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Biostereometry is the measurement of living things (especially the human body) in 3 dimensions. Moire topography provides a simple, one-step method for mapping contours of the face, or other parts of the body--a method which has potential value for the plastic surgeon. A prospective study of the value and the uses of this method is now under way at our institution.
Utilizing the techniques of biostereometric photography and current state-of-the-art computergraphics, topographic contourgrams have been generated in a series of patients with complex craniofacial malformations. These contourgrams are considered useful in diagnosis and treatment planning and as an aid in postoperative follow-up. We hope that the technique will provide a means to study longitudinal growth in unoperated and operated patients with craniofacial malformations. Comparisons between these groups and normal patients are currently being investigated.
A study of volumes of the right and left breasts of 248 subjects was undertaken using biostereometric analysis. This measurement technique uses close-range stereophotogrammetry to characterize the shape of the breast and is noncontact, noninvasive, accurate, and rapid with respect to the subject involvement time. Volumes and volumetric differences between breast pairs were compared, using chi-square tests, with handedness, perception of breast size by each subject, age, and menstrual status. No significant relationship was found between the handedness of the subject and the larger breast volume. Several groups of subjects based on age and menstrual status were accurate in their perception of breast size difference. Analysis did not confirm the generally accepted clinical impression of left breast volume dominance. Although a size difference in breast pairs was documented, neither breast predominated.
Binder's syndrome (maxillonasal dysplasia) is a disorder characterized by nasomaxillary hypoplasia. To ascertain the extent of underdevelopment of the midfacial skeleton and soft tissues, 19 of 29 patients with Binder's syndrome were retrospectively evaluated, both with cephalometry and anthropometry. Ten females and nine males were placed collectively into three age groups: 6 years, 10 years, and 16 to 17 years. Cephalometric measurements disclosed a short anterior cranial base (S-N), a normal length of the vertical maxilla (SE-PNS), a decreased horizontal maxilla (PNS-A, Co-A), a recessed orbitale (SNO), and a high-normal mandibular length (Co-Gn). Anthropometry revealed a large nasofrontal angle, acute nasal inclination and nasolabial angle, decreased nasal prominence (Sn-Prn), a decreased columellar length (C-Sn), and a normal vertical nose (N-Sn) and upper lip (Sn-Sto) length.
The nasolabial fold was analyzed by studying changes with aging in the nasolabial fold and adjacent soft-tissue features. Chronologic photographs were obtained from 19 older subjects, taken approximately every 10 years, from age 20 to their present age. In a separate phase of the study, facial portraits in repose and smiling were taken of young and old adult subjects with a mechanical frame used for setting an objective point of reference. Facial landmarks were identified and depth measurements were made in the anteroposterior direction. Relative lengths of selected points also were determined in the other dimensions (in the coronal plane) from photographs; these distances were normalized by using lower face length (distance from medial canthus to menton) for the vertical orientation and interpupillary distance to normalize horizontal dimensions. It was found that with aging there is anterior, lateral, and inferior displacement of the cheek mass with a resultant deepening of the nasolabial fold, while relationships between the upper lip and the fold itself remain constant. Also with age, the lateral commissure was found to move laterally, while the apparent angle of the nasolabial fold was decreased; this latter dimension was reflected by a decrease in the horizontal component of the fold length. These results support the theory that nasolabial fold deepening with age is caused by changes in the cheek mass and its support.
The principle of synchronous repair of bilateral complete cleft lip and nasal deformity is established, and the techniques are evolving. We undertook photogrammetric comparison of the method described by Mulliken (group I, n = 15) and that described by Trott (group II, n = 10). Facial proportions and angles were measured on preoperative and postoperative photographs using defined anthropometric points. The following criteria were quantified for each test group: nasolabial angle, nasal tip angle and projection, nasal width, columellar length and width, and philtral width. All parameters in both groups were compared against each other and against normal age-matched values. Results were analyzed by t test. The nasolabial angle, nasal tip angle, and nasal width were abnormally wide for both techniques (p < 0.01 for both), and there was no difference between them. Nasal tip projection was greater than normal in both techniques (p < 0.01); group I had significantly greater projection than group II (p = 0.02). Columellar length as a proportion of nasal tip protrusion approached normal in group I but was significantly shorter than normal in group II (p < 0.001). Columellar width, as a proportion of nasal width, was normal for both groups. Philtral width, in proportion to nasal width, was normal in group I and abnormally high in group II (p < 0.001). This difference was significant between the two groups (p < 0.001). In a separate cohort of 10 group I patients, the nasolabial angle was measured on lateral photographs taken 1 year post-repair and at intervals to late childhood and adolescence. Nasolabial angle changed with age from obtuse to normal in 7 of 10 patients followed to 9 years of age and in 5 of 6 patients followed until age 15 years. Columellar and upper labial inclination to the vertical were measured in 7 of these patients at 3 to 4 years and again at 13 to 15 years. There was an increase in inclination of both columella and the upper lip, between the ages of 3 to 4 and 13 to 15 years, reflecting improved lip support and growth of septum and lateral cartilages.
