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Three-Dimensional Imaging of the Face: A Comparison Between Three Different Imaging Modalities
Abstract
Background
Three-dimensional (3D) imaging of the face is being used extensively in medicine for clinical decision making, surgical planning, and research. Nowadays, several companies are offering a broad range of 3D imaging systems, varying in price, method, and mobility. However, most planning and evaluation methods are created and validated solely with one imaging system. Therefore, it is important to analyze possible differences in the 3D surface reconstruction between different systems.
Objectives
The objective of this study was to analyze differences in the 3D surface reconstruction between three systems: 3dMDface system, Vectra XT, and Artec Eva.
Methods
Three-dimensional images of the face were acquired from 15 healthy patients with each imaging system. Reproducibility of each device was calculated and a comparison of the Vectra XT and Artec Eva with the 3dMDface was made.
Results
All 3D imaging devices showed high reproducibility, with a mean difference of 0.18 ± 0.15 mm (3dMDface system), 0.15 ± 0.15 mm (Vectra XT), and 0.26 ± 0.24 mm (Artec Eva). No significant difference in reproducibility was found between the Vectra XT and 3dMDface, while a significant difference was found between 3dMDface and Artec Eva, and between Vectra XT and Artec Eva. The mean difference between 3dMDface and Vectra XT was 0.32 ± 0.26 mm. The mean difference between 3dMDface and Artec Eva was 0.44 ± 1.09 mm.
Conclusions
All three imaging devices showed high reproducibility and accuracy. Although the Artec Eva showed a significant lower reproducibility, the difference found was not clinically relevant. Therefore, using these different systems alongside each other in clinical and research settings is possible.
Level of Evidence: 3
... The limits of agreement (LoA) were calculated using the mean difference (bias, d) and the standard deviation (s) of all differences between paired measurements, and 95% of the differences lie between d + 1.96 s and d − 1.96 s if differences are normally distributed. The normal distribution of the differences was evaluated with a Kolmogorov-Smirnov test (α = 0.05), while the agreement between methods was confirmed for the amplitude of LoA not exceeding 0.50 mm, which is the clinically acceptable value defined accordingly to previous studies [64,65]. Thus, 95% limits of agreement beyond 0.50 mm were deemed clinically unacceptable. ...
... The acceptable level of agreement between two different techniques or methods is a matter of clinical judgment, and the clinically acceptable limits for bias and limits of agreement or mean error should, therefore, always be defined in advance, depending on the target populations in which the methods/techniques are intended to be used. In our case, a difference of less than 0.50 mm can be considered acceptable and clinically irrelevant, according to some authors [64,65]. Considering this value, although the two-way repeated measures ANOVA suggested the existence of significant differences between the three methods, the analysis cannot confirm if the differences lay under the clinical significance attested to 0.50 mm in the literature [64,65]. ...
... In our case, a difference of less than 0.50 mm can be considered acceptable and clinically irrelevant, according to some authors [64,65]. Considering this value, although the two-way repeated measures ANOVA suggested the existence of significant differences between the three methods, the analysis cannot confirm if the differences lay under the clinical significance attested to 0.50 mm in the literature [64,65]. The Bland-Altman and the percentage similarity model analysis helped the interpretation of our results: we can propose Methods 1 [53] and 2 [8] as interchangeable methods for any type of facial surface, while Method 3 [54] is equivalent to the other two methods only for the face/hemiface and the upper third of the face, although the amplitude was low (always less than 0.60 mm). ...
Background/Objectives: Facial asymmetry is gaining an increasing diagnostic interest in many clinical contexts. Several three-dimensional surface-based methods have been proposed for its assessment; however, they might provide non-equivalent data. Since there is a lack of comparative studies in these terms, this study aims to compare three methods for assessing the asymmetry of the face and facial thirds, thus addressing whether the potential differences can be considered clinically acceptable or not. Methods: Two ‘maxillofacial’ methods based on the trigeminal nerve distribution and one ‘orthodontic’ method based on reference horizontal planes were used to identify the facial thirds on 3D facial models of 80 Italian healthy adults to calculate the asymmetry of the face, and the upper, middle, and lower thirds of the face differently selected by each method. As a measure of asymmetry, the Root Mean Square value was calculated through a mirroring surface-based registration. Intra- and inter-operator reliability was verified for each method. Differences and interchangeability between the methods were tested, respectively, by two-way repeated measures ANOVA (Analysis of Variance) and Bland–Altman and Similarity Percentage model analysis. Additionally, the time required to perform each method was assessed. Results: All methods demonstrated excellent intra- and inter-operator reliability. While the ANOVA analysis found significant differences (p < 0.001) for the majority of facial Regions of Interest between each method, the Bland–Altman analysis revealed that the differences were clinically acceptable (<0.50 mm) for all facial regions between the trigeminal methods, and for the face and the upper third of the face between the orthodontic method, which was revealed to be faster, and the trigeminal ones. The additional similarity percentage model provided visual support for the complete interchangeability of the two trigeminal methods, as evidenced by the lower Coefficient of Variation value. Conclusions: There is no best method for assessing facial asymmetry that applies to all types of clinical settings, as we have shown that different methods may not be completely interchangeable. However, we suggest that the methods based on the trigeminal subdivision can be used interchangeably in contexts where the morpho-functional analysis of maxillofacial regions with different embryological origins is considered. Thus, the clinical setting imposes the choice of one method over another and, as we have pointed out, the consequent comparison of data with those obtained with methods whose interchangeability has been demonstrated.
... Three pods with a total of six cameras [11]. ...
... The oldest included study was published in 2010 by De Menezes et al. [2], while the most recent was published in 2021 by Liu et al. [9] All the included studies evaluated the precision and reproducibility of Canfield's Vectra devices. Six articles validated static devices [2,4,5,[9][10][11], while four validated the Vectra H1 portable device [1,6-8]. ...
... Among the studies on static devices, two evaluated the Vectra M5 system [4,10], three the Vectra M3 system [2,5,9] and one the Vectra XT system [11]. Table 2 shows the main data extracted from the articles included in this systematic review. ...
Aim: Three-dimensional facial imaging systems are a useful tool that is gradually replacing two-dimensional imaging and traditional anthropometry with calipers. In this varied and growing landscape of new devices, Canfield (Canfield Scientific, Parsippany, NJ, USA) has proposed a series of static and portable 3D imaging systems. The aim of this systematic review was to evaluate the current literature regarding the validation of Canfield’s Vectra imaging systems. Materials and Methods: A search strategy was developed on electronic databases including PubMed, Web of Science and Scopus by using specific keywords. After the study selection phase, a total of 10 articles were included in the present review. Results: A total of 10 articles were finally included in the present review. For six articles, we conducted a validation of the Vectra static devices, focusing especially on the Vectra M5, Vectra M3 and Vectra XT. For four articles, we validated the Vectra H1 portable system. Conclusions: All of the reviewed articles concluded that Canfield’s Vectra 3D imaging systems are capable of capturing accurate and reproducible stereophotogrammetric images. Minor errors were reported, particularly in the acquisition of the perioral region, but all the evaluated devices are considered to be valid and accurate tools for clinicians.
... Several handheld scanners using structured light scanning are gaining popularity and results have been compared to those of the 3dMD system [4][5][6] . However, these structured light scanners use a sequence of pictures that form the 3D model instead of an individual 3D picture, whereby accuracy may be lost during post-processing. ...
... The Artec Eva (Artec Group Inc., Luxembourg, Luxembourg) has been used in multiple studies, showing poorer reliability then the 3dMD system 4 . According to manufacturer speci cations, the Artec Space Spider (Artec Group Inc., Luxembourg, Luxembourg) has a better validity than the Eva system (www.artec3d.com). ...
Introduction
Several new systems of three-dimensional (3D) surface imaging of the face have become available to assess changes following orthognathic or facial surgery. Before they can be implemented into practice their reliability and validity must be established. Our aim was therefore to study 3dMD (stereophotogrammetry), Artec Eva and Artec Space Spider (both structured light scanners) regarding intra- and inter-system reliability and validity.
Material and Methods
Intra- and inter-system reliability expressed in root mean square (RMS) distance was determined by scanning multiple times a mannequin’s head and faces of healthy volunteers. Validity was determined by comparing linear measurements of scans with known distances of a 3D printed model. Post-processing errors were calculated.
Results
Intra-system reliability of mannequin’s head was best for the Artec Space Spider (0.04 mm Spider; 0.07 mm 3dMD; 0.08 mm Eva;). Inter-system reliability of the mannequin’s head showed least differences between Artec Space Spider and Artec Eva. Intra-system reliability of human subjects was best for the Artec Space Spider (0.15 mm Spider; 0.20 mm Eva; 0.23 mm 3dMD). Inter-system reliability of human subjects showed least differences between Artec Eva and Artec Space Spider. Validity of linear measurements was most accurate in the Artec Space Spider. Post-processing error was 0.01mm for all systems.
Conclusion
The Artec Space Spider was the most reliable and valid scanning system.
... There have been several reports on the accuracy of facial imaging using handheld-type scanners. However, most of these studies examined human faces [13][14][15][16][17]. The shortcomings of these studies were the movement of the measuring points on the face, resulting in rough information on facial image deformation. ...
... Several studies have evaluated the distances between certain measuring points using a caliper; however, the measurement accuracy of the caliper is limited because of the minimum reading of the caliper and handling ability. Further, certain studies have evaluated the accuracy of facial imaging using the root mean square error or surface deviation color map of the models [15,[18][19][20]. In addition, the scanning accuracy should be considered in terms of trueness and precision. ...
Purpose:
Handheld-type scanners are widely used in clinical practice. This study examined the accuracy of handheld-type scanners using plaster statues to assess their performance in facial recognition.
Methods:
Twelve 4-mm zirconia balls as measuring points were attached to the facial portions of three types of plaster statue. Six digital facial images of each plaster statue were obtained using one of the following five handheld-type scanners: Artec Eva, Artec Spider, Bellus 3D FaceApp, SNAP, and Vectra H1. Four-millimeter spherical objects were manually placed at the measurement points on the scanned data generated using computer-aided design software and coordinate positions were measured using a contact-type high-resolution three-dimensional measurement device. Consequently, the discrepancy between the distance measured using the contact-type device and that measured using the handheld-type scanner was calculated. The scanning time, processing time, and deviation of the distance between the measuring points were analyzed using two-way analysis of variance and t-test with Bonferroni correction.
Results:
The scanning and processing times ranged from 15.2 to 42.2 s and 20.7 to 234.2 s, respectively. Overall, 97% of all measured distances by Spider were within ±1.00% deviation; 79%, Vectra; 73%, Eva; 70%, Bellus; and 42%, SNAP.
Conclusions:
The performance of handheld-type scanners using plaster statues varied among the different scanners. The scanning time of Eva and the processing time of Bellus were significantly shorter than those of other scanners. Furthermore, Spider exhibited the best accuracy, followed by Eva, Vectra, Bellus, and SNAP.
... In addition, other advanced 3D surface-imaging technologies, such as stereophotogrammetry, laser-based scanning, and structured light scanning, have been devised to capture highly realistic 3D facial images. Nevertheless, their practical implementation in routine clinical environments is currently limited due to their exorbitant cost, the need for skilled personnel, a designated area for stationary cameras, and robust computer systems to handle image processing [29,30]. In order to address these practical challenges, there is an increasing interest in leveraging mobile phone technology for capturing 3D facial images in numerous medical and dentistry fields [31,32]. ...
Objectives
To evaluate the validity and reliability of smartphone-generated three-dimensional (3D) facial images for routine evaluation of the oronasal region of patients with cleft by comparing their accuracy to that of direct anthropometry (DA) and 3dMD.
