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British Journal of Medicine & Medical Research
15(2): 1-11, 2016, Article no.BJMMR.25350
ISSN: 2231-0614, NLM ID: 101570965
SCIENCEDOMAIN international
www.sciencedomain.org
Evaluation of Soft Tissue Profile Change Following
Bi-maxillary Surgery in Dento-skeletal Class III by
Photogrammetric Analysis
Andrea Torroni
1
, Giulio Gasparini
1*
, Alessandro Moro
1
, Gianmarco Saponaro
1
,
Enrico Foresta
1
, Paolo De Angelis
1
, Daniele Cervelli
1
, Camillo Azzuni
1
,
Roberto Boniello
1
, Luca Pallottini
2
, Anna Borelli
2
, Giulia Jafari
1
, Sandro Pelo
1
,
Roberto Deli
2
and Giuliana Longo
1
1
U.O.C. Maxillo Facial Surgery, Catholic University Medical School, Largo Agostino Gemelli 1,
00168 Rome, Italy.
2
School of Orthodontics, Catholic University Medical School, Largo Agostino Gemelli 1, 00168 Rome,
Italy.
Authors’ contributions
This work was carried out in collaboration between all authors. Authors AT, RD and SP designed the
study, wrote the protocol and wrote the first draft of the manuscript. Authors GJ and GG managed the
literature searches, analyses of the study and authors LP and AB managed the experimental process.
All authors read and approved the final manuscript.
Article Information
DOI: 10.9734/BJMMR/2016/25350
Editor(s):
(1)
Ibrahim El-Sayed M. El-Hakim, Ain Shams University, Egypt and Riyadh College of Dentistry and Pharmacy, Riyadh,
Saudi Arabia.
Reviewers:
(1) Takahiro Kanno, Shimane University, Japan.
(2)
Rodrigo Crespo Mosca, Sao Paulo University, Brazil.
(3) Babatunde O. Bamgbose, Bayero University, Kano, Nigeria.
Complete Peer review History:
http://sciencedomain.org/review-history/14157
Received 28
th
February 2016
Accepted 5
th
April 2016
Published 14
th
April 2016
ABSTRACT
3D analysis allows for simulation of orthognathic surgery and prediction of aesthetic and functional
outcomes. Our study aims to find common and repeatable parameters on the behaviour of soft
tissues following bone movement by pre- and post-treatment by photogrammetric analysis. Three
representative patients who underwent bimaxillary surgery of advancement/retrusion of the jaws
for correction of class III dento-skeletal malformation were presented. By overlapping pre-operative
and post-operative 3D photos we obtained colour and millimetric maps that allowed the objective
appreciation of facial soft tissues modification in all planes of the space after orthognathic surgery.
Original Research Article
Torroni et al.; BJMMR, 15(2): 1-11, 2016; Article no.BJMMR.25350
2
The study disclosed interesting insight into the soft tissue behaviour following orthognathic surgery
and highlighted the possibility to draw reliable dissipation curves of facial skin after orthognathic
surgery. This study also provided the base for future development of 3D images analysis (3D VTO)
to plan and predict aesthetic outcomes of patients with dento-skeletal malformation.
Keywords: Dento-skeletal malformation; orthognatic surgery; preoperative planning; soft tissue
behaviour; tri-dimensional analysis; photogrammetry.
1. INTRODUCTION
Although assessment of craniofacial morphology
would always require a 3D approach, today the
planning of orthognathic surgery is mostly
performed with 2D methods, making it difficult to
correctly evaluate the changes of thickness and
position of soft tissue, and obtain reliable
previsions of outcomes [1-5].
In recent years, application of 3D imaging has
gained priority because of its advantages over
the 2D techniques: It allows for simulation of
surgery and prediction of aesthetic and functional
outcomes, improving both the treatment planning
and results [1].
