Dynamic facial asymmetry in patients with repaired cleft lip using 4D imaging (video stereophotogrammetry)

Enhancing Philtrum Morphology Using Fat Grafting Combined with Percutaneous Rigottomy in Repaired Unilateral Cleft Lip

BACKGROUND

Improving the philtrum morphology of patients with a secondary cleft lip deformity has been a challenge in cleft care. Combining fat grafting with percutaneous rigottomy has been advocated for treatment of volumetric deficiency associated with a scarred recipient site. This study assessed the outcome of synchronous fat grafting and rigottomy for improvement of cleft philtrum morphology.

METHODS

Consecutive young adult patients ( n = 13) with a repaired unilateral cleft lip who underwent fat grafting combined with rigottomy expansion technique for enhancement of philtrum morphology were included. Preoperative and postoperative three-dimensional facial models were used for three-dimensional morphometric analyses including philtrum height, projection, and volume parameters. Lip scar was qualitatively judged by a panel composed by two blinded external plastic surgeons using a 10-point visual analogue scale.

RESULTS

Three-dimensional morphometric analysis revealed a significant (all P < 0.05) postoperative increase of the lip height-related measurements for cleft philtrum height, noncleft philtrum height, and central lip length parameters, with no difference ( P > 0.05) between cleft and noncleft sides. The postoperative three-dimensional projection of the philtral ridges was significantly ( P < 0.001) larger in cleft (1.01 ± 0.43 mm) than in noncleft sides (0.51 ± 0.42 mm). The average philtrum volume change was 1.01 ± 0.68 cm 3 , with an average percentage fat graft retention of 43.36% ± 11.35%. The panel assessment revealed significant ( P < 0.001) postoperative scar enhancement for the qualitative rating scale, with mean preoperative and postoperative scores of 6.69 ± 0.93 and 7.88 ± 1.14, respectively.

CONCLUSION

Synchronous fat grafting and rigottomy improved philtrum length, projection, and volume and lip scar in patients with repaired unilateral cleft lip.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Is the Nasolabial Region Symmetric in Individuals With Cleft Lip and Palate?

OBJECTIVE

To assess the nasolabial symmetry in smile and resting position in individuals with nonsyndromic unilateral cleft lip and palate (UCLP) and compare with Class I individuals without cleft lip and palate (CLP).

MATERIALS AND METHODS

Frontal photographs of 40 individuals with UCLP (mean age 14.30 ± 0.25 years; 20 female, 20 male) and 40 skeletal Class I individuals without CLP (mean age 14.60 ± 0.34 years; 20 female and 20 male) were examined. Bland-Altman Levels of Agreements, Mann-Whitney U test, independent sample t-test were conducted, and intraclass correlation coefficients (ICCs) were calculated for statistical analysis.

RESULTS

Differences in the transverse lip distance (d-d') and vertical lip height at crista philtri (e-e') were lesser in the UCLP group at smile (P = .001; P = .005, respectively). When comparing the differences in these measurements at rest between control and UCLP groups, vertical lip height was longer at crista philtri (e-e') (P = .014), crista philtri was more laterally located (f-f') (P = .002), and the transverse lip distance was greater (d-d') (P = .004) in the UCLP group. Distance of the crista philtri to the midline of the face (f-f') (P = .007) were higher in the UCLP group during smiling compared to control group.

CONCLUSIONS

Nasolabial region asymmetry in smiling and rest position in individuals with UCLP was significantly different from the control group. However, the asymmetry in the nasolabial region, which is more evident in the resting position in individuals with UCLP, decreases during smiling.

Use of 3-Dimensional Stereophotogrammetry to Detect Disease Progression in Craniofacial Morphea

Importance

Objectively determining disease progression in craniofacial morphea (CM) is challenging, as clinical findings of disease activity are often lacking.

Objective

To evaluate the utility of 3-dimensional (3D) stereophotogrammetry in detecting disease progression in CM over time.

Design, Setting, and Participants

This prospective cohort study included 27 pediatric and adult patients with CM from 2 hospitals in Boston (Boston Children's Hospital and Brigham & Women's Hospital) consecutively enrolled from April 1, 2019, to March 1, 2023. Review of 3D stereophotogrammetry images and data analysis occurred from March 1 to April 1, 2023.

Main Outcomes and Measures

Clinical and 3D stereophotogrammetry assessments were performed at 2- to 12-month intervals, depending on the clinical context. The 3D stereophotogrammetry images were then qualitatively rated as demonstrating no progression or definitive progression by an expert (board-certified plastic craniofacial surgeon) and nonexpert (board-certified dermatologist) in 3D stereophotogrammetry. In addition, κ coefficients were calculated for interrater reliability.

