Digital Surface Photogrammetry for Anthropometric Analysis of the Cleft Infant Face (original) (raw)
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We analyzed the facial features of Chinese children with repaired unilateral cleft lip and palate (UCLP) and compared them with a normal control group using a three-dimensional (3D) stereophotogrammetry camera. This cross-sectional study examined 3D measurements of the facial surfaces of 20 Chinese children with repaired UCLP and 40 unaffected Chinese children aged 7 to 12 years old, which were captured using the VECTRA 3D five-pod photosystem and analyzed using Mirror software. Twenty-five variables and two ratios were compared between both groups using independent t-test. Intra-and inter-observer reliability was determined using ten randomly selected images and analyzed using intra-class correlation coefficient test (ICC). The level of significance was set at p < 0.0018. Intra-and inter-observers' reliability was considered fair to excellent with an ICC value ranging from 0.54 to 0.99. Statistically significant differences (p < 0.0018) were found mainly in the nasolabial region. The cleft group exhibited wider alar base root width, flattened nose and broader nostril floor width on the cleft side. They tended to have shorter upper lip length and thinner upper vermillion thickness. Faces of Chinese children with repaired UCLP displayed meaningful differences when compared to the normal group especially in the nasolabial regions. Surgical repair of cleft lip and palate (CLP) is usually carried out early in life, with cheilorhinoplasty performed at three months of age and palatoplasty accomplished between ages of six months to one year 1. Regardless of the timing of surgery and techniques used, residual deformity and asymmetry around the nasolabial region seems to characterise the facial appearance of CLP patients 2. Among the secondary deformities observed after corrective surgery of CLP are wide alar implantations, short and flat upper lip, hypoplastic maxilla leading to upper lip retru-sion and flat nose 3. These abnormalities have an important influence on facial attractiveness and psychosocial well-being. CLP patients are more shy and socially inhibited when compared with non-cleft individuals. They also reported being teased in their childhood and adolescence; and are often stigmatised in social situations 4. Comprehensive assessment of a multitude of aspects of CLP is essential. Whilst patient satisfaction 5 , psychosocial well-being 6 , speech 7 , and dental arch relationship 8,9 have been thoroughly assessed, evaluation of facial appearance is limited. There is diversity in the assessment of cleft-related deformity and this can be broadly classified into quantitative and qualitative assessment. Qualitative evaluation of nasolabial appearance involves subjective perception of deformity without performing any measurement on the stimulus material, which can range from coloured photographs , projected colour transparencies to on-screen digital photographs 10. Asher-McDade et al. 11 developed a standardised method to assess nasolabial appearance of patients with unilateral cleft lip and palate (UCLP) using standard coloured frontal and lateral photographs. The nasolabial area is rated using a five-point ordinal scale, 1 being very good appearance and 5 being very poor. Although this method is simple and quick, it is also rather subjective and relies heavily on judges' experience and familiarity with the technique. Quantitative analysis of cleft-related deformity involves facial measurements between specified facial landmarks. The anthropometric evaluation can be conducted directly on live subjects 12 or indirectly on plaster casts 13 , two-dimensional (2D) photographs 14 , and three-dimensional (3D) imaging 15–27. While direct subject measurement was thought to be the gold standard, it has many disadvantages which include the fact that it is time consuming , requires significant patient cooperation and poses risks of injury especially when involving measurement
3D facial morphometry in children with oral clefts
Objectives: The aim of this study was to characterize three-dimensional (3D) facial morphological variation of children with cleft lip and palate compared to an age- and sexmatched control group. Design: Cross-sectional, case-controlled observational morphometric study. Materials and Methods: Subjects were 103 children aged 8 to 12 years old with cleft lip and palate—40 with unilateral cleft lip and palate, 23 with unilateral cleft lip and alveolus, 19 with bilateral cleft lip and palate, and 21 with isolated cleft palate (ICP)—and 80 sex- and age-matched control subjects. Subjects were scanned using 3D stereophotogrammetry. Thirty-nine landmarks were digitized for each scan, and the x, y, and z coordinates for each landmark were extracted. Linear and angular facial measurements were computed. Multivariate analysis of covariance was undertaken to detect significant differences in facial morphometry between the groups. Results: Statistically significant differences (P , .05) were observed between all groups. The greatest morphometrical impact was seen in those groups where both lip and palate were affected and repaired; the group with ICP was the most similar to the control subjects. Conclusions: Significant differences were seen in 3D soft-tissue measurements, mainly in the nasolabial region, between the cleft groups where the lip is affected and the ICP and control group
The Cleft Palate-Craniofacial Journal, 2016
Objective To assess a three-dimensional (3D) stereophotogrammetric method for area delimitation and evaluation of the dental arches of children with unilateral cleft lip and palate (UCLP). Obtained data were also used to assess the 3D changes occurring in the maxillary arch with the use of orthopedic therapy prior to rhinocheiloplasty and before the first year of life. Design Within the collaboration between the Università degli Studi di Milano (Italy) and the University CES of Medellin (Colombia), 96 palatal cast models obtained from neonatal patients with UCLP were analyzed using a 3D stereophotogrammetric imaging system. Main Outcome Measures The area of the minor and greater cleft segments on the digital dental cast surface were delineated by the visualization tool of the stereophotogrammetric software and then examined. “Trueness” of the measurements, as well as systematic and random errors between operators' tracings (“precision”) were calculated. Results The method gave a...
PeerJ, 2019
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 no...
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 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. 3D 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. 3D 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 agematched 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.
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 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. 3D 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. 3D 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 agematched 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.