Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Surgical Correction for Metopic Craniosynostosis: A 3D Photogrammetric Analysis of Cranial Vault Outcomes
Olivia E. Linden, BA, Vanessa M. Baratta, BA, Margaret M. Byrne, RN, Petra M. Klinge, MD PhD, Stephen R. Sullivan, MD MPH, Helena OB Taylor, MD PhD.
Warren Alpert Medical School of Brown University, Rhode Island Hospital, Hasbro Children's Hospital, Providence, RI, USA.

PURPOSE - Currently, little quantitative data exists for metopic craniosynostosis outcomes following cranial vault surgery. In the past, measurements of surgical outcomes have relied on limited anthropometric measurements and computed tomography (CT). In recent years, three-dimensional (3D) photogrammetry has had an increasing presence in quantitatively evaluating plastic surgery outcomes. 3D photogrammetry enables the analysis of soft tissue topography and has proven precise, accurate, and reproducible. Since CT imaging is often not indicated for post-surgical evaluation, 3D imaging makes the collection of post-operative images possible and thus, creates the opportunity for pre- and post-operative quantitative comparisons.
Our purpose was to use 3D photogrammetry to evaluate the post-operative head shape of patients who had undergone cranial vault remodeling for metopic synostosis, and to compare these results with age-matched controls.
METHODS - Following IRB approval, we analyzed pre and postoperative images of pediatric patients with CT-diagnosed metopic craniosynostosis. All patients had undergone anterior cranial vault remodeling. For comparison, we imaged age-matched subjects with no history of craniofacial disorders, facial surgery, or facial trauma. Surface scans of patient and control faces were obtained using the Canfield™ VECTRA system.
To ensure standardized facial orientation, each facial image was positioned to best fit the preoperative facial image by aligning six soft tissue landmarks: left and right medial and lateral canthi, subnasale, and prochelion (Figure 1). Landmarks were positioned 20mm above the glabella and spaced 10mm apart laterally across the forehead. All distances were measured from an origin positioned in a horizontal plane 60 mm behind the soft tissue surface of the face (Figure 2).
RESULTS - The average age at postoperative imaging for craniosynostosis patients was 3.2±0.9 years (range 2.2-5.1) and 3.3±1.0 years (range 2.1-5.2) for controls. Patient images were analyzed preoperatively (n=12), immediately postoperatively (mean, 0.2 yrs) (n=11) and over a year postoperatively (mean, 2.0 yrs) (n=7). The average distances from the origin to the soft tissue of the forehead were 59.3±0.7 mm, 59.1±0.9 mm, 59.5±0.5 mm for immediate postoperative, >1 year postoperative and control images, respectively, compared to 55.1±3.5mm in preoperative faces (Figure 3).
CONCLUSIONS - Three-dimensional photogrammetry provides a safe and quantitative assessment of post-surgical changes and their stability. One year postoperative soft tissue contours were comparable to the normative forehead contours in the age-matched controls. Reconstructions were stable in the postoperative patients to over one year after correction. With further development, 3D imaging can be an effective substitute for CT imaging for the surgical evaluation of cranial vault surgeries and thus, reduce the amount of radiation exposure to these pediatric patients.



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