Photographic protocol for image acquisition in craniofacial microsomia

Abstract

Craniofacial microsomia (CFM) is a congenital condition associated with orbital, mandibular, ear, nerve, and soft tissue anomalies. We present a standardized, two-dimensional, digital photographic protocol designed to capture the common craniofacial features associated with CFM.

Figure 1

Example of possible configurations for the image environment. Photo of the recommended set up (A) and illustrations of a set up with the monopod flash behind the participant (B) and to the side of the participant (C). (1) Blue background, (2) flash reflection on the background, (3) monopod flash, (4) participant seat, (5) camera.

Figure 2

Making Faces for the CFM Photo Protocol. This collage illustrates optimal image acquisition for each of the views described in this protocol. This figure can be used during image acquisition to show participants examples of the requested facial expressions. The grid lines on views A-E can be used on the camera's viewer to ensure optimal head positioning in the Frankfort horizontal plane. The circle overlying images A-E represents the focal point of the image.

Figure 3

Contact sheet used in the general evaluation in phenotypic assessment tool for CFM. The views obtained during image acquisition can be used to create a contact sheet for quick categorization of the common craniofacial features affected in CFM. The contact sheet illustrated in this figure includes views that can be used to complete the ratings for the orbit, mandible, ear, nerve, and soft tissue in the OMENS classification system. The complete contact sheet incorporates the 16 views obtained in the protocol, in addition to 4 enlarged views of the ears and eyes as illustrated in Figure 4.

Figure 4

Contact sheet used in the detailed evaluation in phenotypic assessment tool for CFM. This page of the contact sheet is designed to allow raters to quickly assess physical features included in the "Detailed Assessment" of the phenotypic assessment tool for CFM. Enlarged views of the eyes and ears were created by enlarging views A, C, and E. Multiple views of the tongue allow for assessment of unilateral or bilateral hypoplasia.

Figure 5

An example of suboptimal images. This collage provides optimal and suboptimal examples of five views. The first three images (A-C) are of View A. Image B is suboptimal for three reasons: the subject's head is tilted back, the blue background is not filling the background completely, and the photographer is angling the camera up for the picture. Image C is suboptimal for two reasons: the subject's head is tilted forward and the photographer is angling the camera down for the picture. The other views represented in this figure include View B (Images D & E), View C (Images F & G), View H (Images H & I), and View F (Images J-M). Image M is suboptimal for two reasons: the subject's mouth is open and the head is not tilted far enough back.

Figure 6

Photo acquisition image check list. This figure provides a check list to be used during image acquisition, along with a section to document notes about the image capture session. These data can be useful for interpretation of the reliability of the images for evaluating nerve function. For example, if the participant tried to smile during the View I, but it looks like a frown, it is important to document that the participant followed instructions. If, however, you ask the participant to smile and they are not cooperative, you would also want to document that as well.