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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (4): 708-715. doi: 10.19723/j.issn.1671-167X.2023.04.023

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Category of facial symmetry perception after maxillary reconstruction using anterolateral thigh flap

Ying HUANG,Zhi-yuan WU,Xing-hong ZHOU,Zhi-gang CAI,Jie ZHANG*()   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2020-08-14 Online:2023-08-18 Published:2023-08-03
  • Contact: Jie ZHANG E-mail:zhangjie06@126.com

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Abstract:

Objective: To preliminarily establish a category of facial symmetry perception after maxillary reconstruction using anterolateral thigh flap (ALTF) by the methods of stereophotogrammetry and subjective assessment. Methods: The patients underwent maxillectomy due to neoplasms invasion, and all the maxillary defects were reconstructed using ALTF.Three-dimensional (3D) photographs were captured from the patients with a stereophotogrammatrical camera set-up.In the Geomagic software, the mirror image was created by reflecting along an arbitrary plane outside of the face.After the registration, the postoperative side on the original 3D photograph was segmented into 6 areas.The 3D change of the facial soft-tissue was measured using surface-based color map.Twenty laypeople took part in the study as observers, and they were asked to rate the 3D photographs using 5 point Likert-type scale according to their own aesthetic standard.The soft tissue asymmetry was graded according to the score.The collected data were subjected to statistical analysis using the SPSS 24.0 software. Results: In the study, 44 subjects were recruited (21 males and 23 females, age range from 19 to 79 years).The soft-tissue symmetry was graded into three levels according to the subjective scores.The grade Ⅰ was basically symmetrical.The grade Ⅱ was slightly asymmetrical.The grade Ⅲ was obviously asymmetrical.Statistically significant differences were found in the suborbital (P < 0.05) and zygomatic (P < 0.05) areas when comparing all grades of soft-tissue asymmetry, and in the buccal (P < 0.05) and superiolabial (P < 0.05) areas when comparing grades Ⅰ and Ⅲ.The extent of maxillary defect had significant impact on the symmetry of the midface soft-tissue after maxillary reconstruction. Conclusion: Varying extent maxillectomy would result in varying degrees of asymmetry, and cause different grades of symmetry perception even if they had been reconstructed using ALTF.The higher the grade, the worse the symmetry of facial soft-tissue.Suborbital and zygomatic areas were important aesthetic units that affected the facial symmetry perception, followed by buccal and superiolabial areas.The clinicians should pay attention to the soft-tissue support in these areas when reconstructing the maxillary defect, especially large defect with orbital floor involved.

Key words: Maxillary defect, Anterolateral thigh flap, Stereophotogrammetry, Subjective assessment, Perception category

CLC Number: 

  • R782.4

Figure 1

Mirrored 3D photograph creation and surface registration process A, original 3D photograph; B, mirrored 3D photograph; C, registration of two photographs."

Table 1

Facial soft-tissue landmarks"

Landmarks Anatomical location
Endocanthion Lower and innermost point at junction between upper and lower eyelids
Exocanthion Outer skin junction, where upper eyelid meets lower; most lateral extent of lower eyelid
Nasion Maximum concavity of nasal bridge in profile
Tragion Midpoint of the tragus
Alare Most lateral point on the alar contour
Subnasale Midpoint on the nasolabial soft tissue contour between the columella crest and the upper lip
Labiale superius Midpoint of the vermilion line of the upper lip
Cheilion Point located at the labial commissure
Menton Lowest median point on the lower border of the mandible
Gonion Most lateral point on the mandibular angle
A’ One third of the mandibular margin
B’ The lower third of the line cheilion-alare
C’ Parallel line of line tragion-gonion that go through A’ and intersect with line tragion-B’, C’ is the intersection

Figure 2

Soft-tissue landmarks and facial areas A, soft-tissue landmarks were manually marked on the original 3D photograph; B, postoperative side on the original 3D photography was segmented into 6 areas. En, endocanthion; Ex, exocanthion; Ns, nasion; TraR, tragion (right); Al, alare; Sn, subnasale; Ls, labiale superius; Ch, cheilion; Me, menton; GoR, gonion (right); A', one third of the mandibular margin; B', the lower third of the line cheilion-alare; C', parallel line of line tragion-gonion that go through A' and intersect with line tragion-B', C' is the intersection."

Figure 3

Surface-based color map Distance map showing the differences between each region and the mirrored photograph, a color-coded scale, corresponding to the distances, was also generated. A, suborbital; B, superiolabial; C, nasal; D, zygomatic; E, buccal; F, masseteric."

