3D Analysis of the Cranial and Facial Shape in Craniosynostosis Patients: A Systematic Review.

With increasing interest in 3D photogrammetry, diverse methods have been developed for craniofacial shape analysis in craniosynostosis patients. This review provides an overview of these methods and offers recommendations for future studies. A systematic literature search was used to identify publications on 3D photogrammetry analyses in craniosynostosis patients until August 2023. Inclusion criteria were original research reporting on 3D photogrammetry analyses in patients with craniosynostosis and written in English. Sixty-three publications that had reproducible methods for measuring cranial, forehead, or facial shape were included in the systematic review. Cranial shape changes were commonly assessed using heat maps and curvature analyses. Publications assessing the forehead utilized volumetric measurements, angles, ratios, and mirroring techniques. Mirroring techniques were frequently used to determine facial asymmetry. Although 3D photogrammetry shows promise, methods vary widely between standardized and less conventional measurements. A standardized protocol for the selection and documentation of landmarks, planes, and measurements across the cranium, forehead, and face is essential for consistent clinical and research applications.

Reliability and Agreement of Automated Head Measurements From 3-Dimensional Photogrammetry in Young Children.

This study aimed to assess the reliability and agreement of automated head measurements using 3-dimensional (3D) photogrammetry in young children. Specifically, the study evaluated the agreement between manual and automated occipitofrontal circumference (OFC) measurements (n = 264) obtained from 3D images of 188 patients diagnosed with sagittal synostosis using a novel automated method proposed in this study. In addition, the study aimed to determine the interrater and intrarater reliability of the automatically extracted OFC, cephalic index, and volume. The results of the study showed that the automated OFC measurements had an excellent agreement with manual measurements, with a very strong regression score ( R2 = 0.969) and a small mean difference of -0.1 cm (-0.2%). The limits of agreement ranged from -0.93 to 0.74 cm, falling within the reported limits of agreement for manual OFC measurements. High interrater and intrarater reliability of OFC, cephalic index, and volume measurements were also demonstrated. The proposed method for automated OFC measurements was found to be a reliable alternative to manual measurements, which may be particularly beneficial in young children who undergo 3D imaging in craniofacial centers as part of their treatment protocol and in research settings that require a reproducible and transparent pipeline for anthropometric measurements. The method has been incorporated into CraniumPy, an open-source tool for 3D image visualization, registration, and optimization, which is publicly available on GitHub ( https://github.com/T-AbdelAlim/CraniumPy ).

Cone Beam Computed Tomographic Analysis Demonstrates a 94% Radiographic Success Rate in 783 Alveolar Bone Grafts.

PURPOSE: Success of alveolar bone grafting has been estimated using 2-dimensional periapical radiographs that are associated with image distortion. Cone beam computed tomography (CBCT) accurately displays 3-dimensional anatomy. This study sought to develop and apply a radiographic measure of alveolar bone grafting success using CBCT. METHODS: This was a retrospective case series composed of patients with cleft lip/palate who had iliac crest bone grafting by 1 surgeon from 2005 to 2020. CBCT scans were obtained ≥4 months after graft. The outcome variables included vertical bone height on cleft adjacent teeth, labiopalatal thickness, and nasal floor symmetry and were scored using a 1 to 4 ordinal scale. Vertical height was determined by the distance from the cementoenamel junction to the marginal bone level of cleft adjacent teeth (1: ≥75% root length, 2: ≥50 to <75%, 3: ≥25 to <50%, 4: <25%), labiopalatal thickness was scored by comparing graft thickness with root width of cleft adjacent teeth (1: <50%, 2: ≥50, 3: ≥75%, 4: ≥100%), and piriform symmetry was established by comparing the nasal floor height between sides (1: ≥6 mm, 2: ≥3 and < 6 mm, 3: ≥1 and < 3 mm, 4: a score of ≥3 < 1 mm). To be considered a successful graft, each dimension scored ≥3. Grafts were also successful if piriform symmetry scored 2, when all other measures indicated success. RESULTS: The sample was composed of 618 patients with 783 alveolar cleft sites. Subjects' median age was 10.0 (interquartile range 1.6 years), and 59% were male. CBCT scans were obtained a median of 9.7 months (interquartile range 68.8 months) after grafting. There was good-to-excellent intrarater and inter-rater agreement for measurements. Alveolar bone grafting was radiographically successful in 94% of patients. CONCLUSIONS: This is a valid and reliable assessment tool, and when applied to a large cohort, it demonstrated a 94% graft success rate. Future studies will identify predictor variables associated with bone graft outcomes.