Recognition of aesthetic factors and prediction of
final facial profile plays an important role in
orthognathic treatment planning, since the facial
profile produced by orthognathic surgery is often
of high importance for patients [2-4]; however,
the effects of skeletal surgery on soft tissue
profiles is not easy to predict [5].
Many strategies have been attempted to
evaluate the relationship between hard tissue
movement and its effect on overlying soft tissue
for predicting facial changes. However, most
of these studies involve the use of complex
techniques that variously combine photo-
grammetry, 3D laser, CT scan and / or CBTC,
with considerable expenses and biological costs,
exposing the patients to ionizing radiation [6-9].
Photogrammetry is a non-invasive and free of
biological costs technique, which involves the
use of digital photographs. The possibility to
have a "3D photographic image" of the face
opens new perspectives of diagnostic and
therapeutic planning: 3D evaluation of soft tissue
integrates the information from cephalometry,
improving the diagnosis, treatment plan, and
evaluation of results by comparing pre- and post-
treatment conditions.
Photogrammetry is a valid alternative to laser
scanning 3D, which is the technique used in the
majority of three-dimensional analysis of the
human body, although burdened by high costs of
the equipment, long times of image acquisition,
and also requiring a strict collaboration of the
subject in exam [9-13]. Photogrammetry is an
economical method, easy to use, with reduced
acquisition time: Factors that increase patient
compliance, repeatability, and accuracy [9]. In
our hospital photogrammetry is an integral part of
the orthognathic assessment, and is free of
charge for the patient.
Our study aims to find common and repeatable
parameters on the behaviour of soft tissues
following the bone movement in the sagittal plan
by pre- and post-treatment photogrammetric
analysis. Dissipation curves of facial soft tissues
pre- and post-orthognathic surgery were drawn
and analysed on 45 consecutive cases, using
photogrammetric assay; three representative
cases were presented in detail to explain step by
step our methodological approach. The proposed
method, once validated, might provide useful
information to develop 3D analysis for an
accurate previewing of the face of patients
undergoing orthognathic surgery.
2. MATERIALS AND METHODS
Fortyfive consecutive patients who underwent
bimaxillary surgery at the Department of Oral and
Maxillofacial Surgery of the Catholic University of
Sacred Heart from January 2011 to December
2012 were selected. Inclusion criteria were age ≥
18 years, and linear movement of the maxillary
segments on the sagittal plane (i.e.
advancement/retrusion of the jaws) for correction
of class III (twenty four cases) and class II
(twenty one cases) dento-skeletal malformation
(Fig. 1); in this preliminary study for the
evaluation of soft tissue behaviour following
orthognathic surgery by photogrammetry
analysis, we voluntarily excluded cases with
severe vertical discrepancies (impaction of the
maxilla ≥ 4 mm) and asymmetric patients in order
to reduce confounding factors. The study
received IRB approval from the ethic committee
of the Catholic University, and informed consent
to the procedure and for publication of relevant
clinical information and photos has been obtain
by each participant.
Fig. 1. Pre-
operative view of the three patients with class II
Imaging method: 3D photos were taken with the
3dMD Face Scan System; the 3dMD system is
constituted by a pole stand with three supporting
arms (one ve
rtical and two lateral, left and right),
containing three digital cameras (one colour and
two black and white), and a projector that shows
a reference grid on the face of the patient. The
digital information obtained will subsequently be
used for processin
g the images and realize the
3D model. The system also contains three
flashes lights. The whole structure is connected
to a computer that contains both the software for
image acquisition (3dMD face) and the software
for their processing (3dMD vultus).
The
values of diaphragm overture, white balance
and exposure time are set by the manufacturer
company, and them cannot be modified.
The system requires, as all three
machinery, a calibration of the positioning
sensors before use for achieve consi
results.
The calibration phase must be performed before
each acquisition, and it consists of a photograph
in two different positions of a panel with a
calibration grid, placed exactly in the centre of
the system. After that, the system is ready for
acquisition of the patient's images. The subjects
are seated on a stool with adjustable height. The
correct position of the head is checked on a
monitor by the operator through the use of a
webcam.