Results

Of 27 patients with CM (19 female; median age, 14 [range, 5-40] years) and 3D stereophotogrammetry images obtained from a minimum of 2 time points (median, 4 [range, 2-10] images) spaced a median of 3 (range, 2-12) months apart, 10 experienced progression of their disease based on clinical assessments performed during the study period. In all cases in which clinical progression was favored, blinded qualitative assessment of 3D stereophotogrammetry images also favored progression with substantial interrater reliability (κ = 0.80 [95% CI, 0.61-0.99]). Furthermore, review of 3D stereophotogrammetry detected occult progression of asymmetry not noted on clinical examination in 3 additional patients.

Conclusions and Relevance

In this prospective cohort study, blinded assessment of sequential 3D stereophotogrammetry images in patients with CM not only corroborated clinical assessment of disease progression but also detected occult progression of facial asymmetry not appreciable on clinical examination alone. Therefore, 3D stereophotogrammetry may serve as a useful adjunct to clinical examination of patients with CM over time. Future investigations are warranted to validate 3D stereophotogrammetry as an outcome measure in CM.

The impact of orthodontic-surgical treatment on facial expressions-a four-dimensional clinical trial

OBJECTIVE

The objective of this clinical trial was to compare facial expressions (magnitude, shape change, time, and symmetry) before (T0) and after (T1) orthognathic surgery by implementing a novel method of four-dimensional (4D) motion capture analysis, known as videostereophotogrammetry, in orthodontics.

METHODS

This prospective, single-centre, single-arm trial included a total of 26 adult patients (mean age 28.4 years; skeletal class II: n = 13, skeletal class III: n = 13) with indication for orthodontic-surgical treatment. Two reproducible facial expressions (maximum smile, lip purse) were captured at T0 and T1 by videostereophotogrammetry as 4D face scan. The magnitude, shape change, symmetry, and time of the facial movements were analysed. The motion changes were analysed in dependence of skeletal class and surgical movements.

RESULTS

4D motion capture analysis was feasible in all cases. The magnitude of the expression maximum smile increased from 15.24 to 17.27 mm (p = 0.002), while that of the expression lip purse decreased from 9.34 to 8.31 mm (p = 0.01). Shape change, symmetry, and time of the facial movements did not differ significantly pre- and postsurgical. The changes in facial movements following orthodontic-surgical treatment were observed independently of skeletal class and surgical movements.

CONCLUSIONS

Orthodontic-surgical treatment not only affects static soft tissue but also soft tissue dynamics while smiling or lip pursing.

CLINICAL RELEVANCE

To achieve comprehensive orthodontic treatment plans, the integration of facial dynamics via videostereophotogrammetry provides a promising approach in diagnostics.

TRIAL REGISTRATION NUMBER

DRKS00017206.

An innovative analysis of nasolabial dynamics of surgically managed adult patients with unilateral cleft lip and palate using 3D facial motion capture

AIM

To compare dynamic nasolabial movement between end-of-treatment cleft and a matched non-cleft group in adult patients.

MATERIALS AND METHODS

Thirteen treated adult participants with unilateral cleft lip and palate had images taken using a facial motion capture system performing a maximum smile. Seventeen landmarks were automatically tracked. For each landmark pair, on either side of the midline, changes in the x, y, and z directions were used to analyze the magnitude of displacement and path of motion. An asymmetry score was developed at rest, mid-smile, and maximum smile to assess the shape of the mouth and/or nose.

RESULTS

At maximum smile, displacement of right and left cheilion was clinically and statistically (p < 0.05) less in the cleft group. The lip asymmetry score was greater (p < 0.05) at each time point in the cleft group using the clinical midline. Using Procrustes superimposition, the differences were significant (p < 0.05) only at rest and mid-smile. The alar bases were displaced significantly less (p < 0.05) in the z direction in the cleft group. The asymmetry score of the alar base was significantly higher using the clinical midline than using Procrustes superimposition in patients with cleft conditions (p < 0.001). In the cleft group, at maximum smile, the right and left cristae philter moved significantly less (p < 0.05) in the x and z directions.

CONCLUSIONS

There was an increase in asymmetry score of the corners of the mouth and alar bases from rest to maximum smile. The lips were similar in shape but oriented differently in the faces of patients with cleft conditions than in individuals without those conditions.

Evaluation of Facial Esthetics Following NAM Versus CAD/NAM in Infants With Bilateral Cleft Lip and Palate: A Randomized Clinical Trial

OBJECTIVE

The aim is to compare the facial esthetics following nasoalveolar molding (NAM) versus computer-aided design NAM (CAD/NAM) in patients with bilateral cleft lip/palate (CLP).

DESIGN

The trial is a randomized comparative trial with a 1:1 allocation ratio.

PARTICIPANTS

Thirty infants with bilateral complete cleft lip and palate were recruited.

INTERVENTIONS

Patients were randomized between NAM and CAD/NAM groups. The treatment steps described by Grayson were followed for the NAM group. In the CAD/NAM group, digitized maxillary models were made to create a series of modified virtual models, which were used to fabricate the molding plates using 3-dimensional printing technology. The nasal stents were then added to the intraoral plates following the Grayson method. The study lasted for 4 months.

