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Condylar hyperplasia is known to result in facial asymmetries and constitutes a well-recognized group of unilateral mandibular enlargements. Condylar hyperplasia has been sub-classified into hemimandibular hyperplasia and hemimandibular elongation. A much rarer disorder, hemifacial hyperplasia (or hemifacial hypertrophy) is a congenital malformation characterized by prominent unilateral overdevelopment of the hard and soft tissues of the face. The affected side grows at a faster rate than the non-affected side, creating a marked asymmetry that potentially involves the skeleton and teeth, as well as all components of the associated soft tissues. Hemifacial hyperplasia is usually identified at birth and progresses towards puberty, but is not thought to alter throughout the lifetime of affected individuals. A case series of five patients clinically diagnosed with hemifacial hyperplasia is presented, with the aim of reviewing the clinical features, discussing their individual surgical management, and summarizing the more recent identification of possible genetic mutations that may be responsible for hemifacial hyperplasia and related overgrowth disorders. It is speculated that depending on the genetic factors, the disorder may be progressive in specific cases., (Copyright © 2020 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Asymmetries in the human face are quite common but do not get enough attention with regard to forensics and criminalistics. A face with asymmetries has a higher recognition value than a face without such morphological deviations. Therefore it is useful to determine the frequency of facial asymmetries to be able to evaluate the individual asymmetries focusing their rarity. This can be used primarily in forensic anthropology, particularly in the identification of persons. This aspect is the basis of this study. Therefore several structures in the faces of 130 volunteers (65 male, 65 female) from southern Germany were examined for asymmetries based on 3D laser scans. The study showed that asymmetries frequently occur in the eyes, the mouth and the ears. Rarer are asymmetries in the bridge of the nose and the shape of the chin. There is also considerable variation in the degree of asymmetry. Basically it can be said that small-scale structures, such as those in the eye area, have less pronounced asymmetries than large-scale structures such as the nose, mouth, chin and ear.

Perfect bilateral symmetry is the optimal outcome of the development of bilateral traits in the absence of developmental perturbations. Any random perturbation in this perfect symmetrical state is called Fluctuating Asymmetry (FA). Many studies have been conducted on FA as an indicator of Developmental Instability (DI) and its possible link with stress and individual quality in general and with attractiveness, health and level of masculinity or femininity in humans. Most human studies of facial asymmetry use 2D pictures and a limited number of landmarks. We developed a protocol to utilize high-density 3D scans of human faces to measure the level of asymmetry. A completely symmetric spatially dense anthropometric mask with paired vertices is non-rigidly mapped on target faces using an Iterative Closest Point (ICP) registration algorithm. A set of 19 manually indicated landmarks were used to validate the mapping precision. The protocol's accuracy in FA calculation is assessed, and results show that a spatially dense approach is more accurate. In addition, it generates an integrated asymmetry estimate across the entire face. Finally, the automatic nature of the protocol provides a great advantage by omitting the tedious step of manual landmark indication on the biological structure of interest., Competing Interests: The authors have declared that no competing interests exist.

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.)

Cornelia de Lange syndrome (CdLS) is a clinically heterogeneous disorder characterized by typical facial dysmorphism, cognitive impairment and multiple congenital anomalies. Approximately 75% of patients carry a variant in one of the five cohesin-related genes NIPBL, SMC1A, SMC3, RAD21 and HDAC8. Herein we report on the clinical and molecular characterization of 11 patients carrying 10 distinct variants in HDAC8. Given the high number of variants identified so far, we advise sequencing of HDAC8 as an indispensable part of the routine molecular diagnostic for patients with CdLS or CdLS-overlapping features. The phenotype of our patients is very broad, whereas males tend to be more severely affected than females, who instead often present with less canonical CdLS features. The extensive clinical variability observed in the heterozygous females might be at least partially associated with a completely skewed X-inactivation, observed in seven out of eight female patients. Our cohort also includes two affected siblings whose unaffected mother was found to be mosaic for the causative mutation inherited to both affected children. This further supports the urgent need for an integration of highly sensitive sequencing technology to allow an appropriate molecular diagnostic, genetic counseling and risk prediction., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To compare 2 digital methods to determine median sagittal plane of three-dimensional facial data-the interactive closest point algorithm and Procrustes analysis., Methods: The three-dimensional facial data of the 30 volunteers were got by the Face Scan 3D optical sensor (3D-Shape GmbH, Erlangen, Germany), and then were input to the reverse engineering software Imageware 13.0 (Siemens, Plano, TX) and Geomagic 2012 (Cary, NC). Their mirrored data were acquired and superimposed with the original data by the methods of interactive closest points and Procrustes analysis. The median sagittal planes of the 2 methods were extracted from the original and mirrored facial data respectively, 3 asymmetry indices were measured for comparison. Differences between the facial asymmetry indices of the 2 methods were evaluated using the paired sample t-test., Results: In terms of the 3 asymmetry indices, there were no significant differences between interactive closest points and Procrustes analysis for extracting median sagittal plane from three-dimensional facial data.(t = 0.0.060, P = 0.953 for asymmetry index (AI) 1, t = -0.926, P = 0.362 for AI 2, t = 1.1172, P = 0.0.251 for AI 3)., Conclusions: In this evaluation of 30 subjects, the Procrustes analysis and the interactive closest point median-sagittal planes were similar in terms of the 3 asymmetry indices. Thus, Procrustes analysis and interactive closest point can both be used to abstract median sagittal plane from three-dimensional facial data.

Current approaches to facial reconstruction are based on the assumption of facial symmetry, though this has yet to be established in the literature. Through quantitative and qualitative analysis, symmetry of normal, male faces is examined here using the zygomatic complex as a bellwether for the rest of the facial skeleton. Three-dimensional models reconstructed from the computed tomography scans of 30 adult male patients displaying normal facial skeletal anatomy were analyzed. Seven zygomatic landmarks were identified on all craniofacial models, and asymmetry scores were calculated based on the average deviation distance upon reflection of 1 hemiface across the midfacial plane. Deviation maps were then generated for each zygomatic pair to enable visualization of the asymmetry. All landmarks displayed a slight (<3 mm) deviation from perfect symmetry, and analysis of zygomatic form asymmetry revealed an average of 0.4 mm of surface deviation between hemifaces. The presence of such slight asymmetries in the zygoma warrants further investigation as to the clinical relevance of such skeletal asymmetries from both an esthetic and biomechanical consideration to provide insight as to the proper approach to zygomatic restoration in cases of zygomatic fracture.