The presence of a reference grid that appears on
the
screen guides the proper position to be taken
Torroni et al.; BJMMR, 15(2): 1-11, 2016
; Article
3
operative view of the three patients with class II
I dento-
skeletral malformation
Imaging method: 3D photos were taken with the
3dMD Face Scan System; the 3dMD system is
constituted by a pole stand with three supporting
rtical and two lateral, left and right),
containing three digital cameras (one colour and
two black and white), and a projector that shows
a reference grid on the face of the patient. The
digital information obtained will subsequently be
g the images and realize the
3D model. The system also contains three
flashes lights. The whole structure is connected
to a computer that contains both the software for
image acquisition (3dMD face) and the software
values of diaphragm overture, white balance
and exposure time are set by the manufacturer
company, and them cannot be modified.
The system requires, as all three
-dimensional
machinery, a calibration of the positioning
sensors before use for achieve consi
stent
The calibration phase must be performed before
each acquisition, and it consists of a photograph
in two different positions of a panel with a
calibration grid, placed exactly in the centre of
the system. After that, the system is ready for
the
acquisition of the patient's images. The subjects
are seated on a stool with adjustable height. The
correct position of the head is checked on a
monitor by the operator through the use of a
The presence of a reference grid that appears on
screen guides the proper position to be taken
during the shooting procedure, with the head at
the centre of the grid. After a simultaneous click
three photographic images are immediately
processed by the program 3dMD
realization of 3D model. T
he models obtained are
then imported into the 3dMD vultus software for
the processing phase.
The system automatically measures both the
points and the mutual distances between the
points, in order to obtain distances, angles and
volumetric measurements; the images obtained
provide a faithful representation of the face and
are therefore particularl
y suited to the analysis of
soft tissues. Once the three dimensional surface
of face has been created, it can be exported in
wrml format and used for analysis on Geomagic.
Analysis method: Pre-
op and post
acquired with the 3dMD system, were i
into Geomagic Qualify to perform the analysis of
3D deviations point by point between the two
models; the pre-
treatment model, based on the
3D image acquired at T0 time, was indicated as
“reference model”, while the post-
surgery model,
whose image
was obtained at list 6 months post
op (T1 time), was named “test model” (the model
in which the changes have occurred).
Geomagic Studio is a software house that allows
conversion of 3D images into polygons and Non
Uniform Rational Basis-
Splines (NURBS),
permits analysis on measurable data. For our
analysis we used the latest version of Geomagic
(12).
; Article
no.BJMMR.25350
skeletral malformation
during the shooting procedure, with the head at
the centre of the grid. After a simultaneous click
three photographic images are immediately
processed by the program 3dMD
-face for the
he models obtained are
then imported into the 3dMD vultus software for
The system automatically measures both the
points and the mutual distances between the
points, in order to obtain distances, angles and
volumetric measurements; the images obtained
provide a faithful representation of the face and
y suited to the analysis of
soft tissues. Once the three dimensional surface
of face has been created, it can be exported in
wrml format and used for analysis on Geomagic.
op and post
-op 3D photos
acquired with the 3dMD system, were i
mported
into Geomagic Qualify to perform the analysis of
3D deviations point by point between the two
treatment model, based on the
3D image acquired at T0 time, was indicated as
surgery model,
was obtained at list 6 months post
-
op (T1 time), was named “test model” (the model
in which the changes have occurred).
Geomagic Studio is a software house that allows
conversion of 3D images into polygons and Non
Splines (NURBS),
and
permits analysis on measurable data. For our
analysis we used the latest version of Geomagic
The analysis performed by Geomagic entailed 3
phases:
1)
Optimized alignment: for optimal match of
both the reference and test model of the
face; for the accuracy of this phase it was
important to select areas of the face which
did not change after surgery; the areas
selected for this matching process were:
The
forehead, nasal bones, and the upper
part of zygomatic bone and zygomatic
arch.