MAIN OUTCOMES

The assessment of the changes observed in the interlabial gap and nasolabial esthetics was done using standardized 2-dimensional photographs. The correlation between dental arch changes and extraoral facial esthetics was studied.

RESULTS

Both modalities showed improvement in nasolabial esthetics before the lip surgery. No statistically significant difference was found between NAM and CAD/NAM groups in any of the assessed variables.

CONCLUSIONS

Both interventions were effective in the management of infants with bilateral CLP.

3D assessment of the nasolabial region in cleft models comparing an intraoral and a facial scanner to a validated baseline

We aimed to validate the metric accuracy of a 3-dimensional (3D) facial scanner (FS) and an intraoral scanner (IOS) in capturing the nasolabial region in ex vivo unilateral cleft lip and palate (UCLP) models. The nasolabial region of 10 UCLP models was scanned using a 3D FS as well as an IOS and a previously validated stationary 3D scanner as a reference. Intraoral scan was performed directly on the UCLP models. In order to apply the FS on the models, they were embedded in a 3D printed sample face. Both test groups were aligned to the reference by applying a section-based best-fit algorithm. Subsequent analysis of the metric deviation from the reference was performed with a 3D analysis tool. Mean distance and integrated distance served as main parameters for surface and volume comparison. Point comparison served as an additional parameter. Statistical analysis was carried out using t-test for unconnected samples. Considering mean distance and integrated distance as main parameters for 3D evaluation of the scanner's accuracy, FS and IOS differ significantly in their metric precision in scanning the cleft model compared to the reference. The IOS proved to be significantly more accurate than the FS compared to the previously described stationary 3D scanner as reference and validated baseline. Further validation of the tested IOS and FS for 3D assessment of the nasolabial region is presented by adding the previously validated ATOS III Triple Scan blue light scanner as a reference. The IOS shows, compared to a validated baseline scan, significantly higher metric precision in experimental cleft model scanning. The collected data provides a basis for clinical application of the IOS for 3D assessment of the nasolabial region.

Comparing definitive unilateral cleft rhinoplasty with and without diced-cartilage alar-base augmentation: A retrospective cohort study

This retrospective cohort study aimed to compare the long-term aesthetic outcomes and satisfaction of patients who underwent two techniques of definitive unilateral cleft rhinoplasty. The two cohorts, comprising patients with mature unilateral cleft deformity, were managed with definitive rhinoplasty, either with or without diced-cartilage alar-base and peri-alar augmentation (ABPA). Thirty patients were included in each cohort. Anthropometric measurements, complications, patient satisfaction scores, and third-party surgeon assessment scores were reviewed. In both cohorts, anthropometric parameters improved. Rhinoplasty with ABPA was the superior cohort in terms of columellar length (10.3 ± 1.0 in the cohort with ABPA, compared with 7.9 ± 0.6 in the cohort without ABPA; p < 0.001), alar-base angle (0.2 ± 0.2, compared with 4.3 ± 0.3; p < 0.001), and columellar deviation (2.5 ± 1.4, compared with 10.3 ± 2.1; p < 0.001). This cohort also had more symmetry in nostril height and nostril width (p < 0.001), a lower recurrence rate (one case compared with 22 cases; p < 0.001), a higher patient satisfaction score (p = 0.002), and a higher surgeon assessment score (p < 0.001, Cronbach's alpha = 0.706, Kendall's coefficient of concordance = 0.787). Within the limitations of this study, it appears that the described technique for augmenting the alar-base and peri-alar maxillary area is manageable, and yields consistent long-term results.

Measuring asymmetry in facial morphea via 3-dimensional stereophotogrammetry

BACKGROUND

Objectively determining tissue loss in craniofacial morphea is challenging. However, 3-dimensional (3D) stereophotogrammetry is a noninvasive modality that may be a useful adjunct.

OBJECTIVE

To prospectively evaluate 3D stereophotogrammetry in the assessment of craniofacial linear morphea.

METHODS

Participants underwent clinical, quality-of-life, and 3D-stereophotogrammetry assessments. Traditional photographs and 3D-stereophotogrammetry images were rated as mild, moderate, or severe by 2 experts and 2 nonexperts. In addition, interrater and intrarater reliability (on delayed rescoring) were calculated.

RESULTS

Of 23 patients with craniofacial morphea, 3D stereophotogrammetry detected pathologic asymmetry in 14 (20.6%) patients. Providers rated patients as more severely affected when using 3D stereophotogrammetry versus when using traditional photographs (19% severe on 3D stereophotogrammetry vs 0% severe on traditional photographs, P = .004). Qualitative ratings of both traditional and 3D images showed high inter- and intrarater reliability between experts and nonexperts alike. Physicians' Global Assessment of Damage scores correlated with mouth asymmetry (P = .0021), cheek asymmetry (P = .04), and 3D-stereophotogrammetry ratings (median, mild: 27.5 vs moderate: 46.5 vs severe: 64, P = .0152). Lower face asymmetry correlated with worse quality-of-life scores (P = .013).

