Regional facial asymmetries in unilateral orofacial clefts

SummaryObjectives: Assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilateral cleft lip and alveolus (UCLA), and unilateral cleft lip, alveolus, and palate (UCLP), and to evaluate which area of the face is most asymmetrical. Methods: Standardized three-dimensional facial images of 58 patients (9 UCL, 21 UCLA, and 28 UCLP; age range: 8.6-12.3 years) and 121 controls (age range 9-12 years) were mirrored and distance maps were created. Absolute mean asymmetry values were calculated for the whole face, cheek, nose, lips, and chin. One-way analysis of variance, Kruskal-Wallis, and t-test were used to assess the differences between clefts and controls for the whole face and separate areas. Results: Clefts and controls differ significantly for the whole face as well as in all areas. Asymmetry is distributed differently over the face for all groups. In UCLA, the nose was significantly more asymmetric compared with chin and cheek (P = 0.038 and 0.024, respectively). For UCL, significant differences in asymmetry between nose and chin and chin and cheek were present (P = 0.038 and 0.046, respectively). In the control group, the chin was the most asymmetric area compared to lip and nose (P = 0.002 and P = 0.001, respectively) followed by the nose (P = 0.004). In UCLP, the nose, followed by the lips, was the most asymmetric area compared to chin, cheek (P < 0.001 and P = 0.016, respectively). Limitations: Despite division into regional areas, the method may still exclude or underrate smaller local areas in the face, which are better visualized in a facial colour coded distance map than quantified by distance numbers. The UCL subsample is small. Conclusion: Each type of cleft has its own distinct asymmetry pattern. Children with unilateral clefts show more facial asymmetry than children without cleft

Longitudinal 3D assessment of facial asymmetry in unilateral cleft lip and palate

Objective: Longitudinal evaluation of asymmetry of the surgically managed unilateral cleft lip and palate (UCLP) to assess the impact of facial growth on facial appearance. Design: Prospective study. Setting: Glasgow Dental Hospital and School, University of Glasgow, United Kingdom Patients: Fifteen UCLP infants. Method: The 3-D facial images were captured before surgery, 4 months after surgery, and at 4-year follow-up using stereophotogrammetry. A generic mesh which is a mathematical facial mask that consists of thousands of points (vertices) was conformed on the generated 3-D images. Using Procustean analysis, an average facial mesh was obtained for each age-group. A mirror image of each average mesh was mathematically obtained for the analysis of facial dysmorphology. Facial asymmetry was assessed by measuring the distances between the corresponding vertices of the original and the mirror copy of the conformed meshes, and this was displayed in color-coded map. Results: There was a clear improvement in the facial asymmetry following the primary repair of cleft lip. Residual asymmetry was detected around the nasolabial region. The nasolabial region was the most asymmetrical region of the face; the philtrum, columella, and the vermillion border of the upper lip showed the maximum asymmetry which was more than 5 mm. Facial growth accentuated the underlying facial asymmetry in 3 directions; the philtrum of the upper lip was deviated toward the scar tissue on the cleft side. The asymmetry of the nose was significantly worse at 4-year follow-up (P &lt; .05). Conclusion: The residual asymmetry following the surgical repair of UCLP was more pronounced at 4 years following surgery. The conformed facial mesh provided a reliable and innovative tool for the comprehensive analysis of facial morphology in UCLP. The study highlights the need of refining the primary repair of the cleft and the potential necessity for further corrective surgery

Automatic facial analysis for objective assessment of facial paralysis

Facial Paralysis is a condition causing decreased movement on one side of the face. A quantitative, objective and reliable assessment system would be an invaluable tool for clinicians treating patients with this condition. This paper presents an approach based on the automatic analysis of patient video data. Facial feature localization and facial movement detection methods are discussed. An algorithm is presented to process the optical flow data to obtain the motion features in the relevant facial regions. Three classification methods are applied to provide quantitative evaluations of regional facial nerve function and the overall facial nerve function based on the House-Brackmann Scale. Experiments show the Radial Basis Function (RBF) Neural Network to have superior performance

The effect of facial expression on facial symmetry in surgically managed unilateral cleft lip and palate patients (UCLP)

Aim: To evaluate the symmetry of facial expression in surgically managed UCLP patients. Materials and methods: The study was conducted on 13 four-year-old children. Facial images were captured at rest and at maximum smile using stereophotogrammetry. A generic mesh, which is a mathematical facial mask consisting of a fixed number of indexed vertices, was utilised for the assessment of facial asymmetry. This was quantified by measuring the disparity between the left- and right-hand sides of the face after superimposing the original 3D images on their mirror copies. Results: Residual asymmetries at rest were identified at the vermillion of the upper lip and at the nares with a deviation of the philtrum towards the scar tissue. Vertical and anteroposterior asymmetries were identified on the cleft side. At maximum smile, the asymmetry increased noticeably at the vermillion of the upper lip and at the alar base. In the mediolateral direction, the philtrum deviated towards the cleft side with a significant increase of the asymmetry scores. Discussion: Asymmetry of the upper lip has significantly increased at maximum smile as a result of the upward forces of all perioral lifting muscles, which affected the lip directly. Conclusions: The innovation of this study is the measurement of facial asymmetry for the objective outcome measure of the surgical repair of UCLP. The philtrum was the main site of residual asymmetry, which indicates the need for refining the primary repair of the cleft lip. Further corrective surgery may be required