The auricle is more mobile than generally recognized and is subject to displacement during rhytidectomy. When the auricle is displaced by a rhytidectomy, movement generally occurs in an anteroinferior direction with forward rotation of the inferior pole. This displacement/rotation is often obscured by concurrent elevation of the temporal hairline and insetting errors of the lobule that may appear to be the sole deformities. Using computer assistance, auricular position was compared in before and after photographs of published rhytidectomy results. Auricular displacement of varying degree was found in 62 percent of the analyzed results. Correlation of the presence, direction, and severity of the displacement with the described surgical technique implicates distraction on the periauricular superficial musculoaponeurotic system/platysma and skin at the time of closure as the causative agent. This retrospective photogrammetric study confirms that the auricle can be displaced if direct or indirect tension is placed on it during rhytidectomy.
Frequently, the diagnosis of disease of the low back is a difficult matter due to the multitude of factors affecting the patient's symptoms. In this report an attempt is made to use biomechanical testing to objectify certain aspects of the diagnostic process. Our philosophy is that a biomechanical assessment is one of the disciplines that should be brought to bear on the low-back pain patient. A group of biomechanical tests has been developed by adding quantitative measurement techniques to certain standard clinical maneuvers: muscle testing, range of motion testing, and straight leg raising testing. Moire fringe topography is employed for studying posture. Results of application of these techniques to 117 patients and 10 controls indicate potential utility in the method for epidemiologic and clinical research.
A total of 6,321 school children were screened using Moiré topography in Ottawa in 1979. Analyses of 400 roentgenograms showed that 39% had rotation of a nonstandard variety. The most common type was rotation extending beyond the end vertebra by more than one level. Seven percent had rotation to the opposite side of the major curve; 4% showed asymmetry due to isolated vertebral rotation without any lateral curve. The correlation of the Moiré hump to the area of the lateral curve and vertebral rotation is recorded.
The prevalence of trunk asymmetries was studied in 6464, 10-year-old, school children in Malmö City. All those with visible trunk asymmetries were moiré photographed and a subset roentgenographed. Moiré, positive findings were seen in 13% of the boys and in 16% of the girls. A more prominent moiré asymmetry (a deviation of two moire contour lines or more) was seen in 0.6% of the boys and 0.9% of the girls. The Cobb angles in this latter group varied between 14-25 degrees. Children with small clinical and moiré asymmetries (deviations of less than one moiré fringe) had no or very small (less than 10 degrees), lateral deviations seen on the x-ray and should, therefore, be regarded rather as normal variations of the shape of the trunk. On the other hand, these small asymmetries cannot be disregarded as possible indications of a risk group in which structural scoliosis can develop later during the period of growth.
A computer-assisted photogrammetric method for the detection of pseudarthrosis following spinal fusion is described. This radiologic method is quantitative and noninvasive and requires a minimum of clinician time. Results of tests with a phantom specimen are presented. Preliminary indications are that the method may prove to be a useful adjunct to the clinician in monitoring the postoperative course of patients requiring fusion procedures.
An analysis of the diagnostic reliability and the clinical value of moiré topography is presented. Moiré topography was used as an adjunct to clinical assessment and roentgenographic examination in a consecutive series of 139 scoliosis observations. In 17%, the moiré pattern lateral to the scapulae was impossible to analyze. One false negative finding and 23 false positive findings were observed. There was no correlation between the moiré asymmetry and the Cobb angle. An asymmetry of one contour line implied a curve less than 25 degrees. (The location of the maximal moiré asymmetry did not necessarily coincide with the apex of the scoliosis.) It is concluded that moiré topography is loaded with pitfalls that must be considered. However, used in a designed way, the method is of clinical value, complementing physical examination in screening and longitudinal observation of scoliosis.
