Facial morphospace: a clinical quantitative analysis of the three-dimensional face in patients with cleft lip and palate

Abstract

Aim: The aims were: (1) to examine the clinical application of a geometric morphometric method (GMM) that quantifies the three-dimensional (3D) configuration of the facial soft tissues in patients with a repaired unilateral cleft lip and palate (UCLP); and (2) to determine the morphological characteristics that distinguish between non-cleft participants and patients with UCLP.

Methods: 3D facial images at rest were recorded from Japanese patients with a repaired UCLP (Cleft group; n = 60) and healthy adults featuring a straight type facial profile with normal occlusion (Control group; n = 200) using 3D photogrammetric cameras. For each participant, wire mesh fitting was conducted based on the assignment of landmarks to each 3D facial image. This method generated landmark-based GMM models consisting of 6017 nodes on the fitted wire mesh. For each node, the mean and standard deviation were determined in the Control group and were used as the normative range of the faces. With this normative range, the Z-scores before and after surgery were evaluated for patients with UCLP who underwent orthognathic bimaxillary surgery. Further, the morphological characteristics of the Cleft group were evaluated using a principal component (PC) regression analysis that distinguished between two subject groups. In addition, K-means clustering analysis and MANOVA were used to examine the morphological variation of the Cleft group.

Results: A patient with UCLP was evaluated with the system. After surgery, the normal area increased by 8%-20% on all axes, which means that the surgery was effective for normalizing the patient’s face. However, even after surgery, the protrusion of the lower lip and asymmetry remained. Nine PCs were extracted, and seven PCs were selected for the regression model to discriminate two subject groups, e.g., midfacial retrusion, nasal bump, and chin protrusion. The MANOVA also revealed significant differences between both the Cleft and Control groups and the sex subgroups, and the effects of cleft on the facial morphology was found to be related to sex (all, P < 0.01).

Conclusion: The clinical application of GMM was confirmed to be effective. GMM detected variations of the Cleft group and morphological characteristics. GMM is considered to be a powerful tool to quantitatively evaluate faces in clinics.

Keywords

Cleft lip and palate / face / geometric morphometric analysis / three-dimensional analysis

References

[1] Sykes JM.Cleft lip rhinoplasty..Facial Plast Surf Clin North Am2009;17:133-44

[2] Yamada T,Minami K,Sugahara T.Three-dimensional facial morphology, following primary cleft lip repair using the triangular flap with or without rotation advancement..J Craniomaxillofac Surg2002;30:337-42

[3] Fujimoto T,Hatano T,Tamai M.Follow-up of unilateral cleft-lip nose deformity after secondary repair with a modified reverse-U method..J Plast Reconstr Aesthet Surg2011;64:747-53

[4] Mori A,Kaneko T,Aoki Y.Analysis of 109 Japanese children’s lip and nose shapes using 3-dimensional digitizer..Br J Plast Surg2005;58:318-29

[5] Anastassov Y.Analysis of nasal and labial deformities in cleft lip, alveolus and palate patients by a new rating scale: preliminary report..J Craniomaxillofac Surg2003;31:299-303

[6] Kim DW,Hong HK,Park JH.Statistical evaluation of the cleft lip nose deformity image..Conf Proc IEEE Eng Med Biol Soc2006;1:3840-2

[7] Nagy K.Analysis of the cleft-lip nose in submental-vertical view, Part I--reliability of a new measurement instrument..J Craniomaxillofac Surg2007;35:265-77

[8] Farkas LG.Anthropometry of the head and face.1994;2nd edNew YorkRaven Press

[9] Ferrario VF,Dellavia C,Carù A.Three-dimensional nasal morphology in cleft lip and palate operated adult patients..Ann Plast Surg2003;51:390-7

[10] Ras F,van Ginkel FC.Method for quantifying facial asymmetry in three dimensions using stereophotogrammetry..Angle Orthod1995;65:233-9

