LAUSR

INTRODUCTION Objective assessment of craniofacial surgery outcomes in a pediatric population is challenging due to complexity of patient presentations, diversity of procedures performed, and rapid craniofacial growth. There is a paucity of robust methods to quantify anatomic measurements by age and objectively compare craniofacial dysmorphology and postoperative outcomes. Here the authors present data in developing a racially and ethnically sensitive anthropomorphic database, providing plastic and craniofacial surgeons with "normal" three-dimensional anatomic parameters to appraise and optimize aesthetic and reconstructive outcomes. METHODS Patients with normal craniofacial anatomy receiving head MRIs from 2008-2021 were included in this retrospective study. Images were used to construct composite (template) images with diffeomorphic image registration method using the Advanced Normalization Tools (ANTs) package. Composites were thresholded to generate binary three-dimensional segmentations used for anatomic measurements in Materalise Mimics. RESULTS High-resolution MRIs from 130 patients generated 12 composites from an average of ten MRI sequences each: four three-year-olds, four four-year-olds, and four five-year-olds (two male, two female, two black, and two white). The average head circumference of three-, four-, and five-year-old composites was 50.3 cm, 51.5 cm, and 51.7 cm, respectively, comparable with normative data published by the World Health Organization. CONCLUSIONS Application of diffeomorphic registration-based image template algorithm to MRI is effective in creating composite templates to represent "normal" three dimensional craniofacial and soft tissue anatomy. Future research will focus on development of automated computational tools to characterize anatomic normality, generation of indices to grade preoperative severity, and quantification of postoperative results to reduce subjectivity bias.