Assessment of Facial Symmetry After Facial Reconstruction Using Three-dimensional Stereophotogrammetry (SymFACE)

Development, Validation and Clinical Application of a Method for Quantitative 3D Assessment of Facial Symmetry After Facial Reconstruction Using Three-dimensional Stereophotogrammetry

Facial reconstruction follows removal of a malignant or benign tumor of the oral cavity or face, complex facial trauma, or resection of osteonecrosis of the jaws. It's a challenge that aims to restore not only the functions of the face, but also its aesthetics, which is just as crucial. A poor aesthetic result after facial reconstruction has a serious impact on patient's lives. To develop more personalized surgery, and to anticipate and correct poor results in the future, it is essential to better understand the factors associated with poor aesthetic results in this type of surgery, as well as their impact on the patient's life.

This means correctly assessing the aesthetic outcome of this surgery. Today, however, aesthetic evaluation criteria remain inadequate. A number of criteria are involved in facial attractiveness, and facial symmetry is a key factor. It is generally accepted that severe facial asymmetries considerably diminish facial attractiveness. Currently, aesthetic evaluation criteria (particularly symmetry) are based primarily on the subjective perception of the surgeon or patient. However, there is a need to be able to measure facial symmetry objectively.

Methods for assessing symmetry rely on the placement of anatomical landmarks and the calculation of Euclidean distance, which involves locating homologous landmarks on each side of the face and comparing the length ratios of all possible lines connecting the landmarks on each side. However, these techniques are based on measurements often on two-dimensional (2D) photographs and do not take into account the three-dimensional nature of the face. Methods for three-dimensional analysis of facial symmetry have been developed based on three-dimensional CT reconstructions. However, this technique implies the use of an irradiating imaging technique, not systematically indicated at a distance from surgery.

This study aims to validate a method for analyzing facial symmetry using three-dimensional stereophotogrammetry, to identify risk factors for facial asymmetry in patients who have undergone facial reconstruction, and to assess the impact of facial asymmetry on patients' quality of life.

Study Overview

• Status: Recruiting
• Conditions: Facial Reconstruction
• Intervention / Treatment: Device: Three-dimensional stereophotogrammetry; Other: Questionnaires

• Study Type: Observational
• Enrollment (Estimated): 50

Contacts and Locations

• Study Contact: Name: Nicolas GRAILLON, MD; Phone Number: +33 04 91 43 6319; Email: nicolas.graillon@ap-hm.fr

Study Locations

• France
  • Marseille, France, 13005
    • Recruiting
    • Assistance Publique - Hopitaux de Marseille
    • Contact: Nicolas GRAILLON, MD; Phone Number: +33 04 91 43 63 19; Email: nicolas.graillon@ap-hm.fr
    • Principal Investigator: Nicolas GRAILLON, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients who underwent facial reconstruction, returning for consultation 1 year post-surgery.

Description

Inclusion Criteria:

• Male or female, 18 years of age or older,
• Patient having given non-opposition for participation in this study,
• Reconstruction of the lower or middle third of the face by pedicled flap or microanastomosed free flap following excision of a benign or malignant tumor of the oral cavity or face, osteonecrosis of the jaws, loss of facial traumatic substance,
• Surgery and routine follow-up performed in the 3 departments (maxillofacial surgery, ENT, plastic and reconstructive surgery) of the PROMOD cluster at Marseille's CHU Conception

Exclusion Criteria:

• History of reconstruction of the lower or middle third of the face other than that being evaluated at one year for this study,
• Subjects covered by articles L1121-5 to 1121-8 of the French Public Health Code (minors, adults under guardianship, patients deprived of their liberty, pregnant or breast-feeding women),
• Persons who cannot read and understand the French language well enough to be able to give their non-opposition to participating in the research.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Facial reconstruction patients; Reconstruction of the lower or middle third of the face using a pedicled flap or microanastomosed free flap following excision of a benign or malignant tumor of the oral cavity or face, osteonecrosis of the jaws, or traumatic loss of facial substance	Device: Three-dimensional stereophotogrammetry; Three stereoscopic photographs; Other: Questionnaires; SF-36 quality of life scale for general health inquiry; Rosenberg Self-Esteem Scale; Self-perception scale

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Correlation coefficient between root mean square deviation (RMSE) score and surgeon's assessment score	Day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intraclass Correlation Coefficient to assess intra-operator reproducibility		Day 1
Intraclass Correlation Coefficient to assess inter-operator reproducibility		Day 1
Demographic factors associated with objective facial asymmetry one year after facial reconstruction surgery		Day 1
Clinical factors associated with objective facial asymmetry one year after facial reconstruction surgery		Day 1
Therapeutic factors associated with objective facial asymmetry one year after facial reconstruction surgery		Day 1
Relationship between objective measurement of facial asymmetry and the patient's subjective assessment of perception (satisfaction and body image)	The patient perception score is assessed by a scale constructed by the investigative team.	Day 1
Relationship between objective measurement of facial asymmetry and the patient's quality of life	The patient quality of life score is assessed by the French-validated SF-36 quality of life scale for general health inquiry" (36 items).	Day 1
Relationship between objective measurement of facial asymmetry and patient self-esteem	The patient self-esteem score is assessed by the French-validated Rosenberg self-esteem scale (10 items).	Day 1

Collaborators and Investigators

• Sponsor: Assistance Publique Hopitaux De Marseille
• Collaborators: Fondation des Gueules Cassées
• Investigators: Study Director: CREMIEUX François, AP-HM

Study record dates

Study Major Dates

• Study Start (Actual): June 3, 2025
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): June 1, 2027

Study Registration Dates

• First Submitted: July 30, 2024
• First Submitted That Met QC Criteria: July 30, 2024
• First Posted (Actual): August 2, 2024

Study Record Updates

• Last Update Posted (Actual): November 20, 2025
• Last Update Submitted That Met QC Criteria: November 17, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Three-dimensional stereophotogrammetry; Facial symmetry
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Facies; Health Care Quality, Access, and Evaluation; Investigative Techniques; Epidemiologic Methods; Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Public Health; Environment and Public Health; Surveys and Questionnaires
• Other Study ID Numbers: RCAPHM23_0384; ID RCB (Other Identifier: ANSM)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No