Facial Soft-Tissue Asymmetry in 3D Cone Beam Computed Tomography Images of Children with Surgically Corrected Unilateral Clefts

Cleft lip with or without cleft palate (CL/P) is a relatively common craniofacial malformation involving bony and soft-tissue disruptions of the nasolabial and dentoalveolar regions. The combination of CL/P and subsequent craniofacial surgeries to close the cleft and improve appearance of the cutaneous upper lip and nose can cause scarring and muscle pull, possibly resulting in soft-tissue depth asymmetries across the face. We tested the hypothesis that tissue depths in children with unilateral CL/P exhibit differences in symmetry across the sides of the face. Twenty-eight tissue depths were measured on cone-beam computed tomography images of children with unilateral CL/P (n = 55), aged 7 to 17 years, using Dolphin software (version 11.5). Significant differences in tissue depth symmetry were found around the cutaneous upper lip and nose in patients with unilateral CL/P

Three-dimensional assessment of dentofacial deformity in children with clefts

Background: Changes in clinical management; advances in non-invasive three-dimensional imaging; developments in methods of shape analysis. Aim: To assess three-dimensional dentofacial deformity with a view to early appraisal of primary surgical outcome. Results: Significant differences in upper lip morphology were found between the cleft children and their unaffected peers; nasal asymmetry that became more obvious in function was noted in cleft children; the maxillary dental arches of the children with repaired cleft palate were shallow, short and narrow; and the dental arch, deformity and the facial soft tissue deformity were unrelated. Contributions to the field: It has been shown that deviation from normal could be detected as young as 3 years of age using computerised stereophotogrammetry; preliminary, objective, three-dimensional analysis of facial function has been completed in young children; the accuracy of three-dimensional CT scanning of dentate study models and the time cost of data collection were quantified; and this study has produced a body of three-dimensional data that can test and support analytical advances

Prenatal development of skull and brain in a mouse model of growth restriction

Patterns of covariation result from the over-lapping effect of several developmental processes. By perturbing certain specific developmental processes, ex-perimental studies contribute to a better understanding of their particular effects on the generation of phenotype. The aim of this work was to analyze the interactions among morphological traits of the skull and the brain during late prenatal life (18.5 days postconception) in mice exposed to maternal protein undernutrition. Images from the skull and brain were obtained through micro-computed tomography and 3D landmark coordinates were digitized in order to quantify shape and size of both structures with geometric morphometric techniques. The results highlight a systemic effect of protein restriction on the size of the skull and the brain, which were both significantly reduced in the under-nourished group compared to control group. Skull shape is partially explained by brain size, and patterns of shape variation were only partially coincident with previous re-ports for other ontogenetic stages, suggesting that allomet-ric trajectories across pre- and postnatal ages change their directions. Within the skull, neurocranial and facial shape traits covaried strongly, while subtle covariation was found between the shape of the skull and the brain. These find-ings are in line with former studies in mutant mice and reveal the importance of carrying out analyses of pheno-typic variation in a broad range of developmental stages. The present study contributes to the basic understanding of epigenetic relations among growing tissues and has di-rect implications for the field of paleoanthropology, where inferences about brain morphology are usually derived from skull remains.Los patrones de covariación entre rasgos fenotí-picos resultan de la acción de diversos procesos que se sola-pan durante el desarrollo. Los estudios experimentales cons-tituyen la aproximación más adecuada para evaluar el efecto de procesos específicos en la generación de tales patrones. El objetivo de este trabajo es analizar las interacciones entre rasgos morfológicos craneofaciales y cerebrales durante la vida prenatal tardía (18,5 días posconcepción) en ratones ex-puestos a desnutrición proteica materna. Se obtuvieron imá-genes del cráneo y cerebro a partir de microtomografía com-putada y se digitalizaron landmarks en 3D para cuantificar la forma y tamaño con técnicas de morfometría geométrica. Los resultados subrayan un efecto sistémico de la restricción proteica en el tamaño del cráneo y el cerebro. La forma del cráneo es parcialmente explicable por el tamaño cerebral y los patrones de variación en forma fueron sólo en parte coin-cidentes con los reportados antes para otras edades, lo cual sugiere que las trayectorias alométricas a lo largo de la vida pre- y posnatal cambian su dirección. Los rasgos de forma del neurocráneo y el esqueleto facial covariaron fuertemen-te, aunque se encontró una asociación débil entre la forma del cráneo y del cerebro. Estos resultados concuerdan con estudios previos en ratones mutantes y revelan la relevancia de analizar la variación fenotípica en distintas etapas. El pre-sente estudio contribuye al conocimiento básico de las inte-racciones epigenéticas entre tejidos en crecimiento y tiene implicancias en el campo paleoantropológico en el que las inferencias acerca de la morfología cerebral son usualmen-te derivadas del análisis del cráneo.Fil: Barbeito Andrés, Jimena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico CONICET- La Plata. Instituto de Genética Veterinaria "Ing. Fernando Noel Dulout". Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Instituto de Genética Veterinaria; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo; ArgentinaFil: Gonzalez, Paula Natalia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico CONICET- La Plata. Instituto de Genética Veterinaria "Ing. Fernando Noel Dulout". Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Instituto de Genética Veterinaria; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo; ArgentinaFil: Hallgrimsson, Benedikt. University of Calgary; Canad

