Search

To review and report the demographic and diagnostic data in a population with active unilateral condylar hyperplasia. The surgical intervention, sequencing of surgery, and treatment outcomes, including a quality-of-life survey, are described.Eighty patients were diagnosed with active disease. Demographic, treatment, and treatment outcomes were assessed. Quality of life was assessed by a 21-question questionnaire.Women were affected more frequently than men (W - 52; 65%; P = .008). Hemimandibular elongation (HE) (49; 61%; P - .004) occurred more frequently than hemimandibular hyperplasia (HH) (24; 30%) and HH-HE (7; 9%). Right side was affected more than left (R - 49; 61%; P - .003) overall, and when stratified. All racial groups were represented. Of the 80 patients in the sample, 80 (100%) underwent condylectomy on the side of active growth, 70 (87%) underwent bimaxillary osteotomies, 53 patients (66%) had single-piece maxillary osteotomies, 17 (21%) underwent segmental maxillary osteotomies, and 38 (48%) genioplasties were performed. Four patients (5%) underwent a second operation within a year of the first surgery to adjust the position of the mandible. Four (5%) facial nerve deficits were recorded. Class I cuspid occlusion was achieved with coincident maxillary and mandibular midlines and resolution of crossbite in 70 (88%) patients. Twenty three of the 24 respondents (96%) reported that they were satisfied with the treatment.Both HH and HE are diagnosed through clinical and radiographic examinations. Our results showed that HE occurs more frequently, all deformity subclassifications occur more frequently in females, the majority present in adolescence, and all racial groups are affected. The right side predominated. This study suggests that simultaneous condylectomy and orthognathic surgery provides predictable and stable outcomes for patients with active unilateral condylar hyperplasia and associated dentofacial deformities with an improvement in quality of living.

The study aimed to evaluate the morphologic changes in the pharyngeal airway after bimaxillary surgery in skeletal Class III malocclusion patients with or without asymmetry. We also analyzed the correlation between positional changes in the menton, hyoid bone, and changes in the dimensions of the pharyngeal airway.We included 32 patients with skeletal Class III malocclusion who underwent bimaxillary surgery. There were 16 subjects in the symmetry group (10 male, 6 female; mean age, 22.44 ± 5.14 years), and 16 in the asymmetry group (10 male, 6 female; mean age, 21.38 ± 4.62 years). Preoperative and postoperative (2 months after surgery) cone-beam computed tomography scans were taken and then analyzed by comparing postoperative changes in each group.The anteroposterior lengths at the uvula level (P2L) and epiglottis level (P3L) were significantly decreased in the symmetry group. The P2L was also significantly decreased in the asymmetry group, and a difference in the P3L was observed. However, there was no significant change in the width at the uvula level (P2W) and epiglottis level (P3W) in the symmetry group. In contrast, in the asymmetry group, P2W and P3W were significantly decreased. The cross-sectional ratio was significantly decreased P2 (P2L/P2W) and P3 (P3L/P3W) in the symmetry group. However, a statistically significant decrease occurred only at P3 in the asymmetry group. Anteroposterior positional changes of the menton and P2L (r = -0.370; P .05), P3L (r = -0.414; P 0.05), and P3L/P3W (r = -0.361; P 0.05) were correlated.Differences in the morphologic features of the pharyngeal airway after bimaxillary surgery was observed in both the symmetry and asymmetry groups. Bimaxillary surgery with a mandibular setback in patients with skeletal Class III malocclusion worsened morbidity of the elliptical structure of the pharyngeal airway. However, it worsened less in the asymmetry group than in the symmetry group.

