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Introduction: Clinical measurements in the frontal view underevaluate chin deviation in mandibular asymmetry. The aim of this descriptive study is to search for a reliable method of measuring deviant chins using a facial X-ray as reference., Material and Method: Seventy patients with mandibular asymmetry who had consulted a maxillofacial surgeon were systematically included. Age, sex, cephalometric characteristics, reasons for patient consultation and type of surgery were collected. Two cephalometric methods were tested with respect to the medial sagittal plane (PSM) to compare the assessment of mandibular asymmetry on soft tissue and by cephalometry., Results: On average, the patients selected were young (26 years +/- 9), women (75% of cases), presented open bite (average FMA: 28° +/- 8°), a skeletal class III tendency, a left-side shift of the chin (63% of cases). They consulted for both aesthetic and functional reasons (51% of cases) and required bimaxillary surgery (66% of cases). Comparison between the photographic angle (formed by the PSM and the line passing through the nasion and reaching the chin point) and the radiographic angle (formed by the PSM and the line passing through the Crista Galli process and the bony chin point angle) showed no significant difference (p = 0.937) and is thus reliable., (© EDP Sciences, SFODF, 2018.)

Introduction: The study examines how the shape of the teeth is taken into account in the context of facial hyperdivergency. One aim was to check out the widely-held belief that the hyperdivergent patient has long teeth., Discussion: Our study found no link between the shape of the teeth and facial hyperdivergency, thus confirming the results in the literature. We examined the issue of how to characterize dental shapes. We found three diversely-appreciated types of shape: rectangular, triangular and ovoid. Individualized management of tooth shape harmony enables the clinician to envisage recontouring the shape of a patient's teeth using interproximal enamel reduction. The anatomical demands of this type of tooth remodeling favor the less popular ovoid and triangular shapes. However, following treatment, they tend to adopt a more widely-accepted rectangular shape., Materials and Methods: Using a spreadsheet, we built a computational tool to perform the dimensional quantitative diagnosis and made drawings in order to approach the shapes from a qualitative point of view. This method enables us to determine the areas to be recontoured and to obtain a preview of our treatment objectives. The result is harmonious with respect to shapes, proportions and positions as well as from a functional and periodontal point of view., (© EDP Sciences, SFODF, 2017.)

Fluctuating asymmetry is the stochastic, minor deviation from perfect symmetry in bilaterally symmetrical organisms. It reflects the limit of developmental precision. Such a precision can be influenced by various factors, both internal (genetic mutations, stochastic variation at every levels of development) and external (environmental influences). Fluctuating asymmetry has receive an extreme attention for the past few decades, that culminated in the 90s: it has been used as an estimator of heterozygosity, fitness, environmental stress, and widely applied to human biology, sociobiology and psychology before being more or less discredited in the early 2000s. The reasons for such an extreme popularity and then disgrace are discussed here. Far from suggesting to abandon the study of fluctuating asymmetry, we indicate some of the most promising research avenues. ‡., (© 2016 médecine/sciences – Inserm.)

Introduction: When occurring in childhood, temporomandibular ankylosis joint is responsible for complex maxillofacial deformities, including mandibular growth deficiency. We present a case of temporomandibular joint ankylosis associated with severe mandibular asymmetry treated by mandibular bone distraction performed under computer assistance., Observation: A 27-year-old patient presented with a severe facial asymmetry consisting in hypoplasia of the left hemi-mandible and maxilla. Mouth opening was non-existent. The CT-scan showed a left temporomandibular ankylosis. A left mandibular distraction was decided. The distraction characteristics (choice and positioning of the distractor, axis and amount of distraction) were determined preoperatively on the 3D CT-scan. The planning has been transferred to a navigation console (Kolibri®, Brainlab®). A combined intraoral and cutaneous was performed. Navigation allowed for an appropriate placement of the osteotomy line and fixation of the distractor. Distraction was started at the 5th postoperative day at the rate of 1mm per day and lasted 25 days without complication., Discussion: 3D planning allows for better indication setting, better preparation of the procedure, reducing complications and operative time. It may help as an educational tool for young surgeons and for a better understanding from the patient. Navigation is an accurate method for the transfer of the planning in the operation room., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

