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Harrison LM, Kenyon L, Mathew DP, Derderian CA, Hallac RR. Alar Asymmetry in Patients with Unilateral Cleft Lip: Implications for Secondary Rhinoplasty. Cleft Palate Craniofac J 2024; 61:1324-1328. [PMID: 37016740 PMCID: PMC11308346 DOI: 10.1177/10556656231168769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE Alar asymmetry in unilateral cleft lip (UCL) nasal deformity is a well-recognized clinical feature. However, there is a lack of comprehensive quantitative analysis of this asymmetry. This study compares the shape, volume, and axis rotation between the cleft and non-cleft ala in skeletally mature patients with UCL. DESIGN A retrospective comparative study utilizing three-dimensional rendered CT scans. SETTING Tertiary care pediatric institution. PATIENTS, PARTICIPANTS This study included 18 patients with UCL nasal deformity at skeletal maturity. MAIN OUTCOME MEASURE(S) Cleft and non-cleft side ala volume, surface area, and axis to the midsagittal plane. RESULTS The cleft-side ala was significantly lesser in volume by 27.3%, significantly lesser in surface area by 17.6%, and significantly greater in surface area to volume ratio by 14.6% than the non-cleft ala. The cleft-side ala was significantly greater by 43.1% horizontal axis to the midsagittal plane. In patients with primary rhinoplasty, the cleft-side ala had 28.0% less volume and 18.7% less surface area. In intermediate rhinoplasty, the cleft-side ala had 39.1% less volume and 23.5% less surface area than the non-cleft ala. CONCLUSIONS Significant asymmetry exists between the cleft-side and non-cleft ala in patients with UCL. The cleft-side ala is significantly smaller in volume and surface area than the non-cleft ala. Additionally, the cleft-side ala demonstrates a significantly greater horizontal axis that contributes considerably to nasal asymmetry, supporting the need to restore a normal vertical axis to the clef-side ala.
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Affiliation(s)
- Lucas M. Harrison
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Laura Kenyon
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Denzil P. Mathew
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Rami R. Hallac
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA
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Shiigi A, Okawachi T, Kamiya T, Hosoki D, Nomoto N, Ratman MF, Amir MS, Ishihata K, Nakamura N. Three-Dimensional Quantification of Postoperative Facial Asymmetry in Patients With Unilateral Cleft lip and Palate Using Facial Symmetry Plane. Cleft Palate Craniofac J 2024; 61:209-218. [PMID: 36112866 DOI: 10.1177/10556656221123276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE To quantitatively assess three-dimensional (3D) soft tissue facial asymmetry in patients with unilateral cleft lip and palate (UCLP) who have undergone primary lip repair. DESIGN Clinical, retrospective, comparative, methodological study. PATIENTS/PARTICIPANTS Twenty patients with UCLP were selected after a review of the records. INCLUSION CRITERIA Complete UCLP; surgically treated without secondary repair. An age-matched and sex-matched Control group was employed. MAIN OUTCOME MEASURES A 3D facial symmetry plane (FSP) was obtained by superimposing the point clouds of the original 3D facial image excluding the surgical site and including lip and nose areas and those of a mirrored facial image using the iterative closest point (ICP) adjustment method. The discrepancies in the depth and angle of the normal vector of the facial surface of each point cloud between right and left sides (cleft and non-cleft sides in the UCLP group, respectively) based on FSP were calculated. RESULTS Facial asymmetry in the UCLP group was significantly greater than in the Control group regarding both the discrepancies in the depth (1.34 ± 0.62, 0.73 ± 0.32 pixels, respectively) (P = .0004) and surface angle (18.0 ± 5.88, 12.8 ± 4.0°, respectively) (P = .0024). Biaxial assessment of the discrepancies in the depth and surface angle allowed us to visually extract UCLP patients with greater facial asymmetry. CONCLUSIONS Facial asymmetry analysis based on 3D FSP effectively facilitates the facial asymmetry quantification and soft tissue surgical outcome evaluation in patients with UCLP.