2)
3D Comparison: creation of a colour map
that showed the deviations between test
and reference models. The setting
included the choice of colour range and the
setting of the col
our scale, with a critical
minimum value, and maximum critical
value (the latter used to set the range
where at each value corresponded only
one colour). Based on
input
program creates a colour map of the
overlapping models as depicted in Fig. 2.
3)
Section of overlapping models and
measurements: The
colour model was cut
by 24 planes parallel to the horizontal
plane XZ, not equally spaced, but adapted
to the patient's face. In particular, we
selected 9 nasal sections (from n1 to n9),
taking care to in
clude nostrils in sections
from n7 to n9; 4 sections for upper lip (from
ls10 to ls13) up to the apex of filter, 4
Fig. 2.
Colour map obtained by overlapping pre
deviations between the test and the reference models and the visual appreciation of the facial
soft tissues modification after orthognathic surgery
Torroni et al.; BJMMR, 15(2): 1-11, 2016
; Article
4
The analysis performed by Geomagic entailed 3
Optimized alignment: for optimal match of
both the reference and test model of the
face; for the accuracy of this phase it was
important to select areas of the face which
did not change after surgery; the areas
selected for this matching process were:
forehead, nasal bones, and the upper
part of zygomatic bone and zygomatic
3D Comparison: creation of a colour map
that showed the deviations between test
and reference models. The setting
included the choice of colour range and the
our scale, with a critical
minimum value, and maximum critical
value (the latter used to set the range
where at each value corresponded only
input
data the
program creates a colour map of the
overlapping models as depicted in Fig. 2.
Section of overlapping models and
colour model was cut
by 24 planes parallel to the horizontal
plane XZ, not equally spaced, but adapted
to the patient's face. In particular, we
selected 9 nasal sections (from n1 to n9),
clude nostrils in sections
from n7 to n9; 4 sections for upper lip (from
ls10 to ls13) up to the apex of filter, 4
sections for the mouth (from b14 to b17)
taking care to pass for labial commissure
(b15), and 7 sections for lower lip and chin
(up to skin menton) (Fig. 3).
Each cut obtained, called "colorimetric
moustache" (Fig. 4), represented the transversal
section of the model, characterized by different
length and colour depending on
3D deviation i
the space.
In every cut 23 equidistant points were
11 to the right and 11 to the left, in addition to the
central lying on sagittal cut; each point was then
analysed to identify the total 3D deviation in
space (Fig. 5).
The numeric data obtained for each patient were
included in a table of our
ideation (Fig.
the rows were drawn according to the face
sections previously described, while the
columns were equidistant (topographically on
the 3D model); the columns "C" identifying
values of the sagittal plane, the columns "d"
passing through th
e cutaneous portion
immediately adjacent to the nostrils, the
columns "e" passing through labial
commissures, the columns "g" through
cheekbone, the columns "h", "i", "j" through
the zygomatic arch, and finally the columns
"k" anterior to the tragus.
Colour map obtained by overlapping pre
-
op and post photogrammetry showing the
deviations between the test and the reference models and the visual appreciation of the facial
soft tissues modification after orthognathic surgery
; Article
no.BJMMR.25350
sections for the mouth (from b14 to b17)
taking care to pass for labial commissure
(b15), and 7 sections for lower lip and chin
Each cut obtained, called "colorimetric
moustache" (Fig. 4), represented the transversal
section of the model, characterized by different
3D deviation i
n
In every cut 23 equidistant points were
identified,
11 to the right and 11 to the left, in addition to the
central lying on sagittal cut; each point was then
analysed to identify the total 3D deviation in
The numeric data obtained for each patient were
ideation (Fig.