Unilateral posterior crossbite, one of the most frequent malocclusions, is often associated with functional lateral shift of the mandible. Although the effects of functional lateral shift on the mandible and temporomandibular joint have been examined in various animal experiments, cranial and maxillary changes have received less attention.The aim of this study was to investigate the effects of functional lateral shift on the craniofacial complex in growing rats.Eighty 5-week-old male Sprague-Dawley rats were randomly divided into an experimental group (n = 40), which received an oblique guide appliance that shifted the mandible to the left during closure, and a control group (n = 40). The rats were scanned by cone-beam computed tomography at 3 days and 1, 2, 4 and 8 weeks. The dimensions of the mandibular bone, condyle, maxilla and cranium were measured.The mandibles of rats in the experimental group were smaller than those of the rats in the control group and were asymmetrical. The condyles of the rats in the experimental group were thinner than those of the control rats. The condylar length on the ipsilateral side was shorter and wider than that on the contralateral side from 4 to 8 weeks. No significant differences in cranial length or height were observed between the experimental and control groups. The height of the upper first molar and alveolar bone on the contralateral side was significantly smaller than that on the ipsilateral side and in the controls from 4 to 8 weeks.Functional shift in the mandible produces morphological asymmetries in the mandible and maxillary region and may cause bilateral condylar degenerative changes.

Objectives To investigate the association between three-dimensional (3D) skeletal variables and self-recognition of facial asymmetry in skeletal Class III patients. Materials and Methods Questionnaires and cone beam computed tomography of 74 patients (42 men and 32 women; mean age: 22.8 ± 4.5 years) with skeletal Class III and facial asymmetry were collected retrospectively. Patients were classified into three groups: group Sy (recognition of symmetry), group NS (not sure), and group Asy (recognition of asymmetry), according to their responses to the questionnaires. To assess 3D anatomic differences in the maxillomandibular region, six 3D hard tissue variables: maxillary height, ramal length, frontal ramal inclination (FRI), lateral ramal inclination (LRI), mandibular body length (Mn BL), and mandibular body height (Mn BH) were compared among the three self-recognition groups. Six 3D hard tissue variables and Menton deviation were reduced into three factors and their association with the self-recognition of facial asymmetry was investigated. Results Maxillary height, FRI, LRI, Mn BH, and Menton deviation demonstrated significant differences among the three self-recognition groups. The reduced factors, which consisted of transverse and vertical parameters, and vertical parameter of the mandibular corpus, demonstrated significant differences among the three self-recognition groups. The difference in Mn BH influenced the self-recognition of facial asymmetry. Conclusions Both the transverse and vertical parameter of the skeleton were determinant in self-recognition of facial asymmetry. Identification of the skeletal difference in the lateral view involving LRI and Mn BH should be included for assessment of facial asymmetry.

Ossifying fibroma (OF) is a rare, benign, fibro-osseous lesion of the jawbone characterised by replacement of the normal bone with fibrous tissue. The fibrous tissue shows varying amount of calcified structures resembling bone and/or cementum. The central variant of OF is rare, and shows predilection for mandible among the jawbone. Although it is classified as fibro-osseous lesion, it clinically behaves as a benign tumour and can grow to large size, causing bony swelling and facial asymmetry. This paper reports a case of large central OF of mandible in a 40-year-old male patient. The lesion was treated by segmental resection of mandible. Reconstruction of the surgical defect was done using avascular fibula bone graft. Role of three-dimensional printing of jaw and its benefits in surgical planning and reconstruction are also highlighted.

BACKGROUND The extent of facial involvement in positional plagiocephaly is only little investigated so far. Investigation methods that take into account the challenging anatomical conditions and growth of infants' faces are desirable. In this study, the authors established a new three-dimensional photogrammetry quantification method evaluating pretherapeutic and posttherapeutic facial asymmetry in positional plagiocephaly. Furthermore, a facial asymmetry index was established and evaluated. METHODS Three-dimensional photographs of 100 children undergoing treatment with head orthoses were analyzed by constructing a standardized interindividual coordinate system. Defining landmarks, section planes, and point coordinates with a computer-aided design software, both sides of the faces were compared. Facial asymmetry was quantified by measuring differences between left and right sides and pretherapeutic and posttherapeutic changes in each patient. The facial asymmetry index was calculated by putting the absolute differences in relation with the coordinates of the nonaffected side. RESULTS Present results indicate that positional plagiocephaly results in a distinct facial asymmetry (range, -3.8 to 9.6 mm) in nearly all spatial directions and facial regions. Helmet therapy led to a significant reduction (p < 0.05) of intraindividual facial asymmetry (median change in facial asymmetry index, -1.9 to 3.1 percent). However, no correlation of the Cranial Vault Asymmetry Index and facial asymmetry (Spearman rank correlation coefficient, ρ = -0.09 to 0.47) has been seen. According to these results, severe occipital deformation does not necessarily provoke distinct facial asymmetry. CONCLUSIONS Present three-dimensional photogrammetry method allows the longitudinal quantification of facial involvement in positional plagiocephaly. Asymmetry has been determined in all facial regions. The facial asymmetry decreased through helmet therapy but was not eliminated completely.