LIMITATIONS

Small sample size and cross-sectional design.

CONCLUSION

3D stereophotogrammetry can reliably detect and quantify asymmetry in craniofacial morphea with greater sensitivity than that observed with traditional assessment alone. 3D stereophotogrammetry may be a useful adjunct to clinical examination.

Static and Motion Facial Analysis for Craniofacial Assessment and Diagnosing Diseases

Deviation from a normal facial shape and symmetry can arise from numerous sources, including physical injury and congenital birth defects. Such abnormalities can have important aesthetic and functional consequences. Furthermore, in clinical genetics distinctive facial appearances are often associated with clinical or genetic diagnoses; the recognition of a characteristic facial appearance can substantially narrow the search space of potential diagnoses for the clinician. Unusual patterns of facial movement and expression can indicate disturbances to normal mechanical functioning or emotional affect. Computational analyses of static and moving 2D and 3D images can serve clinicians and researchers by detecting and describing facial structural, mechanical, and affective abnormalities objectively. In this review we survey traditional and emerging methods of facial analysis, including statistical shape modeling, syndrome classification, modeling clinical face phenotype spaces, and analysis of facial motion and affect. Expected final online publication date for the Annual Review of Biomedical Data Science, Volume 5 is August 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Evaluation of cheiloplasty and palatoplasty on palate surface area in children with oral clefts: longitudinal study

This study evaluated the palatal surface area in children with different oral clefts after primary surgeries and at five years of age. This longitudinal study was composed by 216 digital models: unilateral complete cleft lip (UCL), unilateral complete cleft lip and palate (UCLP), and complete cleft palate (CP). The models were analysed at four time periods: T1 (before cheiloplasty), T2 (before palatoplasty), T3 (after palatoplasty); and T4 - (at five years of age). Area of the dental arches was measured through stereophotogrammetry software. Measurements evaluated with Student's test and ANOVA followed by the Tukey test (p<0.05) (AQ 1). In the UCL group, the palatal surface area significantly increased among phases. In the primary surgery periods, UCLP and CP significantly decreased (p<0.001). Palatal area in the UCLP group was significantly greater than the CP group. Overall, no statistically significant differences occurred among groups. At T4, the area of the palate in the UCL group was significantly greater than the UCLP group and no significant differences occurred between UCLP and CP groups. This study suggests that cheiloplasty did not inhibit the growth of the palatal surface area in children with UCL and UCLP. Palatoplasty significantly decreased the palatal area in children with UCLP and CP, demonstrating a significant negative effect of palatal repair on maxillary growth. At five years, children with UCLP and CP had a significantly smaller palate area than those with UCL.

Three-Dimensional Motion Capture of a Smile in Repaired Unilateral Cleft Lip: What's Our Vector, Victor?

INTRODUCTION

Following surgical repair, patients with unilateral cleft lip (UCL) exhibit dynamic asymmetry during facial expressions compared to healthy individuals. Previous studies using Euclidean distances to describe this asymmetry fail to take the direction of the movement into account. The aim of this study is to compare differences in participants with UCL and controls using analysis of motion vectors during facial expressions.

METHODS

In this cross-sectional study, twenty-six pediatric participants were recruited: 13 participants with repaired left UCL and 13 participants with no craniofacial diagnosis. Participants were recorded performing a maximal smile by a 4D stereophotogrammetric system. Phases of the smile were divided into closed lip and open lip smiles. Ten regions of interest were analyzed: subnasal area, upper lip, lower lip, oral commissure, and ala on both sides. The motion vectors were calculated and vector magnitude and direction for each region was compared.

RESULTS

Between cleft and control groups, the differences in vector direction were greater than the magnitude differences. Significant differences in vector direction were identified at both oral commissures in the closed lip smile; and at the oral commissure, subnasal, upper lip, and lower lip regions during open lip smile.

CONCLUSIONS

Vector analysis demonstrated significant movement asymmetry during facial animation in participants following UCL repair, not previously identified when analyzing magnitude of skin displacement.

Analysis of Facial Movement in Repaired Unilateral Cleft Lip Using Three-Dimensional Motion Capture

ABSTRACT

Unilateral cleft lip (UCL) is one of the most common craniofacial deformities. Surgical intervention reconstructs lip and nose anatomy; however, some degree of asymmetry persists after repair. This demonstrates a need for a model for studying and improving outcomes for patients with orofacial clefts. This study's main question was whether there is a significant difference in dynamic facial asymmetry between participants with repaired UCLs and control participants during smiling. Ten pediatric subjects with repaired left UCLs and 12 with no craniofacial diagnoses were recorded performing maximum smiles using a markerless 4D video stereophotogrammetrical system. A facial mesh template containing 884 landmarks was conformed to each initial frame and tracked throughout. Kinetic analysis of smiles was performed by calculating landmark 3D Euclidean distance between frames. Patients with left repaired UCL showed increasing facial asymmetry throughout smiling. Oral commissures, upper, and lower lips demonstrated significantly greater movement on the right side (P < 0.05). Control patients showed facial asymmetry during the first half of smiling, with greater movement on the left side. Displacement difference between right and left was significantly greater at oral commissures and upper lips in patients with repaired ULC compared to control patients. This study provides a highly detailed, quantitative analysis of postoperative UCLs, and help improve outcomes of future repair surgeries.

