Analysis of Facial Asymmetry in Deformational Plagiocephaly Using Three-Dimensional Computed Tomographic Review

ABSTRACT Objective: To investigate discrepancies in results of facial asymmetry analysis using different cone beam computed tomography (CBCT) image reorientation methods and the effectiveness of soft tissue as a reorientation reference for analysis of facial asymmetry. Materials and Methods: An asymmetric group of 30 patients with 4 mm or more of chin point (menton [Me]) deviation and a symmetric group of 30 patients with less than 4 mm of deviation of Me were chosen as study subjects. Three orientation methods were used to calculate and compare Me deviation values of the 60 subjects. Two methods used only skeletal landmarks for reference, and one method included the soft tissue landmarks around the eye. Preferences of an expert group for the facial midline as determined by each reorientation method were also examined. Results: The examinations showed significant discrepancies in Me deviation values between the three reorientation methods. The expert group showed the greatest preference for the facial midline reorientation method that incorporated soft tissue landmarks of the eye. Conclusions: These study findings suggest that the inclusion of soft tissue landmarks, especially those around the eyes, is effective for three-dimensional CBCT image reorientation for facial asymmetry analysis.

Download Full-text

Three-Dimensional Computed Tomography Cephalometry of Plagiocephaly: Asymmetry and Shape Analysis

The Cleft Palate-Craniofacial Journal ◽

10.1597/04-174.1 ◽

2006 ◽

Vol 43 (2) ◽

pp. 201-210 ◽

Cited By ~ 41

Author(s):

D. J. Netherway ◽

A. H. Abbott ◽

N. Gulamhuseinwala ◽

K. L. McGlaughlin ◽

P. J. Anderson ◽

...

Keyword(s):

Computed Tomography ◽

Small Sample Size ◽

Three Dimensional ◽

Principal Component ◽

Facial Asymmetry ◽

Cranial Base ◽

Parietal Bone ◽

Small Sample ◽

Deformational Plagiocephaly ◽

Cross Sectional

Objective To investigate facial asymmetry associated with both deformational and synostotic plagiocephaly and to identify variables based on skeletal landmarks that distinguish the conditions and quantify severity. Design Retrospective, cross sectional. Setting Australian Craniofacial Unit, Adelaide. Main Outcome Measures Proportional differences between bilateral distances and principal component (PC) analysis of the skeletal landmarks. Patients The three-dimensional positions of 78 osseous landmarks were determined from computed tomography (CT) scans of 21 patients with deformational plagiocephaly (DP), 20 patients with unilateral coronal synostosis (UCS), and 2 patients with unilateral lambdoid synostosis (ULS). Results For both DP and UCS, significant asymmetry was found for the orbital depths, mandibular lengths, maxillary depths, zygomatic arch lengths, lateral base of the parietal bone, and the angle between the anterior and the posterior cranial base projected onto the axial plane. The small sample size for ULS precluded definitive statistical statements but allowed some useful comparisons with the other conditions. The first three PC scores were able to distinguish among the three conditions and which side was affected. Conclusions The asymmetry of the cranial base and facial structures, arising from localized abnormality or deformational forces in either the frontal or the occipital regions, can be quantified by a plethora of bilateral features or summarized by PC analysis.

Download Full-text

Craniofacial Asymmetry from One to Three Years of Age: A Prospective Cohort Study with 3D Imaging

Journal of Clinical Medicine ◽

10.3390/jcm9010070 ◽

2019 ◽

Vol 9 (1) ◽

pp. 70 ◽

Cited By ~ 2

Author(s):

Anniina M. Launonen ◽

Ville Vuollo ◽

Henri Aarnivala ◽

Tuomo Heikkinen ◽

Pertti Pirttiniemi ◽

...

