CT-Based Size and Shape Determination of the Craniofacial Skeleton: A New Scoring System to Assess Bony Deformities in Hemifacial Microsomia

The purpose of this study was to design a better craniofacial classification system for bony deformities in patients with hemifacial microsomia than the existing ones. It was meant to incorporate the deformity of the craniofacial skeleton other than that of the mandible. The "Mandibular Deformity Scoring" System (MDS), the "Cranial Deformity Scoring" System (CDS), the the "Craniofacial Deformity Scoring" System (CFDS) are three newly developed classification systems, which are based on three-dimensional computed tomography (3-D CT) reconstructions. The size and shape of the craniofacial structures of 34 children, 25 with hemifacial microsomia and 9 with minimal dysplasia or trauma, were determined from CT scans, using 3-D image segmentation and rendering. Contiguous 1.5-mm CT scans were made using a Philips Tomoscan 350 and were processed using a Cemax 1500X 3-D workstation. The precision of the 3-D imaging was assessed by repeated determinations carried out by two observers (intra-and interreliability). Accuracy of the bone determination technique was assessed by comparing the interpretations of the craniofacial skeleton by 3-D CT reconstructions of laser-stereolithographic 3-D models. Correlations of the Pruzansky/Kaban classification system and the newly developed classification systems were demonstrated by the use of the Pearson product moment correlation coefficients. The new CFDS (=CDS + MDS) provides an adequate basis for assessment of bony structures using three-dimensional imaging and demonstrates a high correlation with the known Pruzansky/Kaban classification system. This new scoring system can handle the wide variety of individual variation of the deformity seen in patients with hemifacial microsomia better than the existing scoring systems.