Three-Dimensional Dynamic Analysis of the Reproducibility of Verbal and Nonverbal Facial Expressions

OBJECTIVE

The aim of this study is to compare the short- and long-term reproducibility of verbal and nonverbal facial expressions of normal people using dynamic 3-dimensional (3-D) imaging.

DESIGN

Prospective, cross-sectional, controlled study.

SETTING

Peking University School and Hospital of Stomatology, Beijing, China.

PATIENTS AND PARTICIPANTS

Twenty-seven participants, 12 males and 15 females, were recruited for this study.

METHODS

A 3-D dynamic system was applied to capture the process of 4 nonverbal facial expressions (smile lips closed, smile lips open, lip purse, cheek puff) and 2 verbal facial expressions (/i:/, /u:/) at an initial time point, 15 minutes later, and 1 week later. Key frames were selected from each expression recording sequence.

MAIN OUTCOME MEASURES

The root mean square (RMS) between each key frame and its corresponding frame at rest was calculated. ΔRMS reflected the difference of the same key frames between the different sessions of the same expression of the same participant. The reproducibility of different facial expressions at different time intervals were analyzed.

RESULTS

There was no significant difference in verbal and nonverbal expression repeatability during a 15-minute interval, except for cheek puff motion. Following a 1-week interval, verbal expression repeatability was superior to that of nonverbal expressions (P < .01). Compared with nonverbal expressions, the repeatability of verbal expressions did not obviously decrease with the increase in recording interval.

CONCLUSIONS

Dynamic 3-D imaging is a useful technique for facial expression analysis. Verbal expressions showed greater reproducibility than nonverbal expressions.

Does Head Orientation Influence 3D Facial Imaging? A Study on Accuracy and Precision of Stereophotogrammetric Acquisition

This study investigates the reliability and precision of anthropometric measurements collected from 3D images and acquired under different conditions of head rotation. Various sources of error were examined, and the equivalence between craniofacial data generated from alternative head positions was assessed. 3D captures of a mannequin head were obtained with a stereophotogrammetric system (Face Shape 3D MaxiLine). Image acquisition was performed with no rotations and with various pitch, roll, and yaw angulations. On 3D images, 14 linear distances were measured. Various indices were used to quantify error magnitude, among them the acquisition error, the mean and the maximum intra- and inter-operator measurement error, repeatability and reproducibility error, the standard deviation, and the standard error of errors. Two one-sided tests (TOST) were performed to assess the equivalence between measurements recorded in different head angulations. The maximum intra-operator error was very low (0.336 mm), closely followed by the acquisition error (0.496 mm). The maximum inter-operator error was 0.532 mm, and the highest degree of error was found in reproducibility (0.890 mm). Anthropometric measurements from alternative acquisition conditions resulted in significantly equivalent TOST, with the exception of Zygion (l)–Tragion (l) and Cheek (l)–Tragion (l) distances measured with pitch angulation compared to no rotation position. Face Shape 3D Maxiline has sufficient accuracy for orthodontic and surgical use. Precision was not altered by head orientation, making the acquisition simpler and not constrained to a critical precision as in 2D photographs.

An Innovative Assessment of the Dynamics of Facial Movements in Surgically Managed Unilateral Cleft Lip and Palate Using 4D Imaging

OBJECTIVE

Assess facial asymmetry during maximum smile in patients with surgically managed unilateral cleft lip and palate (UCLP), using a dynamic 3-dimensional (3D) imaging (4-dimensional) system.

DESIGN

Prospective 2 cohort comparative study.

METHODS

Twenty-five surgically managed UCLP cases and 75 controls at 8 to 10 years of age were recruited. Facial movements during maximum smile were recorded using video stereophotogrammetry at a rate of 60 3D facial images per second. Maximum smile took approximately 3 seconds and generated 180 3D facial images for the analysis. A generic facial mesh which consists of more than 7000 quasi landmarks was used for the assessment of facial asymmetry at 5 key 3D frames representing the pattern of maximum smile.

RESULTS

Statistically significant differences were seen regarding the magnitude of facial asymmetry between the UCLP group and the noncleft controls. Higher average asymmetry in the UCLP group was seen in the 3D frame midway between maximum smile and rest (frame 4) followed by the frame at peak expression of maximum smile (frame 3). The average magnitude of nasolabial asymmetry of the control group was within 0.5 mm in comparison with the UCLP cases which was about 1.8 mm.