A longitudinal study of facial growth in infants using a three-dimensional imaging technique

This study aimed to measure the facial morphology and growth of 100 infants in the West of Scotland from the age of 3 months to 2 years using a three dimensional imaging system, C3D. One of the aims of the study was to validate the use of the C3D system to measure facial morphology in infants. Further aims were to establish references values for facial dimensions in infants, to establish the normal growth of facial parameters from 3 months to 2 years, to correlate facial and body growth, to ascertain any sexual dimorphism, to establish the degree of facial asymmetry and to determine any longitudinal changes in facial asymmetry in infant’s faces. Eighty three infants at 3 months, 93 infants at 6 months, 91 infants at 1 year and 92 infants at 2 years were successfully captured with a lips apart pose. Reference values for facial dimensions in infants at these ages were established. Significant gender differences were found for most facial measurements at all ages with the males being larger than the females. These differences were greatest for face height, depths and widths with mean differences ranging from 1.7 to 4.0 mm. No gender differences were found in any of the angles measured. Several dimensions on the right side of the face were found to be significantly larger than the left. This was most marked for face depths with mean differences of 0.8 mm. The range of normal facial asymmetry scores was determined. No significant difference in asymmetry was found between the males and females. The upper face was found to be the most asymmetric region studied and the nostrils were the least asymmetric. Correlation of facial measurements with body dimensions found weak but significant correlations with the highest correlation coefficient of 0.69 between face depth and body weight. Nasal tip protrusion, nostril dimensions and lip heights were not correlated with body dimensions. Seventy one infants, 37 males and 34 females, were successfully captured at all four ages with the lips apart and were included in the longitudinal analysis. The longitudinal changes in facial parameters were established from 3 months to 2 years and mean growth curves produced. The fastest growth was found from 3 to 6 months and the slowest from 1 to 2 years. There were no correlation between growth of the face and growth in body weight, length and head circumference. Significant reductions in the overall facial asymmetry score were found from 3 months to 2 years. The clinical significance of this reduction is still to be determined

Dysmorphometrics: the modelling of morphological abnormalities

<p>Abstract</p> <p>Background</p> <p>The study of typical morphological variations using quantitative, morphometric descriptors has always interested biologists in general. However, unusual examples of form, such as abnormalities are often encountered in biomedical sciences. Despite the long history of morphometrics, the means to identify and quantify such unusual form differences remains limited.</p> <p>Methods</p> <p>A theoretical concept, called dysmorphometrics, is introduced augmenting current geometric morphometrics with a focus on identifying and modelling form abnormalities. Dysmorphometrics applies the paradigm of detecting form differences as outliers compared to an appropriate norm. To achieve this, the likelihood formulation of landmark superimpositions is extended with outlier processes explicitly introducing a latent variable coding for abnormalities. A tractable solution to this augmented superimposition problem is obtained using Expectation-Maximization. The topography of detected abnormalities is encoded in a dysmorphogram.</p> <p>Results</p> <p>We demonstrate the use of dysmorphometrics to measure abrupt changes in time, asymmetry and discordancy in a set of human faces presenting with facial abnormalities.</p> <p>Conclusion</p> <p>The results clearly illustrate the unique power to reveal unusual form differences given only normative data with clear applications in both biomedical practice & research.</p

Neural Markers of Opposite-Sex Bias in Face Processing

Some behavioral and neuroimaging studies suggest that adults prefer to view attractive faces of the opposite sex more than attractive faces of the same sex. However, unlike the other-race face effect (Caldara et al., 2004), little is known regarding the existence of an opposite-/same-sex bias in face processing. In this study, the faces of 130 attractive male and female adults were foveally presented to 40 heterosexual university students (20 men and 20 women) who were engaged in a secondary perceptual task (landscape detection). The automatic processing of face gender was investigated by recording ERPs from 128 scalp sites. Neural markers of opposite- vs. same-sex bias in face processing included larger and earlier centro–parietal N400s in response to faces of the opposite sex and a larger late positivity (LP) to same-sex faces. Analysis of intra-cortical neural generators (swLORETA) showed that facial processing-related (FG, BA37, BA20/21) and emotion-related brain areas (the right parahippocampal gyrus, BA35; uncus, BA36/38; and the cingulate gyrus, BA24) had higher activations in response to opposite- than same-sex faces. The results of this analysis, along with data obtained from ERP recordings, support the hypothesis that both genders process opposite-sex faces differently than same-sex faces. The data also suggest a hemispheric asymmetry in the processing of opposite-/same-sex faces, with the right hemisphere involved in processing same-sex faces and the left hemisphere involved in processing faces of the opposite sex. The data support previous literature suggesting a right lateralization for the representation of self-image and body awareness