Objective To examine the level of agreement between the conventional method and a machine learning approach to facial midline determination and asymmetry assessment. Settings and sample population The study included a total of 90 samples (53 female; 37 male) with different levels of mandibular asymmetry. Materials and methods Two researchers placed predefined soft tissue landmarks individually on selected facial frontal photographs and created 10 reference lines. The midsagittal line was determined as perpendicular to the midpoint of the bipupillary line, and the same two reference lines and facial landmarks were automatically determined by the software using machine learning algorithms, and researchers created the other 8 reference lines using the facial landmarks that were determined automatically by the software. In the following stage, 2 linear and 10 angular measurements were made by a single researcher on 270 photographs, and the consistency and differences between the measurements were evaluated with a one sample t-test, an intraclass correlation coefficient (ICC) and Bland-Altman Plots. Results The level of agreement of measurements between the researchers and the software was low for eight parameters (ICC˂0.70). The one-sample t-test revealed that differences between the software and researcher measurements of lip canting and pronasale deviation were not statistically significantly different (P>0.05). Aside from the body inclination difference in Group 3 (samples with a mandibular body inclination difference >6°), there was no clinically significant difference (˂3°) between the measurements of the two methods. Conclusions Machine learning algorithms have the potential for clinical use in asymmetry assessment and midline determination, and can help clinicians in a manual approaches.

Summary Objective This study aimed to evaluate the mandibular skeletal asymmetry in pre-orthodontic patients with the unilateral posterior dental crossbite (UPCB). Materials and methods Using a retrospective design, 30 pre-orthodontic patients with a UPCB, (16 on the right side, 14 on the left side), 18 females and 12 males were selected (mean age: 21.2 ± 4.92 years), along with 30 controls matched by age and sex with cl I occlusal relationship (mean age: 21.9 ± 4.80 years). The patients were from an Orthodontic Department of Dental Faculty of Hamadan University of Medical Sciences and a private office from 2009 to 2013. In the UPCB group, at least one molar tooth was in the crossbite position. All the patients had initial CBCT 1 and pre-orthodontic study models. 10 linear and 3 angular measurements were performed to evaluate the mandibular skeletal asymmetry. repeated measure-ANCOVA 2 by controlling the effect of age and sex, T-test and paired-samples t-test were used for comparisons. Measurement's reliability was measured with ICC 3 test. Results There was a positional deviation of mandible to the crossbite side 95% CI 4 (0.166 - 1.087). The intergroup analysis showed that Corpus Length (P ≤ 0.014), Ramus Angle in frontal view (P ≤ 0.046), and Condylar-Width in axial view (P ≤ 0.029) in the crossbite side of the case group were significantly smaller than the control group. In the subjects with UPCB, mandibular condylar width was smaller in the crossbite side (17.31 ± 2.50) relative to the non-crossbite side (18.06 ± 2.18). Conclusions The adults with dental UPCB, in addition to deviation to crossbite side, may show smaller condylar head and Corpus length in crossbite side relative to the control group.

