Objective Assessment of the Unilateral Cleft Lip Nasal Deformity Using Three-Dimensional Stereophotogrammetry: Severity and Outcome.
Objective Assessment of the Unilateral Cleft Lip Nasal Deformity Using Three-Dimensional Stereophotogrammetry: Severity and Outcome.
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DOI：
10.1097/prs.0000000000004233
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发表时间：
2018-04
影响因子：
3.6
通讯作者：
Tse RW
中科院分区：
文献类型：
--
作者：
Mercan E;Oestreich M;Fisher DM;Allori AC;Beals SP;Samson TD;Sitzman TJ;Matic DB;Siebold BS;Tse RW
由于缺乏客观的措施来量化术前严重程度和结果，阻碍了单侧唇裂鼻畸形矫治护理的优化。本研究的目的是：使用3D立体摄影测量法制定鼻外观的共识标准；确定是否可以使用人体测量来量化严重程度和结果；并确定术前严重程度是否能预测术后结果。我们收集了100名受试者的面部3D图像，分为三组：45名唇裂修复前的婴儿；同样45名唇裂修复后的婴儿；还有45个8-10岁的孩子之前有过手术。每组再加入5名年龄匹配的未受影响的对照受试者。七名专家外科医生根据鼻部外观对每组图像进行排序。排名和得分作为共识标准。对每张图像进行人体测量分析，并与秩和评分进行比较。将术前排名和人体测量值与术后排名进行比较。在3个图像集上，评分者间和评分者内的信度都很好（ICC>0.76和Pearson相关>0.75）。鼻小柱角、鼻孔宽比、外侧唇高比与术前严重程度高度相关，与术后鼻外观中度相关。术后结果与术前严重程度（等级和人体测量）相关。在三维图像上可以对术前严重程度和术后结果进行一致的排序。术前严重程度预测术后预后。鼻小柱角、鼻孔宽比和侧唇高比是客观的测量指标，与不同年龄外科医生的一致评分相关。
Optimization of care to correct the unilateral cleft lip nasal deformity is hampered by lack of objective measures to quantify pre-operative severity and outcome. The purpose of this study was to: develop a consensus standard of nasal appearance using 3D stereophotogrammetry; determine if anthropometric measurements could be used to quantify severity and outcome; and determine if pre-operative severity predicts post-operative outcome. We collected facial 3D images of 100 subjects in three groups: 45 infants before cleft lip repair; the same 45 infants after cleft lip repair; and 45 children age 8–10 years with previous repairs. Five additional age-matched unaffected control subjects were included in each group. Seven expert surgeons ranked images in each group according to nasal appearance. The rank sum score was used as consensus standard. Anthropometric analysis was performed on each image and compared to the rank sum score. Pre-operative rank and anthropometric measurements were compared to post-operative rank. Inter-rater and intra-rater reliability was excellent (ICC>0.76 and Pearson correlation >0.75 respectively) on each of the 3 image sets. Columellar angle, nostril width ratio, and lateral lip height ratio were highly correlated with pre-operative severity and moderately correlated with post-operative nasal appearance. Post-operative outcome was associated with pre-operative severity (rank and anthropometric measurement). Consensus ranking of pre-operative severity and post-operative outcome can be achieved on 3d images. Pre-operative severity predicts post-operative outcomes. Columellar angle, nostril width ratio, and lateral lip height ratio are objective measures that correlate with consensus ratings by surgeons at multiple ages.