Three-dimensional Imaging Methods for Quantitative Analysis of Facial Soft Tissues and Skeletal Morphology in Patients with Orofacial Clefts: A Systematic Review

Fudalej PS (2014) Three-dimensional Imaging Methods for Quantitative Analysis of Facial Soft Tissues and Skeletal Morphology in Patients with Orofacial Clefts: A Systematic Review. PLoS ONE 9(4): e93442. doi:10.1371/journal.pone.0093442 Three-dimensional Imaging Methods for Quantitative Analysis of Facial Soft Tissues and Skeletal Morphology in Patients with Orofacial Clefts: A Systematic Review Mette A. R. Kuijpers 0 Yu-Ting Chiu 0 Rania M. Nada 0 Carine E. L. Carels 0 Piotr S. Fudalej 0 Irina Kerkis, Instituto Butantan, Brazil 0 1 Department of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, the Netherlands, 2 Cleft Palate Craniofacial Unit, Radboud University Medical Centre , Nijmegen , The Netherlands , 3 Department of Dentistry and Craniofacial Center, Chang Gung Memorial Hospital , Taipei, Taiwan , 4 Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern Switzerland, 5 Department of Orthodontics, Palacky University Olomouc , Olomouc , Czech Republic Background: Current guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising. Objective: To identify 3D imaging methods for quantitative assessment of soft tissue and skeletal morphology in patients with cleft lip and palate. Study selection: We included publications using 3D imaging techniques to assess facial soft tissue or skeletal morphology in patients older than 5 years with a cleft lip with/or without cleft palate. We reviewed studies involving the facial region when at least 10 subjects in the sample size had at least one cleft type. Only primary publications were included. Data extraction: Independent extraction of data and quality assessments were performed by two observers. Results: Five hundred full text publications were retrieved, 144 met the inclusion criteria, with 63 high quality studies. There were differences in study designs, topics studied, patient characteristics, and success measurements; therefore, only a systematic review could be conducted. Main 3D-techniques that are used in cleft lip and palate patients are CT, CBCT, MRI, stereophotogrammetry, and laser surface scanning. These techniques are mainly used for soft tissue analysis, evaluation of bone grafting, and changes in the craniofacial skeleton. Digital dental casts are used to evaluate treatment and changes over time. Conclusion: Available evidence implies that 3D imaging methods can be used for documentation of CLP patients. No data are available yet showing that 3D methods are more informative than conventional 2D methods. Further research is warranted to elucidate it. Systematic review registration: International Prospective Register of Systematic Reviews, PROSPERO CRD42012002041 - Introduction Patients with cleft lip and palate (CLP) are treated for an extended period of time. They often undergo several types of surgery as well as other treatment procedures by specialists collaborating with interdisciplinary teams from infancy until adulthood. The surgical procedures are necessary to reconstruct the anatomy of the alveolar arch and the face, and to restore the functions of the palate, lip muscles, and nose. Although treatment improves function and esthetics, it potentially can lead to tissue distortion and have a negative effect on craniofacial growth [1]. This may lead to less optimal facial esthetics along with negative psychosocial effects on a patients well-being [2,3]. Many treatment protocols exist for the management of patients with CLP. Therefore, evaluating the results of treatment becomes more and more important. The Eurocleft study [4] evaluated treatment outcomes in Europe in the 1990s and recently the Americleft study [5,69] examined treatment outcome in the US. Both studies proposed documentation and record taking for evaluation of treatment outcomes at certain time points, while they leave liberty for records at other time points. For record taking it appears that the first most complete data records are generally not documented earlier than age 5 [4,5]. At this age, some records, especially dental casts, have a predictive value for growth and further treatment [10,11]. It is expected that the majority of cleft palate treatment teams will use newly introduced three dimensional (3D) imaging technology to assess their treatment results. An increasing number of papers have been published regarding 3D evaluation of facial morphology and treatment outcomes in patients with clefts. Pharyngeal space is assessed with magnetic resonance imaging (MRI), computed tomography (CT), or cone beam computed tomography (CBCT). Results of bone grafting are evaluated with CT or CBCT. The jaw relationship, dental and alveolar arch, and the effects of surgery are examined with digital models and CBCT. The guidelines derived from Eurocleft, and later from Americleft, are still based on two-dimensional (2D) evaluation, except for dental casts, which are 3D by nature. Further evaluation may be I. Study design (7 ) A. Objectiveobjective clearly formulated ( ) B. Sample sizeconsidered adequate ( ) C. Sample sizeestimated before collection of data ( ) D. Selection criteriaclearly described ( ) E. Baseline characteristicssimilar baseline characteristics ( ) F. Timingprospective ( ) G. Randomizationstated ( ) II. Study measurements (3 ) H. Measurement methodappropriate to the objective ( ) I. Blind measurementblinding ( ) J. Reliabilityadequate level of agreement ( ) III. Statistical analysis (5 ) K. Dropoutsdropouts included in data analysis ( ) L. Statistical analysisappropriate for data ( ) M. Confoundersconfounders included in analysis ( ) N. Statistical significance levelP value stated ( ) O. Confidence intervals provided ( ) Maximum number of s = 15 (Gordon JM, Rosenblatt M, Witmans M, Carey JP, Heo G, Major PW, et al. Rapid palatal expansion effects on nasal airway dimensions as measured by acoustic rhinometry. A systematic review. Angle Orthod. 2009;79(5): 10001007.). doi:10.1371/journal.pone.0093442.t002 needed to determine whether guidelines are necessary for the newer craniofacial imaging technologies. A recent systematic review [12] about methods to quantify softtissue based facial growth and treatment outcomes in children younger than 6 years of age concluded that stereophotogrammetry seems to be the best method to longitudinally assess facial growth in these children. Studies on infants with CLP using 3D imaging techniques have been performed mainly to evaluate lip changes after surgery [1315] and the effect of nasoalveolar molding [16]. A systematic review of existing 3D technologies for assessing treatment outcome in patients with CLP would provide clues for evaluating treatment effects and planning, as well as a comparison of treatment possibilities. Therefore, the objective of this systematic review was to identify 3D imagi (...truncated)