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.)

Statement of Problem: Facial asymmetry is prominent with individuals with unilateral bone resorption and can lead to decreased quality of life., Purpose: The purpose of this study was to investigate the influence of maxillary obturator prostheses on facial morphology of individuals with unilateral maxillary defects by using 3-dimensional digital stereophotogrammetry., Material and Methods: The facial data of 8 participants with unilateral maxillary defects were acquired with a noncontact 3-dimensional digitizer, both with and without maxillary prostheses. The mid-facial plane was established by overlapping an original facial image with its mirror image. Displacement at 18 measurement points, including 7 bilateral pairs, was compared between the 2 sides, with and without the prostheses. Asymmetry indices of these 7 pairs also were calculated. Multivariate repeated-measures ANOVA was used to determine differences., Results: Displacements of the lateral and inferior points at the ala of the nose were significantly greater on the defect side than on the normal side. The distances between the ideal and defect side points at the superior ala, the upper lip, and the angle of the mouth decreased significantly with the prosthesis. No significant differences were found in asymmetry indices, but the angle of the upper lip line to the mid-sagittal plane increased significantly with the prosthesis., Conclusions: The 3-dimensional analyzing method developed in this study can be useful in evaluating facial reconstruction with maxillary obturator prostheses with individuals with unilateral maxillary defects. The prostheses affect the region of the nasal ala, the upper lip, and the angles of the mouth., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to investigate the effects of alar base cinch suture in Le Fort I osteotomy in mandibular prognathism with and without asymmetry., Material and Methods: Forty patients who underwent Le Fort I osteotomy were divided into an asymmetry group and a symmetry group (n = 20 each). Computed tomography (CT) was taken in all patients before and 1 year after surgery. The CT-3D volume rendering data with Aquarius Net (TeraRecon, Foster City, CA, USA) was reconstructed and the soft tissue was measured as follows, the distance between the bilateral alar base (Alar base width), the distance between the bilateral alar (Alar width), the angles between the FH plane and the line between the bilateral alar base (Alar base angle), the angle between the FH plane and the line between the bilateral alar (Alar angle), the angle between the FH plane and the line between the bilateral corners of the mouth (Lip angle), and the angle between the perpendicular line to the FH plane and the Philtrum (Philtrum angle)., Results: Significant differences were observed in the Alar width (P = 0.0448), the Alar angle (P = 0.0044), the Lip angle (P < 0.0001), and the Philtrum angle (P = 0.0057) between before and after surgery in the asymmetry group., Conclusions: This study suggested that the alar base cinch suture could prevent increases in the alar base width in both groups and help to improve the angle of soft tissue in the asymmetry group, although alar width significantly increases after surgery., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background/objective: Facial asymmetry is very common in adult class III patients; however, the degree of facial asymmetry in growing class III subjects has been poorly investigated. Therefore, the aim was to assess the degree of facial asymmetry of growing class III subjects and to compare it with a sample of growing subjects without malocclusion, recorded using a three-dimensional laser scanning method and classified according to the dentition phase., Subjects/methods: A group of 156 Caucasian subjects, 52 with class III malocclusion (28 females and 24 males) and 104 without malocclusion (control, 51 females and 53 males), with an overall mean age 6.7±1.4 years (range 4.3-10.3 years), were included. The subjects were further subdivided according to the presence of either primary or early/intermediate mixed dentitions. Facial asymmetry was assessed on three-dimensional surface facial images obtained using a laser scanning device in terms of mirrored face distances and percentages of asymmetry. Multivariate analyses were used to assess the differences among class III and control groups., Results: Complete facial symmetry was not seen in any subject. No significant differences of facial asymmetry were observed between the class III and control groups, neither in the primary nor in the early/intermediate mixed dentition phases., Limitations: No conclusions about longitudinal changes in the degree of facial asymmetry among class III subjects could be drawn from the present cross-sectional study., Conclusions: Based on three-dimensional facial asymmetry analysis, class III subjects do not show clinically relevant facial asymmetry, at least during the pre-pubertal growth period., (© The Author 2013. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Laser scanning is a non-invasive method for three-dimensional assessment of facial morphology and symmetry. The aim of this study was to quantify facial symmetry in healthy adolescents and explore if there is any gender difference. Facial scans of 270 subjects, 123 males and 147 females (aged 15.3 ± 0.1 years, range 14.6-15.6), were randomly selected from the Avon Longitudinal Study of Parents and Children. Facial scans were processed and analysed using in-house developed subroutines for commercial software. The surface matching between the original face and its mirror image was measured for the whole face, upper, middle, and lower facial thirds. In addition, 3 angular and 14 linear parameters were measured. The percentage of symmetry of the whole face was significantly lower in males (53.49 ± 10.73 per cent) than in females (58.50 ± 10.27 per cent; P < 0.01). There was no statistically significant difference in the amount of symmetry among facial thirds within each gender (P > 0.05). Average values of linear parameters were less than 1 mm and did not differ significantly between genders (P > 0.05). One angular parameter showed slight lip line asymmetry in both genders. Faces of male 15-year-old adolescents were less symmetric than those of females, but the difference in the amount of symmetry, albeit statistically significant, may not be clinically relevant. Upper, middle, and lower thirds of the face did not differ in the amount of three-dimensional symmetry. Angular and linear parameters of facial symmetry did not show any gender difference.

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.)

The face is the most important vehicle of human communication because of the fact that faces are not alike. The major objective of this article is to demonstrate qualitatively and quantitatively this determination based on 108 images. The first approach is based on Figure 1, which demonstrates the following five shapes of the human face: round, square, heart shaped, oval, and long. The disadvantage of this approach is that it is based on the eye of the beholder. In other words, 2 people might decide differently for the same face shape. The second approach is a quantitative one based on the determination of face symmetry. The major conclusion in both cases is that faces are not alike.

