title: Measuring Symmetry in Children With Unrepaired Cleft Lip: Defining a Standard for the Three-Dimensional Midfacial Reference Plane.
abstract: Quantitative measures of facial form to evaluate treatment outcomes for cleft lip (CL) are currently limited. Computer-based analysis of three-dimensional (3D) images provides an opportunity for efficient and objective analysis. The purpose of this study was to define a computer-based standard of identifying the 3D midfacial reference plane of the face in children with unrepaired cleft lip for measurement of facial symmetry.
  
  
  
  The 3D images of 50 subjects (35 with unilateral CL, 10 with bilateral CL, five controls) were included in this study.
  
  
  
  Five methods of defining a midfacial plane were applied to each image, including two human-based (Direct Placement, Manual Landmark) and three computer-based (Mirror, Deformation, Learning) methods.
  
  
  
  Six blinded raters (three cleft surgeons, two craniofacial pediatricians, and one craniofacial researcher) independently ranked and rated the accuracy of the defined planes.
  
  
  
  Among computer-based methods, the Deformation method performed significantly better than the others. Although human-based methods performed best, there was no significant difference compared with the Deformation method. The average correlation coefficient among raters was .4; however, it was .7 and .9 when the angular difference between planes was greater than 6° and 8°, respectively.
  
  
  
  Raters can agree on the 3D midfacial reference plane in children with unrepaired CL using digital surface mesh. The Deformation method performed best among computer-based methods evaluated and can be considered a useful tool to carry out automated measurements of facial symmetry in children with unrepaired cleft lip.
authors.forename: Jia
authors.initials: J
authors.lastname: Wu
authors.forename: Carrie
authors.initials: C
authors.lastname: Heike
authors.forename: Craig
authors.initials: C
authors.lastname: Birgfeld
authors.forename: Kelly
authors.initials: K
authors.lastname: Evans
authors.forename: Murat
authors.initials: M
authors.lastname: Maga
authors.forename: Clinton
authors.initials: C
authors.lastname: Morrison
authors.forename: Babette
authors.initials: B
authors.lastname: Saltzman
authors.forename: Linda
authors.initials: L
authors.lastname: Shapiro
authors.forename: Raymond
authors.initials: R
authors.lastname: Tse
mesh_terms: D002508:Cephalometry / Q000592:standards*; D002971:Cleft Lip / Q000000981:diagnostic imaging*; D002972:Cleft Palate / Q000000981:diagnostic imaging*; D005145:Face / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D005146:Facial Asymmetry / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male
keywords: 3D stereophotogrammetry; cleft lip; outcomes; symmetry