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Affiliation(s)
- Ayano Shiigi
- Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takako Okawachi
- Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tohru Kamiya
- Department of Mechanical and Control Engineering, Faculty of Engineering, Kyushu Institute of Technology, Kitakyushu, Japan
| | - Daisuke Hosoki
- Department of Mechanical and Control Engineering, Faculty of Engineering, Kyushu Institute of Technology, Kitakyushu, Japan
| | - Namiko Nomoto
- Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, Kagoshima, Japan
| | - Mohamad Farid Ratman
- Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Indonesia University, Depok, Indonesia
| | - Muhammad Subhan Amir
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia
| | - Kiyohide Ishihata
- Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, Kagoshima, Japan
| | - Norifumi Nakamura
- Department of Oral and Maxillofacial Surgery, Field of Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Sari KP, Saputro ID, Hariani L. Use of a Three-dimensional Smartphone Scanner in the Quantitative Analysis of Repaired Unilateral Cleft Lip during the Coronavirus Disease Pandemic. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4895. [PMID: 37006990 PMCID: PMC10060093 DOI: 10.1097/gox.0000000000004895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/06/2023] [Indexed: 03/31/2023]
Abstract
Cleft lip, a major craniofacial abnormality, is highly prevalent among people with low socioeconomic status in Indonesia. Direct two-dimensional measurement of the affected region is the gold standard for surgical preparation; however, its compliance and usability are limited in pediatric patients. Modern smartphones, including iPhones, are equipped with high-resolution cameras, which can record images and videos of a face. Here, we investigated whether a three-dimensional (3D) smartphone scanner can be used for the facial measurements of patients with unilateral cleft lip.
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Affiliation(s)
- Kartika P. Sari
- From the Department of Reconstructive and Aesthetic Plastic Surgery, Dr. Soetomo General Hospital affiliated to the Faculty of Medicine Airlangga University, Surabaya, Indonesia
| | - Iswinarno D. Saputro
- From the Department of Reconstructive and Aesthetic Plastic Surgery, Dr. Soetomo General Hospital affiliated to the Faculty of Medicine Airlangga University, Surabaya, Indonesia
| | - Lynda Hariani
- From the Department of Reconstructive and Aesthetic Plastic Surgery, Dr. Soetomo General Hospital affiliated to the Faculty of Medicine Airlangga University, Surabaya, Indonesia
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Facial Asymmetry Phenotypes in Adult Patients With Unilateral Cleft Lip and Palate and Skeletal Class III Malocclusion Using Principal Component Analysis and Cluster Analysis. J Craniofac Surg 2023; 34:e314-e319. [PMID: 36939920 DOI: 10.1097/scs.0000000000009284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/06/2022] [Indexed: 03/21/2023] Open
Abstract
The purpose of this study was to classify and characterize facial asymmetry (FA) phenotypes in adult patients with unilateral cleft lip and palate (UCLP) and skeletal class III malocclusion. The samples comprised 52 adult UCLP patients (36 men and 16 women; mean age, 22.43 y) who had undergone orthognathic surgery for correction of class III malocclusion. After measurement of 22 cephalometric parameters in posteroanterior cephalograms taken 1 month before orthognathic surgery, principal component analysis was performed to obtain 5 representative parameters [deviation (mm) of ANS (ANS-dev), maxillary central incisor contact point (Mx1-dev), and menton (Me-dev); cant (degree) of the maxillary anterior occlusal plane (MxAntOP-cant) and mandibular border (MnBorder-cant)]. K-means cluster analysis was conducted using these representative parameters. The differences in cephalometric parameters among the clusters were statistically analyzed. The FA phenotypes were classified into 4 types: No-cant-and-No-deviation type (cluster-4, n=16, 30.8%); MxMn-cant-MxMn-dev to the cleft-side type (cluster-3, n=4, 7.7%); Mx-cant-Mn-shift to the cleft-side type (cluster-2, n=15, 28.8%); and Mn-cant-Mn-dev to the noncleft-side type (cluster-1, n=17, 32.7%). Asymmetry in the maxilla and/or mandible were observed in 70% of patients. One third of patients (cluster-2 and cluster-3; sum, 36.5%) exhibited significant cant of MxAntOP induced by cleft and cant or shift of the mandible to the cleft side. Another one third of patients (cluster-1, 32.7%) demonstrated significant deviation and cant of the mandible to the noncleft-side despite cleft in the maxilla. This FA phenotype classification might be a basic guideline for diagnosis and treatment planning for UCLP patients.
