Three-dimensional nasolabial displacement during movement in repaired cleft lip and palate patients

The objective of this study was two-fold: (1) to explore the suitability of a novel modified Procrustes fit method to adjust data for head motion during instructed facial movements, and (2) to compare the adjusted data among repaired unilateral (n = 4) and bilateral (n = 5) cleft lip and palate patients and noncleft control subjects (n = 50). Using a video-based tracking system, three-dimensional displacement of 14 well-defined nasolabial landmarks was measured during four set facial animations without controlling for head motion. The modified Procrustes fit method eliminated the contributions of head motion by matching the most stable landmarks of each video-recorded frame of the face during function to frames at rest. Its effectiveness was found to approximate that of a previous method (i.e., use of a maxillary occlusal splint to which stable dentition-based markers were attached). Data from both the unilateral and bilateral cleft lip and palate patients fell outside the normal range of maximum displacements and of asymmetry, and individual patients demonstrated greater right-versus-left asymmetry in maximum displacement than did individual noncleft subjects. It is concluded that the modified Procrustes fit method is fast, is easy to apply, and allows subjects to move the head naturally without the inconvenience of a splint while facial movement data are being collected. Results obtained using this method support the view that facial movements in cleft patients may be severely hampered and that assessment of facial animation should be strongly considered when contemplating surgical lip revisions.     

Restoring palpebral fissure shape after previous lower blepharoplasty

The youthful palpebral fissure can be described as long and narrow. Both the aging process and transcutaneous lower blepharoplasty can cause descent of the lower lid margin and medial migration of the lateral canthus, resulting in a rounding of the palpebral fissure. This article presents a technique to correct significant postsurgical lower lid malposition and palpebral fissure distortion without the use of outer or inner lamellar grafts. In overview, subperiosteal dissection frees scarred lid structures and cheek soft tissues, creating a continuous composite flap. Elevation of the cheek soft tissues recruits deficient outer lamellae and allows the sub-orbicularis oculi fat to be positioned between the orbital rim and scarred lid structures, filling this space and helping to support the repositioned lid margin. Titanium screws placed in the lateral orbit provide a point for secure fixation of elevated cheek tissues. Transosseous wire fixation securely repositions the lateral canthus. This procedure not only restores lower lid position and the vertical height of the palpebral fissure, but it also restores the palpebral fissure's horizontal length and the lateral canthal angle. It has been effective in correcting palpebral fissure distortion after lower blepharoplasty in 15 patients during a 6-year period.     

A natural history of a child with monosomy 5p syndrome (Cat-cry/Cri-du-chat syndrome) during the 18 years of follow-up

A record of a natural history of a long-term case study devoted to monosomy 5p (Cat-cry/Cri-du-chat) syndrome has been described rarely. Knowledge on the range of the changes in phenotype attributable to advancing age can be useful in clinical diagnosis of monosomy 5p at the different developmental stages, including adolescence, as well in prognosis for genetic counseling. In this case a detailed analysis of the morphologic phenotype in a girl with del(5)(p13.3) observed from 4 months to 18 years of age is reported. The comparative analysis of the girl's phenotype in different developmental stages has revealed that microcephaly, flat occipital region, face asymmetry, wide spaced palpebral fissures, epicanthic folds, small mouth fissure, thin mucous lip, small and low set ears and short IV metacarpals has not changed with advancing age. However, facial asymmetry was more evident, frontal tubers were less prominent, nasal root and back became prominent nasal back became elongated, the subnasal region was shorter and marked malocclusion appeared.     

A head-model reconstruction based upon photogrammetric data from Sri Lankan adult males relevant to the design of headgear

Due to the large variability in heads and faces in one population, the standard anthropometric dimensions of the head, measured from anatomical landmarks alone, may not suffice for the design of fitting headgear, e.g., helmets. To provide adequate data of the shapes and contours of the head to the designer, appropriate head models sculptured using comprehensive head dimensions, must be developed. This paper describes (a) a procedure of collecting comprehensive anthropometric data of the head using a photogrammetric method and (b) a simple sculpturing technique to reconstruct a head model of the user population.     