CONCLUSION

This study provided for the first time, an objective tool for analysis of the dynamics of muscle movements which provided an unprecedented insight into the anatomical basis of the residual dysmorphology. The research demonstrates the limitations of the primary lip repair in achieving symmetrical results and underpins the required refinements to improve the quality of surgical repair of cleft lip.

The Validation of an Innovative Method for 3D Capture and Analysis of the Nasolabial Region in Cleft Cases

Objective:

To validate a newly developed method for capturing 3-dimensional (3D) images of the nasolabial region for assessing upper lip scarring and asymmetry in surgically managed unilateral cleft lip and palate (UCLP) cases.

Design:

Validation study, single cohort.

Materials and Methods:

Eighteen surgically managed UCLP cases were recruited, the nasolabial region of each face was scanned using an intraoral scanner (IOS) to produce 3D images. The images were manually segmented to allow the calculation of surface area of the scar and upper lip asymmetry. Five professionals and 5 lay assessors subjectively evaluated the same images and graded the upper lip scarring and asymmetry at 2 separate occasions. The relationship between the subjective and objective assessments was evaluated.

Results:

Moderate correlation was found between subjective and objective evaluations of the upper lip scarring and total asymmetry. The captured 3D images were of good quality for the objective measurements of lip asymmetry and residual scarring. Moderate to strong correlations were detected between the 2 panels (T ranging between 0.5 and 0.9) with no significant difference (P > .05) in the mean score of the subjectively evaluated parameters.

Conclusion:

The IOS is a useful tool for the capture of the nasolabial morphology. The captured 3D images are a reliable source for measuring lip asymmetry and scar surface area. The method has sufficient validity for routine clinical use and for objective outcome measures of the surgical repair of cleft lip.

The effect of resting morphological lip shape during lip movement: A three-dimensional motion analysis study

Purpose

The aim of this study was to determine the influence of different morphological lip shape during lip movement.

Method

A sample of 80 individuals with three-dimensional facial images at rest and during speech were recorded. Subjects were asked to pronounce four bilabial words in a relaxed manner and scanned using the 3dMDFace™ Dynamic System at 48 frames per second. Six lip landmarks were identified at rest and the landmark displacement vectors for the frame of maximal lip movement for all six visemes were recorded. Principal component analysis was applied to isolate relationship between lip traits and their registered coordinates. Eight specific resting morphological lip traits were identified for each individual. The principal component (PC) scores for each viseme were labelled by lip morphological trait and were graphically visualized as ellipses to discriminate any differences in lip movement.

Results

The first five PCs accounted for up to 95% of the total variance in lip shape during movement, with PC1 accounting for at least 38%. There was no clear discrimination between PC1, PC2 and PC3 for any of the resting morphological lip traits.

Conclusion

Lip shapes during movement are more uniform between individuals and resting morphological lip shape does not influence movement of the lips.

Three dimensional (3D) imaging techniques in orthodontics-An update

3D imaging is a technique which develops or creates the impression of depth within an image by deploying 2D data into 3-dimensional format. To aid in quality regulating processes for industrial purposes, 3D imaging has become an extremely valuable factor. Owing to their various drawbacks, a wide range of investigative methods formulated for demonstration of facial structures and the dentition were dilapidated. Currently in medicine, the most prevalent method is perhaps 3D imaging technique renders thorough and problem specific information regarding hard and the soft tissues, such as Computerized Tomography (CT), Cone Beam Computerized Tomography (CBCT), Micro Computerized Tomography (MCT), 3D laser scanning, structured light technique, stereophotogrammetry or 3D surface imaging systems (3dMD), 3D facial morphometry (3DFM), Tuned Aperture Computed Tomography (TACT), and Magnetic Resonance Imaging (MRI). 3D imaging techniques in orthodontics plays an important role by facilitating more elaborated diagnostic information on the precise cases like patients having craniofacial anomalies. Hence, the aim of this study was to review advances in 3D imaging with in the field of orthodontics.

The Effect of Autologous Alveolar Bone Grafting on Nasolabial Asymmetry in Unilateral Cleft Lip and Palate

The objective of this study was to examine whether an autologous alveolar bone graft has an effect on the nasolabial asymmetry in unilateral cleft lip, alveolus, and palate. Fifteen children (mean age 7.5 ± 2.4 years) with non-syndromic unilateral cleft lip and palate (CLP) were included. Non-ionizing three-dimensional images were acquired prior to and three months after the alveolar bone grafting procedure. A 2D and a landmark-independent 3D asymmetry assessment were used to detect changes of asymmetry in the nasolabial area. For the 2D assessment, a cleft and non-cleft side ratio for 4 linear nasal and 2 linear labial distances was expressed as a Coefficient of Asymmetry (CA). The 3D asymmetry assessment comprised a robust superimposition of the face with its mirror image, expressed as a root-mean-square-error (RSME) in mm. A significant decrease in the CA for the labial distance from the facial midline to the labial commissure was observed (P = 0.036). Also, the CA for the labial distance from the facial midline to the highest point of Cupid's bow increased significantly (P = 0.028). Non-significant changes were observed for the CA for the 2 nasal distances and the 2 other labial distances. No significant changes in 3D nasal asymmetry were detected (P = 0.820). Alveolar bone grafting completes the alveolar ridge but has only little to no clinical effect on the asymmetry of the secondary cleft lip nasal deformity.