Keyword(s):

Three Dimensional ◽

Facial Asymmetry ◽

University Hospital ◽

Asymmetric Effect ◽

Deformational Plagiocephaly ◽

Facial Symmetry ◽

Normal Birth ◽

The Face ◽

Age Range ◽

The Impact

Deformational plagiocephaly (DP) is considered a risk factor for facial asymmetry. This cohort-based, prospective, follow-up study used three-dimensional (3D) stereophotogrammetry to assess the development of facial asymmetry in a normal birth cohort and to investigate the impact of DP on facial asymmetry for the age range of one to three years. The study sample consisted of 75 children: 35 girls (47%) and 40 (53%) boys recruited from Oulu University Hospital. A total of 23 (31%) subjects had a history of DP in infancy. 3D facial images were obtained at the mean (SD) age of 1.01 (0.04) year old at T1 and 3.02 (0.14) years old at T2. To determine facial asymmetry, both landmark-based and surface-based facial symmetry methods were used. As measured with the surface-based methods, upper facial symmetry improved from T1 to T2 (p < 0.05). As measured with the landmark-based methods, facial symmetry improved on the upper and lower jaw from T1 to T2 (p < 0.05). The asymmetric effect of DP on the upper parts of the face tends to correct spontaneously during growth. Results indicate that previous DP does not seem to transfer to facial or occlusal asymmetry at the age of three years old.

Download Full-text

Faculty Opinions recommendation of Integrated electroanatomic mapping with three-dimensional computed tomographic images for real-time guided ablations.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.10002.466764 ◽

2006 ◽

Author(s):

David Callans

Keyword(s):

Real Time ◽

Three Dimensional ◽

Electroanatomic Mapping ◽

Tomographic Images ◽

Computed Tomographic

Download Full-text

Central ossifying fibroma of mandible

BMJ Case Reports ◽

10.1136/bcr-2020-239286 ◽

2020 ◽

Vol 13 (12) ◽

pp. e239286

Author(s):

Kumar Nilesh ◽

Prashant Punde ◽

Nitin Shivajirao Patil ◽

Amol Gautam

Keyword(s):

Fibrous Tissue ◽

Three Dimensional ◽

Facial Asymmetry ◽

Ossifying Fibroma ◽

Mandible Reconstruction ◽

Three Dimensional Printing ◽

Osseous Lesion ◽

Large Size ◽

Dimensional Printing

Ossifying fibroma (OF) is a rare, benign, fibro-osseous lesion of the jawbone characterised by replacement of the normal bone with fibrous tissue. The fibrous tissue shows varying amount of calcified structures resembling bone and/or cementum. The central variant of OF is rare, and shows predilection for mandible among the jawbone. Although it is classified as fibro-osseous lesion, it clinically behaves as a benign tumour and can grow to large size, causing bony swelling and facial asymmetry. This paper reports a case of large central OF of mandible in a 40-year-old male patient. The lesion was treated by segmental resection of mandible. Reconstruction of the surgical defect was done using avascular fibula bone graft. Role of three-dimensional printing of jaw and its benefits in surgical planning and reconstruction are also highlighted.

Download Full-text

Quantification of three-dimensional facial asymmetry for diagnosis and postoperative evaluation of orthognathic surgery

Maxillofacial Plastic and Reconstructive Surgery ◽

10.1186/s40902-020-00260-9 ◽

2020 ◽

Vol 42 (1) ◽

Cited By ~ 1

Author(s):

Hua-Lian Cao ◽

Moon-Ho Kang ◽

Jin-Yong Lee ◽

Won-Jong Park ◽

Han-Wool Choung ◽

...

