A novel approach for pre-surgical evaluation of facial morphometry in children using magnetic resonance imaging scans of the brain: A feasibility analysis Facial morphometry in magnetic resonance imaging

A novel approach for pre-surgical evaluation of facial morphometry in children using magnetic resonance imaging scans of the brain: A feasibility analysis
Facial morphometry in magnetic resonance imaging

Main Article Content

Iroshani Kodikara
Dhanusha Gamege
Ganananda Nanayakkara
Isurani Ilaperuma

Abstract

Pre-surgical evaluation of facial morphometry is frequently warranted for children with facial dysmorphism. Though many methods utilized previously for such purposes, data is scarce on using magnetic resonance (MRI) brain images for such purposes. The purpose of this study was to appraise the feasibility of utilizing MRI brain scans done in epilepsy imaging protocol to assess facial morphometry. Measurements of the face; orbit, mouth, and nose of children aged 1 to 7 years were obtained using T1 sagittal, T2 axial and three dimensional (3D) MRI images of the brain (n=20). Ability to obtain facial measurements, inter and intra-observer variability calculated. The mean age of the studied children was 4±2 years, of which 40% (n=8) were boys, and 60% (n=12) were girls. Obtaining facial measurements were reliable with high intra-observer (α=0.757 to 0.999) and inter-observer agreements (α=0.823 to 0.997). The landmarks of the cranium, upper face, and upper nose could be identified (100%) in both two dimensional (2D) and 3D images when such landmarks were contained in the imaging field of view (FOV). Landmarks of lower nose, (subalar width = 0%) or mouth (0%) were not contained in the FOV of 2D images, but contained in 3D images (100%). Both 2D and 3D images did not allow assessment of lower face or the mandible as such landmarks were not contained in the FOV.


We conclude that Brain MRIs performed to evaluate cerebral pathology can be executed to assess facial measurements, provided the FOV of the scan is adjusted to include all significant landmarks.

References

Agbenorku P. (2013) Orofacial Clefts: A Worldwide Review of the Problem. Int Sch Res Notices; ID 348465. http://dx.doi.org/10.5402/2013/348465

Arlachov Y, Ganatra RH.(2012) Sedation/anaesthesia in paediatric radiology.Br J Radiol (1019):e1018‐e1031. https://doi.org/10.1259/bjr/28871143

Barrera JE. (2011) Addressing Challenges of Cleft Lip and Palate Deformity in Afghanistan. Arch Facial Plast Surg. https://doi.org/10.1001/archfacial.2011.70

Bekele KK, Ekanem PE. (2019) Anatomical patterns of cleft lip and palate deformities among neonates in Mekelle, Tigray, Ethiopia; implication of environmental impact. BMC pediatric. https://doi.org/10.1186/s12887-019-1624-2

Campbell A, Costello B, Ruiz R. (2010) Cleft lip and palate surgery: An update of clinical outcomes for Primary Repair. Oral Maxillofac Surg Clin NA. https://doi.org/10.1016/j.coms.2009.11.003

Çeliktutan O, Ulukaya S, Sankur B. (2013) A comparative study of face landmarking techniques. Eurasip J Image Video Process. https://doi.org/10.1186/1687-5281-2013-13

Chakravarty MM, Aleong R, Leonard G, at al. (2011) Automated Analysis of Craniofacial Morphology Using Magnetic Resonance Images. PLoS ONE. https://doi.org/10.1371/journal.pone.0020241

Chuang J, Barnes C, Wong B. (2016) Overview of Facial plastic surgery and current developments. Surg J. https://dx.doi.org/10.1055%2Fs-0036-1572360

Daboul A, Ivanovska T, Bu R, et al. (2018) Procrustes-based geometric morphometrics on MRI images: An example of inter-operator bias in 3D landmarks and its impact on big datasets. PLoS ONE: e0197675. https://doi.org/10.1371/journal.pone.0197675

David M, Yousem MD. (2010) Neuroradiology: the requisites Elsiever USA. https://www.elsevier.com/books/neuroradiology-the-requisites/nadgir/978-1-4557-7568-2

Fakhim SA, Shahidi N, Lotfi A. (2016) Prevalence of Associated Anomalies in Cleft Lip and / or Palate Patients. Iran J Otolaryngology. https://pubmed.ncbi.nlm.nih.gov/27280100/

Farkas LG (1994) Anthropometry of the head and face. 2nd ed., New York: Raven Press.

Johnston B, Chazal P de. (2018) A review of image-based automatic facial landmark identification techniques. Eurasip J Image Video Process. https://doi.org/10.1186/s13640-018-0324-4

Marazita M. (2007) Subclinical features in non-syndromic cleft lip with or without cleft palate (CL/P): review of the evidence that subepithelial orbicularis oris muscle defects are part of an expanded phenotype for CL/P. Craniofac Res. https://doi.org/10.1111/j.1601-6343.2007.00386.x

de Menezes M, Sforza C. (2010) Three-dimensional face morphometry. Dental Press J Orthod. https://www.scielo.br/pdf/dpjo/v15n1/en_02.pdf

Moss J, Linney A, Grindrod S. Arridge S, Clifton J (1987) Three-dimensional visualization of the face and skull using computerized tomography and laser scanning techniques. Eur J Orthod. https://doi.org/10.1093/ejo/9.4.247

Neiswanger K, Weinberg SM, Rogers CR, et al. (2007) Orbicularis oris muscle defects as an expanded phenotypic feature in non-syndromic cleft lip with or without cleft palate. Am J Med Genet A. https://doi.org/10.1002/ajmg.a.31760

Nopoulos P, Langbehn DR, Canady J, at al. (2007) Abnormal Brain Structure in Children with Isolated Clefts of the Lip or Palate. Arch Pediatr Adolesc Med. https://ja.ma/3bCMwEY

Nopoulos P, Berg S, Van Demark D, et al. (2001) Increased Incidence of a Midline Brain Anomaly in Patients with Non syndromic Clefts of the Lip and/or Palate. J Neuroimaging. https://doi.org/10.1111/j.1552-6569.2001.tb00072.x

Othman, S., Aidil Koay, N. (2016) Three-dimensional facial analysis of Chinese children with repaired unilateral cleft lip and palate. Sci Rep 6, 31335. https://doi.org/10.1038/srep31335

Osborn AG. (2017) Osborn’s brain: imaging, pathology and anatomy. 2nd ed.; Elsevier - Health Sciences Division, Philadelphia, USA. https://www.elsevier.com/books/osborns-brain/osborn/978-0-323-47776-5

Paranaíba LMR, Miranda RT de, Ribeiro LA, et al. (2011) Frequency of congenital craniofacial malformations in a Brazilian Reference Center. Rev Bras Epidemiol. https://doi.org/10.1590/S1415-790X2011000100014

Reeth EV, Tham IWK, Tan CH, Poh CLOO. (2012) Super-Resolution in Magnetic Resonance Imaging: A Review. Concept Magn Reson A. https://doi.org/10.1002/cmr.a.21249

Ribeiro P, Ladeira S De, Alonso N. (2012) Protocols in Cleft Lip and Palate Treatment: Systematic Review. Plast Surg Int; ID 562892 https://doi.org/10.1155/2012/562892

Shkoukani MA, Chen M, Vong A. (2013) Cleft lip – a comprehensive review. Front Pediatric. https://doi.org/10.3389/fped.2013.00053