Öwall Louise, Darvann Tron A, Hove Hanne B, Bøgeskov Lars, Kreiborg Sven, Hermann Nuno V
1 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen; Centre of Head and Orthopedics, Copenhagen University Hospital Rigshospitalet; and Department of Applied Mathematics and Computer Science, Technical University of Denmark), Copenhagen, Denmark.
2 Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Cleft Palate Craniofac J. 2019 Aug;56(7):918-928. doi: 10.1177/1055665618821821. Epub 2019 Jan 7.
To assess improvement of soft-tissue facial symmetry in children surgically treated for unicoronal synostosis (UCS) in infancy, to correlate pre- and postsurgical facial asymmetry and to evaluate whether the improvement was visually recognizable.
Case-controlled follow-up.
PATIENTS/SETTINGS: Eleven Danish children diagnosed with UCS were included, 3 of whom had tested positive for Muenke mutation. Preoperative computed tomography scans and postoperative 3dMD surfaces were available for measurements. A control group of healthy children matched for age and sex was employed.
Pre- and postsurgical facial asymmetry was analyzed using a computerized method capable of objective and spatially detailed quantification in 3-dimension (transverse, vertical, and sagittal directions). Asymmetry was evaluated in the facial region and 6 subregions (forehead, mouth, eyes, nose, cheek, and chin).
The largest significant improvement was seen in the sagittal direction of the facial (1.9 mm), forehead (2.0 mm), and cheek (3.4 mm) regions. Small but significant improvements were also seen in the mouth, chin, and eye regions. No significant improvement was seen in the nose region. Significant correlations were found between the pre- and postsurgically calculated facial asymmetry and between calculated asymmetry and clinical validation scores.
All patients presented with improved facial symmetry after surgery and the improvements were visually recognizable. However, only 1 (9.1%) of the 11 patients reached a level of facial asymmetry as low as that seen in the control group. The best outcome was, in general, seen in cases with mild facial asymmetry presurgically.
评估婴儿期接受单冠缝早闭（UCS）手术治疗的儿童面部软组织对称性的改善情况，将手术前后的面部不对称情况进行关联，并评估这种改善在视觉上是否可识别。
病例对照随访研究。
患者/研究背景：纳入11名被诊断为UCS的丹麦儿童，其中3名检测出Muenke突变呈阳性。有术前计算机断层扫描（CT）图像和术后3dMD面部表面图像可供测量。采用年龄和性别匹配的健康儿童作为对照组。
使用一种能够在三维空间（横向、纵向和矢状方向）进行客观且空间细节量化的计算机化方法，分析手术前后的面部不对称情况。在面部区域和6个亚区域（额头、嘴巴、眼睛、鼻子、脸颊和下巴）评估不对称情况。
面部矢状方向（1.9毫米）、额头（2.0毫米）和脸颊（3.4毫米）区域的改善最为显著。嘴巴、下巴和眼睛区域也有虽小但显著的改善。鼻子区域未见显著改善。手术前后计算出的面部不对称之间，以及计算出的不对称与临床验证评分之间均存在显著相关性。
所有患者术后面部对称性均有改善，且这种改善在视觉上可识别。然而，11名患者中只有1名（9.1%）的面部不对称程度降低至对照组的水平。总体而言，术前面部不对称程度较轻的病例效果最佳。