Asymmetrical changes in blood perfusion and asynchronous blood supply to head tissues likely contribute to migraine pathophysiology. Imaging was widely used in order to understand hemodynamic variations in migraine. However, mapping of blood pulsations in the face of migraineurs has not been performed so far. We used the Blood Pulsation Imaging (BPI) technique, which was recently developed in our group, to establish whether 2D-imaging of blood pulsations parameters can reveal new biomarkers of migraine. BPI characteristics were measured in migraineurs during the attack-free interval and compared to healthy subjects with and without a family history of migraine. We found a novel phenomenon of transverse waves of facial blood perfusion in migraineurs in contrast to healthy subjects who showed synchronous blood delivery to both sides of the face. Moreover, the amplitude of blood pulsations was symmetrically distributed over the face of healthy subjects, but asymmetrically in migraineurs and subjects with a family history of migraine. In the migraine patients we found a remarkable correlation between the side of unilateral headache and the direction of the blood perfusion wave. Our data suggest that migraine is associated with lateralization of blood perfusion and asynchronous blood pulsations in the facial area, which could be due to essential dysfunction of the autonomic vascular control in the face. These findings may further enhance our understanding of migraine pathophysiology and suggest new easily available biomarkers of this pathology.

Evidence-based practice in oral and maxillofacial surgery would greatly benefit from an objective assessment of facial harmony or gestalt. Normal reference faces have previously been introduced, but they describe harmony in facial form as an average only and fail to report on harmonic variations found between non-dysmorphic faces. In this work, facial harmony, in all its complexity, is defined using a face-space, which describes all possible variations within a non-dysmorphic population; this was sampled here, based on 400 healthy subjects. Subsequently, dysmorphometrics, which involves the measurement of morphological abnormalities, is employed to construct the normal-equivalent within the given face-space of a presented dysmorphic face. The normal-equivalent can be seen as a synthetic identical but unaffected twin that is a patient-specific and population-based normal. It is used to extract objective scores of facial discordancy. This technique, along with a comparing approach, was used on healthy subjects to establish ranges of discordancy that are accepted to be normal, as well as on two patient examples before and after surgical intervention. The specificity of the presented normal-equivalent approach was confirmed by correctly attributing abnormality and providing regional depictions of the known dysmorphologies. Furthermore, it proved to be superior to the comparing approach., (Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

It is one of the hot research problems nowadays to find a quick and accurate method of acquiring the facial plastic surgery area to provide sufficient but irredundant autologous or in vitro skin source for covering extensive wound, trauma, and burnt area. At present, the acquisition of facial plastic surgery area mainly includes model laser scanning, point cloud data acquisition, pretreatment of point cloud data, three-dimensional model reconstruction, and computation of area. By using this method, the area can be computed accurately, but it is hard to control the random error, and it requires a comparatively longer computation period. In this article, a facial plastic surgery area acquisition method based on point cloud mathematical model solution is proposed. This method applies symmetric treatment to the point cloud based on the pretreatment of point cloud data, through which the comparison diagram color difference map of point cloud error before and after symmetry is obtained. The slicing mathematical model of facial plastic area is got through color difference map diagram. By solving the point cloud data in this area directly, the facial plastic area is acquired. The point cloud data are directly operated in this method, which can accurately and efficiently complete the surgery area computation. The result of the comparative analysis shows the method is effective in facial plastic surgery area.

Purpose: The purpose of the present study was to investigate whether asymmetric mandibular prognathism accompanies a fundamental difference in soft tissue thickness and whether asymmetric mandibular setback surgery would influence the contour and thickness of the soft tissue of the chin., Materials and Methods: The present retrospective study included skeletal class III patients with significant mandibular chin deviation greater than 6 mm at the pogonion, who had undergone cone-beam computed tomography before and 6 months after surgery during a 2-year period. The predictor variables were timing (pre- and postoperatively) and side (asymmetric vs contralateral). The outcome measures were the hard and soft tissue contours and soft tissue thickness of the chin at the infradentale, B-point, and pogonion level evaluated with reformatted computed tomography images. The study variables were statistically compared using regression model and correlation analysis., Results: The present study consisted of 20 patients (10 males and 10 females; average age 20.2 years; range, 18 to 25). Preoperatively, the chin deviation side showed a more prominent hard and soft tissue outline but had a thinner soft tissue thickness, which camouflaged the hard tissue asymmetry. After surgery, the hard and soft tissue outline was greatly improved, and the soft tissue thickness had become nearly symmetric. Most of the soft tissue thickness changes correlated negatively with the hard tissue changes., Conclusions: Asymmetric mandibular prognathism accompanied the 3-dimensional soft tissue contour and thickness asymmetry. Because the soft tissue responds favorably after skeletal surgery, the correction of 3-dimensional asymmetry of bone should be emphasized in patients with asymmetric mandibular prognathism., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Condylar hyperplasia is an overdevelopment of the condyle, which may manifest unilaterally or bilaterally. This pathological condition can lead to facial asymmetry, malocclusion, and dysfunction of the temporomandibular joint. The etiology and pathogenesis of condylar hyperplasia remain uncertain, but it has been suggested that its etiology may be associated with hormonal factors, trauma, and hereditary hypervascularity, affecting both genders. The diagnosis is made by clinical examination, and radiological imaging, and additionally, bone scintigraphy, is a fundamental resource for determining whether the affected condyle shows active growth. Patients with active condylar hyperplasia management have better results when they are subjected to the high condylectomy procedure. The authors report a case in a 20-year-old female subject with unilateral active condylar hyperplasia who was treated by high condylectomy. The patient has been followed up for 4 years without signs of recurrence and with good functional stability of the occlusion.

