Evaluation of Nasal Morphology in Cleft Lip and Palate Patient by Fuzzy Theory Fuzzy Evaluation of Improvement after Prim ary Cheiloplasty Yasuo HONDA

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1 Evaluation of Nasal Morphology in Cleft Lip and Palate Patient by Fuzzy Theory Fuzzy Evaluation of Improvement after Prim ary Cheiloplasty Yasuo HONDA, Norifumi NAKAMURA, Tetsuji NAGATA, Masaaki SASAGURI and Masamichi OHISHI Abstract : The purpose of this study is to evaluate the postoperative results of the cleft nose reflecting the subjective perception by fuzzy theory. Fifty-two Japanese unilateral cleft lip and/ or palate patients who underwent primary cheiloplasty at Kyusyu University Dental Hospital were the subjects. Facial pictures which were taken before and at least 6 months after the operation were studied. One oral surgeon was asked to evaluate each picture based on his subjective perception according to the Section of Oral & Maxillofacial Oncology, Division of Maxillofacial Diagnostic & Surgical Sciences, F aculty of Dental Science, Kyushu University (Chief : Prof. Masamichi OHISHI)

2 evaluation form. This form was originally made for the evaluation of nose and included 5 items to evaluate nasal morphology : (1) alar base, (2) nasal tip, (3) margin of nostril, (4) nostril, and (5) columella. Overall subjective evaluation was performed on the 5 items, and calculated VAS (Visual analogue scale) score in 100 points on VAS, and calculated VAS improvement score. On fuzzy analysis, point of each item was transformed into three different categories : "good," "medium," or "poor," and from these data the fuzzy improvement score was determined. The VAS improvement score showed with the average of 36.3 points. There was a tendency that the severe the nose deformity, the higher the improvement score. Fuzzy improvement score showed with the average of 65.9 points reflecting the evaluator's subjectivity. Our expert esthetic evaluation system expressed the rater subjective evaluation numerically and enabled the synthetic judgement of the postoperative result of the nose reflecting subjective perceptions. Key words : cleft lip and palate, nasal revision, esthetic, fuzzy theory

3 な お,判 3.フ 定 は 初 見 の1回 の み と し た ア ジ イ処 理 今 回 行 っ た フ ァ ジ ィ処 理 の 流 れ を 図1に 示 す 人 間 の 思 考 過 程 の な か で も し あ る 条 件 がAで れ ば,そ の 結 論 はBで はIf-Thenruleと あ あ る と い う形 式 の 表 現 呼 ば れ る こ の よ う な二 値 論 理 に 基 づ く推 論 は,真 理 が イ エ ス か ノ ー の2つ しか な い と す れ ば き わ め て 明 確 で あ る し か し実 際 に わ れ わ れ の 日常 に存 在 す る 問 題 は,ほ と ん どが こ の よ う に 二 値 に 明 確 に 分 か れ る も の は な い フ ジ ィ理 論 は そ う い っ た 曖 昧 な 問 題(集 ジ ィ 集 合 と と ら え,こ で は な く,い ァ フ ァ れ を記 号 の ま ま推 論 す る の っ た ん 言 葉 の デ ー タ(良 中 等 度 な ど)に 合)を い,悪 い, 変 換 し,任 意 に 設 定 さ れ た メ ンバ ー 1)鼻 翼 基 部 の偏 位 シ ッ プ 関 数 を 介 して 数 値 表 現 に 変 換 す る も の で あ 2)鼻 尖 の偏 位 る 3)鼻 孔 縁 の下 垂 具 体 的 に は,1)フ ァ ジ ィ 化(fuzzification), 4)鼻 孔 の非 対 称 2)ル 5)鼻 柱 の偏 位 化(defuzzification)で 以上 の5項 目に 関 して,経 験 年 数15年 の 口腔 外 科 医1名 が 患児 の術 前 な らび に術 後 の 顔 面 写 真 1)フ ー ル 評 価(ruleevaluation) If-Thenruleの 条 件 部 にVASの は め,good,medium,badと AnalogueScale(VAS)で お,評 フ アジ イ ア ジ ィ化 を視 診 評 価 し,各 項 目 と も100点 満 点 のVisual 評 点 した な,3)非 構 成 さ れ る デー タ をあて い う3つ の言葉 の デ ー タ(フ ァ ジ イ ラ ベ ル)に 価 者 には 前 も って情 報 を与 える こ とな く無 作 為 に で あ る 入 力 す る の は 術 前 術 後 の 顔 面 写 真 の 評 資料 を提 示 した さ らに術 前 後 のVAS評 価 点 数 で,こ よ り改善 度(VAS改 善 度)を 求 め た 点の差 れ は,任 変 換 す る処 理 の こ と 意 に 設 定 さ れ た メ ンバ ー シ ッ プ関 数 に よ り当て は ま る フ ア ジ イ ラベ ル とそ の 集

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7 1) Mccomb, H.: Primary correction of unilateral creft lip nose ; A 10-years review. Plast. Reconstr. Surg., 75 : , ) Salyer, K. E. : Primary correction of the unilateral creft lip nose. Plast. Reconstr. Surg., 77 : , ) Mamdani, E. H.: Application of fuzzy algorithms for control of simple dynamic plant. Proc. IEEE, 121 : , ) Yamada, T., Sugahara, T., Mori, Y., et al : Development of a 3-D measurement and evaluation system for facial forms with a liquid crystal range finder. Comput. Methods. Programs. Biomed., 58 : , ) Yamada, T., Sugahara, T., Mori, Y., et al : Rapidthree-dimensional measuring system for facial surface structure. Plast. Resonstr. Surg., 102 : , ) Brusse, C. A., Van der Werff, J. F., Stevens, H. P., et al : Symmetry and morbidity assesment of unilateral complete cleft lip nose corrected with or without primary nasal correction. Cleft. Palate-Craniofac. J., 36 : , ) Coghlam, B. A., Laitung, J. K. G., Pigott, R. W.: A computer-aided method of measuring nasal symmetry in the cleft lip nose. Br. J. Plast. Surg., 46 : 13-17, ) Masui, I., Honda, T., Tanaka, H.: Quantitative evaluation of profile esthetics by means of fuzzy inference. Biochem. Fuzzy. Human, Sciences., 2 : 1-7, 1996.

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