Lateral facial clefts: a case report

A female new-born with bilateral lateral facial clefts, resulting in macrostomia, is reported. In addition she had a diminished palpebral fissure length. She died suddenly at the age of 6 months, presumably due to respiratory insufficiency. The unique combination of facial anomalies, present in this patient, has not been reported before. We discuss the differential diagnosis and the classification of facial clefts.     

MACROSCOPIC OBSERVATIONS OF THE FACIAL MUSCLES IN THE BAIKAL SEAL (PHOCA SIBIRICA)

This study was performed to determine if, as expected, the enlarged eye of the Baikal seal ( Phoca sibirica ) has an influence on the form and function of the skull and facial muscles. Macroscopic observation of these muscles demonstrated that the M. orbicularis oculi expands around the palpebral fissure and that some facial muscles attach and insert in the M. orbicularis oculi , possibly supporting M. orbicularis oculi function. We suggest that these muscles move the eye and palpebral area and constitute a morphological and synergistic facial muscle complex system. Further, the development of the M. rectus lateralis around the sclera of the eye indicates that this muscle is also involved in eye movement.     

Development and application of portable manual non-contact-type anthropometric instruments for measuring human anatomical longitudinal parameters

Several contact-type anthropometric instruments have been previously established for use in population surveys that contribute to the construction of anthropometric databases. Manual anthropometric measurements need to comply with or fulfill the following conditions: anatomical landmarks (term, location, and detecting method); measuring methods (item and subject's posture); five contact-type instruments (anthropometer, large sliding caliper, sliding caliper, spreading caliper, and tape measure); and well-trained examiners. Here, two manual non-contact-type portable anthropometric instruments were developed for measuring small regions such as the head and for larger regions such as the trunk of the human body, and for obtaining anatomical longitudinal parameters (length, height, breadth, and depth) based on the principle of projection by spot irradiation using laser markers. A new landmark-detecting method, based on the idea of visual landmarks, was proposed instead of the conventional palpation method (direct feeling with fingers), which was not appropriate for a non-contact measuring system. The accuracy of each instrument was tested using industrial tools, and performance was compared with contact-type instruments using a skeletal model (four measurements), a free posture manikin (eight measurements), and the healthy human body (five males and five females; nine measurements). Measurement errors and visual inspection to detect landmarks were discussed. The instruments show applicability to non-contact anthropometry.     

The safe face lift with bony anatomic landmarks to elevate the SMAS

The risk for facial nerve injury has been reported to be increased with the inclusion of superficial musculoaponeurotic system (SMAS) elevation as compared with a skin-only face lift. The facial nerve courses through the parotid gland. The SMAS is elevated superficial to the parotid gland. However, in elevating the SMAS anterior to the parotid gland, the facial nerve is at risk of injury where its branches emerge from the anterior edge of the parotid gland. The purpose of this study was to identify bony anatomic landmarks to predict the location of the anterior edge of the parotid gland to avoid injury to the facial nerve branches as they exit the parotid gland. The authors dissected 20 cadaver face halves to determine bony landmarks-the masseteric tuberosity and the inferior lateral orbital rim-to predict the location of the anterior parotid edge. Then they measured the anterior edge of the parotid gland in relation to the vector formed between these two bony landmarks. They identified and measured the most anterior portion of the parotid gland in relation to this vector. Then the most posterior aspect of the parotid gland in relation to this vector was measured. In the 20 dissections, the authors found the most anterior portion of the parotid gland to be 2.7 +/- 1.0 mm anterior to the vector from the inferior lateral orbital rim to the masseteric tuberosity. The most posterior part of the anterior edge of the parotid gland in relation to this vector was found to be 1.0 +/- 1.5 mm posterior to this vector. The parotid gland measured an average of 38.8 +/- 3.5 mm in width from the tragus to the anterior parotid edge. In elevating the SMAS with a face lift, the facial nerve branches can be predicted to exit the anterior edge of the parotid gland, which can be located 38.8 mm anterior to the tragus and near the vector from the inferior lateral orbital wall to the masseteric tuberosity.     