Keyword(s):

Orthognathic Surgery ◽

Three Dimensional ◽

Facial Asymmetry ◽

Postoperative Evaluation

Download Full-text

Imaging in Propeller Flap Surgery

Seminars in Plastic Surgery ◽

10.1055/s-0040-1715159 ◽

2020 ◽

Vol 34 (03) ◽

pp. 145-151

Author(s):

Shimpei Ono ◽

Hiroyuki Ohi ◽

Rei Ogawa

Keyword(s):

Low Cost ◽

Three Dimensional ◽

Duplex Sonography ◽

Computed Tomographic Angiography ◽

Ease Of Use ◽

Computed Tomographic ◽

Imaging Tool ◽

Preoperative Mapping ◽

Flap Design ◽

Tomographic Angiography

AbstractSince propeller flaps are elevated as island flaps and most often nourished by a single perforator nearby the defect, it is challenging to change the flap design intraoperatively when a reliable perforator cannot be found where expected to exist. Thus, accurate preoperative mapping of perforators is essential in the safe planning of propeller flaps. Various methods have been reported so far: (1) handheld acoustic Doppler sonography (ADS), (2) color duplex sonography (CDS), (3) perforator computed tomographic angiography (P-CTA), and (4) magnetic resonance angiography (MRA). To facilitate the preoperative perforator assessment, P-CTA is currently considered as the gold standard imaging tool in revealing the three-dimensional anatomical details of perforators precisely. Nevertheless, ADS remains the most widely used tool due to its low cost, faster learning, and ease of use despite an undesirable number of false-positive results. CDS can provide hemodynamic characteristics of the perforator and is a valid and safer alternative particularly in patients in whom ionizing radiation and/or contrast exposure should be limited. Although MRA is less accurate in detecting smaller perforators of caliber less than 1.0 mm and the intramuscular course of perforators at the present time, MRA is expected to improve in the future due to the recent developments in technology, making it as accurate as P-CTA. Moreover, it provides the advantage of being radiation-free with fewer contrast reactions.

Download Full-text

Preoperative Use of CT Angiography in Infants With Coarctation of the Aorta

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116683929 ◽

2017 ◽

Vol 8 (2) ◽

pp. 196-202 ◽

Cited By ~ 8

Author(s):

Kirsten Rose-Felker ◽

Joshua D. Robinson ◽

Carl L. Backer ◽

Cynthia K. Rigsby ◽

Osama M. Eltayeb ◽

...

Keyword(s):

Radiation Dose ◽

Surgical Approach ◽

New Technology ◽

Three Dimensional ◽

Coarctation Of The Aorta ◽

Computed Tomographic Angiography ◽

Great Vessel ◽

Z Score ◽

Computed Tomographic ◽

Tomographic Angiography

Background: Computed tomographic angiography (CTA) and echocardiography (echo) are used preoperatively in coarctation of the aorta to define arch hypoplasia and great vessel branching. We sought to determine differences in quantitative measurements, as well as surgical utility, between modalities. Methods: Infants (less than six months) with both CTA and echo prior to coarctation repair from 2004 to 2013 were included. Measurements were compared and correlated with surgical approach. Three surgeons reviewed de-identified images to predict approach and characterize utility. Computed tomographic angiography radiation dose was calculated. Results: Thirty-three patients were included. No differences existed in arch measurements between echo and CTA ( z-score: −2.59 vs −2.43; P = .47). No differences between modalities were seen for thoracotomy ( z-score: −2.48 [echo] vs −2.31 [CTA]; P = .48) or sternotomy ( z-score: −3.13 [echo] vs −3.08 [CTA]; P = .84). Computed tomographic angiography delineated great vessel branching pattern in two patients with equivocal echo findings ( P = .60). Surgeons rated CTA as far more useful than echo in understanding arch hypoplasia and great vessel branching in cases where CTA was done to resolve anatomical questions that remain after echo evaluation. Two of three surgeons were more likely to choose the surgical approach taken based on CTA (surgeon A, P = .02; surgeon B, P = .01). Radiation dose averaged 2.5 (1.6) mSv and trended down from 2.9 mSv (1.8 mSv; n = 20) to 1.6 mSv (0.5 mSv; n = 7) ( P = .06) with new technology. Conclusion: Although CTA and echo measurements of the aorta do not differ, CTA better delineates branching and surgeons strongly prefer it for three-dimensional arch anatomy. We recommend CTA for patients with anomalous arch branching patterns, diffuse or complex hypoplasia, or unusual arch morphology not fully elucidated by echo.

Download Full-text