Comparison of methodologies for craniofacial soft-tissue cephalometrics: The value of virtual reality

Myriad options are available for plastic surgeons to perform soft-tissue analysis, which is vital to perioperative evaluation and research. Our objective is to compare the accuracy, precision, and efficiency of the available cephalometric modalities for conducting facial soft-tissue measurements. Twenty soft-tissue facial measurements were performed by 5 measurers with varying experiences on 5 adult subjects, using 6 methods—manual calipers, cone-beam CT, virtual reality (VR), 3D stereophotogrammetry, iPad-based 3D photogrammetry, and 2-dimensional photographs. Measurement sessions were timed and performed in triplicate, for a total of 9000 measurements. Intraclass correlation coefficient (ICC) was calculated for accuracy and one-way ANOVA was used for comparison. The coefficient of variation (CoV) was compared among groups to evaluate the precision of different methods by considering caliper measurements as the gold standard. ICC among raters was 0.932, indicating excellent reliability. VR was significantly faster than other methods (137 s vs. 217 s for caliper, p