There have been numerous studies of facial esthetics, but few have benefited from the new techniques provided by 3D imaging. The aim of this study is to determine which are the most crucial cephalometric criteria for facial esthetics by identifying the strongest correlations between the esthetic rating and 3D Cephalometric values, the Cepha 3Dt. A group of 91 subjects (from 10 to 60 years of age) was rated by a jury of 50 randomly selected judges (from 12 to 65 years of age) using an analog scale. We then looked for the most important correlations between the esthetic ratings and the tridimensional cephalometric values by using 3D Cephalometric Analysis on a global sample, and on Class II and Class III sub-samples. Facial esthetics therefore appeared to be especially linked to: anterior-posterior dimension, maxillo-mandibular disharmony, relationships between the anterior areas (alveolar and basal), the alveolar region has a greater impact than the basal area on facial architecture. In the Class II group, sagittal discrepancies and mandibular divergence have an equal impact on the assessment of facial esthetics., (© EDP Sciences, SFODF, 2014.)

How to manage craniofacial malformative cases? It seems to be very difficult, especially in orthodontics because of the lack of consensus. The authors' aim is to propose a physiopathologic classification of these craniofacial syndromes in order to simplify the medical practice when we meet these patients. More than fifty cases are actually treated and followed in our hospital; we have described all of these cases before to choose the most representative in each category. These syndromes are classified in four categories, organ abnormalities of one or many functional matrix, localized abnormalities of the anatomical structures, general abnormalities of the connective tissue, mixed syndromes., (© EDP Sciences, SFODF, 2011.)

Subject: The number of plagiocephalies without synostosis (PWS) strongly increased in the last decade. Its impact on the mandible remains badly understood, the more so as there are various forms of PSS. The purpose of this study was to analyze mandible deformation according to the deformation of PWS., Material and Methods: The study was carried out retrospectively starting from three-dimensional scans of children presenting with a PWS. They were classified in 2 groups according to the deformation of the cranium. There were 51 frontal plagiocephalies (PF) and 19 occipital plagiocephalies (PO) for which the cephalic index was calculated. The position of the mandible compared to the base of cranium and its intrinsic asymmetry were analyzed (paired parametric Student test)., Results: The mandible was symmetrical in PO whereas it was asymmetrical for PF. This asymmetry was present at the level of the corpus and developed in 2 ways: that is to say asymmetry compensated for that of the base of the cranium (68.6%); or it worsened it (23.5%). The degree of brachycephaly was more important in PO than the PF with a cranial index of 0.93+/-0.07 and 0.85+/-0.07 respectively (P<0.05). In both cases the position of the mandibular condyle followed the asymmetry of the base of cranium and the asymmetry of the temporomandibular joint (TMJ) was secondary with that of the base of cranium., Discussion: In addition to the asymmetry of TMJ position there was an intrinsic mandibular asymmetry in PF which was not found in PO. This asymmetry of the mandible was variable but in most cases it tended to compensate for the asymmetry of the base of the cranium which was more important in PF. The risk to have asymmetry of dental occlusion seems more important in PF than in PO, and an orthodontic follow-up appeared to be justified for these children.

Unilateral disto-occlusion of the molars and the canine teeth, described by Angle as Class II subdivision, is often characterized by asymmetric development of the maxillae in conjunction with a disturbance in physiological mastication. In addition to the unilateral malposition of the molars and the canine, this Class II subdivision condition is routinely accompanied by an ensemble of symptoms that the authors propose regrouping under the designation "children's acquired unilaterally dominant mastication syndrome". They use several clinical examples to illustrate the diagnosis of this condition that they consider to be a syndrome of craniofacial asymmetry.

The 75th meeting of the French Orthodontics Society will be held in Biarritz May 8-9-10-11 2002. The main topic for discussion will be: "facial asymmetry". During the meeting, authors will present study of facial asymmetries using a new innovative three-dimensional cephalometry. The method combines CT scans data, anatomical landmarks and mathematical tools to create, using the "Cepha" software, a 3D model of the human face. Balance and symmetry of the model are stable enough to define normality for each individual even with different ethnic and cultural origins. Unbalance and asymmetry characterize pathologies. Follow up shape and size of models allows growth prediction and modeling. The model is in the process of becoming the indispensable reference for all those who are interested in studying the human face: Orthodontics, Surgery, Anatomy, Anthropology, Plastic surgery, Forensic Medicine.