Materials and methods
Eighteen soft-tissue facial landmarks were manually labelled on each of the 17 (9 males and 8 females; mean age 23.3 ± 5.4 years) cleft lip and palate (CLP) patients’ faces. Two surface imaging systems, 3dMDface and Bellus3D FaceApp, were used to perform two imaging operations on each labelled face. Subsequently, 32 inter-landmark facial measurements were directly measured on the labelled faces and digitally measured on the 3D facial images. Statistical comparisons were made between smartphone-generated 3D facial images (SGI), DA, and 3dMD measurements.
Results
The SGI measurements were slightly higher than those from DA and 3dMD, but the mean differences between inter-landmark measurements were not statistically significant across all three methods. In terms of clinical acceptability, 16% and 59% of measures showed differences of ≤ 3 mm or ≤ 5º, with good agreement between DA and SGI and 3dMD and SGI, respectively. A small systematic bias of ± 0.2 mm was observed generally among the three methods. Additionally, the mean absolute difference between the DA and SGI methods was the highest for linear measurements (1.31 ± 0.34 mm) and angular measurements (4.11 ± 0.76º).
Conclusions
SGI displayed fair trueness compared to DA and 3dMD. It exhibited high accuracy in the orolabial area and specific central and flat areas within the oronasal region. Notwithstanding this, it has limited clinical applicability for assessing the entire oronasal region of patients with CLP. From a clinical application perspective, SGI should accurately encompass the entire oronasal region for optimal clinical use.
Clinical relevance
SGI can be considered for macroscopic oronasal analysis or for patient education where accuracy within 3 mm and 5º may not be critical.
... Currently, the use of 3D scanners is growing in multiple medical fields. 46 Moreover, 3D printers are also increasingly used in the standard clinical practice of multiple disciplines and departments of health care. 47 For in-house production, the hospital could greatly benefit from this growing technology if a dedicated unit would provide 3D scanning and 3D printing expertise for multiple departments. ...
Non-invasive respiratory support delivered through a face mask has become a cornerstone treatment for adults and children with acute or chronic respiratory failure. However, an imperfect mask fit using commercially available interfaces is frequently encountered, which may result in patient discomfort and treatment inefficiency or failure. To overcome this challenge, over the last decade increasing attention has been given to the development of personalized face masks, which are custom made to address the specific facial dimensions of an individual patient. With this scoping review we aim to provide a comprehensive overview of the current advances and gaps in knowledge regarding the personalization of ventilation masks. We performed a systematic search of the literature, and identified and summarized a total of 23 studies. Most studies included were involved in the development of nasal masks. Studies targeting adult respiratory care mainly focused on chronic (home) ventilation and included some clinical testing in a relevant subject population. In contrast, pediatric studies focused mostly on respiratory support in the acute setting, while testing was limited to bench or case studies only. Most studies were positive regarding the performance (i.e. comfort, level of air leak and mask pressure applied to the skin) of personalized masks in bench testing or in human, healthy or patient, subjects. Advances in the field of 3D scanning and soft material printing were identified, but important gaps in knowledge remain. In particular, more insight into cushion materials, headgear design, clinical feasibility and cost-effectiveness is needed, before definite recommendations can be made regarding implementation of large scale clinical programs that personalize non-invasive respiratory support masks for adults and children.
... To the best of our knowledge, no 3D camera system has been described within literature as a gold standard for 3D image acquisition of the forearm and hand. The 3dMD system was considered the reference system in this research due to its clinical application within our hospital and coverage in the literature for other anatomical regions [14,16,17].Measurements on a phantom were performed to determine the true accuracy. Results showed that neither one of the 3D imaging systems was superior to the other. ...
The conventional treatment for distal radius fractures typically involves immobilization of the injured extremity using a conventional forearm cast. These casts do cause all sorts of discomfort during wear and impose life-style restrictions on the wearer. Personalized 3D printed splints, designed using three-dimensional (3D) imaging systems, might overcome these problems. To obtain a patient specific splint, commercially available 3D camera systems are utilized to capture patient extremities, generating 3D models for splint design. This study investigates the feasibility of utilizing a new camera system (SPENTYS) to capture 3D surface scans of the forearm for the design of 3D printed splints. In a prospective observational cohort study involving 17 healthy participants, we conducted repeated 3D imaging using both the new (SPENTYS) and a reference system (3dMD) to assess intersystem accuracy and repeatability. The intersystem accuracy of the SPENTYS system was determined by comparison of the 3D surface scans with the reference system (3dMD). Comparison of consecutive images acquired per device determined the repeatability. Feasibility was measured with system usability score questionnaires distributed among professionals. The mean absolute difference between the two systems was 0.44 mm (SD:0.25). The mean absolute difference of the repeatability of the reference -and the SPENTYS system was respectively 0.40 mm (SD: 0.30) and 0.53 mm (SD: 0.25). Both repeatability and intersystem differences were within the self-reported 1 mm. The workflow was considered easy and effective, emphasizing the potential of this approach within a workflow to obtain patient specific splint.
... 11 As compared to another 3D imaging system (Artec Eva), 3dMD Face system showed a significant difference in reproducibility with a mean difference of 0.44 ± 1.09 mm. 7 Another study evaluating the accuracy of 3dMD system with linear measurements found an intradirect anthropometry. 12 Despite 3D imaging is widely used to evaluate the outcomes of various interventions in the oral and maxillofacial area with the focus on orthognathic surgery, to the best of our knowledge it has never been tested to characterize extra-oral soft tissue changes after dental implant placement. ...
Objective: This pilot study aimed to evaluate, for the first time, the changes in facial tissues following the placement of a single dental implant.
Methods and Materials: Patients were scanned with a 3D facial scanner (3dMD) before implant surgery, immediately after surgery (T1), at 7 days post-operatively (T2), and at the impression stage (T3). Acquired images were processed using 3dMDVultus software program and volume differences and linear depth measurements were calculated to determine the morphometric changes over time. A total of 11 patients were included in the analyses. Descriptive statistics were employed to analyze the data.
Results: The volumetric changes and maximum depth differences indicated an initial increase, followed by a progressive decrease in tissue volume after implant placement in the area of the surgery. The volume change values ranged between 2.5 to 3.9 cc for T1, whereas for T2, the volume change decreased to a range of 0.8 to 1.8 cc. Maximum depth differences ranged between 2.06 to 2.80 mm in the soft tissues right after the implant surgery and reduced to around 2.01 mm to 0.55 mm in the impression stage. The amount of painkiller used was not related to the magnitude of linear depth measurements at any assessed time point.
Conclusion: The results from this report documented that there is a longitudinal decrease in soft tissue volume and depth difference in extra-oral soft tissues in the region of implant placement after surgery to 6 weeks. The use of a facial scanner is a promising non-invasive method to monitor 3D morphometric changes after implant surgery.
... [15][16][17] In contrast, handheld professional scanners based on structured light technology offer mobility, comparable scanning quality, and no extensive space needs but are still relatively expensive and often require considerable training. [16][17][18][19][20][21][22][23][24] Alternatively, structured light sensors have been developed as accessories for mobile smartphone and tablet computers. These accessories offer cheaper alternatives and the possibility of a more user-friendly workflow with custom software applications. ...
... For instance, if the capturing of landmarks outside 3dMDface's capture range, which has ear-to-ear coverage, is deemed necessary, then a system upgrade to 3dMDtrio or 3dMDhead, with a wider image capture range, would be beneficial. Advanced stationary systems such as the Vectra XT and mobile systems like Artec Eva can be used alongside 3dMDface in the clinical setting owing to their comparable reproducibility and accuracy [99]. Despite the fact that the next-generation mobile systems have outperformed the stationary systems in terms of portability and functionality, 3dMD continues to be the "gold standard" in 3D face acquisition due to its proven precision and accuracy [100,101]. ...
Digitalizing all aspects of dental care is a contemporary approach to ensuring the best possible clinical outcomes. Ongoing advancements in 3D face acquisition have been driven by continuous research on craniofacial structures and treatment effects. An array of 3D surface-imaging systems are currently available for generating photorealistic 3D facial images. However, choosing a purpose-specific system is challenging for clinicians due to variations in accuracy, reliability, resolution, and portability. Therefore, this review aims to provide clinicians and researchers with an overview of currently used or potential 3D surface imaging technologies and systems for 3D face acquisition in craniofacial research and daily practice. Through a comprehensive literature search, 71 articles meeting the inclusion criteria were included in the qualitative analysis, investigating the hardware, software, and operational aspects of these systems. The review offers updated information on 3D surface imaging technologies and systems to guide clinicians in selecting an optimal 3D face acquisition system. While some of these systems have already been implemented in clinical settings, others hold promise. Furthermore, driven by technological advances, novel devices will become cost-effective and portable, and will also enable accurate quantitative assessments, rapid treatment simulations, and improved outcomes.
... [15][16][17] In contrast, handheld professional scanners based on structured light technology offer mobility, comparable scanning quality, and no extensive space needs but are still relatively expensive and often require considerable training. [16][17][18][19][20][21][22][23][24] Alternatively, structured light sensors have been developed as accessories for mobile smartphone and tablet computers. These accessories offer cheaper alternatives and the possibility of a more user-friendly workflow with custom software applications. ...
Digital smile design and ceramic veneers are described with virtual patient representation. The procedure included facial scanning with a 3D scanner accessory (Structure sensor pro; Occipital Inc) mounted on a tablet computer (iPad; Apple Inc) and an innovative chairside silicone guide to replace the intraoral scan body for a straightforward and user-friendly workflow.
... 10 The 3DMD scanner is largely considered to be the gold standard of 3D facial scanners. 11 In a study by Zhao et al. in 2017, 12 a 3DMD scan was compared to an industrial laser scanner and identified that the accuracy of obtained 3DMD scans for facial deformities was 0.58 ± 0.11 mm. The 3D accuracy of different facial partitions was inconsistent; the middle face had the best performance. ...
Background
Three dimensional (3D) facial imaging is becoming a popular method of facial analysis and a means of anthropometry. There is potential for 3D imaging to provide enough diagnostic information to parallel lateral cephalograms, which could, in time, reduce the need for radiation exposure to patients. The present study aimed to assess the accuracy of the Bellus3D ARC-7 (Bellus) camera by comparing the measurements of soft tissue facial landmarks obtained from Bellus scans to the measurements taken using Vernier callipers.
Method
Nineteen anatomical points were located on four subjects using a standard black ballpoint pen on a white, circular sticker. Distances were measured between these points using digital callipers, with the subject in a resting pose. This was repeated twice by two examiners for each subject. Two examiners subsequently performed measurements of each subject in a smiling pose. Following landmark identification, images were captured under standard conditions, using the Bellus camera. The same measurements were obtained digitally, repeated twice by two examiners for each subject in both resting and smiling poses.
Results
There was high precision in repeated measurements on the digital models, with less than 1.5 mm deviation between measurements. Both intra-examiner and inter-examiner reproducibility were greater following the digital measurements compared to manual measurements, with 100% of the digital measurements of landmarks falling within a set threshold deviation of ≤1.5 mm. When comparing the manual and digital measurements, the greatest deviations (>1.0 mm) occurred in regions around the cheeks and lower third of the face, while the measurements for the ears and midline structures (forehead and nose bridge) deviated the least (≤1.0 mm). This was demonstrated in models at rest and smiling.
Conclusions
The Bellus system produced an accurate and true image of the face from which reproducible measurements can be made within and between examiners. 3D facial images from the Bellus3D ARC-7 system were comparable to direct anthropometry, therefore the use of 3D facial scanning in orthodontics for diagnosis and treatment planning appears promising.
