Unveiling Software Limitations in the Assessment of the Minimum Sectional Area and Volume in Cleft LIP and Palate Patients

The increasing use of cone beam computed tomography (CBCT) has led to a growing demand for DICOM software that enables the assessment and measurement of craniofacial structures. This study aimed to compare the airway volume and the minimum axial area in patients with cleft lip and palate using five different imaging software programs: Dolphin3D, InVivo Dental, ITK Snap, InVesalius, and NemoFAB. Initially, 100 CBCT scans were selected by an examiner, and their corresponding DICOM files were collected. The oropharyngeal segments were delineated following the manufacturer's guidelines, using two different segmentation techniques: interactive and fixed threshold. The results were analyzed using the Friedman test and Wilcoxon post hoc test, with a 5% significance level for all statistical tests. The findings for both the minimum axial area and total volume revealed that the median values across the software groups were higher than expected, and significant differences were observed when comparing the groups (<i>p</i> < 0.001). All five software programs showed notable differences in their outputs. Specifically, a statistically significant difference in volume was found across all groups, except between InVivo and ITK-Snap. It is recommended that pre- and post-treatment comparisons be performed using the same software for consistency.