6):
the rows were drawn according to the face
sections previously described, while the
columns were equidistant (topographically on
the 3D model); the columns "C" identifying
values of the sagittal plane, the columns "d"
e cutaneous portion
immediately adjacent to the nostrils, the
columns "e" passing through labial
commissures, the columns "g" through
cheekbone, the columns "h", "i", "j" through
the zygomatic arch, and finally the columns
op and post photogrammetry showing the
deviations between the test and the reference models and the visual appreciation of the facial
Fig. 3. Horizontal section
of the colour map in 24 planes adapted to the patient's face
Fig. 4.
Transversal section of the model characterized by different length and colour
depending on the 3D deviation on the space
After filling the cells with the corresponding
values, we created millimetred tables for each
patient (Figs. 7A, 7B and 7C).
The tables reported empty spaces in the centre,
where data were not included; these spaces
corresponded to the nostrils and lips a
their values were not included because subjected
to movement artefacts by the action of voluntary
muscles.
3. RESULTS
From photogrammetric analysis we obtained two
images at T0 and T1 time, which gave a faithful
three-
dimensional representation of the face of
Torroni et al.; BJMMR, 15(2): 1-11, 2016
; Article
5
of the colour map in 24 planes adapted to the patient's face
Transversal section of the model characterized by different length and colour
depending on the 3D deviation on the space
After filling the cells with the corresponding
values, we created millimetred tables for each
The tables reported empty spaces in the centre,
where data were not included; these spaces
corresponded to the nostrils and lips a
reas, and
their values were not included because subjected
to movement artefacts by the action of voluntary
From photogrammetric analysis we obtained two
images at T0 and T1 time, which gave a faithful
dimensional representation of the face of
the patient. By overlapping the images we
obtained colour maps that allowed the visual
appreciation of facial sof
t tissues modification
after orthognathic surgery (Figs
. 8A, B and C).
The colour map was generated using a colour
scale ranging from blue to red based on the
displacement of soft tissues in the area; the
coloured areas indicate respectively:
1. RED: T1
point is more external to T0 point,
so there is a volume increase;
2.
GREEN: the two images coincide, so there
isn't substantial change between T1 and
T0 images;
; Article
no.BJMMR.25350
of the colour map in 24 planes adapted to the patient's face
Transversal section of the model characterized by different length and colour
the patient. By overlapping the images we
obtained colour maps that allowed the visual
t tissues modification
. 8A, B and C).
The colour map was generated using a colour
scale ranging from blue to red based on the
displacement of soft tissues in the area; the
coloured areas indicate respectively:
point is more external to T0 point,
so there is a volume increase;
GREEN: the two images coincide, so there
isn't substantial change between T1 and
3.
BLUE: T1 area is internal to T0, indicating
a volume decrease.
Fig. 5.
23 equidistant point highlighted on the transversal section of the model for the analysis
of the total 3D deviation in the space
Fig. 6.
Empty table of our ideation; B millimetred table results by inclusion of numeric data for
each patient. The empty spaces in the centre without corresponded to the nostrils and lips
Torroni et al.; BJMMR, 15(2): 1-11, 2016
; Article
6
BLUE: T1 area is internal to T0, indicating We report three cases of skeletal Class III
examined with the relative millimetered tables
23 equidistant point highlighted on the transversal section of the model for the analysis
of the total 3D deviation in the space
Empty table of our ideation; B millimetred table results by inclusion of numeric data for
each patient. The empty spaces in the centre without corresponded to the nostrils and lips
areas
; Article
no.BJMMR.25350
We report three cases of skeletal Class III
examined with the relative millimetered tables
.