... In recent years, 3-dimensional (3D) stereophotogrammetry has been widely used in maxillofacial and craniofacial surgery. [1][2][3][4] The periocular region, especially the eyelid, plays a critical role in facial appearance and changes in expression. 5 The 3D imaging system has great potential for assessing age-related changes in lower eyelid tension and medial canthal tendon, 6-8 inflammation, surgical, or trauma-induced edema, 9 scarring, 10 and tumors. ...
Background
Portable three-dimensional (3D) imaging system has been used for periocular measurement analysis. However, this imaging system has yet to be performed and validated for the periocular area and volume measurements.
Objectives
To define the upper eyelid and upper eyelid fold region through a modified landmark strategy and validate the portable 3D imaging system for area and volume measurements in this periocular region.
Methods
Eighty-one healthy adult Caucasians underwent 3D facial imaging using the VECTRA M3 and VECTRA H2 3D imaging systems (Canfield Scientific, Inc., Parsippany, NJ). Subsequently, the upper eyelid and upper eyelid fold regions were selected using a modified landmark localization strategy. Then, direct measurements of area and volume were performed to assess intra-rater, inter-rater, intra-method, and inter-method reliability and compare the agreement between the two devices.
Results
VECTRA M3 and VECTRA H2 showed high reliability on upper eyelid area measurements. Excellent intra-, inter-, and intra-method reliability agreements were observed in intra-class correlation coefficient (ICC); very good agreement in intra-rater reliability was observed in relative error of measurement (REM) and relative technical error of measurement (rTEM); and good inter- and intra-method reliability were observed in REM and rTEM. For area measurement of the upper eyelid fold, VECTRA M3 for intra-rater, inter-rater, and intra-method reliability was lower than VECTRA H2. M3 and H2 had poor intra-rater, inter-rater, and intra-method reliability for volume measurements in the upper eyelid and upper eyelid fold region.
Conclusions
The new portable 3D imaging system achieves excellent or very good reliability values for standardized direct measurements of the upper eyelid and upper eyelid fold region, while volume measurements seem less reliable.
... Some examples include the evaluation of congenital craniofacial dysmorphisms 1 and for the early screening of genetic anomalies, 2 along with pretreatment planning and treatment monitoring in orthodontics 3 and facial aesthetic surgery. 4,5 Compared to two-dimensional (2D) imaging, 3D methods have been shown to be more accurate and reliable, especially when assessing complex facial movements such as smiling and oral synkinesis. 6,7 For example, when images are taken face-on, 2D imaging is inherently prone to underestimating amplitude in the anteroposterior plane, which may be clinically relevant depending on the purpose of the assessment. ...
Background:. Three-dimensional imaging can be used to obtain objective assessments of facial morphology that is useful in a variety of clinical settings. The VECTRA H1 is unique in that it is relatively inexpensive, handheld, and does not require standardized environmental conditions for image capture. Although it provides accurate measurements when imaging relaxed facial expressions, the clinical evaluation of many disorders involves the assessment of facial morphology when performing facial movements. The aim of this study was to assess the accuracy and reliability of the VECTRA H1, specifically when imaging facial movement.
Methods:. The accuracy, intrarater, and interrater reliability of the VECTRA H1 were assessed when imaging four facial expressions: eyebrow lift, smile, snarl, and lip pucker. Fourteen healthy adult subjects had the distances between 13 fiducial facial landmarks measured at rest and the terminal point of each of the four movements by digital caliper and by the VECTRA H1. Intraclass correlation and Bland–Altman limits of agreement were used to determine agreement between measures. The agreement between measurements obtained by five different reviewers was evaluated by intraclass correlation to determine interrater reliability.
Results:. Median correlation between digital caliper and VECTRA H1 measurements ranged from 0.907 (snarl) to 0.921 (smile). Median correlation was very good for both intrarater (0.960–0.975) and interrater reliability (0.997–0.999). The mean absolute error between modalities, and both within and between raters was less than 2 mm for all movements tested.
Conclusion:. The VECTRA H1 met acceptable standards for the assessment of facial morphology when imaging facial movements.
... These systems are the most advanced products in their product range. However, very advanced devices often go along with high costs ranging from € 8.000 -40.000 [34]. Moreover, these devices are time-consuming since the analysis of the 3D image is not performed directly on the cameras themselves. ...
Introduction:
The quality of scars has become an important outcome of burn care. Objective scar assessment through scar surface area measurement enables quantification of scar formation and evaluation of treatment efficacy. 3D technology has proven valid and reliable but often remains cumbersome, expensive, and time-consuming. 3D technology with depth sensors on mobile devices has become available and might surpass these limitations. This study provides a clinimetric assessment of the validity and reliability of a 3D system with a depth sensor for scar surface area measurement.
Methods:
A technology involving a depth sensor mounted on a mobile device was used. Images and analyses were made with a custom-made software application. A standardized one-keyframe image capturing procedure was followed. To assess validity, stickers with predefined dimensions (8.01 cm2 - 77.70 cm2) were imaged in a single observer setting on various body parts of healthy volunteers. To assess reliability, hypertrophic scars, keloids, and normotrophic scars were imaged and rated by two observers independently. Data are expressed as mean (+/-SD), Coefficient of Variation (CV), Intraclass Correlation Coefficients (ICC), and Limits of Agreements (LoA).
Results:
Eighty stickers placed on 20 healthy volunteers showed validity with CV between 0.62%- 1.67% for observer A and 0.75%- 1.19% for observer B. For the reliability study, 69 scars on 36 patients were included. Mean scar surface area ranged from 0.83 cm2 to 155.59 cm2. Mean scar surface area measurement was 13.83 cm2 (SD 23.06) for observer A and 13.59 cm2 (SD 23.31) for observer B. Adjusted interobserver CV for trained observers is estimated as 5.59%, with corresponding LoA = 0 ± 0.15 x mean surface area. Interobserver ICCs were 0.99-1.00.
Conclusion:
This 3D technology with a depth sensor for measuring scar surface area provides valid and reliable data and thereby surpasses expensive and time-consuming 3D cameras.
... In a previous maxillofacial study, the acceptable error threshold for MAD and TEM was set to less than two units [19]. Because the values in the periocular region are smaller, some studies have suggested that their thresholds should be less than one unit [20,21]. REM and rTEM were graded as \ 1%, 1-3.9%, 4-6.9%, [22]. ...
Introduction: In this study, we measured the volume of customized tumor models in the periocular area using three-dimensional (3D) stereophotogrammetry and evaluated the reproducibility of these measurements.
Methods: Five tumor models of different colors and sizes were placed in different periocular
positions, and 3D facial images were obtained from 68 healthy adult volunteers. Subsequently, the volumes of the tumor models were measured, and the intra- and interrater reproducibility was assessed.
Results: The gray 6 mm model revealed the highest reliable measurements in both Caucasians (intra- and interrater intraclass correlation coefficients of 0.981 and 0.899, mean
absolute difference of 1.446 and 3.327 mm3, relative error measurement of 3.497% and
8.120%, technical error of measurement of 1.450 and 3.105 mm3, and relative technical
error of measurement of 3.506% and 7.580%) and Asians (0.968 and 0.844, 1.974 and
4.067 mm3, 4.772% and 9.526%, 2.100 and 4.302 mm3, and 5.076% and 10.076%, respectively). The highest reliability of measurements in the lateral upper eyelid (0.88 and 0.95, 4.042 and 3.626 mm3, 9.730% and 9.020%, 5.714 and 3.358 mm3, and 9.730% and 8.350%, respectively) and medial upper eyelid (0.81 and 0.89, 4.313 and 4.226 mm3, 9.730% and 9.020%, 6.098 and 4.069 mm3, and 9.730% and 8.350%, respectively) with eyes closed was evident in Caucasians, while the same trend (0.841 and 0.815, 2.828 and 3.757 mm3, 9.860% and 9.840%, 4.052 and 4.308 mm3, and 9.860% and 9.740%, respectively) was observed in Asians in the medial canthus with eyes closed.
Conclusions: This study confirms, for the first time, the high reliability of periocular tumor
volume measurements using 3D stereophotogrammetry, suggesting its feasibility for eyelid tumor measurement. Further trials are required to investigate its clinical use for documentation and follow-up of different eyelid tumors.
... Moreover, with the multiple integration steps, the accuracy of the protocol relies much on the quality of 3D images and 3D models. The scanning systems (3Shape TRIOS intraoral scanner and 3dMDface system) utilized in the present study have been terrified to have high accuracy [26][27][28], but the potential of errors derived from the 3D image/model should be considered when applying protocol with other equipment or software. ...
Background
Accurate integration of the dentitions with the face is essential in dental clinical practice. Here we introduce a noninvasive and efficient protocol to integrate the digitized maxillary dentition with the three-dimensional (3D) facial photo using a prefabricated modified computer-aided design/computer-aided manufacture (CAD/CAM) facebow.
Methods
To integrate the maxillary dentition with the 3D facial photo, the CAD/CAM facebow protocol was applied to 20 patients by taking a series of 3D facial photos in the clinic and integrating them in the laboratory. The integration accuracy of this protocol was compared with that of a valid 3D computed tomography (CT)-aided protocol concerning translational deviations of the landmarks representing maxillary incisors and maxillary first molars as well as the rotational deviation of the maxillary dentition. The intra- and inter-observer reproducibility was assessed, and the time of clinical operation and laboratory integration was recorded.
Results
This facebow-aided protocol generated 3D fused images with colored faces and high-resolution dentitions, and showed high reproducibility. Compared with the well-established CT-aided protocol, the translational deviations ranged from 0 to 1.196 mm, with mean values ranging from 0.134 to 0.444 mm, and a relatively high integration error was found in the vertical dimension (Z) with a mean ± standard deviation (SD) of 0.379 ± 0.282 mm. Meanwhile, the rotational deviations ranged from 0.020 to 0.930°, with mean values less than 1°, and the most evident deviation was seen in pitch rotation with a mean ± SD of 0.445 ± 0.262°. The workflow took 4.34 ± 0.19 min (mins) for clinical operation and 11.23 ± 0.29 min for laboratory integration.
Conclusion
The present radiation-free protocol with the modified CAD/CAM facebow provided accurate and reproducible transfer of the digitized maxillary dentition to the 3D facial photo with high efficiency.
... Several studies con rmed that the data obtained through the Vectra 3D scanner and 3dMD Face System were generally comparable; thus, the 3D images obtained using both systems could be merged. The eye and ear regions were identi ed to have signi cant errors in the 3dMD and Vectra 3D representations; therefore, these regions were excluded from the further morphometric analysis [31,32]. ...
Objectives: To assess modelled facial development of infants with unilateral cleft lip (CL)/cleft lip and palate (UCLP) compared to controls for up to two years.
Materials and methods: A total of 201 facial images of children (clefts, controls) were obtained in 4 different age categories (in years; T0: 0.2–0.5; T1: 0.6–1.0; T2: 1.1–1.5; T3: 1.6–2.0); they were evaluated using 3D stereophotogrammetry and geometric morphometrics.
Results: In the CL patients, the forehead was significantly retracted (p ≤ 0.001), while the supraorbital and ocular regions were prominent (p ≤ 0.001). The oronasal region appeared convex compared to controls (p ≤ 0.001). The lower lip and chin were non-significantly protruded. In UCLP patients, a significantly retracted forehead and prominent supraorbital region were also apparent (p ≤ 0.001). The most striking deviations were observed in the middle face with a markedly retrusive oronasal region (p ≤ 0.001). The chin was significantly protruded anteriorly (p ≤ 0.01). In both clefts, no progression of deviations was confirmed with increasing age. After the first year, a slight improvement in the morphological features appeared due to the patients' growth potential and surgical method. The shape variability of the clefts and controls overlapped, suggesting comparable modelled facial development.
Conclusions: The facial morphology of cleft individuals was comparable to the norm with marked shape deviation in the oronasal region, forehead, and chin, which minimised with increasing age even in complete clefts.
