4.5 Article

Three-dimensional quantification of skeletal midfacial complex symmetry

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SPRINGER HEIDELBERG
DOI: 10.1007/s11548-022-02775-0

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Midfacial complex; Symmetry; Automatic segmentation; CBCT; Mirroring reconstructive surgeries; Virtual surgical planning

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The aim of this study was to assess the symmetry of skeletal midfacial complex in skeletal class I patients. The results showed that female patients had a more symmetrical midfacial complex compared to male patients. The comparison between true and mirrored models justified the applicability of using the mirroring technique in reconstructive surgical procedures.
Purpose Quantification of skeletal symmetry in a healthy population could have a strong impact on the reconstructive surgical procedures where mirroring of the contralateral healthy side acts as a clinical reference for the restoration of unilateral defects. Hence, the aim of this study was to three-dimensionally assess the symmetry of skeletal midfacial complex in skeletal class I patients. Methods A sample of 100 cone beam computed tomography (CBCT) scans (50 males, 50 females; age range: 19-40 years) were recruited. Automated segmentation of the skeletal midfacial complex was performed to create a three-dimensional (3D) virtual model using a convolutional neural network (CNN)-based segmentation tool. Thereafter, the segmented model was mirrored and registered to quantify skeletal symmetry using a color-coded conformance mapping based on a surface part comparison analysis. Results Overall, the mean and root-mean-square (RMS) differences between complete true and mirrored models were 0.14 +/- 0.12 and 0.87 +/- 0.21 mm, respectively. Female patients had a significantly more symmetrical midfacial complex (mean difference: 0.11 +/- 0.1 mm, RMS: 0.81 +/- 0.17 mm) compared to male patients (mean difference: 0.16 +/- 0.13 mm, RMS: 0.94 +/- 0.23 mm). No significant difference existed between left and right sides irrespective of the patient's gender. Conclusion The comparison between true and mirrored complete and left/right split midfacial complex showed symmetry within a clinically acceptable range of 1 mm, which justifies the applicability of using the mirroring technique. The presented data could act as a reference guide for surgeons during planning of reconstructive surgical procedures and outcome assessment at follow-up.

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