Temporary management of upper lid ptosis, lid malposition, and eyelid fissure asymmetry with botulinum toxin type A

During the past 10 years the primary focus for the aesthetic use of botulinum toxin has been directed to the treatment of dynamic facial lines. This agent has been shown to be very effective for the improvement of facial shape. The use of botulinum toxin type A for the correction of a variety of presentations of facial asymmetry has also been well established. The general principles regarding the counter-effects of facial muscle protagonists and antagonists and their potential effects on the position of facial soft-tissue regions apply here as well. Twenty-two patients received botulinum toxin type A for the temporary treatment of mild to moderate unilateral upper eyelid ptosis and aesthetic improvement of lower eyelid position, with favorable results. Although commonly related to a rare yet feared adverse consequence from the inappropriate application of botulinum toxin, its application for the treatment of upper eyelid ptosis, eyelid position, and other lid fissure asymmetries for aesthetic improvement is presented.     

Transdifferentiation Potential of Ciliary and Pigment Epithelial Cells in Lower Vertebrates and Mammals

Cellular composition of the peripheral region of the eye in amphibians and mammals as well as embryonic fissure in amphibians was studied. Different distributions of proliferating cells in retinal pigment epithelium have been revealed in adult amphibians (newt, axolotl, and Xenopus). Single cells incorporated [³H]thymidine in the newt and Xenopus; 0.4% cells, in the axolotl. An embryonic fissure was observed in the eye of the axolotl. Pigment epithelial cells in the embryonic palpebral region actively proliferated: about 20% cells incorporated [³H]thymidine. Proliferating cells were also localized in the ciliary marginal zone of the retina in all studied amphibians, particularly, in the axolotl. In newborn hamsters, [³H]thymidine-labeled cells have been revealed in the pigment epithelium as well as in the outer pigmented and inner unpigmented layers of the ciliary body. Proliferative activity of the peripheral regions of the eye is due to eye growth in adult amphibians and newborn hamsters. After retinectomy, the retina is regenerated from the cells of the growth ciliary marginal zone in all amphibians, pigment epithelial cells in the newt, and pigment epithelial cells of the embryonic fissure in the axolotl. Heterogeneous composition of the pigment epithelium in the newt and axolotl reflects high transdifferentiation potential of these regions. Structural comparison of the peripheral region of the eye in amphibians and mammals demonstrate that the ciliary body of mammals containing stem cells is homologous to the ciliary marginal zone of amphibians containing multipotent cells.     

Craniofacial changes in hemifacial microsomia

Cephalometry, X-ray cephalometry, and somatoscopy were used in the studies of 65 adult males with a severe unilateral microtia subdivided into three groups: with marked asymmetry, with slight asymmetry, and without any obvious facial asymmetry. The group with marked asymmetries was designated as hemifacial microsomia. In this group the affected side of the face was depressed on the average from above and from below towards the level of the external auditory canal. The center of the anteroposterior reduction was situated in the region in front of the pterygomaxillar fissure. The anteroposterior and vertical facial dimensions on the affected side were reduced most markedly, while the width dimensions showed the slightest changes. Hypoplasia was most severe within the lower face and increased towards the otocephalic centre. The mandibular joint was displaced in an anteroinferior and medial direction. Hypertelorism did not occur, but the orbit on the affected side was smaller in height and was frequently vertically dislocated. The facial profile was unchanged except for retrusion of the chin and increased frequency of bite disorders. The mobility of the mandible was limited. Hemihypoplasia also exerted an influence on structures that were not of branchiogenic origin, e.g., the cranial base (narrowing, asymmetry, and more pronounced curvature), the neurocranium (depression in mastoid and tympanotemporal regions, posterior rotation of the vault), and the frontonasal component (deviation of the nose and premaxilla). The cranial vault and the bottom of the occipital bone showed on the average no asymmetries. The similar character of deviations in slightly affected groups revealed that in spite of the high variability of changes typical for branchiogenic malformations the development of the face in these defects was subjected to certain rules. Marked facial asymmetry occurred only in every fifth patient with a severe degree of microtia, while definite signs of asymmetry were absent in every third patient.     