Condylar hyperplasia is (CH) a mandibular malformation that involves a change in the size and morphology of the condylar neck and head. The CH is an abnormality that usually occurs unilaterally and affects equally both men and women. Its etiology is controversial in its own right. Under this condition, mandibular growth occurs in all the 3 planes of space, but more predominantly in one of them. Treatment protocols are variable, but one of the best treatment choices is high condylectomy. Compared to the past, the change in the treatment protocol, as well as the innovations in both surgical and orthodontic technology, allowed a simplification of the therapeutic path, reduced patient discomfort and ensured more stable long-term postsurgical results.The authors present a case of a 40-year-old female patient with relapsed of unilateral CH, treated surgically for the second time and with orthodontic treatment with clear aligners. The clear aligners orthodontic treatment is now considered one the best treatment orthodontic options. In this case, considering the relapse of the hyperplasia and the need of a new orthodontic treatment we decide to use this technique to reduce patient discomfort and teeth force appliance.

Summary Objective Quantification and visualization of the location and magnitude of facial asymmetry is important for diagnosis and treatment planning. The objective of this study was to analyze the asymmetric features of the face for skeletal Class III patients using spatially-dense geometric morphometrics. Methods Three-dimensional facial images were obtained for 86 skeletal Class III patients. About 7160 uniformly sampled quasi-landmarks were automatically identified on each face using template mapping technique. The pointwise surface-to-surface distance between original and mirror face was measured and visualized for the whole face after robust Procrustes superimposition. The degree of overall asymmetry in an individual was scored using a root-mean-squared-error. Automatic partitioning of the face was obtained, and the severity of the asymmetry compared among seven facial regions. Results Facial asymmetry was mainly located on, but not limited to, the lower two-thirds of the face in skeletal Class III patients. The lower cheek and nose asymmetry were detected to have more extensive and of a greater magnitude of asymmetry than other facial anatomical regions but with various individual variations. The overall facial asymmetry index and the regional facial asymmetry indices were higher in males and patients with chin deviation. Conclusions Soft tissue asymmetry is predominately presented in the lower-third of the face in skeletal Class III patients and with various variations on other facial anatomical regions. Morphometric techniques and computer intensive analysis have allowed sophisticated quantification and visualization of the pointwise asymmetry on the full face.

Purpose Our current understanding of unilateral condylar hyperplasia (UCH) was put forth by Obwegeser. He hypothesized that UCH is 2 separate conditions: hemimandibular hyperplasia and hemimandibular elongation. This hypothesis was based on the following 3 assumptions: 1) the direction of overgrowth, in UCH, is bimodal—vertical or horizontal, with rare cases growing obliquely; 2) UCH can expand a hemimandible with and without significant condylar enlargement; and 3) there is an association between the condylar expansion and the direction of overgrowth—minimal expansion resulting in horizontal growth and significant enlargement causing vertical displacement. The purpose of this study was to test these assumptions. Patients and Methods We analyzed the computed tomography scans of 40 patients with UCH. First, we used a Silverman Cluster analysis to determine how the direction of overgrowth is distributed in the UCH population. Next, we evaluated the relationship between hemimandibular overgrowth and condylar enlargement to confirm that overgrowth can occur independently of condylar expansion. Finally, we assessed the relationship between the degree of condylar enlargement and the direction of overgrowth to ascertain if condylar expansion determines the direction of growth. Results Our first investigation demonstrates that the general impression that UCH is bimodal is wrong. The growth vectors in UCH are unimodally distributed, with the vast majority of cases growing diagonally. Our second investigation confirms the observation that UCH can expand a hemimandible with and without significant condylar enlargement. Our last investigation determined that in UCH, there is no association between the degree of condylar expansion and the direction of the overgrowth. Conclusions The results of this study disprove the idea that UCH is 2 different conditions: hemimandibular hyperplasia and hemimandibular elongation. It also provides new insights about the pathophysiology of UCH.