Clinical relevance Visualising the facial surface through 3D stereophotogrammetry may improve early childhood surgical planning and postoperative therapy.
... Many institutions in Japan face hurdles in using 3D techniques for diagnostics because 3D scanners are expensive. Compared to a scanner that can take measurements within a few milliseconds from several spatial directions and create a stereophotogrammetric dataset, the Artec Eva 3D scanner used in the current study has the advantage of being mobile, although it takes a little longer to take images, and artifacts occur due to infant movements [25]. As shown in our measurement precision analyses, the 3D scanner used in our current study was useful for considering human errors between measurers in 2D evaluations [7,8]. ...
This study aimed to assess the measurement precision of a three-dimensional (3D) scanner that detects the geometric shape as surface data and to investigate the differences between two-dimensional (2D) and 3D evaluations in infants with deformational plagiocephaly. Using the 3D scanner that can perform both 2D and 3D evaluations, we calculated cranial asymmetry (CA) for the 2D evaluation, and the anterior symmetry ratio (ASR) and posterior symmetry ratio (PSR) for the 3D evaluation. Intra- and inter-examiner precision analyses revealed that the coefficients of the variation measurements were extremely low (<1%) for all variables, except CA (5%). In 530 infants, the coincidence rate of CA severity by the 2D evaluation and the 3D evaluation was 83.4%. A disagreement on severity was found between 2D and 3D evaluations in 88 infants (16.6%): 68 infants (12.8%) were assessed as severe by 2D evaluation and mild by the 3D evaluation, while 20 infants (3.8%) were evaluated as mild by 2D and severe by 3D evaluation. Overall, the 2D evaluation identified more infants as severe than the 3D evaluation. The 3D evaluation proved more precise than the 2D evaluation. We found that approximately one in six infants differed in severity between 2D and 3D evaluations.
Background
Primary rhinoplasty is gaining popularity in cleft care. However, for a comprehensive reconstruction of 3-dimensional nasal morphology, an emphasis on lip muscle repair is essential to achieve nasal symmetry. Surgeons aiming to improve outcomes need to extend their understanding of the interrelationships among the alar bases, columellar base, and the underlying skeletal structure in primary condition and up to skeletal maturity.
Methods
This study analyzed imaging data from 192 skeletally matured patients, dividing them into unilateral complete, incomplete, and noncleft groups. Both cone-beam computed tomography and 3D photographs were utilized to investigate the 3-dimensional relationships among bilateral alare and subnasale , including underlying structures (soft-tissue thickness and skeletal asymmetry). Statistical comparisons were performed. Through stepwise multiple linear regression analysis, the study identified significant interrelationships among the nasal bases.
Results
The data revealed that despite the asymmetry in the underlying skeletal foundation, the current surgical methods have been successful in reconstructing the alar bases in a 3-dimensional aspect. However, columellar base deviation was observed when compared to the noncleft patients. The regression analysis revealed a notable correlation between the depression of the cleft-side alar base and columellar base deviation.
Conclusions
This study provides an insight for evaluating the cleft lip repair. Correcting the anteroposterior depression on cleft side alar base, in addition to adequate muscle reconstruction, could possibly reduce the columellar base deviation.
Abstract
Purpose: This study evaluated the accuracy (trueness and precision) of facial scanners
using different technologies and the reliability of the texture maps produced.
Materials and Methods: A volunteer was scanned using nine scanners: Cloner, Artec
MHT, Revopoint Mini, Revopoint POP 2, Vectra H2, EXAscan, Scaniverse app, iPhone
13 Pro MAX, and Nikon Z 7II Camera. Eighty scans were compared to a reference
model (Vectra XT). Root mean square and standard deviation of the dimensional discrepancies
were analyzed using ANOVA and Tukey post-hoc test. Acquisition times
were assessed using Kruskal–Wallis test followed by Mann–Whitney U-test. Two
expert assessments on texture map realism were averaged and compared to the reference
using one sample t-test. The two experts’ intraclass correlation coefficient (ICC)
was calculated.
Results: Eight scanners fully captured the three-dimensional facial geometry. Overall
trueness and precision of the facial scanners were significantly different (p < 0.001).
Seven scanners showed clinically acceptable scanning accuracy of less than or equal
to 2 mm. Cloner displayed the lowest deviation (0.61 ± 0.08 mm), fastest acquisition
time (0.40 ± 0.00 s), and was highly reliable (<1 mm). The texture map of the Vectra
H2 had the highest mean score of 8.50 and was the most realistic. The ICC between the
experts was 0.78 indicating good interexaminer reliability.
Conclusions: The more economical facial scanners within each scanning technology
(iPhone 13 Pro MAX, Cloner, Revopoint MINI, and Scaniverse app) showed clinically
acceptable accuracy with realistic texture maps for facial scanning and therefore could
be eligible substitutes for professional higher-cost scanners.
KEYWORDS
facial scanning, LIDAR, photogrammetry, structured light, texture map, three-dimensional facial model
Craniofacial anthropometry is useful in many dental operations on several levels, including screening, surgical planning, and outcome evaluation. In the fields of cosmetic dentistry, orthodontics, and facial aesthetics, the goal is to improve the aesthetic of the smile and facial features by analysing different facial features and proportions to determine the ideal position and jaws for a more harmonious and aesthetically pleasing facial appearance. Besides this, the development and maturation of the face and jaws can be evaluated using facial anthropometry. Dentists and orthodontists can closely track the growth of the face and jaws by measuring various facial traits over time and determine whether any remedial action is required to address challenges like malocclusion or skeletal discrepancies. Dentists and orthodontists can assess the success of the procedure and implement any necessary modifications to ensure the patient receives the greatest possible benefit by comparing pre- and posttreatment measurements of various facial features. Clinicians are incorporating several more recent, cutting-edge image-processing techniques into surgical instruction and educational activities for better-enhanced visualization. Several newer technologies have been explored in this chapter as potential anthropometric instruments that might provide a realistic depiction of the face and head.
Background
Botulinum toxin type A (BoNT-A) injections are widely administered for facial rejuvenation, but their effects on facial expressions remain unclear.
Objectives
In this study, we aimed to objectively measure the impact of BoNT-A injections on facial expressions with deep learning techniques.
Methods
One hundred eighty patients age 25 to 60 years who underwent BoNT-A application to the upper face were included. Patients were photographed with neutral, happy, surprised, and angry expressions before and 14 days after the procedure. A convolutional neural network (CNN)-based facial emotion recognition (FER) system analyzed 1440 photographs with a hybrid data set of clinical images and the Karolinska Directed Emotional Faces (KDEF) data set.
Results
The CNN model accurately predicted 90.15% of the test images. Significant decreases in the recognition of angry and surprised expressions were observed postinjection (P < .05), with no significant changes in happy or neutral expressions (P > .05). Angry expressions were often misclassified as neutral or happy (P < .05), and surprised expressions were more likely to be perceived as neutral (P < .05).
Conclusions
Deep learning can effectively assess the impact of BoNT-A injections on facial expressions, providing more standardized data than traditional surveys. BoNT-A may reduce the expression of anger and surprise, potentially leading to a more positive facial appearance and emotional state. Further studies are needed to understand the broader implications of these changes.
Level of Evidence: 4 (Therapeutic)
Several new systems for three-dimensional (3D) surface imaging of the face have become available to assess changes following orthognathic or facial surgery. Before they can be implemented in practice, their reliability and validity must be established. Our aim, therefore, was to study the intra- and inter-system reliability and validity of 3dMD (stereophotogrammetry), Artec Eva and Artec Space Spider (both structured light scanners). Intra- and inter-system reliability, expressed in root mean square distance, was determined by scanning a mannequin’s head and the faces of healthy volunteers multiple times. Validity was determined by comparing the linear measurements of the scans with the known distances of a 3D printed model. Post-processing errors were also calculated. Intra-system reliability after scanning the mannequin’s head was best with the Artec Space Spider (0.04 mm Spider; 0.07 mm 3dMD; 0.08 mm Eva). The least difference in inter-system reliability after scanning the mannequin’s head was between the Artec Space Spider and Artec Eva. The best intra-system reliability after scanning human subjects was with the Artec Space Spider (0.15 mm Spider; 0.20 mm Eva; 0.23 mm 3dMD). The least difference in inter-system reliability after scanning human subjects was between the Artec Eva and Artec Space Spider. The most accurate linear measurement validity occurred with the Artec Space Spider. The post-processing error was 0.01 mm for all the systems. The Artec Space Spider is the most reliable and valid scanning system.
Background
Secondary rhinoplasty in patients with bilateral cleft lip poses ongoing challenges and requires a reliable method for achieving optimal outcomes.
Objectives
The purpose of this study was to establish a safe and effective method for secondary bilateral cleft rhinoplasty.
Methods
A consecutive series of 92 skeletally matured patients with bilateral cleft lip and nasal deformity were included. All had undergone secondary open rhinoplasty, performed by a single surgeon, with the use of bilateral reverse-U flap and septal extension graft between 2013 and 2021. Medical records of these 92 patients were reviewed to assess the clinical course. The three-dimensional anthropometric analysis and panel assessment of 32 patients were performed to evaluate the aesthetic improvement using an age-, sex-, and ethnicity-matched normal control group for comparisons.
Results
The methods showed statistically significant improvement in addressing short columella (columellar height), short nasal bridge (nasal bridge length), de-projected nasal tip (nasal tip projection, nasal dorsum angle), poorly defined nasal tip (nasal tip angle, dome height, and panel assessment), and transversely oriented nostrils (columellar height, alar width, nostril type). Importantly, these improvements were accompanied by a low complication rate of 4%. However, upper lip deficiency over the upper lip angle and labial-columellar angle remains without significant improvement.
Conclusions
This study described the effective secondary rhinoplasty that was composed of bilateral reverse-U flap and septal extension graft with acceptable outcome. The 3D anthropometric analysis and panel assessment clarified that our rhinoplasty procedure could bring the nasal morphology in the patients closer to the normal data.
Background
Tip refinement procedure is still controversial in secondary unilateral cleft rhinoplasty. The aim of this study was to assess whether septal extension graft improved nasal and tip deformity and achieved a normal profile with clinical and 3D morphometric analyses.
Methods
A consecutive series of 194 skeletally mature patients with unilateral cleft were included and analyzed. All had undergone secondary open rhinoplasty, performed by a single surgeon, with the use of septal extension graft between 2013 and 2021. Clinical data were collected, and 3D morphometric measurements were performed. An age-, sex-, and ethnicity-matched normal group was included for comparisons.
Results
Our standard procedures included open approach combining reverse U incision, septal extension graft, dorsal augmentation, lip revision, and vermilion augmentation. The postoperative outcome showed significantly increased numerical values (nasal bridge length, nasal height, nasal tip projection, nasal dorsum angle, columellar angle, columellar-lobule angle, nostril height ratio, nasal surface area, nasal volume) and decreased numerical values (alar width, tip/middle deviation, nasal tip angle, labial-columellar angle) than the preoperative morphology. The postoperative measurement showed significantly higher numerical values (nasal protrusion, tip/middle deviation, nasal dorsum angle), and lower numerical values (columellar-lobule angle, nostril height ratio, alar width ratio) than the control group.
Conclusion
This study revealed that our secondary cleft rhinoplasty significantly improved the under-projected, up-rotated, deviated, and poorly defined tip as well as short nasal bridge deformities. The technique could result in the nose of the patients with cleft lip nasal deformity being closer to that of the normative profile.
