Lay People Esthetic Evaluation of Primary Surgical Repair on Three-Dimensional Images of Cleft Lip and Palate Patients

Background and Objectives: Previous literature has disclosed that facial attractiveness affects the esthetic evaluation of nose and lip deformity on frontal and lateral photographs. However, it has never been debated if the removal of the external facial features on three-dimensional (3D) models (“cropped assessment bias”) could provide a considerable usefulness in the interpretation and comparison of the results. Additionally, it has been assumed on two-dimensional (2D) studies that esthetic assessment biases with respect to observer gender, and it is not acknowledged if and to the extent that “gender assessment bias” may be influenced by a three-dimensional layout. The aim of this study is to investigate if facial traits and observers’ gender may affect the esthetic ratings of unilateral cleft lip and palate (UCLP) patients after soft tissue reconstruction. Materials and Methods: Three-dimensional images of ten UCLP patients’ images were acquired before the intervention (T0), one-month (T1) and six-months (T2) postoperative. Geomagic® software (version 2014; 3D Systems, Rock Hill, SC, USA) was used to remove the external facial features of 3D surface models. Five-point scale developed by Asher-McDade et al. was used to rate both nasolabial attractiveness and impairment for full-face (FF) and cropped-face (CF) 3D images. Forty-three judges (21 males, 22 females) were enrolled for the esthetic evaluation. Intraclass correlation coefficient (ICC) was used to test intra- and inter-examiner reliability; a value of 0.7 was set as the minimum acceptable level of reliability. Results: When comparing the 2 sets of observations (FF and CF), the ICC ranged from 0.654 to 0.823. Concerning gender assessment bias, the ICC ranged from 0.438 to 0.686 and from 0.722 to 0.788 for males and females, respectively. Concerning inter-examiner reliability, ICC for questions 2–7 ranged from 0.448 to 0.644 and from 0.659 to 0.817 at T0 and T2, respectively. Conclusions: The removal of external facial features provides subtle differences on the esthetic assessment of UCLP patients. Moreover, based on our data, examiners’ gender differences may affect esthetic assessment of UCLP patients. Despite the subjectivity of esthetic judgments, a reliable, validated and reproducible scoring protocol should consider the influence of gender differences on 3D esthetic assessment of UCLP patients.

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Assessment modalities of non-ionizing three-dimensional images for the quantification of facial morphology, symmetry, and appearance in cleft lip and palate: a systematic review

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2018.05.017 ◽

2018 ◽

Vol 47 (9) ◽

pp. 1095-1105 ◽

Cited By ~ 5

Author(s):

L.A.M. Thierens ◽

N.M.C. De Roo ◽

G.A.M. De Pauw ◽

N. Brusselaers

Keyword(s):

Systematic Review ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Three Dimensional ◽

Facial Morphology ◽

Three Dimensional Images

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Three-Dimensional Printing of Prenatal Ultrasonographic Diagnosis of Cleft Lip and Palate: Presenting the Needed “Know-How” and Discussing Its Use in Parental Education

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620926348 ◽

2020 ◽

Vol 57 (8) ◽

pp. 1041-1044

Author(s):

Matthias Schlund ◽

Jean-Marc Levaillant ◽

Romain Nicot

Keyword(s):

Parental Education ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Three Dimensional ◽

3D Models ◽

Prenatal Counseling ◽

Three Dimensional Printing ◽

3D Printed ◽

3D Information ◽

Dimensional Printing

Parental prenatal counseling is of paramount significance since parents often experience an emotional crisis with feelings of disappointment and helplessness. Three-dimensional (3D) printed model of the unborn child’s face presenting with cleft lip and palate, based on ultrasonographic information, could be used to provide visual 3D information, further enhancing the prospective parent’s comprehension of their unborn child’s pathology and morphology, helping them to be psychologically prepared and improving the communication with the caretaking team. Prospective parents appreciate if prenatal counseling is available with the most detailed information as well as additional resources. The technique necessary to create 3D models after ultrasonographic information is explained, and the related costs are evaluated. The use of such models in parental education is then discussed.

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Rating nasolabial appearance on three-dimensional images in cleft lip and palate: a comparison with standard photographs

European Journal of Orthodontics ◽

10.1093/ejo/cjv024 ◽

2015 ◽

Vol 38 (2) ◽

pp. 197-201 ◽

Cited By ~ 19

Author(s):

Adam Stebel ◽

Dries Desmedt ◽

Ewald Bronkhorst ◽

Mette A Kuijpers ◽

Piotr S. Fudalej

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Three Dimensional ◽

Three Dimensional Images

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Determination of Facial Symmetry in Unilateral Cleft Lip and Palate Patients from Three-Dimensional Data: Technical Report and Assessment of Measurement Errors

The Cleft Palate-Craniofacial Journal ◽

10.1597/04-138.1 ◽

2006 ◽

Vol 43 (2) ◽

pp. 129-137 ◽

Cited By ~ 35

Author(s):

Emeka Nkenke ◽

Bernhard Lehner ◽

Manuel Kramer ◽

Gerd Haeusler ◽

Stefanie Benz ◽

...