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3D Surface Imaging Technology for Objective Automated Assessment of Facial Interventions: a Systematic Review. J Plast Reconstr Aesthet Surg 2022; 75:4264-4272. [DOI: 10.1016/j.bjps.2022.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/22/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022]
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Anthropometric Parameters of Nasomaxillary Complex in 2, 4, 6, and 12-Month-Old Children as a Reference for Cleft Lip and Palate Reconstructive Surgery. J Craniofac Surg 2021; 32:597-599. [PMID: 33704989 DOI: 10.1097/scs.0000000000006830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The purpose of this study was to analyze the morphology of the nasomaxillary complex of Iranian healthy infants of 2, 4, 6, and 12-month-old.In this cross-sectional study, 232 healthy Fars infants of 2, 4, 6, and 12-month-old referred to Mashhad health centers were evaluated. Photographic images were taken from the infants' frontal view at rest position. Anthropometric landmarks including width of the mouth, nose, columella, width and height of the philtrum, and height of the upper lip were measured by Photoshop software.The authors did not find any considerable differences in nasolabial morphology of Fars children between boys and girls, except for columellar width and the width of superior philtrum at all intervals. The mean columellar width decreased with increasing age in both sexes. The width of the lower philtrum decreased from 2 to 4 months in both sexes, but increased from 4 to 6 months. In girls, the mean height of the right and left philtrum and height of the upper lip increased by increasing age from 2 to 4 months. But it consistently reduced from 4 months to 6 and 12-month-old. In boys, the mean height of the right and left philtrum and height of the upper lip decreased from 2 to 4 months. It showed a mild increase from 4 to 6 months, and a relatively large reduction from 6 to 12 months.This study provides useful information for reconstructive surgeries of the nasolabial region in the population studied.
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Brons S, Meulstee JW, Loonen TG, Nada RM, Kuijpers MA, Bronkhorst EM, Bergé SJ, Maal TJ, Kuijpers-Jagtman AM. Three-dimensional facial development of children with unilateral cleft lip and palate during the first year of life in comparison with normative average faces. PeerJ 2019; 7:e7302. [PMID: 31392092 PMCID: PMC6677122 DOI: 10.7717/peerj.7302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Stereophotogrammetry can be used to study facial morphology in both healthy individuals as well as subjects with orofacial clefts because it shows good reliability, ability to capture images rapidly, archival capabilities, and high resolution, and does not require ionizing radiation. This study aimed to compare the three-dimensional (3D) facial morphology of infants born with unilateral cleft lip and palate (UCLP) with an age-matched normative 3D average face before and after primary closure of the lip and soft palate. METHODS Thirty infants with a non-syndromic complete unilateral cleft lip, alveolus, and palate participated in the study. Three-dimensional images were acquired at 3, 6, 9, and 12 months of age. All subjects were treated according to the primary surgical protocol consisting of surgical closure of the lip and the soft palate at 6 months of age. Three-dimensional images of UCLP patients at 3, 6 (pre-treatment), 9, and 12 months of age were superimposed on normative datasets of average facial morphology using the children's reference frame. Distance maps of the complete 3D facial surface and the nose, upper lip, chin, forehead, and cheek regions were developed. RESULTS Assessments of the facial morphology of UCLP and control subjects by using color-distance maps showed large differences in the upper lip region at the location of the cleft defect and an asymmetry at the nostrils at 3 and 6 months of age. At 9 months of age, the labial symmetry was completely restored although the tip of the nose towards the unaffected side showed some remnant asymmetry. At 12 months of age, the symmetry of the nose improved, with only some remnant asymmetry noted on both sides of the nasal tip. At all ages, the mandibular and chin regions of the UCLP patients were 2.5-5 mm posterior to those in the average controls. CONCLUSION In patients with UCLP deviations from the normative average 3D facial morphology of age-matched control subjects existed for the upper lip, nose, and even the forehead before lip and soft palate closure was performed. Compared to the controls symmetry in the upper lip was restored, and the shape of the upper lip showed less variation after primary lip and soft palate closure. At this early age, retrusion of the soft-tissue mandible and chin, however, seems to be developing already.
