A reliable and objective method of measuring soft tissue changes in 2D photographs after distraction osteogenesis in individuals with CL/P.

Pre- and postoperative photos to assess results are widely used in plastic and reconstructive surgery, for instance, in patients with cleft lip and palate (CL/P). Evaluations are often performed by assessment panels by viewing the photos. However, these are prone to be subjective. Measurements of soft tissues in photos could be an alternative method but have not been widely used so far. Some patients with CL/P develop a retrognathic maxilla in adolescence, with ensuing Class III malocclusion. In severe cases, distraction osteogenesis (DO) of the maxilla may be indicated. The effect of DO on the facial soft tissues is sparsely reported, perhaps due to the rare procedure. The primary aim of the present study is to provide a reliable and objective method of measuring soft tissue profiles in two-dimensional digital photos. Furthermore, the study aims at assessing changes in soft tissues following DO. Fourteen patients who had undergone DO at our unit were recruited. Preoperative and postoperative photos were identified, and long-term follow-up photos were taken. Three raters performed measurements of four angles and two distances. Inter- and intra-rater reliability and soft tissue changes were analyzed statistically. Inter- and intra-rater reliability was high overall for most variables. Two angles related to facial convexity changed significantly. So did the upper lip height. Soft tissues can be measured with a high degree of accuracy, but further evaluation of the method is necessary. DO causes a favorable increase in facial convexity, and an increased upper lip height.