Kinematic Analysis of Smiles in the Healthy Pediatric Population Using 3-Dimensional Motion Capture

Introduction:

Facial normalcy, as measured with 2-dimensional or 3-dimensional photographs, has been documented in the healthy pediatric population. However, static images convey far from a complete representation of an individual’s daily interactions with peers. Craniofacial surgery induces changes to soft or osseous tissues and thereby affects dynamic facial expression. To-date, there has not been rigorous, dynamic quantification of normal facial expression. In this study, we used 4-dimensional (4D) imaging to assess the facial expression of healthy children to provide a normative reference point for craniofacial surgeons.

Methods:

A total of 36 healthy pediatric volunteers underwent 4D video recordings while performing a maximal voluntary smile. A face template containing 884 landmarks was registered and tracked throughout the videos using Dimensional Imaging software. Participants were divided into 2 smile groups: open-lip smile and closed-lip smile. Kinematic analysis of smiles was calculated for every landmark from its position in the resting frame to its terminal displacement.

Results:

Composite smiles and Euclidean distance maps were generated displaying areas of greatest displacement near the oral commissures. There was significant difference between closed-lip and open-lip groups in regions of eyes and cheeks. In addition, the open-lip smile group demonstrated significantly greater displacement in the oral commissure on the left side compared to the right ( P < .05); whereas, in the closed-lip group, the eyes and cheeks moved significantly more on the right side.

Conclusion:

This study presents an innovative method that can be used to evaluate facial expressions to help craniofacial surgeons restore functional movement in patients with facial anomalies.

Effect of skin tone on the accuracy of hybrid and passive stereophotogrammetry

BACKGROUND

Three-dimensional (3D) surface images acquired from stereophotogrammetry are increasingly being used to plan or evaluate treatment by plastic surgeons. Stereophotogrammetry exists in active, passive, and hybrid forms. Active and hybrid stereophotogrammetry are believed to capture darker surfaces more accurately than passive stereophotogrammetry. The purpose of this study was to investigate whether skin tone has a clinically relevant effect on the accuracy of hybrid and passive stereophotogrammetry.

MATERIALS AND METHODS

Seven subjects with different skin tones were recruited. 3D-printed face and breast were spray-painted in six different colors, ranging from white to black. The skin tones and paint colors were objectified by measuring their melanin index. 3D photos of the subjects and 3D prints were acquired with hybrid and passive stereophotogrammetry. These 3D photos were matched with specialized software, and their geometric differences were calculated.

RESULTS

None of the 3D photos showed a clinically relevant mean inaccuracy. On the 3D prints, hybrid stereophotogrammetry resulted in a smaller standard deviation of the inaccuracies than passive stereophotogrammetry (0.20 ± 0.06 mm vs. 0.35 ± 0.07 mm, p < 0.001). Passive stereophotogrammetry yielded a correlation between the melanin index of the spray paint colors and the standard deviation of the inaccuracy (Pearson's R = 0.60, p = 0.04). On human subjects, no correlation or difference in standard deviation of the accuracy was found.

CONCLUSION

Skin tone does not influence the accuracy of hybrid and passive 3D stereophotogrammetry in a clinically relevant way.

Fluctuating asymmetry of dynamic smiles in normal individuals

The aim of this study was to quantify the fluctuating dynamic facial asymmetry during smiling in a group of 'normal' adults, using three-dimensional (3D) motion facial capture technology. Fifty-four male and 54 female volunteers were recruited. Each subject was imaged using a passive markerless 3D motion capture system (DI4D). Eighteen landmarks were tracked through the 3D capture sequence. A facial asymmetry score was calculated based on either a clinically derived midline or Procrustes alignment; scores were based on the Euclidean distance between landmark pairs. Facial asymmetry scores were determined at three time points: rest, median, and maximum frame. Based on the clinically derived midline and on Procrustes alignment, the differences between male and female volunteers, as well as those at the three different time points, were not clinically significant. However, throughout a smile, facial and lip asymmetry scores increased over the duration of the smile. Fluctuating facial asymmetry exists within individuals, as well as between individuals. Procrustes superimposition and the clinically derived midline produced similar asymmetry scores and both are valid for symmetrical faces. However, with facial asymmetry, Procrustes superimposition may not be a valid measure, and the use of the clinically derived midline may be more appropriate, although this requires further investigation.

