Quantitative 3D soft tissue analysis of symmetry prior to and after unilateral cleft lip repair compared with non-cleft persons (performed in Cambodia).
OBJECTIVE
The aim of this study was to evaluate the clinical application of three-dimensional (3D) imaging and morphological analysis with subsequent individual therapy planning and postoperative 3D symmetry control in comparison with data from non-cleft persons.


METHODS
This was a prospective study using a 3D surface-imaging and evaluation system in cleft patients and non-cleft persons. The pre- and postoperative 3D facial profiles were recorded from the patients using a 3D laser scanner. The preoperative 3D image was analyzed qualitatively and quantitatively for an individual therapy planning. On the basis of ratios and scores, based on empirical regions of interest, the technique of cleft repair was designed individually. The postoperative result was evaluated regarding symmetry. The surgically created soft tissue shift was defined quantitatively and visualized with vectors. The postoperative symmetry was compared with 3D data from a group of non-cleft persons of the same ethnical group.


METHODS
Eleven patients (mean age 13.8 years, median 13, minimum 2, maximum 41 years) with either a unilateral isolated cleft lip, a cleft lip and alveolus or a complete unilateral cleft lip, alveolus and palate and 25 non-cleft persons (8 children between 4 and 12 years, 17 adults (9 men, 8 women) between 18 and 50 years). All these persons investigated were Asians of Khmer origin.


RESULTS
The analysis permitted quantitative 3D evaluation. The 3D anthropometric data of the non-cleft Khmer persons were collected and named the gold standard of symmetry in this ethnical group. All postoperative 3D images reached symmetrical values within the range of the normal cohort. Soft tissue shifts from pre- to postoperative sites could be visualized.


CONCLUSIONS
A new method for registration was described enabling follow-up registration in patients when growing older. This 3D soft tissue analysis can be a useful tool in quantitative analysis and objective follow-up control in cleft patients. It offers deeper insight into the complex morphology to be treated and could contribute to individualisation of surgical procedures.
Schwenzer-Zimmerer
Katja
K
Hightech Research Centre of Cranio-Maxillofacial Surgery, University Hospital of Basel, Switzerland. kschwenzer@uhbs.ch
Chaitidis
Despina
D
Berg-Boerner
Isabelle
I
Krol
Zdzislav
Z
Kovacs
Laszlo
L
Schwenzer
Nina F
NF
Zimmerer
Stephan
S
Holberg
Christof
C
Zeilhofer
Hans-Florian
HF
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002508:Cephalometry / Q000295:instrumentation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D004954:Esthetics; D005145:Face / Q000033:anatomy & histology; D005146:Facial Asymmetry; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D008297:Male; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D010780:Photogrammetry; D011446:Prospective Studies; D012016:Reference Values; D055815:Young Adult