A. Bell

Three-dimensional assessment of facial appearance following surgical repair of unilateral cleft lip and palate.

Background and Objective Objective assessment of postsurgical facial asymmetry can be difficult, but three-dimensional (3D) imaging techniques have made this possible. The objective of this study was to assess residual asymmetry in surgically repaired unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP) patients and to compare this with noncleft controls. Design Retrospective multicohort comparative study. Patients and Methods Fifty-one 10-year-old children with surgically managed UCLP and 44 children with UCL were compared with a control group of 68 ten-year-olds. The 3D facial models at rest and with maximum smile were created using a 3D imaging system. Asymmetry scores were produced using both anatomical landmarks and a novel method of facial curve analysis. Results Asymmetry for the whole face was significantly higher in both cleft groups compared with controls (P < .001). UCLP asymmetry was higher than UCL (P < .001). In cleft patients, the upper lip and nasal rim were the most asymmetric (P < .001 to .05). Control subjects also displayed a degree of facial asymmetry. Maximum smile did not significantly affect the symmetry of the whole face, but it increased asymmetry of the vermillion border and nasal rim in all three groups (P < .001). Conclusions Despite surgical intervention at an early age, asymmetry remains significant in cleft patients at 10 years of age. Three-dimensional imaging is a noninvasive objective assessment tool that identifies specific areas of the face responsible for asymmetry. Facial curve analysis describes the face more comprehensively and characterizes soft tissue contours.

3D assessment of lip scarring and residual dysmorphology following surgical repair of cleft lip and palate: a preliminary study.

Objective To evaluate lip scarring and the three-dimensional (3D) lip morphology following primary reconstruction in children with unilateral cleft lip and palate (UCLP) relative to contemporaneous noncleft data. Design Retrospective, cross-sectional, controlled study. Setting Glasgow Dental Hospital and School, University of Glasgow, U.K. Patients and participants Three groups of 10-year-old children: 51 with UCLP, 43 UCL (unilateral cleft lip), and 68 controls. Methods Three-dimensional images of the face were recorded using stereo cameras on a two-pod capture station, and 3D coordinates of anthropometric landmarks were extracted from the facial images. A novel method was applied to quantify residual scarring and the associated lip dysmorphologies. The relationships among outcome measures were investigated. Results Residual lip dysmorphologies were more pronounced in UCLP cases. The width of the Cupids bow was increased due to lateral displacement of the Christa philteri left (cphL) in both UCL and UCLP patients. In the upper part of the lip, the nostril base was significantly wider in UCLP cases when compared with UCL cases and controls. Scar redness was more pronounced in UCL than in UCLP cases. No relationship could be identified between lip scarring and other measurements of lip dysmorphology. Conclusions Stereophotogrammetry, together with associated image analysis, allow early detection of residual dysmorphology following cleft repair.

Psychological status as a function of residual scarring and facial asymmetry after surgical repair of cleft lip and palate.

Objective Objective measure of scarring and three-dimensional (3D) facial asymmetry after surgical correction of unilateral cleft lip (UCL) and unilateral cleft lip (UCLP). It was hypothesized that the degree of scarring or asymmetry would be correlated with poorer psychological function. Design In a cross-sectional design, children underwent 3D imaging of the face and completed standardized assessments of self-esteem, depression, and state and trait anxiety. Parents rated childrens adjustment with a standard scale. Setting Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences. Patients Fifty-one children aged 10 years with UCLP and 43 with UCL were recruited from the cohort treated with the surgical protocol of the CLEFTSIS managed clinical network in Scotland. Methods Objective assessment to determine the luminance and redness of the scar and facial asymmetry. Depression, anxiety, and a self-esteem assessment battery were used for the psychological analysis. Results Cleft cases showed superior psychological adjustment when compared with normative data. Prevalence of depression matched the population norm. The visibility of the scar (luminance ratio) was significantly correlated with lower self-esteem and higher trait anxiety in UCLP children (P = .004). Similar but nonsignificant trends were seen in the UCL group. Parental ratings of poorer adjustment also correlated with greater luminance of the scar. Conclusions The objectively defined degree of postoperative cleft scarring was associated with subclinical symptoms of anxiety, depression, and low self-esteem.

The type and quality of paraffin wax is important when constructing tissue microarrays

Tissue microarray (TMA) technology allows the representation of hundreds of tissue samples on a standard microscope slide. This is achieved by arraying small cores (0.6 mm in diameter) of paraffin wax embedded tissue samples in a recipient wax block. Sections cut from the array can then be assessed by immunohistochemistry or in situ hybridisation, according to standard protocols. TMAs enable the high throughput assessment of the presence and location of expressed genes, saving time, reagents, and clinical material. There have been several reviews on TMA construction and use,1 but we have recently encountered a technical problem that, as far as we are aware, has not been described in the literature. Multiple TMAs, each containing 292 cores, were constructed according to standard protocols.2 Sections were cut without mishap using the adhesive …