Objective: The aim of this study was to evaluate the therapeutic effects of intralesion injection of pingyangmycin in combination with triamcinolone acetonide or pingyangmycin alone on lymphatic malformations in oral and maxillofacial regions., Methods: Twenty-nine cases with lymphatic malformations in the oral and maxillofacial region were divided into experimental and control groups. Thirteen patients in the experimental group underwent intralesion injections of pingyangmycin in combination with triamcinolone acetonide, and 16 patients of control group underwent intralesion injections of pingyangmycin alone. The effects of treatments were assessed by measuring lesion volume and facial deformity before and after treatment., Results: Two years after the treatment, the volumes of macrocystic and microcystic lesions were 3.7% ± 0.3 and 4.2% ± 0.4 of pre-treatment volume in the experimental group, respectively, whereas the volumes of macrocystic and microcystic lesions in control group were 15.4% ± 1.3 and 24.1% ± 3.1, respectively. Facial appearance was satisfactory in all subjects in the experimental group, whereas facial asymmetry remained in varying degree in control group., Conclusion: Intralesion injection of pingyangmycin with triamcinolone acetonide was more effective than pingyangmycin alone for treatment of lymphatic malformations in oral and maxillofacial regions., (Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The association of socioeconomic status (SES) with a range of lifecourse outcomes is robust, but the causes of these associations are not well understood. Research on the developmental origins of health and disease has led to the hypothesis that early developmental disturbance might permanently affect the lifecourse, accounting for some of the burden of chronic diseases such as coronary heart disease. Here we assessed developmental disturbance using bodily and facial symmetry and examined its association with socioeconomic status (SES) in childhood, and attained status at midlife. Symmetry was measured at ages 83 (facial symmetry) and 87 (bodily symmetry) in a sample of 292 individuals from the Lothian Birth Cohort 1921 (LBC1921). Structural equation models indicated that poorer SES during early development was significantly associated with lower facial symmetry (standardized path coefficient -.25, p=.03). By contrast, midlife SES was not significantly associated with symmetry. The relationship was stronger in men (-.44, p=.03) than in women (-.12, p=.37), and the effect sizes were significantly different in magnitude (p=.004). These findings suggest that SES in early life (but not later in life) is associated with developmental disturbances. Facial symmetry appears to provide an effective record of early perturbations, whereas bodily symmetry seems relatively imperturbable. As bodily and facial symmetries were sensitive to different influences, they should not be treated as interchangeable. However, markers of childhood disturbance remain many decades later, suggesting that early development may account in part for associations between SES and health through the lifecourse. Future research should clarify which elements of the environment cause these perturbations., (Copyright © 2011 Elsevier B.V. All rights reserved.)

In this study, we evaluated the three-dimensional (3D) soft tissue configuration of Japanese females with/without jaw deformity in order to establish the polygonal view of facial soft tissue deformity three-dimensionally. A polygonal chart was applied to assess the outcomes of orthognathic surgery for patients with mandibular hyperplasia with/without deviation. The study included 20 Japanese females with mandibular hyperplasia with/without deviation. All patients received mandibular setback surgery, and 3D measurements were carried out pre-operation, and at 1, 3 and 6 months postoperatively using a non-contact laser scanning system. Eighteen soft tissue landmarks were set on each 3D image and used to calculate a set of selected parameters. As controls, 20 Japanese females with class I occlusion were included. A polygonal chart was constructed based on the mean and S.D. of the control group. Patients with mandibular protrusion characteristically demonstrated significant variances in the items around the lower face. In asymmetric patients, deviation in the mental area disappeared postoperatively, but a small deviation remained when compared to the controls. The method used in this study seems to be a useful index for diagnosis and as a treatment plan for patients with mandibular hyperplasia with/without deviation., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Accurate measurement of facial sexual dimorphism is useful to understanding facial anatomy and specifically how faces influence, and have been influenced by, sexual selection. An important facial aspect is the display of bilateral symmetry, invoking the need to investigate aspects of symmetry and asymmetry separately when examining facial shape. Previous studies typically employed landmarks that provided only a sparse facial representation, where different landmark choices could lead to contrasting outcomes. Furthermore, sexual dimorphism is only tested as a difference of sample means, which is statistically the same as a difference in population location only. Within the framework of geometric morphometrics, we partition facial shape, represented in a spatially dense way, into patterns of symmetry and asymmetry, following a two-factor anova design. Subsequently, we investigate sexual dimorphism in symmetry and asymmetry patterns separately, and on multiple aspects, by examining (i) population location differences as well as differences in population variance-covariance; (ii) scale; and (iii) orientation. One important challenge in this approach is the proportionally high number of variables to observations necessitating the implementation of permutational and computationally feasible statistics. In a sample of gender-matched young adults (18-25 years) with self-reported European ancestry, we found greater variation in male faces than in women for all measurements. Statistically significant sexual dimorphism was found for the aspect of location in both symmetry and asymmetry (directional asymmetry), for the aspect of scale only in asymmetry (magnitude of fluctuating asymmetry) and, in contrast, for the aspect of orientation only in symmetry. Interesting interplays with hypotheses in evolutionary and developmental biology were observed, such as the selective nature of the force underpinning sexual dimorphism and the genetic independence of the structural patterns of fluctuating asymmetry. Additionally, insights into growth patterns of the soft tissue envelope of the face and underlying skull structure can also be obtained from the results., (© 2012 The Authors. Journal of Anatomy © 2012 Anatomical Society.)