Background
Rhinoplasty is one of the most challenging plastic surgeries because it lacks a uniform standard for preoperative design or implementation. For a long time, rhinoplasties were done without an accurate consensus of aesthetic design between surgeons and patients before surgery and consequently brought unsatisfactory appearance for patients. In recent years, three-dimensional (3D) simulation has been used to visualize the preoperative design of rhinoplasty, and good results have been achieved. However, it still relied on individual aesthetics and experience. The preoperative design remained a huge challenge for inexperienced surgeons and could be time-consuming to perform manually. Therefore, we adopted artificial intelligence (AI) in this work to provide a new idea for automated and efficient preoperative nasal contour design.Methods
We collected a dataset of 3D facial images from 209 patients. For each patient, both the original face and the manually designed face using 3D simulation software were included. The 3D images were transformed into point clouds, based on which we used the modified FoldingNet model for deep neural network training (by pytorch 1.12).ResultsThe trained AI model gained the ability to perform aesthetic design automatically and achieved similar results to manual design. We analysed the 1027 facial features captured by the AI model and concluded two of its possible cognitive modes. One is to resemble the human aesthetic considerations while the other is to fulfil the given task in a special way of the machine.Conclusion
We presented the first AI model for automated preoperative 3D simulation of rhinoplasty in this study. It provided a new idea for the automated, individual and efficient preoperative design, which was expected to bring a new paradigm for rhinoplasty and even the whole field of plastic surgery.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
A BSTRACT
The foundation of reconstructive and cosmetic surgery is a confluence of advanced technologies, plethora of procedures, inventive modifications, and planned strategies. In surgical planning, the most crucial steps for treating a patient are evaluating the facial morphometry and recognizing the deviations from the baseline values of facial parameters. Various imaging and non-imaging modalities and sub-modalities contribute to diagnosis, treatment planning, and follow-up care. These techniques are an important milestone of pre-, peri-, and postoperative care in facial reconstruction. The current research aims to comprehensively explain imaging and non-imaging technologies encompassing both innovative and traditional approaches in facial reconstruction. PubMed, Scopus, and Web of Science were searched from 1990 to 2022, and systematic review was conducted in accordance with the PRISMA recommendations. Undoubtedly, various factors impact the selection of facial analysis acquisition approaches and their prospective. The surgical team must understand such modalities’ potential for diagnosis and treatment. The evolution of three-dimensional imaging has been fueled because of the need for devices with high speed, small size, and several functions. Automation with more efficiency and precision is the way of the future for three-dimensional imaging. Stereophotogrammetry can clearly quantify the field of facial analysis. All the publications under consideration came to the same conclusion: Canfield’s Vectra three-dimensional imaging devices can provide accurate, repeatable stereophotogrammetric pictures. Although a few minor mistakes were recorded, most examined devices are deemed reliable and accurate tools for Plastic surgeons.
Background:
Three-dimensional (3D) imaging technologies are increasingly used in craniomaxillofacial (CMF) surgery, especially to enable clinicians to get an effective approach and obtain better treatment results during different preoperative and postoperative phases, namely during image acquisition and diagnosis, virtual surgical planning (VSP), actual surgery, and treatment outcome assessment. The article presents an overview of 3D imaging technologies used in the aforementioned phases of the most common CMF surgery.
Material and methods:
We searched for relevant studies on 3D imaging applications in CMF surgery published over the past 10 years in the PubMed, ProQuest (Medline), Web of Science, Science Direct, Clinical Key, and Embase databases.
Results:
A total of 2094 articles were found, of which 712 were relevant. An additional 26 manually searched articles were included in the analysis.
Conclusions:
The findings of the review demonstrated that 3D imaging technology is becoming increasingly popular in clinical practice and an essential tool for plastic surgeons. This review provides information that will help for researchers and clinicians consider the use of 3D imaging techniques in CMF surgery to improve the quality of surgical procedures and achieve satisfactory treatment outcomes.
Background:
The four different local therapy strategies used for head and neck rhabdomyosarcoma (HNRMS) include proton therapy (PT), photon therapy (RT), surgery with radiotherapy (Paris-method), and surgery with brachytherapy (AMORE). Local control and survival is comparable; however, the impact of these different treatments on facial deformation is still poorly understood. This study aims to quantify facial deformation and investigates the differences in facial deformation between treatment modalities.
Methods:
Across four European and North American institutions, HNRMS survivors treated between 1990 and 2017, more than 2 years post treatment, had a 3D photograph taken. Using dense surface modeling, we computed facial signatures for each survivor to show facial deformation relative to 35 age-sex-ethnicity-matched controls. Additionally, we computed individual facial asymmetry.
Findings:
A total of 173 HNRMS survivors were included, survivors showed significantly reduced facial growth (p < .001) compared to healthy controls. Partitioned by tumor site, there was reduced facial growth in survivors with nonparameningeal primaries (p = .002), and parameningeal primaries (p ≤.001), but not for orbital primaries (p = .080) All patients were significantly more asymmetric than healthy controls, independent of treatment modality (p ≤ .001). There was significantly more facial deformation in orbital patients when comparing RT to AMORE (p = .046). In survivors with a parameningeal tumor, there was significantly less facial deformation in PT when compared to RT (p = .009) and Paris-method (p = .007).
Interpretation:
When selecting optimal treatment, musculoskeletal facial outcomes are an expected difference between treatment options. These anticipated differences are currently based on clinicians' bias, expertise, and experience. These data supplement clinician judgment with an objective analysis highlighting the impact of patient age and tumor site between existing treatment options.
Background Though in facial plastic surgery, the ideal nasal characteristics are defined by average European-American facial features known as neoclassical cannons, many ethnicities do not perceive these characteristics as suitable.
Methods To investigate the preferences for nasofrontal angle, nasolabial angle, dorsal height, alar width, and nasal tip projection, manipulated pictures of one male and one female model were shown to 203 volunteer patients from a tertiary university hospital's facial plastic clinic.
Results The most aesthetically preferred nasofrontal angles were 137.64 ± 4.20 degrees for males and 133.55 ± 4.53 degrees for females. Acute nasofrontal angles were more desirable in participants aged 25 to 44. The most preferred nasolabial angles were 107.56 ± 5.20 degrees and 98.92 ± 4.88 degrees, respectively. Volunteers aged 19 to 24 preferred more acute male nasolabial angles. A straight dorsum was the most desirable in both genders (0.03 ± 0.78 and 0.26 ± 0.75 mm, respectively). The ideal male and female alar widths were –0.51 ± 2.26 and –1.09 ± 2.18 mm, respectively. More 45- to 64-year-old volunteers preferred alar widths equal to intercanthal distance. The ideal female and male tip projections were 0.57 ± 0.01 and 0.56 ± 0.01, respectively.
Conclusion Results indicate that the general Iranian patients prefer thinner female noses with wider nasofrontal angles for both genders. However, the ideal nasolabial angles, dorsal heights, and tip projections were consistent with the neoclassical cannons. Besides ethnic differences, the trend of nasal beauty is also affected by gender, age, and prior history of aesthetic surgery.
Introduction
Clinical tools are neither standardized nor ubiquitous to monitor volumetric or morphological changes in the periorbital region and ocular adnexa due to pathology such as oculofacial trauma, thyroid eye disease, and the natural aging process. We have developed a low-cost, three dimensionally printed PHotogrammetry for Automated CarE (PHACE) system to evaluate three-dimensional (3D) measurements of periocular and adnexal tissue.
Methods
The PHACE system uses two Google Pixel 3 smartphones attached to automatic rotating platforms to image a subject's face through a cutout board patterned with registration marks. Photographs of faces were taken from many perspectives by the cameras placed on the rotating platform. Faces were imaged with and without 3D printed hemispheric phantom lesions (black domes) affixed on the forehead above the brow. Images were rendered into 3D models in Metashape (Agisoft, St. Petersburg, Russia) and then processed and analyzed in CloudCompare (CC) and Autodesk's Meshmixer. The 3D printed hemispheres affixed to the face were then quantified within Meshmixer and compared to their known volumes. Finally, we compared digital exophthalmometry measurements with results from a standard Hertel exophthalmometer in a subject with and without an orbital prosthesis.
Results
Quantification of 3D printed phantom volumes using optimized stereophotogrammetry demonstrated a 2.5% error for a 244μL phantom, and 7.6% error for a 27.5μL phantom. Digital exophthalmometry measurements differed by 0.72mm from a standard exophthalmometer.
Conclusion
We demonstrated an optimized workflow using our custom apparatus to analyze and quantify oculofacial volumetric and dimensions changes with a resolution of 244μL. This apparatus is a low-cost tool that can be used in clinical settings to objectively monitor volumetric and morphological changes in periorbital anatomy.
Objective:
To assess modelled facial development of infants with unilateral cleft lip (CL) and cleft lip and palate (UCLP) compared to controls up to two years of age.
Design and participants:
A total of 209 facial images of children (CL: n = 37; UCLP: n = 39; controls: n = 137) were obtained in four age categories (T0 = 0.2-0.5; T1 = 0.6-1.0; T2 = 1.1-1.5; T3 = 1.6-2.0 years) and were evaluated using stereophotogrammetry and geometric morphometry. All patients underwent lip surgery before T0, patients with UCLP underwent palatoplasty (T0, T1 before palatoplasty; T2, T3 after palatoplasty).
Results:
In patients with CL, the forehead was significantly retracted (p ≤ 0.001), while the supraorbital and ocular regions were prominent (p ≤ 0.001). The oronasal region appeared convex (p ≤ 0.001). The lower lip and chin were non-significantly protruded. In patients with UCLP, a significantly retracted forehead and prominent supraorbital region were apparent (p ≤ 0.001). A retrusive oronasal region (p ≤ 0.001) was observed in the middle face. The chin was anteriorly protruded (p ≤ 0.01). No progression of deviations was found with increasing age. After the first year, a slight improvement in the morphological features became apparent. The shape variability of the clefts and controls overlapped, suggesting a comparable modelled facial development.
Conclusions:
The facial morphology of individuals with cleft was comparable to the norm. Shape deviation was apparent in the oronasal region, forehead, and chin, which minimised with increasing age even in complete clefts.
Laser imaging detection and ranging (LiDAR) is a modern three-dimensional (3D) technology that utilizes time-of-flight method using the round-trip time of an infrared laser beam to accurately detect the presence and features of objects. Notably, The iPhone XII Pro (Apple, Inc., Cupertino, Calif.) is the first smart mobile device with built-in LiDAR sensors in 2020. Our team developed the software application based on iOS devices with built-in LiDAR sensors for 3D breast scanning and automatically analyzing the breast geometric measurement. Breast geometry, including mid-clavicle-to-nipple distance, sternal notch-to-nipple distance, nipple-to-inframammary fold (IMF) distance, distance between nipples and body circumference on nipple and IMF level were measured using the software application and tapeline. The relative technical error of measurement (rTEM) value was used to calculate the error ratios between the measurements acquired by the software application and those of the tapeline. Good rTEM values ranging from 2.99 to 5.19% were found in the mid clavicle-to-nipple distance, sternal notch-to-nipple distance, distance between nipples, nipple level circumference and IMF level circumference. However, there was a poor rTEM value over 10% in the nipple-to-IMF distance. The proposed software application using current iOS devices with built-in LiDAR sensors can provide an ideal 3D scanning system which has low-cost burden, good accuracy, portability and ease-to-use.
Background:
Botulinum toxin-A（BTX-A）is used in the treatment of nasolabial fold (NLF). However, light and clinician subjectivity play a big role in evaluating the efficacy of this treatment.
Objectives:
With the application of three-dimensional (3D) technology, this study aimed to quantitatively evaluate the effects of muscular type (M) and muscle-fat pad mixed-type (MF) NLF with BTX-A injection.
