Visualizing three-dimensional facial soft tissue changes following orthognathic surgery.

Laser scanning can be used to visualize the face in three dimensions. These scans can then be processed to enable assessment of facial changes. The aim of this single-centre, prospective, longitudinal, cohort study was to investigate whether four different visualization methods correctly represented facial changes occurring as a result of orthognathic surgery. Twenty-six consecutive orthognathic patients (13 female mandibular advancement and 13 male bimaxillary Class III) were included as well as a control group of 12 non-growing adults (6 males and 6 females). Pre- and post-operative facial laser scans were superimposed and four different visualization methods applied: correspondences with sensitivity to movement, normals, radial, and closest point. A group of 10 'blinded' observers determined the surgical procedure (if any) that had been performed by applying a specific colour scale to each facial image. The sensitivities and specificities for each visualization method applied to each subject group were determined. The intraobserver repeatability was investigated using Cohen's kappa (k). The radial method was found to be superior for identifying mandibular advancement patients (sensitivity/specificity 58.5/92.4 per cent), the normals method for visualization of bimaxillary Class III cases (26.2/99.6 per cent), while the control group was best represented using the closest point (60.0/80.8 per cent). Overall, intraobserver repeatability was good (k = 0.61). A good level of repeatability was demonstrated in the separate subject groups (mandibular advancement 0.70, bimaxillary Class III 0.70, and controls 0.62). There was no significant difference in the abilities of the four visualization methods to represent facial changes. Each method allowed correct identification of different proportions of the subject groups.