The effect of facial expression on facial symmetry in surgically managed unilateral cleft lip and palate patients (UCLP)

AIM

To evaluate the symmetry of facial expression in surgically managed UCLP patients.

MATERIALS AND METHODS

The study was conducted on 13 four-year-old children. Facial images were captured at rest and at maximum smile using stereophotogrammetry. A generic mesh, which is a mathematical facial mask consisting of a fixed number of indexed vertices, was utilised for the assessment of facial asymmetry. This was quantified by measuring the disparity between the left- and right-hand sides of the face after superimposing the original 3D images on their mirror copies.

RESULTS

Residual asymmetries at rest were identified at the vermillion of the upper lip and at the nares with a deviation of the philtrum towards the scar tissue. Vertical and anteroposterior asymmetries were identified on the cleft side. At maximum smile, the asymmetry increased noticeably at the vermillion of the upper lip and at the alar base. In the mediolateral direction, the philtrum deviated towards the cleft side with a significant increase of the asymmetry scores.

DISCUSSION

Asymmetry of the upper lip has significantly increased at maximum smile as a result of the upward forces of all perioral lifting muscles, which affected the lip directly.

CONCLUSIONS

The innovation of this study is the measurement of facial asymmetry for the objective outcome measure of the surgical repair of UCLP. The philtrum was the main site of residual asymmetry, which indicates the need for refining the primary repair of the cleft lip. Further corrective surgery may be required.

Orofacial Function, Articulation Proficiency, and Intelligibility in 5-Year-Old Children Born With Cleft Lip and Palate

OBJECTIVE

To explore and describe orofacial function in 5-year-old children born with clefts affecting the palate and to investigate potential relationship with articulation proficiency and intelligibility.

DESIGN

A prospective cohort study of 88 consecutive patients born with cleft lip and palate (CLP) between July 2009 and June 2011.

PARTICIPANTS

Excluding internationally adopted children and children with no speech production resulted in 52 children with different cleft types and additional malformations, examined at age 5. Data on orofacial function were available for 43 children.

OUTCOME MEASURES

Screening of orofacial function resulted in a profile and a total score, narrow phonetic transcription of test consonants produced a percentage of consonants correct (PCC) score, and ratings of intelligibility by speech and language pathologists (SLPs) and by parents gave 2 estimates. Inter- and intra-transcriber agreement was calculated.

RESULTS

Orofacial dysfunction was found in 37% of children, with results not significantly different between cleft types but significantly more frequent than in children born without CLP. Age-appropriate articulation proficiency was found in 39%, 49% presented below -2 standard deviations. Just above 50% had good intelligibility and were always understood by different communication partners according to both SLP and parent ratings. No significant correlation was found between orofacial dysfunction and PCC or intelligibility.

CONCLUSIONS

Orofacial dysfunction was not found to be an explanatory factor for speech outcome in children born with CLP.

Three-Dimensional Imaging in Orthodontics

Orthodontic records are one of the main milestones in orthodontic therapy. Records are essential not only for diagnosis and treatment planning but also for follow-up of the case, communicating with colleagues, and evaluating the treatment outcomes. Recently, two-dimensional (2D) imaging technology, such as cephalometric and panoramic radiographs and photographs, and plaster models were routinely used. However, after the introduction of three-dimensional (3D) technologies (laser scanner, stereophotogrammetry, and computed tomography) into dentistry, 3D imaging systems are more and more commonly preferred than 2D, especially in cases with craniofacial deformities. In fact, 3D imaging provided more detailed and realistic diagnostic information about the craniofacial hard as well as soft tissue and allowed to perform easier, faster, and more reliable 3D analyses. The purpose of this review is to provide an overview of the 3D imaging techniques, including their advantages and disadvantages, and to outline the indications for 3D imaging.

Depth accuracy of the RealSense F200: Low-cost 4D facial imaging

The RealSense F200 represents a new generation of economically viable 4-dimensional imaging (4D) systems for home use. However, its 3D geometric (depth) accuracy has not been clinically tested. Therefore, this study determined the depth accuracy of the RealSense, in a cohort of patients with a unilateral facial palsy (n = 34), by using the clinically validated 3dMD system as a gold standard. The patients were simultaneously recorded with both systems, capturing six Sunnybrook poses. This study has shown that the RealSense depth accuracy was not affected by a facial palsy (1.48 ± 0.28 mm), compared to a healthy face (1.46 ± 0.26 mm). Furthermore, the Sunnybrook poses did not influence the RealSense depth accuracy (p = 0.76). However, the distance of the patients to the RealSense was shown to affect the accuracy of the system, where the highest depth accuracy of 1.07 mm was measured at a distance of 35 cm. Overall, this study has shown that the RealSense can provide reliable and accurate depth data when recording a range of facial movements. Therefore, when the portability, low-costs, and availability of the RealSense are taken into consideration, the camera is a viable option for 4D close range imaging in telehealth.