A fine-structure gynandromorph fate map of the Drosophila head

A gynandromorph fate map of the head of D. melanogaster was produced using 28 landmarks derived from one imaginal disc. An examination of the meaning of fine-structure mapping discloses that the sturt value observed between one pair of landmarks within a disc may approximate the relative physical distance of their progenitor cells at blastoderm, but for another pair of landmarks (assuming no directed cell movements), the sturt value may simply reflect their close geographic location at the time the cells are specified for their particular differentiation, a time much later in development when most cell division within the disc has come to an end. The formation of early developmental compartments has little effect on fate-map distances. Our analysis of the data suggests there are approximately ten cells present at the blastoderm stage that are head progenitors. Each blastoderm cell is likely to be the progenitor of a particular array of landmarks, but there is overlap between arrays from different blastoderm cells.     

巴尔虎蒙古族少年儿童眼部特征的调查研究

本文旨在探索巴尔虎蒙古族少年儿童眼部特征,为巴尔虎蒙古族人种族研究、民族识别、遗传疾病等提供理论依据。本项研究依据《人体测量方法》和Martin测量工具说明观测265人（男性135人、女性130人）巴尔虎蒙古族6-16岁少年儿童蒙古褶（内眦褶）、上眼睑褶皱、眼裂倾斜度等眼部特征,将测量结果进行整理,与可查询到的鄂尔多斯、巴盟、阿拉善等蒙古族人种的数据进行对比分析。结果显示巴尔虎蒙古族少年儿童的眼部特征中蒙古褶、上眼睑褶皱和眼裂倾斜度有别于其他地区的蒙古族;巴尔虎蒙古族少年儿童的蒙古褶、上眼睑褶皱出现率高于鄂尔多斯蒙古族人,其他低于查询到的数据;巴尔虎蒙古族少年儿童眼部特征与其他巴尔虎蒙古族人的数据报道基本相符。说明巴尔虎蒙古族人眼部特征随年龄增长从少年儿童开始明显变化。巴尔虎蒙古族人眼部特征明显有别于其他地区的蒙古族人。从其人类学特征、历史渊源和起源、语言、特有的服饰文化习惯特征看,巴尔虎蒙古族人是一个与其他蒙古族不同的族群,是一个独立的民族或族群。     

Transconjunctival lateral canthopexy in Down's syndrome patients: a nonstigmatizing approach

In Down's syndrome patients, surgical correction of the palpebral fissure obliquity through an external approach may produce a red, slightly hypertrophic scar. A transconjunctival approach for this repair was used for 15 Down's syndrome patients aged 3 to 17 years (mean 8.7 years), and the results were compared with those in two boys aged 6 and 17 years who underwent correction by the external approach. Palpebral fissure inclinations were recorded using anthropometric measurements preoperatively and 6 months postoperatively. Inclinations were reduced significantly by either technique; however, often the precise degree of the improvement was clear only from the measurements rather than from photographs. Complications of the transconjunctival approach were few, and there were no problems with wound healing and no ocular injury. Transconjunctival lateral canthopexy is a safe, effective method that avoids a potentially stigmatizing external scar.     

