facial anomalies were bilateral in 39 participants and unilateral in 40 participants (24 right, 16 left). Microtia (hypoplasia of the ear) was the most common feature (94%), followed by mandibular hypoplasia (76%), soft tissue deficiency (60%), orbital hypoplasia or displacement (53%), and facial nerve palsy (32%). Sixty-five individuals had hearing loss (12 bilateral and 53 unilateral). Hearing loss was conductive in 73% of affected ears, mixed in 10%, sensorineural in 1%, and indeterminate in 16%. Hypoplasia of the ear or mandible was frequently associated with ipsilateral hearing loss, although contralateral hearing loss occurred in 8% of hemifaces. Conclusions Hearing loss is strongly associated with malformations of the ipsilateral ear in craniofacial microsomia and is most commonly conductive. Hearing loss can occur contralaterally to the side with malformations in children with apparent hemifacial involvement. Children with craniofacial microsomia should receive early diagnostic hearing assessments.
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Affiliation(s)
- Ryan M. Mitchell
- Department of Otolaryngology–Head and Neck Surgery, University of Washington
| | | | - Susan J. Norton
- Division of Pediatric Audiology, Seattle Children's Hospital
| | | | - Carrie L. Heike
- Seattle Children's Hospital, and Department of Pediatrics, University of Washington
| | - Daniela V. Luquetti
- Seattle Children's Hospital, and Department of Pediatrics, University of Washington
| | - Kathleen C.Y. Sie
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, and Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington
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Intelligence and Academic Achievement of Adolescents with Craniofacial Microsomia. Plast Reconstr Surg 2017; 140:571-580. [PMID: 28841618 DOI: 10.1097/prs.0000000000003584] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The authors compared the IQ and academic achievement of adolescents with craniofacial microsomia (cases) and unaffected children (controls). Among cases, the authors analyzed cognitive functioning by facial phenotype. METHODS The authors administered standardized tests of intelligence, reading, spelling, writing, and mathematics to 142 cases and 316 controls recruited from 26 cities across the United States and Canada. Phenotypic classification was based on integrated data from photographic images, health history, and medical chart reviews. Hearing screens were conducted for all participants. RESULTS After adjustment for demographics, cases' average scores were lower than those of controls on all measures, but the magnitude of differences was small (standardized effect sizes, -0.01 to -0.3). There was little evidence that hearing status modified case-control group differences (Wald p > 0.05 for all measures). Twenty-five percent of controls and 38 percent of cases were classified as having learning problems (adjusted OR, 1.5; 95 percent CI, 0.9 to 2.4). Comparison of cases with and without learning problems indicated that those with learning problems were more likely to be male, Hispanic, and to come from lower income, bilingual families. Analyses by facial phenotype showed that case-control group differences were largest for cases with both microtia and mandibular hypoplasia (effect sizes, -0.02 to -0.6). CONCLUSIONS The highest risk of cognitive-academic problems was observed in patients with combined microtia and mandibular hypoplasia. Developmental surveillance of this subgroup is recommended, especially in the context of high socioeconomic risk and bilingual families. Given the early stage of research on craniofacial microsomia and neurodevelopment, replication of these findings is needed. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Birgfeld CB, Heike CL, Saltzman BS, Leroux BG, Evans KN, Luquetti DV. Reliable classification of facial phenotypic variation in craniofacial microsomia: a comparison of physical exam and photographs. Head Face Med 2016; 12:14. [PMID: 27029551 PMCID: PMC4815065 DOI: 10.1186/s13005-016-0109-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/16/2016] [Indexed: 01/19/2023] Open
Abstract
Background Craniofacial microsomia is a common congenital condition for which children receive longitudinal, multidisciplinary team care. However, little is known about the etiology of craniofacial microsomia and few outcome studies have been published. In order to facilitate large, multicenter studies in craniofacial microsomia, we assessed the reliability of phenotypic classification based on photographs by comparison with direct physical examination. Methods Thirty-nine children with craniofacial microsomia underwent a physical examination and photographs according to a standardized protocol. Three clinicians completed ratings during the physical examination and, at least a month later, using respective photographs for each participant. We used descriptive statistics for participant characteristics and intraclass correlation coefficients (ICCs) to assess reliability. Results The agreement between ratings on photographs and physical exam was greater than 80 % for all 15 categories included in the analysis. The ICC estimates were higher than 0.6 for most features. Features with the highest ICC included: presence of epibulbar dermoids, ear abnormalities, and colobomas (ICC 0.85, 0.81, and 0.80, respectively). Orbital size, presence of pits, tongue abnormalities, and strabismus had the lowest ICC, values (0.17 or less). There was not a strong tendency for either type of rating, physical exam or photograph, to be more likely to designate a feature as abnormal. The agreement between photographs and physical exam regarding the presence of a prior surgery was greater than 90 % for most features. Conclusions Our results suggest that categorization of facial phenotype in children with CFM based on photographs is reliable relative to physical examination for most facial features.
