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Application of a Novel Semi-Automatic Technique for Determining the Bilateral Symmetry Plane of the Facial Skeleton of Normal Adult Males

Roumeliotis, Grayson MD, MSc*,†; Willing, Ryan PhD; Neuert, Mark MSc§; Ahluwalia, Romy MD, FRCSC; Jenkyn, Thomas PhD§,||,¶; Yazdani, Arjang MD, FRCSC

doi: 10.1097/SCS.0000000000001937
Scientific Foundations

The accurate assessment of symmetry in the craniofacial skeleton is important for cosmetic and reconstructive craniofacial surgery. Although there have been several published attempts to develop an accurate system for determining the correct plane of symmetry, all are inaccurate and time consuming. Here, the authors applied a novel semi-automatic method for the calculation of craniofacial symmetry, based on principal component analysis and iterative corrective point computation, to a large sample of normal adult male facial computerized tomography scans obtained clinically (n = 32). The authors hypothesized that this method would generate planes of symmetry that would result in less error when one side of the face was compared to the other than a symmetry plane generated using a plane defined by cephalometric landmarks. When a three-dimensional model of one side of the face was reflected across the semi-automatic plane of symmetry there was less error than when reflected across the cephalometric plane. The semi-automatic plane was also more accurate when the locations of bilateral cephalometric landmarks (eg, frontozygomatic sutures) were compared across the face. The authors conclude that this method allows for accurate and fast measurements of craniofacial symmetry. This has important implications for studying the development of the facial skeleton, and clinical application for reconstruction.

*Department of Surgery, Division of Plastic Surgery, University of Ottawa, Ontario, Canada

Department of Surgery, Division of Plastic Surgery, Western University, Ontario, Canada

Department of Mechanical Engineering, Thomas J. Watson School of Engineering and Applied Science, Binghamton University, Binghamton, NY

§Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada

||School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada

Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.

Address correspondence and reprint requests to Grayson Roumeliotis, The Ottawa Hospital, Civic Campus 1053 Carling Avenue Ottawa, ON K1Y 4E9, Canada; E-mail:

Received 30 July, 2014

Accepted 13 April, 2015

The authors report no conflicts of interest.

© 2015 by Mutaz B. Habal, MD.