Methods:
BTX-A was injected into the bilateral mark points of the NLF, where the levator labii alaeque nasi(A), zygomaticus minor(B), and zygomaticus major(C) pull the skin to form the NLF (2 U at each injection site). Pretreatment and posttreatment 3D facial images were captured with static and laughing expressions. The curvature, width, depth, and lateral fat volume of the NLF were measured to compare the therapeutic efficacy of patients with type M and MF NLF.
Results:
Thirty-nine patients with type M and 37 with type MF completed the follow-up data. In these patients, the curvature, width, and depth of the NLF showed a significant reduction at 1 month and gradually recovered at three and six months after treatment, with more significant improvement when laughing than when static. Variations compared to the pretreatment values of type MF were greater than those of type M at each time point. The lateral fat volume of the type MF NLF was significantly reduced (P < 0.05).
Conclusions:
Three-dimensional technology can quantitatively evaluate the effects of type M and MF NLF treatments with BTX-A injection. BTX-A has a better effect on the NLF of type MF than that of type M.
IntroductionFat grafting is an efficient and safe procedure for the correction of upper eyelid sulcus deepening. Stromal vascular fraction (SVF) gel has been proven to be an ideal fat derivative and can be widely used for facial augmentation. We aimed to determine the efficacy of SVF gel for the correction of a mild-to-moderate sunken superior sulcus among Asian patients.Methods
Patients with a mild-to-moderate sunken superior sulcus underwent SVF gel grafting of the sunken upper periorbital area. The primary result was the quantitative volume difference in the superior sulcus region before and after grafting. This was evaluated through three-dimensional VECTRA® imaging. The secondary results included the aesthetic quantitative evaluation results (upper lid area and pretarsal space ratio), global aesthetic improvement scale (GAIS) score, and complications.ResultsThirty-one patients with mild-to-moderate sunken upper eyelids were included in this study. The average unilateral injected amount was 1.235 mL (± 0.171 mL). The 1-year delta volume was 0.801 ± 0.086 mL, and the effective survival volume was 65.3% (± 6.1%). The median preoperative pretarsal space and upper lid area ratio was 1.010 (± 0.150). The median postoperative pretarsal space and upper lid area ratio at 1 year was 0.159 (± 0.031) (n = 62; P < 0.0001), indicating a significantly reduced sunken appearance. The average GAIS score was 2.174 (± 0.391). All patients were satisfied with their surgical outcomes. The reoperation rate was 12.9%.ConclusionsSVF gel is safe and effective for the treatment of a mild-to-moderate sunken superior sulcus and is associated with satisfactory clinical outcomes and short recovery times.
Aging is inevitable and progressive, starting in the third decade of life. Contributory factors are both intrinsic and extrinsic and hence both uncontrollable and controllable. Chronological aging encompasses involutional and structural changes and biological aging encompasses genetics as well as extrinsic factors such as ultraviolet radiation, pollution, and lifestyle habits. The two may, however, be asynchronous. The face is considered as one of the most important interfaces between the self and the outer world. Evident signs of aging pull back on one’s self-esteem and image, making people seek treatment for the same [1]. This is more so with an increase in the elderly population cohort and an increase in awareness regarding the remedies for aging. There is a need for earlier interventions in aging skin in our population as Asian Indian population has been proposed to age earlier than the reported ages in Caucasian population [2].
The prevalence of metabolic syndrome is increasing day by day, owing to the sedentary lifestyle, unhealthy food habits, genetic factors, environmental influences and many other conspicuous variables. Skin, aptly considered to be a mirror of internal organs, often manifests with certain signs and symptoms, suggestive of a diagnosis of metabolic syndrome. In this chapter, we have attempted to touch upon the dermatological manifestations (both common and uncommon) of metabolic syndrome.KeywordsMetabolic syndromeDiagnosisSkin manifestations
With the advancement of technology and the integration of digital solutions in treatment planning, clinical prognosis and treatment in oral health science have evolved from a classic two-dimensional (2D) method to a sophisticated three-dimensional (3D) technique. The integration of digital technology in oral health science requires digital 3D images as a primary input data. These 3D digital data can be acquired by different modalities like nonionizing methods (desktop scanning, intraoral scanning, face scanning) to capture the 3D surface data of dento-alveolar-facial tissue and the ionizing methods (conventional CT or CBCT) to capture the 3D data of hard tissue (bone and teeth) of the craniofacial region. In this chapter, the basic principles and their application in dentistry in conjunction with 3D printing of digital surface scanning using desktop scanning, intraoral scanning, and facial scanning and the hard tissue scanning using CBCT are discussed. CBCT along with the state of the art newer ethnologies have improved the level of diagnosis and subsequent care to an paralleled level of accuracy, efficiency, and predictability of the treatment. This chapter provides an in-depth practical understanding of the principles and applications of various 3D scanning methods for 3D digital data acquisition of the craniofacial region in the oral health science.Keywords3D imagingIntraoral scanningDesktop scanningFace sackingCone beam computed tomography (CBCT)Computer-aided designing (CAD)3D printing
Tissue engineering and regenerative medicine (TERM) research has advanced significantly with the development of three-dimensional (3D) printing technology. Specifically, 3D bioprinting provides additional benefits and improvement to 3D printing by incorporating the ability to include cells into the process, creating a cell-laden ink, termed bioink. By incorporating cells in conjunction with the superior temporospatial precision of 3D printing, scientists and clinicians have the potential to print live tissues with sophisticated structures and microarchitectures. While 3D bioprinting is still in its early phase, with limited preclinical animal and human studies, it has been proposed as a promising tool for TERM research in many areas of medicine and dentistry, including craniofacial, oral, and dental (DOC) tissue regeneration. This chapter aims to provide a comprehensive overview of major concepts in 3D bioprinting including its armamentarium, types of bioprinters, bioprinting process, clinical applications in craniofacial regeneration, limitations, and future perspectives.Keywords3D bioprinting3D printingAdditive manufacturingTissue engineeringRegenerative medicineCraniofacial tissue regenerationPeriodontal regenerationPulp regenerationDentistryOral surgery
Costochondral grafts (CCG) are considered the best method for condylar reconstruction in young children with Pruzansky/Kaban type IIB and type III HFM. This orthodontic-surgical intervention immediately corrects the facial asymmetry by eliminating the hypoplastic mandible and the negative influence on the normal maxillary growth simultaneously with ramus height restoration. However, CCG precise surgical positioning is a challenge in these patients due to mandibular hypoplasia when the glenoid fossa is difficult to identify, or it might be absent. The aim of the 3D-printed jig is to manage the precise suitable placement position and fixation of the costochondral rib graft in relation to the contralateral unaffected temporomandibular joint and soft tissues. The jig may preserve the rib’s cartilage cap, prevent fractures at the costochondral junction, and result in a decrease in the risk of interference of cartilage growth.KeywordsHemifacial microsomiaPruzansky/Kaban classificationCostochondral graftsTemporomandibular jointJig3D printing3D models3D CT imaging
Background:
Breast symmetry is an essential component of breast cosmesis. The Harvard Cosmesis scale is the most widely adopted method of breast symmetry assessment. However, this scale lacks reproducibility and reliability, limiting its application in clinical practice. The VECTRA® XT 3D (VECTRA®) is a novel breast surface imaging system that, when combined with breast contour measuring software (Mirror®), aims to produce a more accurate and reproducible measurement of breast contour to aid operative planning in breast surgery.
Objectives:
This study aims to compare the reliability and reproducibility of subjective (Harvard Cosmesis scale) with objective (VECTRA®) symmetry assessment on the same cohort of patients.
Methods:
Patients at a tertiary institution had 2D and 3D photographs of their breasts. Seven assessors scored the 2D photographs using the Harvard Cosmesis scale. Two independent assessors used Mirror® software to objectively calculate breast symmetry by analysing 3D images of the breasts.
Results:
Intra-observer agreement ranged from none to moderate (kappa - 0.005-0.7) amongst the assessors using the Harvard Cosmesis scale. Inter-observer agreement was weak (kappa 0.078-0.454) amongst Harvard scores compared to VECTRA® measurements. Kappa values ranged 0.537-0.674 for intra-observer agreement (p < 0.001) with Root Mean Square (RMS) scores. RMS had a moderate correlation with the Harvard Cosmesis scale (rs = 0.613). Furthermore, absolute volume difference between breasts had poor correlation with RMS (R2 = 0.133).
Conclusion:
VECTRA® and Mirror® software have potential in clinical practice as objectifying breast symmetry, but in the current form, it is not an ideal test.
Level of evidence iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Existing automated objective grading systems either fail to consider the face’s complex 3D morphology or suffer from poor feasibility and usability. Consumer-based Red Green Blue Depth (RGB-D) sensors and/or smartphone integrated 3D hardware can inexpensively collect detailed four-dimensional facial data in real-time but are yet to be incorporated into a practical system. This study aims to evaluate the feasibility of a proof-of-concept automated 4D facial assessment system using an RGB-D sensor (termed OpenFAS) for use in a standard clinical environment. This study was performed on normal adult volunteers and patients with facial nerve palsy (FNP). The setup consists of the Intel RealSense SR300 connected to a laptop running the OpenFAS application. The subject sequentially mimics the facial expressions shown on screen. Each frame is landmarked, and automatic anthropometric calculations are performed. Any errors during each session were noted. Landmarking accuracy was estimated by comparing the ‘ground-truth position’ of landmarks annotated manually to those placed automatically. 18 participants were included in the study, nine healthy participants and nine patients with FNP. Each session was standardized at approximately 106 seconds. 61.8% of landmarks were automatically annotated within approximately 1.575mm of their ground-truth locations. Our findings support that OpenFAS is usable and feasible in routine settings, laying down the critical groundwork for a facial assessment system that addresses the shortcomings of existing tools. However, the iteration of OpenFAS presented in this study is undoubtedly nascent with future work including improvements to landmarking accuracy, analyses components, and RGB-D technology required before clinical application.
Objectives. To develop a semi-automatic technique to evaluate normative facial growth in healthy children between the age of 1.5 and 5.0 years using three-dimensional stereophotogrammetric images.
Materials and Methods. Three-dimensional facial images of healthy children at 1.5, 2.0, 2.5, 3.0, 4.0 and 5.0 years of age were collected and positioned based on a reference frame. A general face template was used to extract the face and its separate regions from the full stereophotogrammetric image. Furthermore, this template was used to create a uniform distributed mesh, which could be directly compared to other meshes. Average faces were created for each age group and mean growth was determined between consecutive groups for the full face and its separate regions. Finally, the results were tested for intra-and inter-operator performance.
Results. The highest growth velocity was present in the first period between 1.5 and 2.0 years of age with an average of 1.50 mm (±0.54 mm) per six months. After 2.0 years, facial growth velocity declined to only a third at the age of 5.0 years. Intra-and inter-operator variability was small and not significant.
Conclusions. The results show that this technique can be used for objective clinical evaluation of facial growth. Example normative facial averages and the corresponding facial growth between the age 1.5 and 5.0 years are shown.
Clinical Relevance. This technique can be used to collect and process facial data for objective clinical evaluation of facial growth in the individual patient. Furthermore, these data can be used as normative data in future comparative studies. How to cite this article Bruggink R, Baan F, Brons S, Loonen TGJ, Kuijpers-Jagtman AM, Maal TJJ, Ongkosuwito EM. 2022. A semi-automatic three-dimensional technique using a regionalized facial template enables facial growth assessment in healthy children from 1.5 to 5.0 years of age. PeerJ 10:e13281 http://doi.org/10.7717/peerj.13281
Aim:
The purpose of this study was to present and validate an innovative semi-automatic approach to quantify the accuracy of the surgical outcome in relation to 3D virtual orthognathic planning among patients who underwent bimaxillary surgery.