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Affiliation(s)
- Craig B Birgfeld
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Carrie L Heike
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA. .,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA. .,Department of Pediatrics, University of Washington, M/S OB.9.520, PO Box 5371 4800 Sand Point Way, Seattle, WA, 98105, USA.
| | - Babette S Saltzman
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.,Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA, USA
| | - Brian G Leroux
- Department of Biostatistics, School of Public Health and Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Kelly N Evans
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics, University of Washington, M/S OB.9.520, PO Box 5371 4800 Sand Point Way, Seattle, WA, 98105, USA
| | - Daniela V Luquetti
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics, University of Washington, M/S OB.9.520, PO Box 5371 4800 Sand Point Way, Seattle, WA, 98105, USA.,Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA, USA
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Reliability of nasolabial anthropometric measures using three-dimensional stereophotogrammetry in infants with unrepaired unilateral cleft lip. Plast Reconstr Surg 2014; 133:530e-542e. [PMID: 24675205 DOI: 10.1097/prs.0000000000000014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical and orthodontic treatment of unilateral cleft lip +/- palate can produce dramatic changes in nasolabial form; however, the lack of ideal methods with which to objectively document three-dimensional form limits the ability to assess treatment outcomes. The purpose of this study was to determine the reliability of three-dimensional stereophotogrammetry for anthropometric assessment of the unilateral cleft lip +/- palate deformity in infants before cleft lip repair. METHODS Preoperative three-dimensional images were acquired from 26 consecutive patients with unrepaired unilateral cleft lip +/- palate. Three raters performed indirect anthropometry on each image on two separate occasions, with at least 1 week between rating sessions. One rater performed direct measurements on participants before surgery while in the operating room. Twenty-six linear and angular measurements were considered, and intrarater, interrater, and intermethod reliability were assessed. RESULTS Regarding intrarater and interrater reliability, most measurements had Pearson coefficients greater than 0.75, mean differences less than 0.8 mm, and mean proportional differences less than 0.1. For measurements involving vermilion height, nostril remnants, or Cupid's bow width, Pearson coefficients ranged from 0.3 to 0.75, mean differences ranged from 0.4 to 0.9 mm, and mean proportional differences ranged from 0.1 to 0.3. Regarding intermethod reliability, correlation coefficients ranged from 0.4 to 0.75 for most measurements. The mean differences for nose and lip measurements were less than 1 mm and between 0.8 and 1.3 mm, respectively. CONCLUSION Three-dimensional stereophotogrammetry provides a reliable method for many anthropometric measurements of nasolabial form in infants with unrepaired unilateral cleft lip +/- palate. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, II.
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Mooney MP, Cooper GM, Marazita ML. Cleft Palate-Craniofacial Journal 50th anniversary editorial board commentary: anatomy, basic sciences, and genetics--then and now. Cleft Palate Craniofac J 2014; 51:253-6. [PMID: 24617328 DOI: 10.1597/14-022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To celebrate the 50th year of the Cleft Palate-Craniofacial Journal we look back to where we started in 1964 and where we are now, and we speculate about directions for the future in a "Then and Now" editorial series. This editorial examines changing trends and perspectives in anatomical, basic science, and genetic studies published in this 50-year interval. In volume 1 there were 45 total papers, seven (16%) of which were peer-reviewed basic science and genetic articles published: four in anatomy, three in craniofacial biology, and none in genetics. In contrast, in volume 50, of 113 articles there were 47 (42%) peer-reviewed basic science and genetic articles published: 30 in anatomy, five in craniofacial biology, and 12 in genetics. Topical analysis of published manuscripts then and now reveal that similar topics in anatomy and craniofacial biology are still being researched today (e.g., phenotypic variability, optimal timing of surgery, presurgical orthopedics, bone grafting); whereas, most of the more recent papers use advanced technology to address old questions. In contrast, genetic publications have clearly increased in frequency during the last 50 years, which parallels advances in the field during this time. However, all of us have noticed that the more "cutting-edge" papers in these areas are not being submitted for publication to the journal, but instead to discipline-specific journals. Concerted efforts are therefore indicated to attract and publish these cutting-edge papers in order to keep the Cleft Palate-Craniofacial Journal in the forefront of orofacial cleft and craniofacial anomaly research and to provide a valuable service to American Cleft Palate-Craniofacial Association members.
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