Craniofacial Anthropometry: Normative Data for Caucasian Infants

Abstract

Purpose: Craniofacial anthropometry is a valuable tool for characterization of facial dysmorphology and evaluation of treatment outcomes. Databases of normal anthropometric ranges are limited for infants. The aim of this study is to establish normative data for craniofacial anthropometric measurements in Caucasian infants. Methods: This is a prospective cross-sectional study including Caucasian infants (≤12 months old) that were recruited from a pediatric medicine practice and Boston Children's Hospital. Infants with craniofacial deformities, trauma or operations were excluded. The sample was stratified by age (in months) into 4 groups: 0 to 3, 3.1 to 6, 6.1 to 9, and 9.1 to 12. Three dimensional (3D) photographs were obtained for all subjects. Forty-five standard anthropometric points were plotted, and 37 measurements were made on the 3D photographs. Two evaluators independently performed all measurements. One examiner repeated the measurements on 25% of the subjects. Intraclass correlation coefficients (ICC) were calculated to assess inter-rater and intra-rater agreement. Results: Thirty-three subjects were enrolled in the study. The mean age for the entire sample was 6.3 ± 3.0 months, and 17 subjects (52%) were female. The mean ages (months) for each group were: 1.9 ± 0.7 for group 1 (n = 6); 4.4 ± 0.7 for group 2 (n = 8); 7.5 ± 1.1 for group 3 (n = 11); and 9.9 ± 1.0 for group 4 (n = 8). Descriptive statistics are presented for each group. Inter- and intra-rater agreements were acceptable (ICC >0.6) for 21 anthropometric measurements. Conclusions: This study generated normative craniofacial anthropometric measurements for Caucasian infants. These data can be used in the interpretation of measurements for research studies evaluating craniofacial anomalies in this population.

Identifying Three-Dimensional Facial Fluctuating Asymmetry in Normal Pediatric Individuals: A Panel Assessment Outcome Study of Clinicians and Observers

“…However, human faces are structurally left–right symmetrical content-wise, but not size-wise or function-wise. Therefore, asymmetric faces would be, to some extent, the norm [2,3,4,5,6,7,8,9,10,11]. In a recent and well-delineated 3D facial image study, Kane’s group found that 99.7% of healthy pediatric individuals aged between 0 and 17.8 had less than 3.2 mm of facial asymmetry [9].…”

“…From an ecology and evolutionary biology standpoint, perfect bilateral symmetry is defined as the optimal outcome of the development of bilateral traits in the absence of perturbations [1]. For human facial anthropometrics, perfect bilateral symmetry almost never exists, because random variations in asymmetry, within limits, have been recognized as normal and are called facial fluctuating asymmetry [2,3,4,5,6,7,8,9,10,11,12,13,14,15]. When facial asymmetry is clinically obvious (called facial asymmetric deformity, which is more commonly directional rather than fluctuating), surgical or nonsurgical treatment may be required [3,4,5].…”

“…When facial asymmetry is clinically obvious (called facial asymmetric deformity, which is more commonly directional rather than fluctuating), surgical or nonsurgical treatment may be required [3,4,5]. Since the restoration of symmetry is the main goal of facial asymmetric deformity reconstruction, establishing facial fluctuating asymmetry by specific ethnic and age groups is crucial as it may be adopted as a target of treatment as well as applied as normative data for genetics, orthodontics, and surgical disciplines [6,7,8,9,10,11].…”

“…The recent introduction of three-dimensional (3D) surface image technology revolutionized facial asymmetry-based investigations by allowing us to acquire consistently high-quality 3D facial imaging without exposure to radiation [7,8,9,10,11,12,13,14,15]. For human faces, which are complex structures, these 3D image capturing systems offer a number of distinct advantages, including minimal invasiveness; quick capture speed; the ability to archive images for subsequent analyses; high-quality images without distortion of spatial form, shape, and size, resulting in a lifelike rendering; a realistic facial view with images moving from one side to the other; and a high degree of reproducibility, reliability, and validity [12,13,14,15].…”

“…Despite the advantages of the computer-based measurement of facial asymmetry [7,8,9,10,11,12,13,14,15], one of the most common outcome measures adopted in facial asymmetry studies is panel assessment, a metric based on perceptions from different categories of raters, including clinicians (professionals using medical- or dental-based judgments) and observers (laypersons with no formal specialized training) [5,8,12,16,17,18,19,20,21,22]. These panel assessment-based studies have been widely adopted to identify the presence of facial asymmetry or to quantify facial asymmetry, with relevant clinical applications, for example, for outcome studies comparing various therapeutic modalities because clinicians represent the specialized judgment of pre- and post-treatment images, whereas observers symbolize the external validity in terms of the public members’ observations of therapeutic effects [5,8,12,16,17,18,19,20,21,22].…”