23 equidistant point highlighted on the transversal section of the model for the analysis
Empty table of our ideation; B millimetred table results by inclusion of numeric data for
each patient. The empty spaces in the centre without corresponded to the nostrils and lips
Fig. 7A, B and C
Torroni et al.; BJMMR, 15(2): 1-11, 2016
; Article
7
A
B
C
Fig. 7A, B and C
. Millimetered tables
; Article
no.BJMMR.25350
Fig. 8A, B and C
Torroni et al.; BJMMR, 15(2): 1-11, 2016
; Article
8
A
B
C
Fig. 8A, B and C
. Three cases of skeletal class III, colour map
; Article
no.BJMMR.25350
Torroni et al.; BJMMR, 15(2): 1-11, 2016; Article no.BJMMR.25350
9
Interesting data come from the observation of
these tables, in particular:
1) The skin displacements along the facial
profile does not behave in a uniform
manner, but follows different dissipation
coefficients; then to a givenΔx on the
sagittal profile corresponds different Δx’
(points to the right and left of the midface,
lying on the same cut), different in the
entity and in dissipation (i.e. the skin of the
face does not behave as a tent sustained
by the underlying bone frame).
2) The skin behaviour seemed to be similar in
all the analysed subjects showing peculiar
characteristics; considering the rows we
found:
a) From n1 to n5, corresponding to the
high paralateral nasal region, the skin
projection showed a strong increase
(up to 210% respect to those of the
median sagittal profile), even for
modest advancement of the underlying
bone;
b) From n6 to n9 the skin millimetric
values around the nostrils (paralateral
nasal) are up to 200% of those of the
sagittal profile;
c) In the LS12 and LS13 and from b14 to
b17 the sagittal changes are
maintained and regularly dissipated.
d) It is also interesting to note the skin
behaviour of mandibular angles. In
particular, we observed the "filling" of
the mandibular angle up to 180% of
the value of Δx on the median sagittal
profile.
As regards the columns:
e) The skin Δx of dissipation at level of
the nose is completed at zygomatic
level (column g);
f) The Δx dissipation of skin profile on
the lower third of the face is gradually
completed far more posteriorly, at level
of the mandibular angles (over the
columns k).
In addition to the expected effects of orthognathic
surgery on the perioral and chin soft tissues, it is
interesting to note a significant "filling" effect of
the skin around the nostrils and up to the lower
portion of cheekbones; a clear objectivity of this
detection may be obtained only by
photogrammetry analysis and not from 2D
photos.
4. DISCUSSION
To accurately predict the aesthetic outcome after
orthognathic surgery is of paramount importance
to clearly understand the behaviour of soft
tissues secondary to the bone-frame
displacement.
Many studies have attempted to evaluate the
relationship between hard tissue movement and
its effect on the overlying soft tissue for
predicting facial changes. However, most of
these studies used complex techniques with
association of photogrammetry, 3D laser, CT and
/ or CTBC scan, with considerable expense and
biological costs, exposing the patients to ionizing
radiation [6-9].
Westermark et al. [10] in their pre-surgery
simulations found a good correlation between
simulation and outcome in 15 patients. However,
the soft tissue changes that accompanied the
movements of the facial bones were not
accurately predicted.
Kaipatur et al performed a literature review of
computerized prediction programs in relation to
hard tissue points, and found that all the
programs could not consistently predict skeletal
changes after orthognathic surgery, but their
results may be considered inside a clinically
acceptable range. Last-minute changes by the
surgeons could also explain the differences [11].
Kaipatur and Flores-Mir performed a systematic
review to investigate the accuracy of computer
programs in predicting soft tissue response
subsequent to skeletal changes after
orthognathic surgery; out of the 40 initially
identified articles only 7 articles fulfilled the final
selection criteria. They found that the area of
most significant error in prediction was the lower
lip, because of the difficulty in controlling the
action of voluntary muscles, which gave
“movement artefacts” and spoiled the accuracy
of the analysis; for the same reason we decided
to not include data corresponding to the areas of
nostrils and lips in our study.
The 7 studies considered showed accurate
prediction of outcomes (less than 2 mm)
compared with the actual results in both
directions, horizontal and vertical. Although the
individual errors were almost always minimal,
their sum could lead to discrepancies between
the prediction and the actual outcome of the
aesthetic outcome of clinical relevance [12].
