The self-defining axis of symmetry: A new method to determine optimal symmetry and its application and limitation in craniofacial surgery

Purpose Analysis of symmetry represents an essential aspect of plastic-reconstructive surgery. For cases in which reference points are either not fixed or are changed due to corrective intervention the determination of a symmetry axis is sometimes almost impossible and a pre-defined symmetry axis would not always be helpful. To assess cranial shape of surgical patients with craniosynostosis, a new algebraic approach was chosen in which deviation from the optimal symmetry axis could be quantified. Materials and methods Optimal symmetry was defined based on a single central point in the fronto-orbital advancement (FOA) hyperplane and a corresponding landmark pair. The forehead symmetry evaluation was based on 3D-scans series of 13 children, on whom cranioplasty with FOA was performed and 15 healthy children who served as control group. Results Children with plagiocephaly showed considerable improvement in symmetry postoperatively, with stable values over one year, while those with trigonocephaly and brachycephaly showed constant good symmetry in the forehead both pre- and postoperatively. Conclusions With the help of an optimally calculated symmetry axis this new analysis method offers a solution, which is independent of preset dimensions. Patients can be evaluated according to their individual needs regarding symmetry and also be compared with one another.