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Three-dimensional quantification of skeletal midfacial complex symmetry

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

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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Acknowledgements

Thanks to Kevin Dotremont from Materialise N.V., Leuven, Belgium, for helping to develop the methodology.

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Authors and Affiliations

  1. OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33 bus 7001, 3000, Leuven, Belgium

    Nermin Morgan, Sohaib Shujaat, Omid Jazil & Reinhilde Jacobs

  2. Department of Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt

    Nermin Morgan

  3. Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Sohaib Shujaat

  4. Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden

    Reinhilde Jacobs

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  1. Nermin Morgan
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Correspondence to Nermin Morgan.

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This study was conducted in compliance with the World Medical Association Declaration of Helsinki on medical research. Ethical approval was obtained from the Ethical Review Board of the University Hospitals Leuven (reference number: S57587).

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Morgan, N., Shujaat, S., Jazil, O. et al. Three-dimensional quantification of skeletal midfacial complex symmetry. Int J CARS 18, 611–619 (2023). https://doi.org/10.1007/s11548-022-02775-0

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