Facial metrics generated from manually and automatically placed image landmarks are highly correlated

Research on social judgments of faces often investigates relationships between measures of face shape taken from images (facial metrics), and either perceptual ratings of the faces on various traits (e.g., attractiveness) or characteristics of the photographed individual (e.g., their health). A barrier to carrying out this research using large numbers of face images is the time it takes to manually position the landmarks from which these facial metrics are derived. Although research in face recognition has led to the development of algorithms that can automatically position landmarks on face images, the utility of such methods for deriving facial metrics commonly used in research on social judgments of faces has not yet been established. Thus, across two studies, we investigated the correlations between four facial metrics commonly used in social perception research (sexual dimorphism, distinctiveness, bilateral asymmetry, and facial width to height ratio) when measured from manually and automatically placed landmarks. In the first study, in two independent sets of open access face images, we found that facial metrics derived from manually and automatically placed landmarks were typically highly correlated, in both raw and Procrustes-fitted representations. In study two, we investigated the potential for automatic landmark placement to differ between White and East Asian faces. We found that two metrics, facial width to height ratio and sexual dimorphism, were better approximated by automatic landmarks in East Asian faces. However, this difference was small, and easily corrected with outlier detection. These data validate the use of automatically placed landmarks for calculating facial metrics to use in research on social judgments of faces, but we urge caution in their use. We also provide a tutorial for the automatic placement of landmarks on face images.     

A Monte Carlo study of the inferential properties of three methods of shape comparison

Three inferential morphometric methods, Euclidean distance matrix analysis (EDMA), Bookstein's edge-matching method (EMM), and the Procrustes method, were applied to facial landmark data. A Monte Carlo simulation was conducted with three sample sizes, ranging from n = 10 to 50, to assess type I error rates and the power of the tests to detect group differences for two- and three-dimensional representations of forms. Type I error rates for EMM were at or below nominal levels in both two and three dimensions. Procrustes in 2D and EDMA in 2D and 3D produced inflated type I error rates in all conditions, but approached acceptable levels with moderate cell sizes. Procrustes maintained error rates below the nominal levels in 2D. The power of EMM was high compared with the other methods in both 2D and 3D, but, conflicting EMM decisions were provided depending on which pair (2D) or triad (3D) of landmarks were selected as reference points. EDMA and Procrustes were more powerful in 2D data than for 3D data. Interpretation of these results must take into account that the data used in this simulation were selected because they represent real data that might have been collected during a study or experiment. These data had characteristics which violated assumptions central to the methods here with unequal variances about landmarks, correlated errors, and correlated landmark locations; therefore these results may not generalize to all conditions, such as cases with no violations of assumptions. This simulation demonstrates, however, limitations of each procedure that should be considered when making inferences about shape comparisons. © 1996 Wiley-Liss, Inc.     

Digital 2D-photogrammetry and direct anthropometry--a comparing study on test accomplishment and measurement data

The aim of this methodological anthropometric study was to compare direct anthropometry and digital two-dimensional photogrammetry in 18 male and 27 female subjects, aged 24 to 65 years, from Potsdam, Germany. In view of the rising interest in reliable biometric kephalofacial data, we focussed on head and face measurements. Out of 34 classic facial anatomical landmarks, 27 landmarks were investigated both by direct anthropometry and 2D-photogrammetry; 7 landmarks could not be localized by 2D-photogrammetry. Twenty-six kephalofacial distances were analysed both by direct anthropometry and digital 2D-photogrammetry. Kephalofacial distances are on average 7.6% shorter when obtained by direct anthropometry. The difference between the two techniques is particularly evident in total head height (vertex-gnathion) due to the fact that vertex is usually covered by hair and escapes from photogrammetry. Also the distances photographic sellion-gnathion (1.3 cm, i. e. 11.6%) and nasal-gnathion (1.2 cm, i. e. 9.4%) differ by more than one centimetre. Differences below 0.5 cm between the two techniques were found when measuring mucosa-lip-height (2.2%), gonia (3.0%), glabella-stomion (3.9%), and nose height (glabella-subnasal) (4.0%). Only the estimates of forehead width were significantly narrower when obtained by 2D-photogrammetry (-1.4 cm, -13.1%). The methodological differences increased with increasing magnitude of the kephalometric distance. Apart from these limitations, both techniques are similarly valid and may replace each other.     