[11] van Loon B,Plooij JM,Borstlap WA.3D Stereophotogrammetric assessment of pre- and postoperative volumetric changes in the cleft lip and palate nose..Int J Oral Maxillofac Surg2010;39:534-40

[12] Russell KA,Tompson B.Nasal morphology and shape parameters as predictors of nasal esthetics in individuals with complete unilateral cleft lip and palate..Cleft Palate Craniofac J2001;38:476-85

[13] Russell KA,Varma D,Lee JM.Three-dimensional morphologic nasal surface characteristics that predict the extremes of esthetics in patients with repaired cleft lip and palate..Cleft Palate Craniofac J2011;48:28-37

[14] Dusková M,Smahel Z.The anthropometric verification of corrective surgery outcome in cleft secondary deformities..J Craniofac Surg2006;17:447-53

[15] Nagasao T,Hikosaka M,Ishii N.A new method to quantify subtle morphological deformities in nasal profile curvatures and its application for analysis of unilateral cleft lip noses..J Craniomaxillofac Surg2008;36:321-34

[16] Yamada T,Minami K,Sugahara T.Computer aided three-dimensional analysis of nostril forms: application in normal and operated cleft lip patients..J Craniomaxillofac Surg1999;27:345-53

[17] Tanikawa C,van Aalst J.Objective three-dimensional assessment of lip form in patients with repaired cleft lip..Cleft Palate Craniofac J2010;47:611-22 PMCID:PMC2970757

[18] Bookstein FL.Landmark methods for forms without landmarks: morphometrics of group differences in outline shape..Med Image Anal1997;1:225-43

[19] Tanikawa C,Takada K.Quantifying faces three-dimensionally in orthodontic practice..J Cranio-maxillofacial Surgery2019;47:867-75

[20] Shintaku Y,Iida S,Kogo M.Maxillary expansion and midline correction by asymmetric transverse distraction osteogenesis in a patient with unilateral cleft lip/palate: a case report..Cleft Palate Craniofac J2015;52:618-24

[21] Tanikawa C,Takada K.Sexual dimorphism in the facial morphology of adult humans: a three-dimensional analysis..Homo2016;67:23-49

[22] Kono K,Yanagita T,Yamashiro T.A novel method to detect 3D mandibular changes related to soft-diet feeding..Front Physiol2017;8:567 PMCID:PMC5557733

[23] Crouch DJM,Koppen WP,Hutnik K.Genetics of the human face: identification of large-effect single gene variants..Proc Natl Acad Sci U S A2018;115:E676-85 PMCID:PMC5789906

[24] Claes P,Daniels K,Quillen EE.Modeling 3D facial shape from DNA..Proc Natl Acad Sci USA2018;115:E676-85

[25] Hammond P.The use of 3D face shape modelling in dysmorphology..Arch Dis Child2007;92:1120-6 PMCID:PMC2066088

[26] Huber P, Hu G, Tena1 R, Mortazavian P, Koppen WP, et al. A multiresolution 3D morphable face model and fitting framework. Available from: http://www.ee.surrey.ac.uk/CVSSP/Publications/papers/Huber-VISAPP-2016.pdf. [Last accessed on 7 Sep 2020]

[27] Yang H, Zhu H, Wang Y, Huang M, Shen Q, et al. FaceScape: a large-scale high quality 3D face Dataset and detailed riggable 3D face prediction. Available from: https://arxiv.org/abs/2003.13989. [Last accessed on 25 Aug 2020]

[28] Farkas LG,Posnick JC.Anthropometric and anthroposcopic findings of the nasal and facial region in cleft patients before and after primary lip and palate repair..Cleft Palate Craniofac J1993;30:1-12

[29] Bardach J.The relationship between lip pressure following lip repair and craniofacial growth: an experimental study in beagles..Plast Reconstr Surg1984;73:544-55

[30] Ayoub A,Millett D,Siebert P.Three-dimensional assessment of early surgical outcome in repaired unilateral cleft lip and palate: Part 1. Nasal changes..Cleft Palate Craniofac J2011;48:571-7