title: Quantitative use of photography in orthognathic outcome assessment.
abstract: This study reports an independent audit of two aspects of orthognathic surgery, namely control of inter-alar width and mandibular outline asymmetry. Measurements were taken from standardized photographs of a consecutive series of 27 patients, using an on-screen digitizing program (IPTool). All patients had undergone bimaxillary osteotomies involving maxillary impaction and/or advancement, by one surgeon, using a cinch suture for nasal width control. Nine-twelve months after surgery, inter-alar width had increased by just 0.08 cm mean (SD 0.3). Four patients showed an increase of just over 2mm, whilst six showed a small reduction. Based on ratios of size (area) and shape (compactness) of the right and left mandibular segments, there was a small overall improvement in mandibular symmetry (0.019 and 0.005 respectively). Whilst in most of the patients the need for surgery was primarily the correction of antero-posterior and vertical discrepancies, five patients with demonstrable asymmetry showed a clear improvement. In three patients whose asymmetry scores were very mild pre-treatment, there was a small, measured increase in asymmetry, but not to a degree that would be clinically noticeable. At a time when 3D imaging is still unavailable to many clinicians, the results of this study suggest that appropriate measurements taken from carefully standardized conventional photographs can provide a valid and objective means of assessing treatment outcome.
authors.affiliation: South Thames Cleft Service, Guy's Hospital, Great Maze Pond, London, UK. edler@richmond163.freeserve.co.uk
authors.forename: R J
authors.initials: RJ
authors.lastname: Edler
authors.forename: D
authors.initials: D
authors.lastname: Wertheim
authors.forename: D
authors.initials: D
authors.lastname: Greenhill
authors.forename: A
authors.initials: A
authors.lastname: Jaisinghani
mesh_terms: D000293:Adolescent; D000328:Adult; D019230:Dental Audit; D005146:Facial Asymmetry / Q000601:surgery*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008334:Mandible / Q000002:abnormalities / Q000601:surgery; D008875:Middle Aged; D055171:Nasal Cartilages / Q000473:pathology*; D009667:Nose Deformities, Acquired / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D056948:Orthognathic Surgical Procedures / Q000009:adverse effects; D019340:Osteotomy, Le Fort; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010781:Photography / Q000706:statistics & numerical data*; D013536:Suture Techniques; D055815:Young Adult