Introduction: The aim of this study was to evaluate 3-dimensional facial shells by incorporating a population-specific average template with a group of Class III subjects preparing to have orthognathic surgery., Methods: The Class III group included 14 male (MCIII) and 15 female (FCIII) subjects. We used 43 male and 44 female Class I subjects to construct average male (AvM) and female (AvF) faces. Coordinates of 3 points on the facial templates of groups MCIII and FCIII and the templates AvM and AvF were compared. MCIII-AvM and FCIII-AvF superimpositions were evaluated for differences., Results: Vertical distances (sella to soft-tissue pogonion) were statistically significantly higher for the AvM (9.1%) and MCIII (10.1%) than for the AvF and FCIII, respectively (P < 0.05). The distances of soft-tissue pogonion in the horizontal x-axis were positive in 80% of the FCIII group and 85.7% of the MCIII group. The Class III subjects differed from the average face in the lower two thirds, but, in 50% (MCIII) and 60% (FCIII), they differed also in the upper facial third., Conclusions: (1) The average and Class III Slovenian male morphologic face heights are statistically significantly higher than those of the female subjects. (2) The Slovenian Class III male and female subjects tend toward a left-sided chin deviation. (3) Differences between Class III patients and a normative data set were determined., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Background: Developmental dysplasia of the hip (DDH) is a condition that affects the femoral head and the acetabulum and leads to hip subluxation and dislocation. Infants with DDH are usually treated using splints that immobilize their hip joint and are forced on their back for long periods of time. The link between positioning and facial asymmetries is poorly understood., Objective: To compare the facial morphologies of children with DDH to a group of healthy controls., Subjects and Methods: Fifty-six Finnish patients born with DDH were matched on the basis of gender and age to a control group. Three-dimensional surface images were captured using the 3dMDface system. Using RF6 PP2 software, anthropometric landmarks were plotted and used to calculate asymmetry based on 3D co-ordinates in a reference framework., Results: There was statistically significant difference between all paired facial shells. Relative to the control group, DDH boys and girls presented a chin-point deviation to the right, a more prominent left orbital ridge, a more protrusive nose and upper lip. The gender-specific subgroups show a similarity of 66.54 and 65.22% in girls and boys, respectively., Conclusions: Patients with DDH present a facial asymmetry when compared to healthy controls. Gender characteristics are marked whether subjects are affected with DDH or not. Three-dimensional surface imaging is a powerful diagnostic and research tool., (© 2010 John Wiley & Sons A/S.)

Purpose: The purpose of this study was to analyze the relationship between mandibular movement and facial morphology parameters measured using 3-dimensional CT data., Materials and Methods: We have developed a mandibular movement tracking and simulation system. The mandibular movement data were acquired from 22 subjects (6 males and 16 females), 3 who had no clinical facial deformities and 19 who had orthofacial deformities. The subjects voluntarily performed maximum mouth opening and closing movements. Three-dimensional maximum linear movements of selected points (bilateral condylions, infradentale, and pogonion) were calculated to represent mandibular movement. Facial morphology values were measured 3-dimensionally from CT data and bilateral morphological values were divided into 2 groups according to the mandibular deviation, the deviated side, and counter-deviated side groups. Correlation coefficients were calculated to evaluate the relationship between mandibular movements and facial morphology., Results: Maximum linear movements of all selected points on the mandible were positively correlated with sella-nasion-point A (SNA) and sella-nasion-point B (SNB). Movements of the infradentale and pogonion were significantly correlated with ramus inclination, lateral mandibular body angle, ramus length, and mandibular body length. Condylar movement was positively correlated with lateral mandibular body angle and mandibular body length. Multiple stepwise linear regression analysis was performed to evaluate the model predicting the effect of morphological values on mandibular movement. Condylar movement was associated with the SNA (R(2) value = 0.32 for the deviated side, R(2) value = 0.26 for the counter-deviated side), and movement of the infradentale was associated with both SNA and ramus length (R(2) value = 0.57). Movement of the pogonion could be predicted by SNA, mandibular length, and condylar head length (R(2) value = 0.65)., Conclusion: The 3D facial morphology values were associated with variations in mandibular movement, and morphological parameters contributed to predicting the movement of the mandible with different degrees., (Copyright © 2010 Mosby, Inc. All rights reserved.)

This prospective cross-sectional, case-controlled morphometric study investigated three-dimensional facial morphological variation among and between 8- and 12-year-old children [40 with a unilateral cleft lip and palate (UCLP), 23 with a unilateral cleft lip and alveolus (UCLA), 19 with a bilateral cleft lip and palate (BCLP), and 21 with an isolated cleft palate (ICP)]. Eighty gender- and age-matched individuals comprised the control group. The mean shape of each group was computed using generalized Procrustes analysis (GPA). Differences in shape between group means were assessed using multivariate analysis of variance and permutation tests, and shape differences were visualized for interpretation using warpings of the grand mean shape and transformation grids computed using thin plate splines (TPA). Statistically significant differences between the mean facial shapes and forms (shape plus size) of all groups were found. The greatest difference was in the BCLP group and the second greatest in the UCLP group. The study of asymmetry indicated different degrees and differences in the nature of asymmetry that characterize different cleft lip and palate (CLP) deformities. Principal component analyses (PCA) of form space and of means, plus reflected means, were informative with respect to the differences in facial size and shape and asymmetry between these groups. The results highlight differences in the aetiology of ICP and CLP groups and underline the potential value of statistical shape analysis in assessing the outcomes of CLP treatment.

