The Expanding Role of Geometric Morphometrics in Craniofacial Surgery

Introduction: Geometric morphometrics (GM) is an advanced landmark-based quantitative method used to study biological shape and form. Historically, GM has been limited to non-biomedical fields such as comparative biology; however, this technique confers advantages over traditional cephalometric methods, warranting a review of current applications of GM to human craniofacial disorders. Methods: The RISmed package was used to extract metadata associated with PubMed publications referencing GM analysis techniques in craniofacial and reconstructive surgery. PubMed search terms included “geometric AND morphometric AND craniofacial;” and “geometric AND morphometric AND reconstructive surgery.” Duplicate search results were eliminated. Results: Search yielded 139 studies between 2005 and 2020, of which 27 met inclusion criteria. Human craniofacial studies constituted 2% of all queried GM studies. Among these, cleft lip and palate were the most commonly studied craniofacial conditions (7 studies, 26%), followed by sagittal craniosynostosis (4 studies, 15%). Seventeen studies (63%) used GM to assess skeletal structures, seven studies (26%) examined both skeletal and soft tissues, and three studies (11%) analyzed soft tissues only. Eleven studies (40.1%) employed a GM approach to evaluate postoperative changes in craniofacial morphology. Two studies (7%) systematically compared GM analysis with conventional shape measurements. Conclusion: The ability to study shape while controlling for variability in structure size and imaging technique make GM a promising tool for understanding growth patterns in complex craniofacial diseases. Furthermore, GM overcomes many limitations of traditional cephalometric techniques, and hence may claim an expanded role in the study of human craniofacial disorders in clinical and research settings.