The value of surface topographical measurements in the assessment of curve progression in adolescent idiopathic scoliosis is demonstrated in a group of 51 patients. Cobb angles at the commencement of the study ranged from 10 degrees -55 degrees (mean 34.5 degrees), and the mean follow-up period was greater than 2 years. The surface shape method correctly identified curve evolution in 84% of the patient group. Of these, the eight patients who underwent spinal instrumentation were correctly predicted as candidates for surgery.
The screening program for scoliosis started by Chiba University in 1979 consists of using moiré topography, low-dose roentgenography and a final ordinary x-ray examination. The number of children screened through this Chiba University Medical School (CUMS) screening program to 1986 amounted to 1,246,798. The incidence of scoliosis of more than 15 degrees increased linearly according to age from the fifth grade primary school children (0.07% in boys, 0.44% in girls) to the second grade junior high school students (0.25% in boys, 1.77% in girls). The female predominance of scoliosis cases with curvatures of more than 20 degrees detected during the total period was 10:1 and this female predominance was the same for primary school children and junior high school students. According to a study of the incidence of scoliosis by districts, (areas were divided according to population density and urbanization) there were no significant differences in the fifth grade primary school children between the sparsely and densely populated areas. In the cases of children beyond the fifth grade primary school level, however, the incidence in the densely populated areas were significantly higher than those in the sparsely populated districts. The incidence of scoliosis of more than 20 degrees decreased significantly every year among junior high school students, because they were screened periodically in school and the scoliotic students who had already been detected were left out of the next screening. This study establishes that screening for scoliosis by the CUMS screening program is cost-effective with a low risk of radiation hazards.
In order to determine why topographic methods have shown a poor correlation with radiographically measured scoliosis in clinical studies, the accuracy of detection of the presence, side, apex, and magnitude of a scoliosis curve was determined topographically (by moiré fringe photography and by projected raster photography) in 104 patients attending a scoliosis clinic. The presence or absence of thoracic curves was correctly shown by the topograms in 77% of cases, and in the lower region (lumbar and thoracolumbar curves) in 79% of cases. For correctly identified curves, the greatest back surface rotation was, on average, 1.0 vertebral levels below the skeletal curve apex in the thoracic region and 0.5 levels below the apex in the lower region. The moiré fringe with the greatest asymmetry occurred on average at 1.5 and 1.8 vertebral levels above the spinal apex in upper and lower regions, respectively. The magnitude of the Cobb angle was determined to within +/- 5 degrees in 24% of cases by moiré measurements, and in 27% by the raster technique. The side of the scoliosis was incorrectly diagnosed by topography in ten patients with minimal or 'nonstandard' vertebral rotation. It was concluded that the presence, level, and side of a scoliosis curvature is well demonstrated by back surface topography in patients with 'standard' rotation, but the magnitude of the scoliosis cannot be determined from topograms sufficiently accurately for most clinical purposes.
Twenty-five patients (21 females and 4 males) with sacroiliac joint disorders were studied with roentgen stereophotogrammetry in physiologic positions as well as in the extreme of physiologic positions. There was a constant pattern of motion with different load, especially around the transverse axis. The rotations were small and in mean between position 2.5 degrees (0.8 degree-3.9 degrees). The translation was, mean, 0.7 mm (0.1-1.6 mm). There was no difference between symptomatic and asymptomatic joints.
Measurement of height in scoliotic patients is complicated by changes in spinal shape in both the coronal and sagittal planes. A method is described by which these changes can be measured and compared with the shape of the normal spine, using an automated stereophotogrammetric technique (ISIS). The resultant height change may be of use in the prediction of respiratory function.
To determine the time-table for intervertebral stabilization after posterolateral fusion without osteosynthesis in the lower lumbar spine, 11 patients with no previous spinal surgery and with fusion due to spondylolysisolisthesis Grade 1 to 2 or lumbar disc disorder/facet joint arthrosis were examined by roentgen stereophotogrammetric analysis (RSA) in supine and erect positions, and by conventional radiography for 1 year after surgery. In eight patients with osseous fusion radiographically, the sagittal and the vertical translations between the fused vertebral segments began to decrease after 3 to 6 months. However, the time for rigid fusion as defined by RSA varied between 3 months and 1 year, and in four patients sagittal/vertical translations of mostly less than 1 mm still persisted at 1 year postoperatively. In three patients with poor fusion radiographically, no rigid fusion as defined by RSA was obtained. Sagittal/vertical translations of 1 to 10 mm persisted at 1 year postoperatively in these patients. The preoperative pain disappeared in all patients except in one who had osseous fusion radiographically but persisting translations after 1 year.