To assess sex- and age-related characteristics in standardized facial movements, 40 healthy adults (20 men, 20 women; aged 20-50 years) performed seven standardized facial movements (maximum smile; free smile; "surprise" with closed mouth; "surprise" with open mouth; eye closure; right- and left-side eye closures). The three-dimensional coordinates of 21 soft tissue facial landmarks were recorded by a motion analyser, their movements computed, and asymmetry indices calculated. Within each movement, total facial mobility was independent from sex and age (analysis of variance, p>0.05). Asymmetry indices of the eyes and mouth were similar in both sexes (p>0.05). Age significantly influenced eye and mouth asymmetries of the right-side eye closure, and eye asymmetry of the surprise movement. On average, the asymmetry indices of the symmetric movements were always lower than 8%, and most did not deviate from the expected value of 0 (Student's t). Larger asymmetries were found for the asymmetric eye closures (eyes, up to 50%, p<0.05; mouth, up to 30%, p<0.05 only in the 20-30-year-old subjects). In conclusion, sex and age had a limited influence on total facial motion and asymmetry in normal adult men and women., (Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Introduction: Precise diagnosis and treatment of facial asymmetry are important in orthodontics. The aims of this study were to determine the soft-tissue characteristics of patients perceived to have severe asymmetry requiring treatment and the soft-tissue factors affecting the subjective assessment of facial asymmetry., Methods: In the first part of this study, 5 observers examined 1000 photographs of patients receiving orthodontic treatment and selected 100 for further assessment. These photographs showed 50 patients who were considered to have little or moderate asymmetry and 50 who were considered to have severe asymmetry. A pilot study was performed to select the reference photographs representing the most symmetric (score of 0) and the most asymmetric (score of 100). A panel of 9 orthodontists then rated the facial asymmetry of the 100 patients on a 100-mm visual analog scale. The scale was divided into 3 equal regions. Region 1 included patients with the least facial asymmetry; according to the orthodontists, these patients did not require treatment. Region 2 included patients with moderate facial asymmetry who did not require treatment. Region 3 included patients with the most facial asymmetry who did require treatment., Results: One-way analysis of variance showed that lip canting, chin deviation, body inclination difference, and gonial angle difference had significant differences between the groups. Chin deviation and gonial angle difference were significant factors affecting the assessment of facial asymmetry, according to stepwise linear regression analysis., Conclusions: These results will help in the diagnosis and treatment planning for patients with asymmetry., (Copyright (c) 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Craniosynostosis is classified according to the included sutures as either symmetric, such as scaphocephaly and brachycephaly, or asymmetric, such as plagiocephaly. Asymmetric craniosynostosis has been known to exert asymmetric effects not only on the cranium but also on the facial skeleton. Nonetheless, the presence of asymmetry in soft tissues is only speculative and is based on the experience of plastic surgeons. In our study, after measuring the surface coordinates of soft and bone tissues from numerous positions on three-dimensional computed tomography (CT), the distance between the coordinates was calculated and the thickness of the soft tissues was obtained by objective measurements. The subjects included a control group of 8 symmetric craniosynostosis patients, and the study group consisted of 7 asymmetric craniosynostosis patients selected by computed tomographic data. In each patient, the thickness of the midfacial area was measured by dividing it into frontal and lateral views. The results show that in symmetric craniosynostosis, the thicknesses of the right and the left soft tissues were statistically identical. However, in asymmetric craniosynostosis, the thickness of soft tissues in the hypoplastic side was statistically significantly thin according to measurements taken at both the frontal and the lateral views (P = 0.048 and P = 0.034, respectively). This suggests that surgeons should pay attention to the asymmetry of soft tissues during follow-up and when correcting facial asymmetry in asymmetric craniosynostosis.

Three-dimensional (3D) laser surface scanning analysis has taken hold in orthodontics, as well as craniomaxillofacial and plastic surgery as a new tool that can navigate away from the limitations of conventional two-dimensional methods. Various techniques for 3D reconstruction of the face have been used in diagnosis, treatment planning and simulation, and outcomes follow-up. The aim of the current prospective study was to present some technical aspects for the assessment of facial changes after orthodontic and orthognathic surgery treatment using 3D laser surface scanning. The technique proposed for facial surface shape analysis represented three-dimensionally the expected surgical changes, and the reduction of the postoperative swelling was verified. This study provides technical information from the data collection to the 3D virtual soft-tissue analysis that can be useful for diagnostic information, treatment planning, future comparisons of treatment stability or facial postoperative swelling, and soft-tissue profile assessment.

We present a novel application of methods for analysis of high-dimensional longitudinal data to a comparison of facial shape over time between babies with cleft lip and palate and similarly aged controls. A pairwise methodology is used that was introduced in Fieuws and Verbeke (2006) in order to apply a linear mixed-effects model to data of high dimensions, such as describe facial shape. The approach involves fitting bivariate linear mixed-effects models to all the pairwise combinations of responses, where the latter result from the individual coordinate positions, and aggregating the results across repeated parameter estimates (such as the random-effects variance for a particular coordinate). We describe one example using landmarks and another using facial curves from the cleft lip study, the latter using B-splines to provide an efficient parameterization. The results are presented in 2 dimensions, both in the profile and in the frontal views, with bivariate confidence intervals for the mean position of each landmark or curve, allowing objective assessment of significant differences in particular areas of the face between the 2 groups. Model comparison is performed using Wald and pseudolikelihood ratio tests.

Nine patients aged between 18 and 35 years who had severe skeletal Class III malocclusion and moderate-to-severe mandibular asymmetry, were assessed by a non-invasive, landmark-based, three-dimensional system before and after mandibular reduction by sagittal split osteotomy and LeFort I maxillary advancement. The three-dimensional coordinates of 50 facial soft tissue landmarks were collected, and a series of anthropometric measurements was calculated and compared with reference values from 240 healthy subjects of similar sex, age, and ethnic group. Patients were more asymmetrical than normal subjects before the operations, particularly in the gonion. Postoperatively, total and lateral asymmetry was considerably reduced. The three-dimensional approach was a valuable complementary diagnostic aid that enabled quantitative evaluation of the final soft-tissue results without invasive procedures.

Background: To obtain the best surgical results in orthognathic surgery, treatment planning and the evaluation of results should be performed on measurable three-dimensional reproductions of the face of the patients, and compared to reference subjects., Methods: Seven women aged 18-35 years, all with a skeletal Class III and mandibular asymmetry, were assessed both before (on average, 2 months) and after (on average, 10.7 months) surgical intervention (mandibular reduction by sagittal split osteotomy and LeFort I maxillary advancement). The three-dimensional coordinates of 50 soft tissue facial landmarks (face, eyes, nose, mouth and lips, ears) were collected with a noninvasive, electromagnetic digitizer; facial volumes were estimated, and compared to reference values collected in 87 healthy women of the same age and ethnic group. Inter-individual modifications in facial shape were also assessed., Results: Before surgery the patients had smaller faces than the reference women, with larger lower lips and noses. A large within-group variability was found. Surgical treatment significantly reduced total facial volume and mandibular volume, increased total and upper lip volumes (Student's t test, p<0.05), and made all values more homogenous within the group. Shape differences were significantly larger before than after surgery. On average, right side gonion was the landmark that moved the most, closely followed by menton, while the tragi and ala nasi moved the least. The three-dimensional approach used in this study enabled quantitative evaluation of the final soft tissue results of surgery, without submitting the patients to invasive procedures.

