A reliable and objective method of measuring soft tissue changes in 2D photographs after distraction osteogenesis in individuals with CL/P
DOI:
https://doi.org/10.2340/jphs.v60.40580Keywords:
Cleft lip and palate, distraction osteogenesis, longterm follow-up, photo, soft tissue measurements, soft tissue changes, anterior maxillary distraction, RED, validityAbstract
Pre- and postoperative photos to assess results are widely used in plastic and reconstructive surgery, for instance, in patients with cleft lip and palate (CL/P). Evaluations are often performed by assessment panels by viewing the photos. However, these are prone to be subjective. Measurements of soft tissues in photos could be an alternative method but have not been widely used so far. Some patients with CL/P develop a retrognathic maxilla in adolescence, with ensuing Class III malocclusion. In severe cases, distraction osteogenesis (DO) of the maxilla may be indicated. The effect of DO on the facial soft tissues is sparsely reported, perhaps due to the rare procedure. The primary aim of the present study is to provide a reliable and objective method of measuring soft tissue profiles in two-dimensional digital photos. Furthermore, the study aims at assessing changes in soft tissues following DO.
Fourteen patients who had undergone DO at our unit were recruited. Preoperative and postoperative photos were identified, and long-term follow-up photos were taken. Three raters performed measurements of four angles and two distances. Inter- and intra-rater reliability and soft tissue changes were analyzed statistically.
Inter- and intra-rater reliability was high overall for most variables. Two angles related to facial convexity changed significantly. So did the upper lip height.
Soft tissues can be measured with a high degree of accuracy, but further evaluation of the method is necessary. DO causes a favorable increase in facial convexity, and an increased upper lip height.
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Phillips JH, Nish I, Daskalogiannakis J. Orthognathic surgery in cleft patients. Plast Reconstr Surg. 2012;129(3):535e–548e. https://doi.org/10.1097/PRS.0b013e31824128e6 DOI: https://doi.org/10.1097/PRS.0b013e31824128e6
Combs PD, Harshbarger RJ, 3rd. Le fort I maxillary advancement using distraction osteogenesis. Semin Plast Surg. 2014;28(4):193–198. https://doi.org/10.1055/s-0034-1390172 DOI: https://doi.org/10.1055/s-0034-1390172
Duggal I, Talwar A, Duggal R, et al. Comparative evaluation of nasolabial appearance of unilateral cleft lip and palate patients by professional, patient and layperson using 2 aesthetic scoring systems: a cross sectional study. Orthod Craniofac Res. 2023;26(4):660–666. https://doi.org/10.1111/ocr.12663 DOI: https://doi.org/10.1111/ocr.12663
Zhu S, Jayaraman J, Khambay B. Evaluation of facial appearance in patients with cleft lip and palate by laypeople and professionals: a systematic literature review. Cleft Palate Craniofac J. 2016;53(2):187–196. https://doi.org/10.1597/14-177 DOI: https://doi.org/10.1597/14-177
Yasin L, Becker M, Svensson H, et al. Long-term patient-reported outcomes after anterior distraction osteogenesis of the maxilla in patients with cleft. J Plast Surg Hand Surg. 2023;57(1–6):488–493. https://doi.org/10.1080/2000656X.2022.2164294 DOI: https://doi.org/10.1080/2000656X.2022.2164294
Klintö K, Svensson H, Wiedel AP. Long-term speech outcome after distraction osteogenesis of the maxilla in patients with cleft lip and palate. J Plast Surg Hand Surg. 2023;58:110–114. https://doi.org/10.2340/jphs.v58.12308 DOI: https://doi.org/10.2340/jphs.v58.12308
Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–163. https://doi.org/10.1016/j.jcm.2016.02.012 DOI: https://doi.org/10.1016/j.jcm.2016.02.012
Salari N, Darvishi N, Heydari M, et al. Global prevalence of cleft palate, cleft lip and cleft plate and lip: a comprehensive systematic review and meta-analysis. Stomatol Oral Maxillofac Surg. 2022;123(2):110–120. https://doi.org/10.1016/j.jormas.2021.05.008 DOI: https://doi.org/10.1016/j.jormas.2021.05.008
Mossey PA, Little J, Munger RG, et al. Cleft lip and palate. Lancet. 2009;374(9703):1773–1785. https://doi.org/10.1016/S0140-6736(09)60695-4 DOI: https://doi.org/10.1016/S0140-6736(09)60695-4
Fink M, Hirschfelder U, Hirschinger V, et al. Assessment of facial soft-tissue profiles based on lateral photographs versus three-dimensional face scans. J Orofac Orthop. 2017;78(1):70–76. https://doi.org/10.1007/s00056-016-0055-z DOI: https://doi.org/10.1007/s00056-016-0055-z
Ikävalko T, Narhi M, Lakka T, et al. Lateral facial profile may reveal the risk for sleep disordered breathing in children – the PANIC-study. Acta Odontol Scand. 2015;73(7):550–555. https://doi.org/10.3109/00016357.2014.997795 DOI: https://doi.org/10.3109/00016357.2014.997795
Filipović T. Changes in the interpupillary distance (IPD) with ages and its effect on the near convergence/distance (NC/D) ratio. Coll Antropol. 2003;27(2):723–727.
Becker M, Svensson H, Jacobsson S. Clinical examination compared with morphometry of digital photographs for evaluation of repaired cleft lips. Scand J Plast Reconstr Hand Surg. 1998;32:301–306. https://doi.org/10.1080/02844319850158642 DOI: https://doi.org/10.1080/02844319850158642
Duppe K, Becker M, Schönmeyr B. Evaluation of facial anthropometry using three-dimensional photogrammetry and direct measuring techniques. J Craniofac Surg. 2018;29:1245–1251. https://doi.org/10.1097/SCS.0000000000004580 DOI: https://doi.org/10.1097/SCS.0000000000004580
Wen-Ching Ko E, Figueroa AA, Polley JW. Soft tissue profile changes after maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: a 1-year follow-up. J Oral Maxillofac Surg. 2000;58(9):959–970. https://doi.org/10.1053/joms.2000.8735 DOI: https://doi.org/10.1053/joms.2000.8735
Meazzini MC, BNasile V, Mazzoleni F, et al. Long-term follow-up of large maxillary advancements with distraction osteogenesis in growing and non-growing cleft lip and palate patients. J Plast Reconstr Aestet Surg. 2015;68(1):79–86. https://doi.org/10.1016/j.bjps.2014.08.069 DOI: https://doi.org/10.1016/j.bjps.2014.08.069
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Copyright (c) 2025 Annika Bergendal Sterner, Henry Svensson, Magnus Becker, Farokh Collander Farzaneh, Anna-Paulina Wiedel
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