Three-Dimensional Anthropometry for Evaluating Philtrum Contour in Patients With Unilateral Cleft Lip: Comparison Between Photographic Assessment and 3-Dimensional Anthropometry.

Philtrum reconstruction in patients with unilateral cleft lip is a major concern in cheiloplasty. Moreover, a quantitative evaluation of the philtrum contour has not been possible. Advances in 3-dimensional (3D) imaging technology have enabled highly accurate assessments of facial surfaces. This study aimed to justify using 3D anthropometric measurements to quantify traditional photographic grading systems. Sixty-six children with unilateral cleft lip, aged 4 to 6 years (mean age: 69.1±5.7 mo), who visited the outpatient clinic from January to December 2020 were included. A plastic surgeon panel graded the philtrum contour using digital photographs, and 3D anthropometry was performed using a 3D imaging system. The philtrum height, philtrum height difference, and dimple depth were measured at the middle of the philtrum. The philtrum height did not show significant changes across the photographic scores ( P =0.06), whereas noticeable differences were observed in the dimple depths based on photographic scores ( P <0.001). The correlation analysis revealed the highest correlation between the photographic score and dimple depth (rho=0.897, P <0.001). The philtrum height on the cleft side (rho=0.478, P <0.001) also correlated with the photographic score, but the correlation was weaker than that of the dimple depth. The dimple depth and philtrum height can help define the philtrum contour. Furthermore, the dimple depth reflects the philtrum contour better and is more suitable as a single parameter. However, relying on a single philtrum height measurement may be insufficient for reliable evaluations, as the relative height from the surrounding tissues is more important than the absolute height measured using 3D anthropometry.

Facial and Cranial Symmetry after One-Piece Fronto-Orbital Advancement with Distraction for Isolated Unilateral Coronal Synostosis.

BACKGROUND: The surgical correction of unilateral coronal synostosis (UCS) aims to achieve longstanding facial and cranial symmetry. The authors hypothesized that endocranial morphology correction achieved by one-piece fronto-orbital advancement with distraction osteogenesis (FODO) could alleviate facial asymmetry because endocranial morphology is thought to be its major determinant. This study aimed to quantitatively analyze the changes in supraorbital and midfacial symmetry after FODO. METHODS: The authors included 27 patients with UCS who underwent FODO between May of 2008 and November of 2019. The supraorbital, midfacial, and orbital symmetry ratios and the endocranial and midface angles were measured using computed tomography images. RESULTS: The mean follow-up period was 3.7 ± 1.9 years. The supraorbital shape became symmetric after FODO; the supraorbital distance ratio changed from 0.88 ± 0.04 to 0.98 ± 0.03 ( P < 0.001). The endocranial angulation improved from 167.5 ± 5.0 degrees to 174.4 ± 3.4 degrees ( P < 0.001) and the midface angulation decreased from 6.6 ± 2.2 degrees to 2.6 ± 1.9 degrees ( P < 0.001). In the long-term follow-up analysis (5.9 years), the endocranial angle experienced a slight relapse (-1.4% ± 0.9%) and supraorbital symmetry experienced a -2.0% ± 3.9% relapse. The midface angle continued to improve over the follow-up periods, but it was not statistically significant ( P = 0.121). CONCLUSIONS: The authors' observations indicate that FODO produced satisfactory outcomes in correcting supraorbital retrusion and midface asymmetry. In addition, FODO may allow anterior cranial base remodeling and help relieve midface and skull base angulation. Therefore, FODO can be a good therapeutic strategy for correcting supraorbital and facial asymmetry in patients with UCS. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Scalp Reconstruction Strategy Based on the Etiology of the Scalp Defects.

ABSTRACT: Scalp defects of various etiologies require distinct reconstruction strategies. Therefore, the authors divided scalp defects into the following categories: scar alopecia, open scalp wound, benign or low-grade malignant tumor, and high-grade malignancy. The authors reviewed the experience with scalp reconstruction of a single center to determine the factors that affect the reconstructive choices.Patients who underwent scalp reconstruction between 2008 and 2020 were retrospectively reviewed. Reconstruction methods were classified according to the etiology of the defect and were compared for each etiology. Accordingly, a reconstruction algorithm for scalp defects was proposed.A total of 180 patients were included in this study, and the reconstruction methods demonstrated significant differences according to etiology (P < 0.05). For scar alopecia and open scalp wounds, reconstruction methods such as direct repair, local flap transfer, and tissue expander placement were used depending on the defect size. Patients with benign or low-grade malignancies mainly underwent reconstruction with local flaps or skin grafts and tissue expanders for covering the defects. Patients with high-grade malignancies underwent reconstruction with free flaps if they were scheduled for preoperative or postoperative radiation therapy.Various factors, suchas the etiology, size, location, and depthofthe defect, should be considered in scalp reconstruction. The defect etiology is an important factor that determines the reconstructive goal. Our algorithm is based on the etiology of defects and is intended to aid physicians in choosing the appropriate treatment for various scalp defects.