3D Craniofacial Anthropometry, Simplified and Accelerated by Semi-Automatic Calliper

  • Constantin A. Landes
  • Michael Trolle
  • Robert Sader
Chapter

Abstract

Anthropometric standard callipers are used in craniofacial conformation assessment of patients with malformations, such as cleft lip and palate, hypoplastic or excessive jaw development, or for aesthetic reasons. Roentgenocephalogram analysis is the mainstay in diagnosing craniofacial osseous and soft-tissue conformation and development. Also called cephalometry, it is based on lateral and posterior–anterior standardized roentgenographs and several insecure landmarks that show considerable intrarater and interrater variation. Moreover, radiation exposure, constant object positioning and the use of costly roentgen equipment is inevitable. Anthropometry, as mostly presented in the literature, is time consuming and cannot reproduce 3D craniofacial conformation. Insecure landmark definitions and soft tissue resilience foster systemic measurement errors. Therefore, a few, easily accessible landmarks, closely related to the underlying bone were selected, measured and reconstructed in their 3D conformation as a wire frame. A soft tissue mask, concentrating on the mid-sagittal profile was added. Facial growth was monitored, growth functions generated and postoperative outcomes evaluated against the preoperative situation. To simplify general anthropometric data acquisition by calliper, a semiautomatic calliper was developed. With its data-input switch connected by optical data cable to a standard personal computer (PC), this calliper permitted completion of standard data sheets, interrater and intrarater validated in test collectives and patients. A major volunteer collective with repeat measurements served for standards and for reliability assessment. Normal growth functions, differentiated by sex, were assessed with 95-percentiles and 5% relative error. Full manual viscerocranial Am was thrice as time-consuming as the semi-automatic calliper-mediated direct data input to the computer. Gauging of the distance of the calliper ends by ruler, taking down the numbers manually, and lastly computer data input were rendered superfluous, and standard relative error decreased. The developed craniofacial Am proved reliable and valid for measurement of craniofacial growth, diagnosis and treatment control. Relative measurement errors are smaller than the ­systematic magnification and distortion in lateral cephalograms. The Am allowed reliable, objective, independent calculation of cranial bone relations and soft tissue projection, sensitive to facial asymmetry. Easy application, versatility and economy were obvious in the assessment of facial proportions, soft tissue ratios, operation planning and follow-up. Semiautomatic anthropometric callipered data acquisition was shown to be faster than the manual technique and equally reliable: measurement errors were effectively diminished and oversight errors avoided. The craniofacial anthropometric routine has been in use over 10 years and proven valuable in growth comparison of different regimens of cleft lip and palate treatment as well as with jaw development in microsomia and jaw deformity treatment, such as dysgnathia. While treating specific craniofacial syndromes, many specialists have needed to assess postnatal growth patterns as a background consideration. Normal development and knowledge of soft-tissues-to-bone relationships and their interaction and the interaction between functional–aesthetic regions have been given high importance in prospective treatment rationales and outcome assessments. Using anthropometric standard callipers, craniofacial features, e.g. of patients with malformations such as cleft lip and palate, dysgnathia (hypoplastic or excessive jaw formation), craniosynostosis are assessed today, as are proportions in the trunk and extremities, with dedicated measurement routines.

Keywords

Crest Helio Craniosynostosis 

Abbreviations

2D

Two-dimensional

3D

Three-dimensional

Am

Anthropometry

Ar

Articulare

Crtl

Control

CT

Computer tomography

Gn

Gnathion

Li

Labiale inferius

Ls

Labiale superius

Mn

Mandibulare

MRI

Magnetic resonance imaging

Mx

Maxillare

N

Nasion

N’