Complex dysmorphies, asymmetries can affect the various elements of the stomatognathic system: cranial base, maxilla, mandible, musculature and dental arches, in the three dimensions of space. Their etiopathogenesis, as well as their clinical forms, vary considerably. Dysembryopathies, growth disorders, TMJ damages, postural or functional disorders and dental anomalies can create, according to their severity and their moment of appearance, severe or minor facial asymmetries, or asymmetries of the arches. An exo- and endobuccal clinical examination endeavors to specify the localization and the severity of the damage, and to evaluate the importance of the possible alveolar compensations. Consolidated by additional examinations, it enables the clinician to differentiate the various forms of asymmetries.

A new case of this rarely described pathology is reported. It concerns a benign infiltrating lipomatosis, strictly located to the face. However, dento-musculo-squelettal structures are constantly involved, usually located to a hemiface. A young female patient has been followed up from her birth. Surgical procedures are reported. Diagnostic and therapeutic difficulties of this rare clinicopathologic entity are discussed.

One case of giant cell tumor located in the mandibular condyle is reported. This case was revealed by a progressive mandibular deviation. Frequency, localization, etiopathogenesis and histological feature are discussed.

The cranio-mandibular syndrome (CMS) is often secondary to an cranio-facial asymmetry (CFA); it associate a painful masticatory dysfunction syndrome with functional and aching clinical signs in relation with a functional torticollis required for oculo-labyrinthal equilibration maintenance. Our anatomical and functional MRI protocol uses tridimensional study of semi-circular canals (SCC) up relation to the medial cerebral axis (MCA), and permit to measure precisely these CFA and propose, with a multispecialist approach, an adapted treatment of the SCM. Application of MRI to SCC asymmetry looks to its future use for spatial intracranial referencial of cerebral structures.

The authors expose a technical innovation concerning mandibular lengthening without any bone graft, by applying to the mandibular Ilizarov's principles about limb lengthening by osseous distraction. This surgical technique concerns children with mandibular hypoplasia, like the Hanhart's syndrome (aglossia-adactylia, first observation), or Hemifacial Microsomia (second observation). The purpose of this new technique is mandibular lengthening with functional and aesthetic correction of the mandibular growth deficiency, and minimal morbidity. A specialist staff is essential to realize a distraction device with his minimal and appropriate shape for children, as well as a protection device conception. This external distraction device is placed with transmandibular pins. After mandibular corticotomy by endobuccal incision, the distraction is accomplished, at home by the parents, at the rythm of 1 mm p. two days. The distraction goes on about 2 months, depending on the lack of mandibular growth, and a retention device, much more light, is necessary during 8 weeks more to stabilize the osteogenesis. At the term of an eight weeks gradual distraction, the mandibular lengthening is 17.5 mm for the horizontal ramus (first observation), and 13 mm for the vertical ramus (second observation). The functional and aesthetic results, the swift and secure surgical procedure, lead to put forward this mandibular distraction technique in any mandibular or facial defects.

Condylar hyperplasia is a pathologic condition associated with an overgrowing of the condylar cartilage. It is possible to distinguish two clinical forms; vertical and horizontal when the lesion is unilateral. We have reported two cases of vertical condylar hyperplasia, both of them treated by simple condylectomy, in our opinion the selected treatment. Histopathological images show an increase of the growth and maturation layers of the condylar cartilage and inclusions of cartilaginous tissue, with appearance of glove fingers into the underlying cancellous bone.

A particular characteristic of dentomaxillary dysharmony, probably the most frequently encountered anomaly in dentofacial orthopedic practice, is often the result of the presence of physiologic facial asymmetry. Attention is drawn to a syndrome, which could be thought to be paradoxical, and which associates facial asymmetry affecting the left side and dentomaxillary dysharmony that is curiously more marked on this same side.

Changes have occurred in the original concepts which led to the current use, either totally or partially, of the various cephalometric tests, and the terminology employed varies from one author to another. A comparative study of the principal measurements used was therefore conducted, based on this acquired knowledge. After discussing the relative values of the reference points and constructions, the authors attempt to establish a relationship between the different evaluation methods used for each element, bony, alveolar, and dental, which are necessary for diagnosis, and for which functional coexistence dominates the prognosis for harmony of the buccodental system.