Table 2

Classification for maxillary deffect"

Items Ⅰ Ⅱb Ⅱd Ⅲb Ⅲd Total
Male, n 1 6 7 2 5 21
Female, n 3 10 4 3 3 23
Total, n 4 16 11 5 8 44

Figure 4

Symmetry of the facial soft-tissue areas of varying perception grades"

Table 3

Comparison of changes in each area of grade Ⅰ, Ⅱ and Ⅲ"

Facial areaMean rankχ2 P
Grade Ⅰ (n=15) Grade Ⅱ (n=12) Grade Ⅲ (n=17)
Suborbital 12.27 23.58 30.76 16.743 ＜0.001*
Zygomatic 12.27 23.50 30.82 16.731 ＜0.001*
Buccal 16.73 21.92 28.00 6.165 0.046*
Masseteric 18.80 23.08 22.76 0.775 0.679
Nasal 17.47 23.58 26.18 3.781 0.151
Superiolabial 16.27 21.00 29.06 8.128 0.017*

Table 4

Comparison of changes in each area of grade Ⅰ and Ⅱ"

Facial areaMean rankZ P
Grade Ⅰ (n=15) Grade Ⅱ (n=12)
Suborbital 10.07 18.92 -2.879 0.004*
Zygomatic 9.73 19.33 -3.123 0.002*
Buccal 12.87 15.42 -0.830 0.407
Masseteric 13.40 14.75 -0.439 0.661
Nasal 12.00 16.50 -1.464 0.143
Superiolabial 12.53 15.83 -1.073 0.283

Table 5

Comparison of changes in each area of grade Ⅱ and Ⅲ"

Facial areaMean rankZ P
Grade Ⅱ (n=12) Grade Ⅲ (n=17)
Suborbital 11.17 17.71 -2.037 0.042*
Zygomatic 10.67 18.06 -2.303 0.021*
Buccal 13.00 16.41 -1.063 0.288
Masseteric 14.83 15.12 -0.089 0.929
Nasal 13.58 16.00 -0.753 0.452
Superiolabial 11.67 17.35 -1.771 0.077

Table 6

Comparison of changes in each area of grade Ⅰ and Ⅲ"

Facial areaMean rankZ P
Grade Ⅰ (n=15) Grade Ⅲ (n=17)
Suborbital 10.20 22.06 -3.569 ＜0.001*
Zygomatic 10.53 21.76 -3.380 0.001*
Buccal 11.87 20.59 -2.625 0.009*
Masseteric 14.80 18.00 -0.953 0.336
Nasal 13.47 19.18 -1.718 0.086
Superiolabial 11.73 20.71 -2.700 0.007*

Table 7

The category of facial symmetry perception of varying maxillary defect"

Items Ⅰ Ⅱb Ⅱd Ⅲb Ⅲd Total
Grade Ⅰ, n 4 7 3 1 0 15
Grade Ⅱ, n 0 7 4 0 1 12
Grade Ⅲ, n 0 2 4 4 7 17
Total, n 4 16 11 5 8 44

Table 8

Comparison of changes in each area of varying maxillary defect /mm"

