Validation of 'total face approach' (TFA) three-dimensional cephalometry for the diagnosis of dentofacial dysmorphisms and correlation with clinical diagnosis.

The last decades have witnessed significant improvements in orthognathic surgery, but a true standardization of cephalometric analysis to guide clinical assessment in three-dimensional (3D) virtual planning is still lacking. Therefore, the aim of this study was to validate the 'total face approach' (TFA) 3D cephalometric model for the diagnosis of dysmorphia and to analyse its correlation with the clinical diagnosis and virtual surgical planning performed in the Maxillofacial Surgery Clinic in Udine. This model was validated by studying different cephalometric points in three modules (vertical dimensions, sagittal dimensions, and symmetry) and their sections. Each section of the different modules evaluates the range of the studied patient according to the TFA analysis executed in Planmeca Romexis software and compares it with the ProPlan CMF data. The results of the statistical analysis defined the degree of concordance for each point studied. An overall high correlation was demonstrated for each of the cephalometric categories (weighted kappa between 0.442 and 0.642 in vertical dimension, between 0.587 and 1 in sagittal dimension, and between 0.773 and 1 in symmetry). The TFA model can be considered a valuable guide for the diagnosis of dysmorphia and 3D virtual planning of orthognathic maxillofacial surgery.