Purpose: This article describes construction of the average face and its application in the clinical environment., Subjects and Methods: A total of 72 children, mean age 11.8 years, were selected for the study. Laser-scanned images of the subjects were obtained under a reproducible and controlled environment with 2 Minolta Vivid 900 (Minolta, Osaka, Japan) optical laser-scanning devices assembled as a stereo pair. A set of left and right scanned images was taken for each subject and each scan took an average of 2.5 seconds. These scanned images were processed and merged to form a composite 3-dimensional soft tissue reproduction of the subjects using commercially-available reverse modeling software. The differences in facial morphology were measured using shell deviation color maps. The average face was used to compare differences between male and female groups and 3 subjects with craniofacial anomalies., Results: The difference between the average male and female face was 0.460 +/- 0.353 mm. The areas of greatest deviation were at the zygomatic area and lower jaw line, with the males being more prominent. The results of the surface deviation between the subjects with craniofacial anomalies were significant., Conclusions: The construction of the average face provides an interesting perspective into measuring changes in groups of patients and also acts as a useful template for the comparison of craniofacial anomalies.

An extremely rare case of asymmetrical bilateral oblique facial cleft presumably secondary to amniotic bands is presented. The cleft on the right side of the patient commenced from the lower lip through the maxillary region of the face to the temporal area and was described as a lower oro-temporal cleft to differentiate it from the previously reported type commencing from the upper lip.

Objective: The aim of this study was to characterize the soft tissue facial features of infants without cleft and to report on the correlation between these with weight, length, and head circumference., Design: This was a prospective study using a noninvasive three-dimensional (3D) stereophotogrammetry (C3D) system to capture the images of the participants. Landmarks were identified on the 3D facial images. Means and SDs were derived for facial distances and angles. A facial asymmetry score was calculated for each image. Two sample Student's t tests, Pearson's correlation coefficients and analysis of covariance were used to ascertain any gender differences and determine whether these could be explained by weight differences., Participants: Eighty-three infants, 41 boys and 42 girls, were captured at rest with their lips apart, at approximately 3 months of age., Results: Significant sex differences, of 1 to 2 mm, were found in several facial dimensions, such as face height and nose width. The larger facial measurements correlated significantly with body measurements. Analysis of variance confirmed these differences could be explained by differences in weight. There were no sex differences in the nose/mouth width ratios or in any of the angles measured, suggesting that there may be little sex difference in shape. A slight degree of asymmetry in the faces of infants without cleft was detected., Conclusions: Comparisons between noncleft controls and infants with cleft should take cognizance of normal age and sex variations in height and weight that occur among infants.

Klippel-Trénaunay-Weber syndrome is characterized by cutaneous hemangioma, arteriovenous fistulas or varicosities (or both), and unilateral hypertrophy of hard and soft tissues with different localization. Klippel-Trénaunay-Weber syndrome represents a syndrome of interest for those in the fields of oral and maxillofacial radiology and pathology because of the high incidence of compromise of the orofacial area in affected patients. The patient reported here presents with all of the 3 characteristic signs of the syndrome. The somatic and facial hypertrophy is contralateral to angiomata. As revealed through the use of magnetic resonance imaging, the primary component of facial hypertrophy is adipic subcutaneous tissue. Statistical analysis of the dental dimensions revealed that teeth on the hypertrophic side are significantly larger than normal.

Background: Aesthetic requests of patients undergoing orthognatic surgery have increased over time and represent nowadays the leading subjective motivation for the patient and a major aim of the treatment for the surgeon. In this regard, anthropometric evaluation has considerably improved the diagnostic capacity of the orthodontist and of the surgeon. Aim of the study is to provide the orthognatic surgeon with anthropometric normal values based on a sample of aesthetically pleasant Italian subjects and to discuss the use of a simplified aesthetical analysis in the set-up of the surgical plan and in the evaluation of treatment outcome., Methods: The present study analyses 94 Italian subjects, by means of anthropometric measurements on photographic images, considering 28 facial proportions and 33 angular values. These figures were compared with the aesthetic judgement provided by 3 common observers and 3 orthodontists. The aesthetic score was attributed on a subjective discrete scale (common observer: above average/average/below average; orthodontist: eumorphic/ dismorphic). Data were also compared with similar evaluations on North-American and African subjects reported in the international literature., Results: This study confirms the sexual dismorphism and the ethnic variability already reported by other Authors and documents specific morphological characters in the Italian population., Conclusions: The described method appears acceptably simple and consistent for clinical application. Its use in orthognatic surgery may provide objective and reproducible data for evaluating the aesthetic outcome of treatment.

We investigated soft tissue facial resemblance among relatives with or without syndromes and among related and unrelated individuals diagnosed with the same syndrome. Using correlation coefficients, we compared facial landmark (i.e., three-dimensional coordinate) positions and measurements gained by photogrammetry in various combinations of normal and syndrome-affected individuals. There were fewer significant correlations for the three-dimensional coordinates and measurements between the normal parent-normal child pairs than for the normal sib pairs. There was no discernible pattern for the single measurements in the parent-child pairs, whereas all of the midline vertical measurements were significantly positively correlated in the normal sib pairs. Significant correlations were always positive in all sib comparisons, but ranged from negative to positive in all parent-child correlations. The shared environment of sibs was a possible explanation for their greater resemblance in comparison with parent-child pairs. We also had measurements from 11 subjects (related and unrelated) diagnosed with one of four syndromes, and we used these to compare individuals with the same syndrome by calculating correlation coefficients based on all available pairs of measurements. The highest significant positive correlations were found for related individuals with the same syndrome (0.72 to 0.83). Unrelated individuals with the same syndrome also had significant positive correlations, but they were lower (0.35 to 0.65). We therefore inferred that the genetic similarities between unrelated individuals with syndromes played a role in the resemblance between them, and that common genes and environment in related individuals further contributed to the high correlations found for them., (Copyright 2001 Wiley-Liss, Inc.)

The ability of the restorative dentist to communicate the location and orientation of the patient's pertinent facial landmarks to the dental laboratory technician has great bearing on the esthetic success of final anterior dental restorations. This article describes a new device designed to facilitate this process.