Velopharyngeal insufficiency, speech, and language impairment in craniofacial microsomia: a scoping review.

This review provides a comprehensive overview of the literature on velopharyngeal insufficiency, associated anomalies, and speech/language impairment in patients with craniofacial microsomia (CFM). A systematic search of the literature was conducted to identify records on VPI and speech impairment in CFM from their inception until September 2022 within the databases Embase, PubMed, MEDLINE, Ovid, CINAHL EBSCO, Web of Science, Cochrane, and Google Scholar. Seventeen articles were included, analysing 1,253 patients. Velopharyngeal insufficiency results in hypernasality can lead to speech impairment. The reported prevalence of both velopharyngeal insufficiency and hypernasality ranged between 12.5% and 55%, while the reported prevalence of speech impairment in patients with CFM varied between 35.4% and 74%. Language problems were reported in 37% to 50% of patients. Speech therapy was documented in 45.5% to 59.6% of patients, while surgical treatment for velopharyngeal insufficiency consisted of pharyngeal flap surgery or pharyngoplasty and was reported in 31.6% to 100%. Cleft lip and/or palate was reported in 10% to 100% of patients with CFM; these patients were found to have worse speech results than those without cleft lip and/or palate. No consensus was found on patient characteristics associated with an increased risk of velopharyngeal insufficiency and speech/language impairment. Although velopharyngeal insufficiency is a less commonly reported characteristic of CFM than other malformations, it can cause speech impairment, which may contribute to delayed language development in patients with CFM. Therefore, timely recognition and treatment of speech impairment is essential.

Forehead shape analysis following surgical and conservative treatment in metopic synostosis: a 3D photogrammetry analysis.

BACKGROUND: The aim of this study is to describe and compare head shape in surgically and conservatively treated patients using 3D photogrammetry. METHODS: A retrospective review (2017-2020) of consecutive patients with isolated metopic synostosis based on 3D photogrammetry was conducted at the age of 4 years old. Images were aligned using a healthy age-matched template, and mean head shapes were reconstructed to evaluate shape development. A comparative sub-analysis based on phenotype was performed between patients that have been treated surgically and conservatively. RESULTS: 44 patients with isolated metopic synostosis were included: 22 received conservative treatment and 22 underwent fronto-orbital advancement. At 4 years of age the surgical group showed retrusion of the complete frontal area, while the conservative group showed a slight frontal prominence. Both groups showed temporal depression with respect to the control. In the sub-analysis, a similar degree of temporal depression was observed between surgical and conservative treatment. Head shape patterns showed considerable similarity across all severity phenotypes. CONCLUSION: This study shows a deviation in forehead shape from normal controls in patients with metopic synostosis following both surgical and conservative treatment by the age of 4 years. Comparison between surgical and conservative treatment shows a similar degree of temporal depression, a slight prominence in the center of the forehead in the conservative group, and retrusion of the entire frontal area in the surgical group. This observed difference is of considerable similarity across all severity types. LEVEL OF EVIDENCE THERAPEUTIC: III.

Predictors of Outcomes in 900 Alveolar Bone Grafts.

BACKGROUND: Significant discrepancies exist in the reported variables influencing alveolar bone graft outcomes. The purpose of this study was to evaluate graft success and identify outcome predictors in a large patient cohort using an objective Cone Beam Computed Tomographic (CBCT) assessment tool. METHODS: Consecutive patients with cleft lip/palate who underwent alveolar bone grafting by one surgeon were included. Predictor variables were age at graft, oronasal fistula, canine position, concurrent premaxillary osteotomy, size of cleft, presence of bony palatal bridge, history of failed graft, location of primary repair, and surgeon experience. The outcome variable was graft success determined using a CBCT assessment tool and defined as a score of > 3 out of 4 in each domain: vertical bone level, labiopalatal thickness, and nasal piriform symmetry. RESULTS: The sample included 900 alveolar cleft sites (median graft age 9.9 years). The success rate was 94.6%. Presence of an erupted canine, large cleft defect, and premaxillary osteotomy were independent predictors of graft failure, while presence of a bony palatal bridge was associated with graft success (p < 0.05). CONCLUSIONS: Presence of an erupted canine, large bony defect, and premaxillary osteotomy increase failure, and a bony palatal bridge portends success. Variables of age > 12 years, visible oronasal fistula, history of failed graft, primary cleft repaired at outside institution, and surgeon experience were associated with higher graft failure but were not independent predictors when controlling for co-variates. Surgeons should be aware that these factors in combination increase the odds of graft failure.