Automated three-dimensional analysis of facial asymmetry in patients with syndromic coronal synostosis: A retrospective study

J Craniomaxillofac Surg. 2024 Jan;52(1):48-54. doi: 10.1016/j.jcms.2023.11.006. Epub 2023 Nov 29.


Craniosynostosis, characterized by premature fusion of one or more cranial sutures, results in a distorted skull shape. Only three studies have assessed facial asymmetry manually in unicoronal synostosis patients. It is therefore important to understand how uni- and bicoronal synostosis affect facial asymmetry with a minimum risk of human bias. An automated algorithm was developed to quantify facial asymmetry from three-dimensional images, generating a mean facial asymmetry (MFA) value in millimeters to reflect the degree of asymmetry. The framework was applied to analyze postoperative 3D images of syndromic patients (N = 35) diagnosed with Muenke syndrome, Saethre-Chotzen syndrome, and TCF12-related craniosynostosis with respect to MFA values from a healthy control group (N = 89). Patients demonstrated substantially higher MFA values than controls: Muenke syndrome (unicoronal 1.74 ± 0.40 mm, bicoronal 0.77 ± 0.21 mm), Saethre-Chotzen syndrome (unicoronal 1.15 ± 0.20 mm, bicoronal 0.69 ± 0.16 mm), and TCF12-related craniosynostosis (unicoronal 1.40 ± 0.51 mm, bicoronal 0.66 ± 0.05 mm), compared with controls (0.49 ± 0.12 mm). Longitudinal analysis identified an increasing MFA trend in unicoronal synostosis patients. Our study revealed higher MFA in syndromic patients with uni- and bicoronal synostosis compared with controls, with the most pronounced MFA in Muenke syndrome patients with unilateral synostosis. Bicoronal synostosis patients demonstrated higher facial asymmetry than expected given the condition's symmetrical presentation.

Keywords: Congenital abnormalities; Craniofacial abnormalities; Craniosynostoses; Facial asymmetry; Photogrammetry; Three-dimensional imaging.

MeSH terms

  • Acrocephalosyndactylia*
  • Craniosynostoses* / complications
  • Craniosynostoses* / diagnostic imaging
  • Craniosynostoses* / surgery
  • Facial Asymmetry / diagnostic imaging
  • Humans
  • Infant
  • Retrospective Studies

Supplementary concepts

  • Muenke Syndrome