Keyword(s):

Measurement Errors ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Intraclass Correlation ◽

Three Dimensional ◽

Correlation Coefficients ◽

Intraclass Correlation Coefficients ◽

Surface Areas ◽

Technical Report

Objective To assess measurement errors of a novel technique for the three-dimensional determination of the degree of facial symmetry in patients suffering from unilateral cleft lip and palate malformations. Design Technical report, reliability study. Setting Cleft Lip and Palate Center of the University of Erlangen-Nuremberg, Erlangen, Germany. Patients The three-dimensional facial surface data of five 10-year-old unilateral cleft lip and palate patients were subjected to the analysis. Distances, angles, surface areas, and volumes were assessed twice. Main Outcome Measures Calculations were made for method error, intraclass correlation coefficient, and repeatability of the measurements of distances, angles, surface areas, and volumes. Results The method errors were less than 1 mm for distances and less than 1.5° for angles. The intraclass correlation coefficients showed values greater than .90 for all parameters. The repeatability values were comparable for cleft and noncleft sides. Conclusion The small method errors, high intraclass correlation coefficients, and comparable repeatability values for cleft and noncleft sides reveal that the new technique is appropriate for clinical use.

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Three-Dimensional Assessment of Morphological Changes Following Nasoalveolar Molding Therapy in Cleft Lip and Palate Patients: A Case Report

Dentistry Journal ◽

10.3390/dj7010027 ◽

2019 ◽

Vol 7 (1) ◽

pp. 27 ◽

Cited By ~ 8

Author(s):

Edoardo Staderini ◽

Romeo Patini ◽

Andrea Camodeca ◽

Federica Guglielmi ◽

Patrizia Gallenzi

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Morphological Changes ◽

Three Dimensional ◽

Dimensional Changes ◽

Technological Advances ◽

Angular Measurements ◽

The Face ◽

Three Dimensional Images ◽

Nasoalveolar Molding

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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Three-Dimensional Nasolabial Changes After Nasoalveolar Molding and Primary Lip/Nose Surgery in Infants With Bilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211012858 ◽

2021 ◽

pp. 105566562110128

Author(s):

Laura Mancini ◽

Shayna Avinoam ◽

Barry H. Grayson ◽

Roberto L. Flores ◽

David A. Staffenberg ◽

...

Keyword(s):

Reconstructive Surgery ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Primary Repair ◽

Intraclass Correlation ◽

Three Dimensional ◽

Control Sample ◽

Surgical Correction ◽

Bilateral Cleft Lip ◽

Nasoalveolar Molding

Objective: Utilize 3-dimensional (3D) photography to evaluate the nasolabial changes in infants with bilateral cleft lip and palate (BCLP) who underwent nasoalveolar molding (NAM) and primary reconstructive surgery. Design: This is a retrospective serial longitudinal study of consecutively enrolled infants from September 2012 to July 2016 with BCLP who underwent NAM before primary lip and nose reconstructive surgery. It included infants who had digital 3dMD stereophotogrammetry records at initial presentation (T1), completion of NAM (T2), and 3 weeks following primary repair (T3). Twelve infants fulfilled the inclusion criteria. 3dMD Vultus software was used to orient images and plot 16 nasolabial points with x, y, z coordinates to obtain the linear and angular measurements. Nasal form changes were measured and analyzed between T1 (0.5 months old), T2 (5 months old), and T3 (6 months old). Intraclass correlation coefficient was performed for intrarater reliability. Averaged data from the 3D images was statistically analyzed from T1 to T2 and T2 to T3 with Wilcoxon tests. Unaffected infant norms from the Farkas publication were used as a control sample. Results: After NAM therapy, statistically significant changes in the position of subnasale and labius superius improved nasolabial symmetry. Both retruded after NAM were displaced downward after NAM and surgical correction with respect to soft tissue nasion. The nasal tip’s projection was maintained with NAM and surgical correction. The columella lengthened from 1.4 to 4.71 mm following NAM. Conclusions: There was a significant improvement in the nasolabial anatomy after NAM, and this was further enhanced after primary reconstructive surgery.

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Comparative Assessment of Dental Arch Relationships Using Goslon Yardstick in Patients with Unilateral Complete Cleft Lip and Palate Using Dental Casts, Two-Dimensional Photos, and Three-Dimensional Images

The Cleft Palate-Craniofacial Journal ◽

10.1597/10-269 ◽

2012 ◽

Vol 49 (3) ◽

pp. 347-351 ◽

Cited By ~ 11

Author(s):

Servet Dogan ◽

Sultan Olmez ◽

Gunvor Semb

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Three Dimensional ◽

Comparative Assessment ◽

Dental Arch ◽

Two Dimensional ◽

Three Dimensional Images ◽

Dental Casts

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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 ◽

10.7717/peerj.7302 ◽

2019 ◽

Vol 7 ◽

pp. e7302 ◽

Cited By ~ 3

Author(s):

Sander Brons ◽

Jene W. Meulstee ◽

Tom G.J. Loonen ◽

Rania M. Nada ◽

Mette A.R. Kuijpers ◽

...

Keyword(s):

Soft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Three Dimensional ◽

Facial Morphology ◽

Upper Lip ◽

Unaffected Side ◽

Surgical Closure ◽

Control Subjects ◽

Three Dimensional Images

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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