This study aims to show our institute’s experience in the treatment of HH and its associated facial deformities in adults and growing adolescents and to investigate condylar remodeling and volumetric changes and long-term stability of orthognathic surgery in adults. The study included consecutive patients with clinical and radiological features of HH who underwent high condylectomy with or without simultaneous orthognathic surgery from 2013 to 2018. The clinical outcomes were assessed based on functional activities, TMJ pain, and recurrence. Postoperative 3D condylar remodeling and orthognathic stability were evaluated with the use of ITK-Snap and 3D Slicer. Thirteen patients (8 females and 5 males) with a mean age of 26.3 ± 5.79 years (range; 13–34 years) were included with facial asymmetry as the chief complaint. The patients were followed up for a minimum of 12 months and a maximum of 4 years (mean; 16.85 ± 10.04). There were no postoperative complications, and all patients achieved a satisfactory functional and aesthetic outcome using a one-stage surgical procedure. There was no incidence of recurrence or further asymmetries, with long-term stability at the selected points showing a mean difference of less than ±1 mm. The affected condylar volume was significantly reduced following high condylectomy, with mean changes between T1 and T2 of −144. 80 mm3 (p = .012). However, the contralateral condylar volume remained stable, with a mean change of 2.54 mm3 (p = .881). One-stage high condylectomy and orthognathic surgery is a viable measure for the treatment of HH and associated deformities in adults. High condylectomy in early adolescence could result in termination of the disease, and aesthetic improvement with further constant orthodontist-surgeon follow-up is required.

A novel heterozygous IVS11-2A>C(c.1957-2A>C) mutation in the GLI2 gene is reported. There was an extremely distinct phenotypical expression in two siblings and their father. The index case was a boy who developed cholestasis and hypoglycaemia in the neonatal period. He had bilateral postaxial polydactyly, mid-facial hypoplasia, high palatal arch, micropenis, and bilateral cryptorchidism. Laboratory examination revealed a diagnosis of multiple pituitary hormone deficiency. There was severe anterior pituitary hypoplasia, absent pituitary stalk and ectopic posterior pituitary on magnetic resonance imaging which suggested pituitary stalk interruption syndrome with no other midline structural abnormality. Molecular genetic analysis revealed a novel heterozygous splicing IVS11-2A>C(c.1957-2A>C) mutation detected in the GLI2 gene. His father and a six-year-old brother with the identical mutation also had unilateral postaxial polydactyly and mid-facial hypoplasia although there was no pituitary hormone deficiency. This novel heterozygous GLI2 mutation detected appears to present with an extremely variable clinical phenotype, even in related individuals with an identical mutation, suggesting incomplete penetrance of this GLI2 mutation.

It is considered normal for facial structures to exhibit mild asymmetry between left and right sides. An automated, landmark-independent method was developed to accurately assess and quantify facial asymmetry in 3 planes of space and describe a midline deviation of each subject and ultimately establish thresholds of significance.The subjects were 279 healthy young Western Australian white adults (134 females and 145 males) with a mean age 22.17 years ± 0.63, (minimum 20.58 years-maximum 24.42 years) without craniofacial anomalies. They were randomly selected from participants in the Raine Study-Generation 2. Surface facial images were obtained using a 3dMDface scanning system (3dMD Inc, Atlanta, Ga). Images were standardized using the dense correspondence technique. An automated landmark detection method was applied, and measurements performed on color deviation maps to quantitatively assess facial asymmetry.Based on asymmetrical projections over the total facial surface area, the proportion of female and males with moderate asymmetry (2-5 mm) was 52.3% and 58.4%, respectively, and with severe asymmetry (5 mm) was 7.1% and 7.7%, respectively. Most asymmetry occurred in the coronal plane (x-axis), followed by the transverse plane (z-axis) and the least asymmetry in the sagittal plane (y-axis). Males were statistically more asymmetrical (P 0.05) in the coronal and transverse planes (males: coronal 36.5%, transverse 15.2%; females: coronal 31.8%, transverse 12.3%). The midline was deviated to the right in all females and in all but 1 male subject.This study presents an automated, rapid and accurate method of assessing 3-dimensional facial asymmetry (using symmetry and midline analyses). Analyses revealed that 50% of the faces of young adults are 2 mm asymmetrical, based on total facial surface area.