Material and method:
For the validation of this new semi-automatic approach, CBCT scans of ten patients who underwent bimaxillary surgery were acquired pre-operatively. Individualized 3D virtual operation plans were made for all patients prior to surgery. During surgery, the maxillary and mandibular segments were positioned as planned by using 3D milled interocclusal wafers. Consequently, post-operative CBCT scan were acquired. The 3D rendered pre- and postoperative virtual head models were aligned by voxel-based registration upon the anterior cranial base. To calculate the discrepancies between the 3D planning and the actual surgical outcome, the 3D planned maxillary and mandibular segments were segmented and superimposed upon the postoperative maxillary and mandibular segments. The translation matrices obtained from this registration process were translated into translational and rotational discrepancies between the 3D planning and the surgical outcome, by using the newly developed tool, the OrthoGnathicAnalyser. To evaluate the reproducibility of this method, the process was performed by two independent observers multiple times.
Results:
Low intra-observer and inter-observer variations in measurement error (mean error < 0.25 mm) and high intraclass correlation coefficients (> 0.97) were found, supportive of the observer independent character of the OrthoGnathicAnalyser. The pitch of the maxilla and mandible showed the highest discrepancy between the 3D planning and the postoperative results, 2.72° and 2.75° respectively.
Conclusion:
This novel method provides a reproducible tool for the evaluation of bimaxillary surgery, making it possible to compare larger patient groups in an objective and time-efficient manner in order to optimize the current workflow in orthognathic surgery.
A variety of commercially available three-dimensional (3D) surface imaging systems are currently in use by craniofacial specialists. Little is known, however, about how measurement data generated from alternative 3D systems compare, specifically in terms of accuracy and precision. The purpose of this study was to compare anthropometric measurements obtained by way of two different digital 3D photogrammetry systems (Genex and 3dMD) as well as direct anthropometry and to evaluate intraobserver precision across these three methods. On a sample of 18 mannequin heads, 12 linear distances were measured twice by each method. A two-factor repeated measures analysis of variance was used to test simultaneously for mean differences in precision across methods. Additional descriptive statistics (e.g., technical error of measurement [TEM]) were used to quantify measurement error magnitude. Statistically significant (P < 0.05) mean differences were observed across methods for nine anthropometric variables; however, the magnitude of these differences was consistently at the submillimeter level. No significant differences were noted for precision. Moreover, the magnitude of imprecision was determined to be very small, with TEM scores well under 1 mm, and intraclass correlation coefficients ranging from 0.98 to 1. Results indicate that overall mean differences across these three methods were small enough to be of little practical importance. In terms of intraobserver precision, all methods fared equally well. This study is the first attempt to simultaneously compare 3D surface imaging systems directly with one another and with traditional anthropometry. Results suggest that craniofacial surface data obtained by way of alternative 3D photogrammetric systems can be combined or compared statistically.
Background:
Volume of the breast can be objectively measured by three-dimensional (3D) photographs. This study describes the analysis of three different positions of the patient in image acquisition, in order to find the best pose for reproducible 3D photographs of the breasts.
Method:
Twenty-four patients were included between February and September 2014 in a consecutive way. Data were collected prospectively. 3D photographs were acquired using a stereophotogrammetry system. Images were taken twice in three different positions (arms behind the back, arms placed on the hips and arms horizontally placed). Surface based matching was applied and the absolute mean distance between the surfaces of both 3D models of the same position was calculated. This difference measure represents the similarity of the photographs.
Results:
Univariate ANOVA showed a significant difference in distance between the three positions (sum of squares 1.12, p < 0.001). The horizontal position presented the lowest absolute mean distance (0.45 mm). Additional post hoc multiple comparisons analysis revealed a statistically significant difference between the distances of horizontal and back position (-0.22 mm, p < 0.001) and of back and hip position (0.13 mm, p = 0.009), with better results of the horizontal and hip positions, respectively.
Conclusion:
Standardization of 3D acquisition in pre- and postoperative breast imaging could improve imaging reproducibility. Based on the results of this study, we recommend a pose with the arms in a horizontal position.
Purpose:
Numerous three-dimensional (3D) facial scanners have emerged on the market; however, publications evaluating their accuracies are sparse. In this study, the accuracy of two 3D scanners used in facial scanning was evaluated.
Materials and methods:
A test specimen was attached at the right cheek and the forehead of 41 volunteers. These volunteers were scanned with Artec EVA(®) and FaceScan3D(®). The acquired data were aligned to a 3D model of the test specimen for comparing the mean error, original length and width and angles to the measured values.
Results:
The mean error in Best Fit alignment is significantly lower using Artec EVA (p < 0.001) for both test specimens. The deviation from the original length and width is significantly lower for the test specimens (p < 0.01) when measured with Artec EVA. The aberration of the angles measured between the front plane and the side plane is significantly lower when measured with Artec EVA (p < 0.001). Captured with Artec EVA the discrepancy between the original angle and the angle measured between the side planes to each other is significantly lower (p < 0.01).
Conclusions:
Scanning with Artec EVA leads to more accurate 3D models as compared to scanning with FaceScan3D. The exactness achieved by both scanners is comparable to other scanners mentioned in literature.
Background:
Upper-extremity lymphedema is a frequent complication in patients treated for breast cancer. Current diagnostic methods for the upper-extremity volume measurements are cumbersome or time consuming. The purpose of this study was to assess the validity and reliability of three-dimensional (3D) stereophotogrammetry for volume measurements in patients with upper-extremity lymphedema.
Method:
Patients with unilateral upper-extremity lymphedema were included. The water displacement volume measurement of both arms was performed using a standardized method. In addition, 3D stereophotogrammetry volume measurements were conducted.
Results:
Eleven patients (22 arms) were included. The mean volumes obtained by 3D stereophotogrammetry and water displacement show a high correlation, with a Pearson's correlation coefficient of 0.99 (p = 0.01). The variance calculated by 3D stereophotogrammetry measurements (205 mL) was statistically significant less than that obtained via water displacement measurements (1540 mL) (p < 0.001).
Conclusion:
3D stereophotogrammetry is an accurate method for measuring upper-extremity volume in patients with lymphedema and gives a lower variance value compared to that of the water displacement measurements. We recommend the use of this method in the diagnosis and follow-up of patients with lymphedema.
The purpose of this study was to evaluate changes in the soft tissue facial profile in patients who underwent bilateral sagittal split osteotomy (BSSO) using 3D stereophotogrammetry and principal component analysis (PCA). Twenty-five female patients (mean age, 24 years; range: 18-26) who underwent BSSO and 70 female controls (mean age, 24 years; range: 18-26) participated in this prospective study. Three-dimensional photographs of all patients and controls were acquired. PCA was used to determine the unique morphological variations (UV) between the dysgnathic group and the control group. The most prominent facial morphologic difference between the dysgnathic group and the control group (UV1) was a clockwise rotation of the mandible and shortening of the lower part of the face, followed by a protrusion of the upper lip, retrusion of the mandible and over-accentuation of the labial-mental fold (UV2). The combination of UV1 and UV2 could be used to simulate a typical Class II facial profile and to automatically differentiate between the preoperative patients, postoperative patients and the control group. Based on the applied PCA method, this study demonstrated that BSSO advancement surgery could only provide a suboptimal improvement of the soft tissue facial profile in the majority of cases.
Objective:
To evaluate the accuracy of three-dimensional (3D) stereophotogrammetry by comparing it with the direct anthropometry and digital photogrammetry methods. The reliability of 3D stereophotogrammetry was also examined.
Materials and methods:
Six profile and four frontal parameters were directly measured on the faces of 80 participants. The same measurements were repeated using two-dimensional (2D) photogrammetry and 3D stereophotogrammetry (3dMDflex System, 3dMD, Atlanta, Ga) to obtain images of the subjects. Another observer made the same measurements for images obtained with 3D stereophotogrammetry, and interobserver reproducibility was evaluated for 3D images. Both observers remeasured the 3D images 1 month later, and intraobserver reproducibility was evaluated. Statistical analysis was conducted using the paired samples t-test, intraclass correlation coefficient, and Bland-Altman limits of agreement.
Results:
The highest mean difference was 0.30 mm between direct measurement and photogrammetry, 0.21 mm between direct measurement and 3D stereophotogrammetry, and 0.5 mm between photogrammetry and 3D stereophotogrammetry. The lowest agreement value was 0.965 in the Sn-Pro parameter between the photogrammetry and 3D stereophotogrammetry methods. Agreement between the two observers varied from 0.90 (Ch-Ch) to 0.99 (Sn-Me) in linear measurements. For intraobserver agreement, the highest difference between means was 0.33 for observer 1 and 1.42 mm for observer 2.
Conclusions:
Measurements obtained using 3D stereophotogrammetry indicate that it may be an accurate and reliable imaging method for use in orthodontics.
3D analysis of facial morphology has delineated facial phenotypes in many medical conditions and detected fine grained differences between typical and atypical patients to inform genotype-phenotype studies. Next-generation sequencing techniques have enabled extremely detailed genotype-phenotype correlative analysis. Such comparisons typically employ control groups matched for age, sex and ethnicity and the distinction between ethnic categories in genotype-phenotype studies has been widely debated. The phylogenetic tree based on genetic polymorphism studies divides the world population into nine subpopulations. Here we show statistically significant face shape differences between two European Caucasian populations of close phylogenetic and geographic proximity from the UK and The Netherlands. The average face shape differences between the Dutch and UK cohorts were visualised in dynamic morphs and signature heat maps, and quantified for their statistical significance using both conventional anthropometry and state of the art dense surface modelling techniques. Our results demonstrate significant differences between Dutch and UK face shape. Other studies have shown that genetic variants influence normal facial variation. Thus, face shape difference between populations could reflect underlying genetic difference. This should be taken into account in genotype-phenotype studies and we recommend that in those studies reference groups be established in the same population as the individuals who form the subject of the study.European Journal of Human Genetics advance online publication, 8 January 2014; doi:10.1038/ejhg.2013.289.
Orthodontists rely heavily on soft-tissue analysis to determine facial esthetics and treatment stability. The aim of this retrospective study was to determine the equivalence of soft-tissue measurements between the 3dMD imaging system (3dMD, Atlanta, Ga) and the segmented skin surface images derived from cone-beam computed tomography.
Seventy preexisting 3dMD facial photographs and cone-beam computed tomography scans taken within minutes of each other for the same subjects were registered in 3 dimensions and superimposed using Vultus (3dMD) software. After reliability studies, 28 soft-tissue measurements were recorded with both imaging modalities and compared to analyze their equivalence. Intraclass correlation coefficients and Bland-Altman plots were used to assess interexaminer and intraexaminer repeatability and agreement. Summary statistics were calculated for all measurements. To demonstrate equivalence of the 2 methods, the difference needed a 95% confidence interval contained entirely within the equivalence limits defined by the repeatability results.
Statistically significant differences were reported for the vermilion height, mouth width, total facial width, mouth symmetry, soft-tissue lip thickness, and eye symmetry.
There are areas of nonequivalence between the 2 imaging methods; however, the differences are clinically acceptable from the orthodontic point of view.
Purpose:
The use of three-dimensional (3D) photography for anthropometric measurements is of increasing interest, especially in the cranio-maxillofacial field. Before standard implementation, accurate determination of the precision and accuracy of each system is mandatory.
Methods:
A mannequin head was labelled with 52 landmarks, and 28 three-dimensional images were taken using a commercially available five-pod 3D photosystem (3D VECTRA; Canfield, Fairfield, NJ) in different head positions. Distances between the landmarks were measured manually using a conventional calliper and compared with the digitally calculated distances acquired from labelling by two independent observers. The experimental set-up accounted for clinical circumstances by varying the positioning (vertical, horizontal, sagittal) of the phantom.