Torroni et al.; BJMMR, 15(2): 1-11, 2016; Article no.BJMMR.25350
10
Marchetti et al. [13] evaluated the use of
SurgiCase-CMF software (Materialise, Leuven,
Belgium) for soft tissue simulation and found a
reliability of 91%, which they judged to be
realistic enough to form an accurate forecast of
the patient’s facial appearance after surgery, but
their analysis involved the use of cephalometric
analysis and CT scans pre and post-surgery,
with considerable biologic costs for the patients
in terms of radiation exposure.
Schendel et al. [14] fused the photogrammetric
scan and cone-beam CT for each of the 23
patients examined, creating a patient-specific
images. The surgery was simulated in 3D form
and the simulated face was compared with the
actual facial scan obtained 6 months
postoperatively by calculating the difference
between the post-operative changes and those
simulated. For 15 landmarks, the difference
between actual and simulated measurements
was smaller than 0.5 mm. Only 3 landmarks had
a difference of 0.5 mm, and these were in the
region of the labial landmarks; considering the
whole face of the patient, this method produced
an error of 1.8 mm.
The analysis of 3D images presented in this
preliminary study, offers millimetric data of the
facial soft tissue displacement after orthognathic
surgery in all planes of space. Moreover, the
constant development of not invasive and low-
cost devices for acquisition and development of
3D computer imaging makes possible to use this
technique with reduced costs and without paying
any biological price; those characteristics makes
the procedure particularly suitable when the
subjects investigated are children, or in cases of
complex craniofacial syndromes that require
serial and frequent investigations. In addition 3D
images acquiring is a not invasive procedure, it
does not cause discomfort to the patient and is
quickly performed, allowing repetition at short
intervals.
The presented preliminary study, which is based
on the simple analysis of 3D pictures, showed
the possibility to find some objective and
repeatable parameters on the behaviour of facial
soft tissues after orthognathic surgery; with the
3D analysis of images we were able to
appreciate and objectively quantify a significant
"filling" effect of the skin around the nostrils and
up to the lower portion of cheekbones, in addition
to the expected effects of orthognathic surgery
on the perioral and chin soft tissues; a result
impossible to achieve rom a standard 2D photos
analysis. Moreover our analysis has the
advantage of being simple and quick, with
reduced economic and biological cost. Despite
those advantages, however the photogrammetry
evaluation has several drawbacks: 1. it was
performed only on simple dento-skeletal
malformations, forcing to consider a small
sample of patients; 2. the procedure did not
overcome the problem of analysing areas
subjected to strong muscular action (i.e. lips and
nostrils), which were therefore excluded from the
analysis; all aspects that will require further
investigations on larger pool of patients.
This study shows that data otherwise “hidden” in
the routine 2D photos can be obtained by 3D
measurements and their analysis. In addition all
data comparable with 2D are more reliable in 3D
images, because of the missing "projection"
artefacts of sizes and shapes that occur in 2D
photos; we have highlighted the possibility to
mathematically quantify the displacement of
facial soft tissue and create reliable dissipation
curves of the various facial districts after
orthognathic surgery, on the basis of simple 3D
images analysis.
This study disclosed interesting insight into the
soft tissue behaviour following orthognathic
surgery providing the base for future
development of 3D images analysis (3D VTO) to
plan and reliably predict aesthetic outcomes of
patients affected by dento-skeletal malformation
requiring orthognathic surgical treatment.
5. CONCLUSION
Photogrammetry is a promising and cost
effective method to predict soft tissue profile
changes following orthognathic surgery. With
further validation by larger clinical trials it could
became a precious tool to perform a
comprehensive 3D-planning of orthognathic
cases, and offering more reliable prevision of the
aesthetic outcome.
COMPETING INTERESTS
Authors have declared that no competing
interests exist.
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© 2016 Torroni et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License
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