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Affiliation(s)
- Sander Brons
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jene W. Meulstee
- Department of Oral and Maxillofacial Surgery, Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tom G.J. Loonen
- Department of Oral and Maxillofacial Surgery, Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rania M. Nada
- Faculty of Dentistry, Kuwait University, Kuwait City, Kuwait
| | - Mette A.R. Kuijpers
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ewald M. Bronkhorst
- Department of Dentistry, Section of Preventive and Curative Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stefaan J. Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Thomas J.J. Maal
- Department of Oral and Maxillofacial Surgery, Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Chou PY, Denadai R, Chen SH, Tseng HJ, Hsu CK, Wang SW, Hallac R, Chen CH, Kane AA, Lo LJ. Identifying Three-Dimensional Facial Fluctuating Asymmetry in Normal Pediatric Individuals: A Panel Assessment Outcome Study of Clinicians and Observers. J Clin Med 2019; 8:E648. [PMID: 31083393 PMCID: PMC6571690 DOI: 10.3390/jcm8050648] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 02/05/2023] Open
Abstract
This study measured three-dimensional facial fluctuating asymmetry in 600 normal and healthy Taiwanese individuals (6 to 12 years old) and assessed the perceptions of increasing levels of facial fluctuating asymmetric severity by using a panel composed of 20 clinicians (surgical professionals), as well as 20 adult and 40 pre-adolescent observers. On average, this normal cohort presented a facial fluctuating asymmetry of 0.96 ± 0.52 mm, with 0.52 ± 0.05, 0.67 ± 0.09, 1.01 ± 0.10, and 1.71 ± 0.36 mm for levels I, II, III, and IV of severity, respectively. For all categories of raters, significant differences in the average symmetry-asymmetry scale values were observed, with level I < level II < level III = level IV (all p < 0.01, except for level III vs. IV comparisons with p > 0.05). For level I, pre-adolescent observers presented a significantly (p < 0.05) higher symmetry-asymmetry scale value than adult observers, with no significant (all p > 0.05) differences for other comparisons. For overall facial asymmetry and levels II, III, and IV, no significant (all p > 0.05) differences were observed. This study reveals that the normal pediatric face is asymmetric and the panel assessment of facial fluctuating asymmetry was influenced by the level of severity and the category of raters and contributes to the literature by revealing that pre-adolescent raters present a similar or higher perception of facial asymmetry than adult raters.
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Affiliation(s)
- Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Shih-Heng Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Hsiao-Jung Tseng
- Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
| | - Chih-Kai Hsu
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Sheng-Wei Wang
- Department of Biomedical Engineering, National Yang-Ming University, Taipei 112, Taiwan.
| | - Rami Hallac
- Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX 75207, USA.
| | - Chih-Hao Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Alex A Kane
- Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX 75207, USA.
- Department of Plastic Surgery, UT Southwestern, Dallas, TX 75390, USA.
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
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Staderini E, Patini R, Camodeca A, Guglielmi F, Gallenzi P. Three-Dimensional Assessment of Morphological Changes Following Nasoalveolar Molding Therapy in Cleft Lip and Palate Patients: A Case Report. Dent J (Basel) 2019; 7:E27. [PMID: 30866516 PMCID: PMC6473357 DOI: 10.3390/dj7010027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/25/2019] [Accepted: 02/20/2019] [Indexed: 12/16/2022] Open
Abstract
The applications of computer-guided technologies for three-dimensional image analysis provide a unique opportunity to quantify the morphological dimensional changes of the face in a practical and convenient way. Symmetry of the nasolabial area is one of the main factors of facial attractiveness as well as being the main objective of the treatment of cleft lip and palate (CLP). Technological advances in computer-guided visualization modes and their applications to three-dimensional stereophotogrammetry provide more practical opportunities and alternatives for facial analysis. Each study, however, uses different protocols for the acquisition and analysis of three-dimensional images. In addition, each study identifies different anthropometric points and calculates linear and angular measurements with overlapping protocols. Therefore, it is appropriate to define a standardization of the three-dimensional analysis of CLP patients to compare the studies of different research centers. The aim of this report is to propose a protocol to standardize the acquisition and analysis of three-dimensional images to evaluate the three-dimensional changes in the nasolabial area in cleft lip and palate patients undergoing pre-surgical nasoalveolar molding (PNAM).
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Affiliation(s)
- Edoardo Staderini
- Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Roma, Italy.
| | - Romeo Patini
- Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Roma, Italy.
| | - Andrea Camodeca
- Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Roma, Italy.
| | - Federica Guglielmi
- Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Roma, Italy.
| | - Patrizia Gallenzi
- Institute of Dentistry and Maxillofacial Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Roma, Italy.