The Klippel-Trénaunay syndrome is a triad of congenital anomalies characterised by haemangiomas, varicosities, and unilateral bony and soft tissue hypertrophy. Hypertrophy usually affects one distal limb, but trunk or face may be affected. Cutaneous haemangiomas (nevus flammeus) of varying extent and irregular contour are often present in the hypertrophic regions. Varicosities may also be part of the vascular lesions of the syndrome. Orofacial manifestations include facial asymmetry, jaw enlargement, and malocclusions as well as premature tooth eruption. Two cases of the Klippel-Trénaunay syndrome are presented here. Both of these show the typical hemifacial hypertrophy and premature eruption of teeth on the affected side. In the first case only the left mandibular region was affected. In contrast, in the second there was hypertrophy of the whole left side of the body including upper and lower jaws. This boy also suffers from congenital ideokinetic retardation, while the first was otherwise normal. Both cases differ from previously reported cases of the Klippel-Trénaunay syndrome in lacking any prominent facial nevus flammeus. In the first case there was also malformation of the crown of the first permanent molar on the affected side that has not been described previously.

We investigated soft tissue facial asymmetry in normal and syndrome-affected individuals ranging in age from 1 year to adulthood. The purposes of our study were to determine if facial asymmetry was greater in syndrome-affected individuals than in normal individuals and, if true, to distinguish those measurements that could be used in routine screening to identify the presence of syndromes in uncertain patients and, lastly, to investigate the causes of measurement asymmetry at the level of the landmarks. The last purpose was possible because we used a stereophotogrammetric method with which the three-dimensional (3D) landmark positions were obtained. In the statistically significantly different measurements, those from the right side were dominant, with one exception in each group, except normal males. In all groups the landmark analyses demonstrated the same trends, and while there was far less patterning in the 3D coordinates, these results were also consistent between the four groups. We compared the statistical findings of the 3D coordinates and measurements and found that there was no predictable relationship between significant findings in the landmarks and the measurements. In particular, we noted that statistical differences in measurements did not infer significant differences in the positions of the landmarks between the right and left sides of the face. Both the normal and syndrome-affected groups appeared to be equally canalized and similarly affected by developmental noise: When the bilateral measurement differences of each syndrome-affected subject were compared to the limits of normal asymmetry, less than 10% of the comparisons exceeded the norms., (Copyright 2000 Wiley-Liss, Inc.)

Purpose: The determination of an acceptable occlusal plane is essential for the development of esthetic prosthodontic restorations. However, since most faces are not symmetric, a method was developed for measuring facial angular asymmetry, i.e., the divergence from the vertical or horizontal of the line joining the midpoint of the intercanthal line and the philtrum of the lip, the interpupillary line, the intermeatal line, the lip commissure line, and the intercuspid line., Materials and Methods: Standardized frontal images (mouth closed, smiling, and biting on a wooden spatula) of 100 subjects were taken using a digital camera. These images were downloaded into a computer, and the angles between the various facial lines and the horizontal were measured. The subjects were grouped by sex, age, and history of trauma and orthodontic treatment., Results: No statistically significant differences were found between the mean values for each group., Conclusion: Asymmetry of the face can be measured using digital camera imaging and computer analysis. A range of facial asymmetries that can influence the choice of occlusal plane during prosthodontic treatment exists. Thus, the use of an occlusal plane parallel to the ala tragus and interpupillary lines, as often advocated by prosthodontists, may result in less than ideal esthetics in the final restoration.

Hemifacial microsomia is also known under quite a number of synonyms. Pathognomonic for these usually sporadic cases are: marked three dimensional asymmetry of the mandible, the ear, the maxilla, the zygoma and the orbit. The more distal the structure, the more marked the asymmetry. Many other optional symptoms are described. The differential diagnosis is almost never a problem in this aspecific complex of symptoms. Surgical therapy asks for expert treatment. The treatment contains usually several operations of which one to three are really major. Even then, very good results are mainly obtained in the less pronounced cases only.

Normal asymmetry in the area of the craniofacial skeleton can be directional or fluctuating in nature. Directionality can in principle be found in three dimensions: anteroposterior, cranio-caudal, and asymmetries in the left-right dimension. When it comes to directional left right differences, an explanation has been difficult to find, although expressions of this type are obvious. Recent findings made in molecular genetics strongly support the genetic inheritance pattern of laterality. When functionally increased asymmetries of facial structures are concerned, it is often difficult to determine the exact contribution of each factor involved. In the light of recent experimental data, however, it seems that the influence of occlusion on the development of balanced facial structures is highly important during the early periods of life. A review of these factors is given in this article.

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.

A clinical study of the craniofacial features in Apert syndrome is based on our experience with 136 cases. Characteristics included hyperacrobrachycephaly, steep wide forehead, flat occiput, common craniofacial asymmetry, ocular hypertelorism and proptosis, downslanting palpebral fissures, divergent upgaze and esotropic downgaze, a tendency towards large ears, and marked depression of the nasal bridge. The nose is short and wide with a bulbous tip, and the anterior facial height is reduced. Common features during infancy included horizontal grooves above the supraorbital ridges that disappear with age, a break in the continuity of the eyebrows, and a trapezoidal-shaped mouth at rest. Radiographic aspects of Apert syndrome were also assessed. Tables are provided which compare the craniofacial features of Apert and Crouzon syndromes.

Soft-tissue facial asymmetry was studied in a group of 80 young healthy white Caucasian adults (40 men, 40 women) with no craniofacial, dental or mandibular disorders. For each subject, the 3-dimensional coordinates of 16 standardised soft-tissue facial landmarks (trichion, nasion, pronasale, subnasale, B point, pogonion, eye lateral canthi, nasal alae, labial commissures, tragi, gonia) were measured by infrared photogrammetry by an automated instrument. The form of the right and left hemifaces was assessed by calculating all the possible linear distances between pairs of landmarks within side. Side differences were tested by using euclidean distance matrix analysis. The mean faces of both groups were significantly asymmetric, i.e. the 2 sides of face showed significant differences in shape, but no differences in size.