Morphometric analysis of Cartesian coordinates of the human skull

A method for locating the three dimensional coordinates of cranial landmarks with respect to the Frankfort, midsagittal, and coronal planes is presented. Sliding calipers were used to obtain the distances from left and right porion and apex to each landmark, except for a few points where spreading calipers are required. In the present example, 35 landmarks (for a total of 105 measurements) were located for each of 35 Peruvian precolumbian skulls. These distances were entered into a program (SKULL) which calculates the Cartesian coordinates of each landmark. The XYZ coordinates of each landmark contain all the information necessary for calculation of the distances between any two landmarks, and these distances may also be obtained as output from program SKULL, if desired (595 distances if all 35 landmarks are used). Reliability of the location of coordinates was determined by comparing computed distances among selected landmarks from program SKULL with traditional anthropometric measurements. Satisfactory agreements were found. Direct multivariate analysis of the coordinates of the landmarks produced insights not available in traditional multivariate analysis of conventional anthropometric measurements.     

Morphology of the orbital region in adults following the cleft lip-palate repair in childhood

Four measurements and two qualitative signs related to the orbits of 145 adult Caucasian cleft lip/palate patients operated on in childhood were compared with similar data on 100 normal Caucasian Canadians. The average interorbital distance in male patients with unilateral and bilateral cleft lip/palate was greater than in controls, while the interorbital distance in both male and female patients with isolated cleft palate was the same as that in controls. A hypertelorism increased interorbital distance of greater than 2 S.D. above the normal was recorded in 10 cleft patients out of 145, the maximum in male cleft patients being 48 mm and in female cleft patients 38 mm. Orbital eye fissure length asymmetry was seen only in the cleft study group while a dislocation of the eye fissure levels in the frontal plane was found both in patients with clefts and in controls. No direct relationship was found between the extent of the cleft and the incidence of hypertelorism, nor between the site of the cleft and eye fissure asymmetry in unilateral cleft lip/palate patients. The epicanthic fold was significantly more frequent in cleft lip/palate patients (28/145) than in controls (10/100). Anti-mongoloid eye fissure type was recorded only in patients with cleft but mongoloid eye fissure was present both in patients with clefts and controls.     

Ethanol-induced face-brain dysmorphology patterns are correlative and exposure-stage dependent

Prenatal ethanol exposure is the leading preventable cause of congenital mental disability. Whereas a diagnosis of fetal alcohol syndrome (FAS) requires identification of a specific pattern of craniofacial dysmorphology, most individuals with behavioral and neurological sequelae of heavy prenatal ethanol exposure do not exhibit these defining facial characteristics. Here, a novel integration of MRI and dense surface modeling-based shape analysis was applied to characterize concurrent face-brain phenotypes in C57Bl/6J fetuses exposed to ethanol on gestational day (GD)7 or GD8.5. The facial phenotype resulting from ethanol exposure depended upon stage of insult and was predictive of unique patterns of corresponding brain abnormalities. Ethanol exposure on GD7 produced a constellation of dysmorphic facial features characteristic of human FAS, including severe midfacial hypoplasia, shortening of the palpebral fissures, an elongated upper lip, and deficient philtrum. In contrast, ethanol exposure on GD8.5 caused mild midfacial hypoplasia and palpebral fissure shortening, a shortened upper lip, and a preserved philtrum. These distinct, stage-specific facial phenotypes were associated with unique volumetric and shape abnormalities of the septal region, pituitary, and olfactory bulbs. By demonstrating that early prenatal ethanol exposure can cause more than one temporally-specific pattern of defects, these findings illustrate the need for an expansion of current diagnostic criteria to better capture the full range of facial and brain dysmorphology in fetal alcohol spectrum disorders.