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Nasolabial Morphology Following Nasoalveolar Molding in Infants With Unilateral Cleft Lip and Palate. J Craniofac Surg 2018; 29:1012-1016. [PMID: 29489580 DOI: 10.1097/scs.0000000000004427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM The aim of the present study is to evaluate the effects of nasoalveolar molding (NAM) therapy on nasolabial morphology three dimensionally, and compare the nasolabial linear and surface distance measurements in infants with unilateral cleft lip and palate. METHODS Facial plaster casts of 42 infants with unilateral cleft lip and palate taken at the onset (pre-NAM) and finishing stage (post-NAM) of NAM were scanned with 3dMDface stereophotogrammetry system (3dMD, Atlanta, GA). Nineteen nasolabial linear and surface distance measurements were performed on three-dimensional images. In addition to standard descriptive statistical calculations (means and SDs), pre- and post-NAM measurements were evaluated by paired t test. RESULTS All measurements except lip gap, nostril floor width, and nostril diameter increased between pre-NAM and post-NAM. Nostril and lip height increased significantly on the cleft side (P < 0.05). No differences were present between linear and surface distance measurements except for nasal width measurement. CONCLUSIONS Nasal and lip symmetry improved with NAM. The use of surface distance measurements may be advised particularly for continuous and curved anatomic structures in which circumference differences are expected.
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Objective Assessment of the Unilateral Cleft Lip Nasal Deformity Using Three-Dimensional Stereophotogrammetry: Severity and Outcome. Plast Reconstr Surg 2018; 141:547e-558e. [PMID: 29257001 DOI: 10.1097/prs.0000000000004233] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Optimization of care to correct the unilateral cleft lip nasal deformity is hampered by lack of objective measures to quantify preoperative severity and outcome. The purpose of this study was to develop a consensus standard of nasal appearance using three-dimensional stereophotogrammetry; determine whether anthropometric measurements could be used to quantify severity and outcome; and determine whether preoperative severity predicts postoperative outcome. METHODS The authors collected facial three-dimensional images of 100 subjects in three groups: 45 infants before cleft lip repair; the same 45 infants after cleft lip repair; and 45 children aged 8 to 10 years with previous repairs. Five additional age-matched unaffected control subjects were included in each group. Seven expert surgeons ranked images in each group according to nasal appearance. The rank sum score was used as consensus standard. Anthropometric analysis was performed on each image and compared to the rank sum score. Preoperative rank and anthropometric measurements were compared to postoperative rank. RESULTS Interrater and intrarater reliability was excellent (intraclass correlation coefficient, >0.76; Pearson correlation, >0.75) on each of the three image sets. Columellar angle, nostril width ratio, and lateral lip height ratio were highly correlated with preoperative severity and moderately correlated with postoperative nasal appearance. Postoperative outcome was associated with preoperative severity (rank and anthropometric measurement). CONCLUSIONS Consensus ranking of preoperative severity and postoperative outcome can be achieved on three-dimensional images. Preoperative severity predicts postoperative outcomes. Columellar angle, nostril width ratio, and lateral lip height ratio are objective measures that correlate with consensus ratings by surgeons at multiple ages.
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12
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Thierens LAM, De Roo NMC, De Pauw GAM, Brusselaers N. Quantifying Soft Tissue Changes in Cleft Lip and Palate Using Nonionizing Three-Dimensional Imaging: A Systematic Review. J Oral Maxillofac Surg 2018; 76:2210.e1-2210.e13. [PMID: 29932938 DOI: 10.1016/j.joms.2018.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE The use of nonionizing 3-dimensional (3D) imaging in cleft lip and palate (CLP) research is well-established; however, general guidelines concerning the assessment of these images are lacking. The aim of the present study was to review the methods for quantification of soft tissue changes on 3D surface images acquired before and after an orthopedic or surgical intervention in CLP patients. MATERIALS AND METHODS A systematic literature search was performed using the databases MEDLINE (through PubMed), CENTRAL, Web of Science, and EMBASE. The literature search and eligibility assessment were performed by 2 independent reviewers in a nonblinded standardized manner. Only longitudinal studies reporting the assessment of pre- and postoperative 3D surface images and at least 10 CLP patients were considered eligible. RESULTS Fifteen unique studies (reported from 1996 to 2017) were identified after an eligibility assessment. The assessment of the 3D images was performed with landmark-dependent analyses, mostly supported by superimposition of the pre- and postoperative images. A wide spectrum of superimposition techniques has been reported. The reliability of these assessment methods was often not reported or was insufficiently reported. CONCLUSIONS Soft tissue changes subsequent to a surgical or an orthopedic intervention can be quantified on 3D surface images using assessment methods that are primarily based on landmark identification, whether or not followed by superimposition. Operator bias is inherently enclosed in landmark-dependent analyses. The reliability of these methods has been insufficiently reported.