Facial area Ⅰ Ⅱb Ⅱd Ⅲb Ⅲd F P
Suborbital 0.96±0.50 1.46±0.73 2.69±2.22 2.93±1.39 6.28±3.09 10.26 ＜0.001*
Zygomatic 1.53±0.74 2.68±1.42 3.62±2.42 4.78±0.59 5.87±3.15 4.74 0.003*
Buccal 2.59±1.59 3.12±2.06 4.35±2.79 4.24±2.35 3.79±2.45 1.00 0.420
Masseteric 2.36±1.21 2.79±1.85 3.24±2.25 2.90±0.74 3.03±1.99 0.20 0.937
Nasal 1.63±1.32 1.62±1.07 1.63±1.44 2.22±0.81 3.12±1.18 2.75 0.042*
Superiolabial 2.18±1.20 2.05±1.17 4.44±2.06 2.99±1.60 4.42±2.58 4.28 0.006*
1 Piazza C , Paderno A , Del Bon F , et al. Palato-maxillary reconstruction by the angular branch-based tip of scapula free flap[J]. Eur Arch Otorhinolaryngol, 2017, 274 (2): 939- 945.
doi: 10.1007/s00405-016-4266-0
2 于森, 王洋, 毛驰, 等. 1107例上颌骨缺损的临床分类及修复方法分析[J]. 北京大学学报(医学版), 2015, 47 (3): 509- 513.
3 Bianchi B , Ferri A , Ferrari S , et al. The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: One surgeon's experience in 92 cases[J]. Microsurgery, 2012, 32 (2): 87- 95.
doi: 10.1002/micr.20952
4 Lavadera P , Schultz J , Sinkin J . Orbital floor and maxillary reconstruction with titanium mesh and anterolateral thigh free flap[J]. Eplasty, 2019, 19 (7): 126- 130.
5 Eitezaz FA , Rashid M , Yousaf S , et al. Can the anterolateral thigh flap replace the rectus abdominis free flap in the reconstruction of complex maxillary defects?[J]. J Ayub Med Coll Abbottabad, 2018, 30 (1): 74.
6 刘志荣, 彭歆, 章文博. 游离腓骨瓣和股前外侧穿支皮瓣修复单侧上颌骨缺损患者的生存质量问卷调查研究[J]. 中华整形外科杂志, 2018, 34 (8): 644- 647.
7 Springer IN , Wannicke B , Warnke PH , et al. Facial attractiveness: Visual impact of symmetry increases significantly towards the midline[J]. Ann Plast Surg, 2007, 59 (2): 156- 162.
doi: 10.1097/01.sap.0000252041.66540.ec
8 Berssenbrugge P , Lingemann-Koch M , Abeler A , et al. Mea-suring facial symmetry: A perception-based approach using 3D shape and color[J]. Biomed Tech (Berl), 2015, 60 (1): 39- 47.
9 Philipp MM , Angelika SE , Ute B , et al. Three-dimensional perception of facial asymmetry[J]. Eur J Orthod, 2011, 33 (6): 647- 653.
doi: 10.1093/ejo/cjq146
10 Patel A , Islam SM , Murray K , et al. Facial asymmetry assessment in adults using three-dimensional surface imaging[J]. Prog Orthod, 2015, 16 (10): 36- 44.
11 Hallac RR , Feng J , Kane AA , et al. Dynamic facial asymmetry in patients with repaired cleft lip using 4D imaging (video stereophotogrammetry)[J]. J Craniomaxillofac Surg, 2017, 45 (1): 8- 12.
doi: 10.1016/j.jcms.2016.11.005
12 Cassi D , Battistoni G , Magnifico M , et al. Three-dimensional evaluation of facial asymmetry in patients with hemifacial microsomia using stereophotogrammetry[J]. J Craniomaxillofac Surg, 2019, 47 (1): 179- 184.
doi: 10.1016/j.jcms.2018.11.011
13 Brown J , Shaw RJ . Reconstruction of the maxilla and midface: Introducing a new classification[J]. Lancet Oncol, 2010, 11 (10): 1001- 1008.
doi: 10.1016/S1470-2045(10)70113-3
14 Krzych J , Lach M , Joniec M , et al. The Likert scale is a powerful tool for quality of life assessment among patients after minimally invasive coronary surgery[J]. Kardiochir Torakochirurgia Pol, 2018, 15 (2): 130- 134.
15 Naini FB , Donaldson A , Cobourne MT , et al. Assessing the influence of mandibular prominence on perceived attractiveness in the orthognathic patient, clinician, and layperson[J]. Eur J Orthod, 2012, 34 (6): 738- 746.
doi: 10.1093/ejo/cjr098
16 邢亚彬, 马爱霞. 欧洲五维健康量表EQ-5D-3L和EQ-5D-5L中文版比较的实证研究[J]. 上海医药, 2013, 25 (7): 31- 35.
17 萧宁, 王勇, 赵一姣. 三维颜面部软组织正中矢状面确定方法的研究进展[J]. 中华口腔医学杂志, 2018, 53 (7): 495- 499.
18 Verhoeven TJ , Coppen C , Barkhuysen R , et al. Three dimen-sional evaluation of facial asymmetry after mandibular reconstruction: Validation of a new method using stereophotogrammetry[J]. Int J Oral Maxillofac Surg, 2013, 42 (1): 19- 25.
19 Schoot RA , Hol MLF , Merks JHM , et al. Facial asymmetry in head and neck rhabdomyosarcoma survivors[J]. Pediatr Blood Cancer, 2017, 64 (10): 26508.
20 牛百平, 叶湘玉. 对面部畸形忍受程度的测量研究[J]. 中华口腔医学杂志, 1994, 29 (4): 213- 216.
21 Hohman MH , Kim SW , Heller ES , et al. Determining the threshold for asymmetry detection in facial expressions[J]. Laryngoscope, 2014, 124 (4): 860- 865.
22 Kim SW , Heller ES , Hohman MH , et al. Detection and percep-tual impact of side-to-side facial movement asymmetry[J]. JAMA Facial Plast Surg, 2013, 15 (6): 411- 416.
23 Alqattan M , Djordjevic J , Zhurov AI , et al. Comparison between landmark and surface-based three-dimensionalanalyses of facial asymmetry in adults[J]. Eur J Orthod, 2015, 37 (1): 1- 12.
24 Wang SJ , Zhang WB , Yao YM , et al. Factors Affecting volume change of anterolateral thigh flap in head and neck defect reconstruction[J]. J Oral Maxillofac Surg, 2020, 78 (11): 2090- 2098.
25 Brown J , Rogers SN , Mcnally DN , et al. A modified classification for the maxillectomy defect[J]. Head Neck, 2000, 22 (1): 17- 26.
26 柯杰, 陈华, 林珠. 西安市正常牙合的青少年软组织X线头影测量研究: 计算机辅助测量[J]. 华西口腔医学杂志, 1994, 12 (3): 188- 191.
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