Date Published: May 20, 2019
Publisher: Public Library of Science
Author(s): Sander Brons, Jene W. Meulstee, Rania M. Nada, Mette A. R. Kuijpers, Ewald M. Bronkhorst, Stefaan J. Bergé, Thomas J. J. Maal, Anne Marie Kuijpers-Jagtman, Gururaj Arakeri.
Three-dimensional (3D) surface imaging systems are replacing direct anthropometry as the preferred method for capturing facial soft-tissues. Aims of this study were: (1) to develop normative average 3D faces of healthy infants aged 3, 6, 9, and 12 months and (2) to describe normative average 3D facial growth data in infants aged 3 to 12 months. Three-dimensional images of 50 healthy children were acquired at 3, 6, 9, and 12 months of age using the 3dMDcranial system. Four average faces with uniform meshes (3, 6, 9, and 12 months) were developed and registered based on the children’s reference frames. Distance maps of growth of the total facial surface and of the nose, upper lip, chin, forehead and cheeks for the intervals 3 to 6 months, 6 to 9 months, and 9 to 12 months of age were calculated. Mean growth of the total facial surface was 3.9 mm (standard deviation [SD] 1.2 mm), 3.5 mm (SD 0.9 mm), and 1.6 mm (SD 0.7 mm) at 3 to 6 months, 6 to 9 months, and 9 to 12 months, respectively. Regarding the selected regions of the face, the mean growth of the nose and upper lip were the largest (3.7 mm and 3.6 mm, respectively) between 6 and 9 months of age. The mean growth of the forehead, cheeks and chin were the largest (5.4 mm, 3.2, and 4.7 mm, respectively) between 3 and 6 months of age. For all facial regions, growth clearly diminished from 9 to 12 months of age. Normative data on the growth of the full face, nose, upper lip, chin, forehead and cheeks are presented. Such data can be used in future studies to identify the effectiveness of treatment of orofacial deformities such as orofacial clefts during the first year of life.
Since the last century, X-ray cephalometric measurements have provided useful data for assessment of deviation of individual morphology from the normal range as well as for studying morphological growth changes of the head and face in response to surgical and orthodontic treatment. The measurements on these two-dimensional cephalograms were primarily profile-oriented and revealed both anteroposterior and vertical relationships of the dentofacial complex. Since the introduction of X-ray cephalometry more than 80 years ago, hundreds of cephalometric studies, including both operated and unoperated cleft individuals, have suggested that deviations from normal facial development are either directly caused by the primary anomaly, and/or by surgical interventions and the subsequent disturbed and compensatory growth of the facial bones [1–8]. A drawback of conventional cephalometric analysis is that it is limited to a lateral two-dimensional projection using simplistic cephalometric analyses for a complex three-dimensional (3D) structure as is the face. Another limitation of conventional cephalometrics is the use of ionizing radiation. Even in infants with orofacial clefts in which radiographic examinations are justifiably obtained to generate diagnostic yield, there is a need for optimization of radiation exposures . Furthermore, since it is unethical to use X-ray imaging in unaffected healthy controls, no normative database on facial growth in babies and young children exists. In 2009, FaceBase, an online collaborative consortium to generate data in support of advancing research into craniofacial development and malformation, was launched . To date, the only normative database on craniofacial growth of healthy newborns and infants is the one of Farkas who used direct anthropometry to describe linear and angular measurements of the head, thereby simplifying the complex 3D nature of craniofacial morphology .
This article describes a technique to develop normative average 3D faces of healthy infants at 3, 6, 9 and 12 months of age. Additionally, normative average 3D facial growth data from 3 to 12 months of age were obtained.
This study describes the development of average faces at 3, 6, 9, and 12 months of age in healthy infants and estimates facial growth during the first year of life using 3D-stereophotogrammetry. Normative data on the growth of the full face, nose, upper lip, chin, forehead and cheeks have been presented. These data could be used in future studies to identify the effectiveness of various treatment protocols for orofacial deformities at an early age.