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Affiliation(s)
- Laurent A M Thierens
- Resident, Department of Orthodontics, Oral Health Sciences, Ghent University, Ghent, Belgium; and Centre for Congenital Facial Anomalies, Ghent University Hospital, Ghent, Belgium.
| | - Noëmi M C De Roo
- Resident, Department of Orthodontics, Oral Health Sciences, Ghent University, Ghent, Belgium
| | - Guy A M De Pauw
- Full Professor, Department of Orthodontics, Oral Health Sciences, Ghent University, Ghent, Belgium; and Centre for Congenital Facial Anomalies, Ghent University Hospital, Ghent, Belgium
| | - Nele Brusselaers
- Full Professor, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Centre for Translational Microbiome Research, Department of Microbiology, Cell and Tumor Biology, Karolinska Institutet, Stockholm, Sweden; and SciLifeLab, Stockholm, Sweden
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13
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Mercan E, Morrison CS, Stuhaug E, Shapiro LG, Tse RW. Novel computer vision analysis of nasal shape in children with unilateral cleft lip. J Craniomaxillofac Surg 2017; 46:35-43. [PMID: 29174554 DOI: 10.1016/j.jcms.2017.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Optimization of treatment of the unilateral cleft lip nasal deformity (uCLND) is hampered by lack of objective means to assess initial severity and changes produced by treatment and growth. The purpose of this study was to develop automated 3D image analysis specific to the uCLND; assess the correlation of these measures to esthetic appraisal; measure changes that occur with treatment and differences amongst cleft types. METHODS Dorsum Deviation, Tip-Alar Volume Ratio, Alar-Cheek Definition, and Columellar Angle were assessed using computer-vision techniques. Subjects included infants before and after primary cleft lip repair (N = 50) and children aged 8-10 years with previous cleft lip (N = 50). Two expert surgeons ranked subjects according to esthetic nose appearance. RESULTS Computer-based measurements strongly correlated with rankings of infants pre-repair (r = 0.8, 0.75, 0.41 and 0.54 for Dorsum Deviation, Tip-Alar Volume Ratio, Alar-Cheek Definition, and Columellar Angle, p < 0.01) while all measurements except Alar-Cheek Definition correlated moderately with rankings of older children post-repair (r ∼ 0.35, p < 0.01). Measurements were worse with greater severity of cleft type but improved following initial repair. Abnormal Dorsum Deviation and Columellar Angle persisted after surgery and were more severe with greater cleft type. CONCLUSIONS Four fully-automated measures were developed that are clinically relevant, agree with expert evaluations and can be followed through initial surgery and in older children. Computer vision analysis techniques can quantify the nasal deformity at different stages, offering efficient and standardized tools for large studies and data-driven conclusions.
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Affiliation(s)
- Ezgi Mercan
- University of Washington, Paul G. Allen School of Computer Science (Director: Henry M. Levy), AC101 Paul G. Allen Center for Computer Science & Engineering, 185 Stevens Way, Seattle, WA 98195, USA.
| | - Clinton S Morrison
- Cleft and Craniofacial Center, Golisano Children's Hospital (Chief, Plastic Surgery: Howard Langstein, M.D.), University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Erik Stuhaug
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital (Surgical Director: Richard A. Hopper, M.D., M.S.), 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Linda G Shapiro
- University of Washington, Paul G. Allen School of Computer Science (Director: Henry M. Levy), AC101 Paul G. Allen Center for Computer Science & Engineering, 185 Stevens Way, Seattle, WA 98195, USA
| | - Raymond W Tse
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital (Surgical Director: Richard A. Hopper, M.D., M.S.), 4800 Sand Point Way NE, Seattle, WA 98105, USA
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