A computer-based program is presented to be used with digitized frontal and basal photographs. SymNose enables the user to quantify asymmetry of the front view of the lip and nose and of the nose from the base view, using the area of mismatch of one side reflected over the other. There is a facility to transfer results to a spreadsheet. The program is simple and quick to use and runs on Apple Macintosh OSX 10.4 or later, power and Intel-based systems. The outline of a feature can be drawn using the mouse or digitizing pad. The program, together with Help files, is available from the authors.
Objective:
To provide a normal comparison group against which to judge symmetry results after
cleft surgery and to introduce the thin lip correction (TLC) feature in SymNose. A
lip–aspect ratio algorithm has been added to the latest version of SymNose to compensate
for the higher degree of overlap in thicker lips when compared to thin lips.
Design:
Retrospective analysis of symmetry in healthy participants, using the computer-based
program SymNose on both anteroposterior (AP) and base view images. Photographs of 91
noncleft children were traced twice by 3 independent investigators experienced with
SymNose.
Participants:
Five-year-old healthy participants from a local state school in Tavistock (West Devon,
United Kingdom).
Main Outcome Measure:
Asymmetry expressed as the perimeter mismatch percentage for nose and lip features on
AP view images and for nose features on base view images.
Results:
The perimeter mismatch reference range for the nose (AP view) was 2.65% to 30.91%, for
the lip 2.13% to 15.44%, for the nose (base view) 1.69% to 14.84%, for the nostrils
4.68% to 26.6%, and for the width–height ratio 1.15% to 1.80%. The perimeter mismatch
percentage for the lip without TLC was significantly higher compared to the perimeter
mismatch percentage with TLC (
P
< .001).
Conclusion:
This article provides a noncleft reference range for all perimeters drawn from SymNose
against which to compare results after cleft surgery at 5 years of age. Furthermore, it
shows the importance of correcting for variance in lip volume per child.
The Symnose semiautomated assessment of outcome of the appearance of the repaired cleft lip and nose was developed to measure asymmetry. Symnose 2 has been further developed to include quantification of the extent of scar color, intensity, and contour and midline dehiscence, underexpressed in the measurement of asymmetry.
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