Results:
In the entire calliper measurement data set (n = 410), a significant difference (p = 0.02) between the directly measured and corresponding virtually calculated distances was found. The mean aberration between both modalities covering all data was 7.96 mm. No differences (p = 0.94) between the two groups were found using a cut-off of 10 % (leaving n = 369 distances) due to considerable errors in direct measurements and the necessary manual data translation. The mean diversity of both measurement modalities after cut-off was 1.33 mm (maximum, 6.70 mm). Inter-observer analysis of all 1,326 distances showed no difference (p = 0.99; maximal difference, 0.58 mm) in the digital measurements.
Conclusion:
The precision and accuracy of this five-pod 3D photosystem suggests its suitability for clinical applications, particularly anthropometric studies. Three-hundred-and-sixty degree surface-contour mapping of the craniofacial region within milliseconds is particularly useful in paediatric patients. Proper patient positioning is essential for high-quality imaging.
A reproducible 3-dimensional photographic system enables plastic surgeons to perform preoperative planning and helps them to understand the patient's expectations. There are a few systems available that allow a reproducible 3-dimensional scans of the patient with direct simulation of the planned procedure. The Vectra Volumetric 3D Surface Imaging® by Canfield® provides such an option and helps the surgeons to document and compare postoperative changes at different time points. Since January 2011 we are digitally documenting all patients receiving form-modulating procedures in our plastic surgery unit. We present the spectrum of clinical implications and discuss advantages and disadvantages of the system. Furthermore, we have studied the accuracy of the system in comparison to direct measurement in 15 volunteers. The system is especially suited for planning and evaluation of breast augmentation, facial aesthetic and reconstructive surgery as well as volumetric measurements before and after liposuction and lipofilling. Computer-assisted measurements correlate with a median deviation of 2.3% with manually measured distances in the face. We found the user-friendly Vectra® system to be a reliable and reproducible device for planning plastic surgery therapies and for documenting postoperative results.
© Georg Thieme Verlag KG Stuttgart · New York.
To evaluate treatment outcomes following oral and maxillofacial surgery, pre- and post-treatment three-dimensional (3D) photographs of the patient's face can assessed, but this procedure is accurate only if the face is captured with the same facial expression every time. The purpose of this prospective study was to determine variations in the face at rest; 100 3D photographs of the same individual were acquired at different times. Initially, 50 3D photographs were obtained; 25 using a wax bite to ensure similar occlusion between subsequent photographs and 25 without wax bite. This procedure was repeated 6 weeks later. Variation of the face at rest was computed. The influence of time and wax bite was investigated. Different anatomical regions were investigated separately. A mean variation of 0.25 mm (0.21-0.27 mm) was found (standard deviation 0.157 mm). No large differences were found between different time points or use of wax bite. Regarding separate anatomical regions, there were small variations in the nose and forehead regions; the largest variations were found in the mouth and eyes. This study showed small overall variation within the face at rest. In conclusion, different 3D photographs can be reproduced accurately and used in a clinical setting for treatment follow-up and evaluation.
To objectively evaluate treatment outcomes in oral and maxillofacial surgery, pre- and post-treatment 3-dimensional (3D) photographs of the patient's face can be registered. For clinical use, it is of great importance that this registration process is accurate (< 1 mm). The purpose of this study was to determine the accuracy of different registration procedures.
Fifteen volunteers (7 males, 8 females; mean age, 23.6 years; range, 21 to 26 years) were invited to participate in this study. Three-dimensional photographs were captured at 3 different times: baseline (T(0)), after 1 minute (T(1)), and 3 weeks later (T(2)). Furthermore, a 3D photograph of the volunteer laughing (T(L)) was acquired to investigate the effect of facial expression. Two different registration methods were used to register the photographs acquired at all different times: surface-based registration and reference-based registration. Within the surface-based registration, 2 different software packages (Maxilim [Medicim NV, Mechelen, Belgium] and 3dMD Patient [3dMD LLC, Atlanta, GA]) were used to register the 3D photographs acquired at the various times. The surface-based registration process was repeated with the preprocessed photographs. Reference-based registration (Maxilim) was performed twice by 2 observers investigating the inter- and intraobserver error.
The mean registration errors are small for the 3D photographs at rest (0.39 mm for T(0)-T(1) and 0.52 mm for T(0)-T(2)). The mean registration error increased to 1.2 mm for the registration between the 3D photographs acquired at T(0) and T(L). The mean registration error for the reference-based method was 1.0 mm for T(0)-T(1), 1.1 mm for T(0)-T(2), and 1.5 mm for T(0) and T(L). The mean registration errors for the preprocessed photographs were even smaller (0.30 mm for T(0)-T(1), 0.42 mm for T(0)-T(2), and 1.2 mm for T(0) and T(L)). Furthermore, a strong correlation between the results of both software packages used for surface-based registration was found. The intra- and interobserver error for the reference-based registration method was found to be 1.2 and 1.0 mm, respectively.
Surface-based registration is an accurate method to compare 3D photographs of the same individual at different times. When performing the registration procedure with the preprocessed photographs, the registration error decreases. No significant difference could be found between both software packages that were used to perform surface-based registration.
To test the accuracy and reproducibility of a 3-dimensional (3D) stereophotogrammetric imaging system for measuring the facial soft tissues of healthy subjects.
Three-dimensional soft tissue facial landmarks were obtained from the faces of 10 adult subjects, by use of a 3D stereophotogrammetric imaging system (Vectra; Canfield Scientific, Fairfield, NJ). Sixteen linear measurements were computed. Systematic and random errors between operators, calibration steps, and acquisitions were calculated.
No systematic errors were found for all performed tests (P > .05, paired t test). The method was repeatable, and random errors were always lower than 1 mm, except for the distance from cheilion to cheilion. Repeated sets of acquisition showed random errors up to 0.91 mm, without systematic biases.
The 3D stereophotogrammetric imaging system can assess the coordinates of facial landmarks with good precision and reproducibility. The method is fast and can obtain facial measurements with few errors.
In modern anthropometry of such complex structures as the face, three-dimensional scanning techniques have become more and more common. Before establishing them as a criterion standard, however, meticulous evaluation of their precision and accuracy under both ideal and clinical circumstances is essential. Potential sources of error need to be identified and addressed.
Under ideal circumstances, a phantom is used to examine the precision and accuracy of the 3dMD system. A clinical setting is simulated by varying different parameters such as angle, distance, and system reregistration, as well as data evaluation under different levels of magnification.
The handling of the system was unproblematic in matters of data acquisition and data analysis. It was very reliable, with a mean global error of 0.2 mm (range, 0.1-0.5 mm) for mannequin head measurements. Neither the position of the head nor that of the camera influenced these parameters. New referencing of the system did not influence precision and accuracy.
The precision and accuracy of the tested system are more than sufficient for clinical needs and greater than those of other methods, such as direct anthropometry and two-dimensional photography. The evaluated system can be recommended for evaluation and documentation of the facial surface and could offer new opportunities in reconstructive, orthognathic, and craniofacial surgery.
In cleft lip and palate patients the shape of the nose invariably changes in three dimensions (3D) due to rhinoplastic surgery. The purpose of this study was to evaluate stereophotogrammetry as a 3D method to document volumetric changes of the nose in patients with a cleft lip (CL) or cleft lip and palate (CLP) after secondary open rhinoplasty. 12 patients with unilateral CL or CLP were enrolled in the study prospectively. 3D facial images were acquired using 3D stereophotogrammetry preoperatively and 3 months postoperatively. A 3D cephalometric analysis of the nose was performed and volumetric data were acquired. The reliability of the method was tested by performing an intra- and inter-observer analysis. Left, right and total nasal volumes and symmetry were compared. No statistically significant differences (p<0.05) were found within and between observers for the measured volumes and symmetry. Postoperatively, the total volume of the nose increased significantly, especially the volume at the cleft side. No significant volume difference pre- and postoperatively was found for the non-cleft side. The symmetry of the nose improved significantly. 3D stereophotogrammetry is a sensitive, quick, non-invasive method for evaluating volumetric changes of the nose in patients with cleft lip or cleft lip and palate.
In 3D photographs the bony structures are neither available nor palpable, therefore, the bone-related landmarks, such as the soft tissue gonion, need to be redefined. The purpose of this study was to determine the reproducibility and reliability of 49 soft tissue landmarks, including newly defined 3D bone-related soft tissue landmarks with the use of 3D stereophotogrammetric images. Two observers carried out soft-tissue analysis on 3D photographs twice for 20 patients. A reference frame and 49 landmarks were identified on each 3D photograph. Paired Student's t-test was used to test the reproducibility and Pearson's correlation coefficient to determine the reliability of the landmark identification. Intra- and interobserver reproducibility of the landmarks were high. The study showed a high reliability coefficient for intraobserver (0.97 (0.90 - 0.99)) and interobserver reliability (0.94 (0.69 - 0.99)). Identification of the landmarks in the midline was more precise than identification of the paired landmarks. In conclusion, the redefinition of bone-related soft tissue 3D landmarks in combination with the 3D photograph reference system resulted in an accurate and reliable 3D photograph based soft tissue analysis. This shows that hard tissue data are not needed to perform accurate soft tissue analysis.
The genetic basis for complex phenotypes is currently of great interest for both clinical investigators and basic scientists. In order to acquire a thorough understanding of the translation from genotype to phenotype, highly precise measures of phenotypic variation are required. New technologies, such as 3D photogrammetry are being implemented in phenotypic studies due to their ability to collect data rapidly and non-invasively. Before these systems can be broadly implemented, the error associated with data collected from images acquired using these technologies must be assessed. This study investigates the precision, error, and repeatability associated with anthropometric landmark coordinate data collected from 3D digital photogrammetric images acquired with the 3dMDface System. Precision, error due to the imaging system, error due to digitization of the images, and repeatability are assessed in a sample of children and adults (n = 15). Results show that data collected from images with the 3dMDface System are highly repeatable and precise. The average error associated with the placement of landmarks is sub-millimeter; both the error due to digitization and due to the imaging system are very low. The few measures showing a higher degree of error include those crossing the labial fissure, which are influenced by even subtle movement of the mandible. These results suggest that 3D anthropometric data collected using the 3dMDface System are highly reliable and, therefore, useful for evaluation of clinical dysmorphology and surgery, analyses of genotype-phenotype correlations, and inheritance of complex phenotypes.
The state-of-the-art diagnostic tools in oral and maxillofacial surgery and preoperative orthodontic treatment are mainly two-dimensional, and consequently reveal limitations in describing the three-dimensional (3D) structures of a patient's face. New 3D imaging techniques, such as 3D stereophotogrammetry (3D photograph) and cone-beam computed tomography (CBCT), have been introduced. Image fusion, i.e. registration of a 3D photograph upon a CBCT, results in an accurate and photorealistic digital 3D data set of a patient's face. The purpose of this study was to determine the accuracy of three different matching procedures. For 15 individuals the textured skin surface (3D photograph) and untextured skin surface (CBCT) were matched by two observers using three different methods to determine the accuracy of registration. The registration error was computed as the difference (mm) between all points of both surfaces. The registration errors were relatively large at the lateral neck, mouth and around the eyes. After exclusion of artefact regions from the matching process, 90% of the error was within+/-1.5 mm. The remaining error was probably caused by differences in head positioning, different facial expressions and artefacts during image acquisition. In conclusion, the 3D data set provides an accurate and photorealistic digital 3D representation of a patient's face.
3-dimensionale Bilderfassung: Erste Erfahrungen in der Planung und Dokumentation plastisch-chirurgischer Operationen
- T Spanholtz
- S Leitsch
- T Holzbach
- E Volkmer
- T Engelhardt
- R Giunta
Spanholtz T, Leitsch S, Holzbach T, Volkmer E,
Engelhardt T, Giunta R. 3-dimensionale Bilderfassung:
Erste Erfahrungen in der Planung und Dokumentation
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