Soft tissue nasion

P

Postgingivale

PC

Personal computer

Pg

Pogonion

Pn

Pronasale or nasal tip

Rcm

Roentgenocephalometry

Sm

Supramentale or supramental fold

Sn

Subnasale or columellar base

T

Tragus or tragion

Ti

Trichion

References

  1. Arnaud E, Marchac D, Renier D. [Diagnosis of facial and craniofacial asymmetry] in French. Ann Chir Plast Esthet. 2001;46:410–23.PubMedCrossRefGoogle Scholar
  2. Baumgaertel S, Palomo JM, Palomo L, Hans MG. Reliability and accuracy of cone-beam computed tomography dental measurements. Am J Orthod Dentofacial Orthop. 2009;136:19–25.PubMedCrossRefGoogle Scholar
  3. Bitter K. Latham’s appliance for presurgical repositioning of the protruded premaxilla in bilateral cleft lip and palate. J Craniomaxillofac Surg. 1992;20:99–110.PubMedCrossRefGoogle Scholar
  4. Bitter K. Repair of bilateral cleft lip, alveolus and palate. Part 3: Follow-up criteria and late results. J Craniomaxillofac Surg. 2001;29:49–55.PubMedCrossRefGoogle Scholar
  5. Bongartz J, Giel D, Hering P. Living human face measurements using pulsed holography. In: Jeong TH, Sobotka WK, editors. Holography, Vol. 4149. Bellingham, Washington: SPIE proceedings series; 2000. pp. 303–8.Google Scholar
  6. Bozkir MG, Karakaş P, Yavuz M, Dere F. Morphometry of the external ear in our adult population. Aesthetic Plast Surg. 2006;30:81–5.PubMedCrossRefGoogle Scholar
  7. Broadbent B-H. A new X-ray technique and its application to orthodontia. Angle Orthod. 1931;1:45–66.Google Scholar
  8. Czerwinski M, Martin M, Lee C. Quantitative topographical evaluation of the orbitozygomatic complex. Plast Reconstr Surg. 2005;115:1858–62.PubMedCrossRefGoogle Scholar
  9. Evereklioglu C, Doganay S, Er H, Gunduz A, Tercan M, Balat A, Cumurcu T. Craniofacial anthropometry in a Turkish population. Cleft Palate Craniofac J. 2002;39:208–18.PubMedCrossRefGoogle Scholar
  10. Farkas LG. Anthropometry of the head and face. 2nd ed. New York: Raven.Google Scholar
  11. Farkas LG, Forrest CR. Changes in anthropometric values of paired craniofacial measurements of patients with right coronal synostosis. Ann Plast Surg. 2006;56:427–30.PubMedCrossRefGoogle Scholar
  12. Farkas LG, Munro IR. Anthropometric facial proportions in medicine. Springfield, MA: Charles C. Thomas; 1987.Google Scholar
  13. Guyot L, Dubuc M, Richard O, Philip N, Dutour O. Comparison between direct clinical and digital photogrammetric measurements in patients with 22q11 microdeletion. Int J Oral Maxillofac Surg. 2003;32:246–52.PubMedCrossRefGoogle Scholar
  14. Heike CL, Cunningham ML, Hing AV, Stuhaug E, Starr JR. Plast Reconstr Surg. Picture perfect? Reliability of craniofacial anthropometry using three-dimensional digital stereophotogrammetry. 2009;124:1261–72.PubMedCrossRefGoogle Scholar
  15. Hellman M. An introduction to growth of the human face from infancy to adulthood. Int J Orthod. 1932;25:777–801.Google Scholar
  16. Honrado CP, Larrabee WF. Update in three-dimensional imaging in facial plastic surgery. Curr Opin Otolaryngol Head Neck Surg. 2004;12:237–331.CrossRefGoogle Scholar
  17. Kohout M, Pai L, Berenguer B, Tayler P, Pracharktam N, Mulliken JB. New instrument for orbital anthropometry. J Craniomaxillofac Surg. 1998;26:174–8.PubMedCrossRefGoogle Scholar
  18. Kolar JC, Salter EM. Craniofacial anthropometry: practical measurement of the head and face for clinical, surgical and research use. Springfield, MA: Charles C. Thomas; 1997.Google Scholar
  19. Landes CA, Bitsakis J, Diehl T, Diehl T, Bitter K. Introduction of a three-dimensional anthropometry of the viscerocranium. Part I: measurement of craniofacial development and establishment of standard values and growth functions. J Craniomaxillofac Surg. 2002a:30:18–24.PubMedCrossRefGoogle Scholar
  20. Landes CA, Zachar R, Diehl T, Diehl T, Kovács AF. Introduction of a three-dimensional anthropometry of the viscerocranium. Part II: evaluating osseous and soft-tissue changes following orthognathic surgery. J Craniomaxillofac Surg. 2002b;30:25–34.PubMedCrossRefGoogle Scholar
  21. Landes CA, Trolle M, Sader R. Rapid 3-dimensional anthropometry by semiautomatic data acquisition and ­processing. Ann Plast Surg Jun. 2007;58:698–703.PubMedCrossRefGoogle Scholar
  22. McCance AM, Moss J, Fright R, James DR, Linney AD. A three-dimensional analysis of bone and soft tissue to bone ratio of movements in 17 Skeletal II patients following orthognathic surgery. Eur J Orthod. 1993;15:97–106.PubMedGoogle Scholar
  23. McCance A, Moss J, Fright R, Linney AD, James DR, Coghlan K, Mars M. Three-dimensional analysis techniques–Part 1: Three-dimensional soft-tissue analysis of 24 adult cleft palate patients following Le Fort I maxillary advancement: a preliminary report. Cleft Palate Craniofac J. 1997;34:36–45.PubMedCrossRefGoogle Scholar
  24. Mortenson PA, Steinbok P. Quantifying positional plagiocephaly: reliability and validity of anthropometric measurements. J Craniofac Surg. 2006;17:413–9.PubMedCrossRefGoogle Scholar
  25. Rakosi T. Atlas und Anleitung zur praktischen Fernröntgenanalyse. Springer, Berlin-Heidelberg-New York; 1982.Google Scholar
  26. Teichgraeber JF, Ault JK, Baumgartner J, Waller A, Messersmith M, Gateño J, Bravenec B, Xia J. Deformational posterior plagiocephaly: diagnosis and treatment. Cleft Palate Craniofac J. 2002;39:582–6.PubMedCrossRefGoogle Scholar
  27. Trolle M. {German} Rapid Anthropometry using a semi-automatic calliper. Doctoral Thesis, Frankfurt University, Germany; 2008.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Constantin A. Landes
    • 1
  • Michael Trolle
  • Robert Sader
  1. 1.Klinik für Kiefer- und Plastische Gesichtschirurgieder Johann Wolfgang Goethe Universität FrankfurtFrankfurt am MainGermany

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