Background Facial asymmetry from unilateral condylar hyperplasia (UCH) may be definitively treated in the presence of active disease (with high condylectomy and concurrent orthognathic surgery) or after waiting for disease inactivity (orthognathic surgery alone). There is currently no consensus on the standard of care. In this study, we sought to compare functional and esthetic outcomes, as well as treatment duration, between these 2 management options. Methods Patients who underwent treatment for UCH were identified through retrospective review. Pre- and postoperative 3-dimensional (3D) images were obtained. Short- and long-term operative outcomes of those treated during the active (group 1) were compared to those treated in the inactive phase (group 2). Total treatment time, operative time, and length of hospital stay were evaluated. Facial asymmetry was also assessed by laypersons using a Likert scale. Results Fifteen patients (mean 25.6 years, range 14-56) were included: 6 in group 1 and 9 in group 2. All surgical outcomes were statistically independent of procedure type. Treatment time was significantly longer in the group 2 (P = 0.03). Both groups demonstrated significant improvement in facial asymmetry scores postoperatively with no significant difference in pre- or postoperative asymmetry between groups (P = 0.64). Conclusions In patients with active UCH, high condylectomy and orthognathic surgery is a procedure that restores facial symmetry and improves jaw function while halting mandibular growth. Good esthetic and functional outcomes, as well as reduced treatment time and disease burden, support the use of this treatment option for this population.

This case report presents the unique treatment of a patient with varying asymmetries at different levels within the face. The patient was a 17-year-old male with a diagnosis of right unilateral coronal synostosis. He had frontal and superior orbital retrusion on the fused side, and bossing of the contralateral side. The middle and lower portions of his face were rotated toward the nonfused side. This unique diagnosis presented particular challenges to surgical and orthodontic correction. The treatment approach, which included a combination of Le Fort I and II osteotomies, bilateral sagittal split osteotomy, and orthodontic treatment with 4 premolar extractions, enabled simultaneous correction of nasal, midfacial, lower facial, and dental asymmetries. The orthodontist and surgeon integrated their efforts to correct dentofacial asymmetry in all 3 planes of space. Facial esthetics and dental function were significantly improved with no appreciable relapse occurring over a 2-year retention period.

This study aimed to evaluate the stability of lingual plate osteotomy after sagittal split ramus osteotomy (SSRO) in patients with severe facial asymmetry. It included 20 patients undergoing lingual plate osteotomy between January 2011 and January 2017. Cephalometric X-ray imaging and three-dimensional computed tomography (3DCT) were performed before the operation and then 1 day and 1 year after the operation. The relapse rate and postoperative complications were assessed. The operation time was compared between lingual plate osteotomy and transoral angle osteotomy. Specific values measured on cephalometric X-ray and 3DCT images showed significant changes 1 day after the operation, with 47.9% correction occurring in the occlusal plane angle (mean ± SD = 1.74 ± 0.84°, p 0.05). However, no significant differences were found between measurements taken 1 day and 1 year after the operation, with a 5% change seen in the occlusal plane angle (mean ± SD = 0.1 ± 0.24°, p = 0.61), suggesting that the surgical outcomes can be well maintained for at least 1 year after surgery. Three patients experienced numbness postoperatively but recovered within 1 year. The operation time for lingual plate osteotomy was shorter than that for transoral angle osteotomy. Our findings indicate that lingual plate osteotomy after SSRO is stable, effective, and safe in patients with severe facial asymmetry.

Humans have structures dedicated to the processing of faces, which include cortical components (e.g., areas in occipital and temporal lobes) and subcortical components (e.g., superior colliculus and amygdala). Although faces are processed more quickly than stimuli from other categories, there is a lack of consensus regarding whether subcortical structures are responsible for rapid face processing. In order to probe this, we exploited the asymmetry in the strength of projections to subcortical structures between the nasal and temporal hemiretina. Participants detected faces from unrecognizable control stimuli and performed the same task for houses. In Experiments 1 and 3, at the fastest reaction times, participants detected faces more accurately than houses. However, there was no benefit of presenting to the subcortical pathway. In Experiment 2, we probed the coarseness of the rapid pathway, making the foil stimuli more similar to faces and houses. This eliminated the rapid detection advantage, suggesting that rapid face processing is limited to coarse representations. In Experiment 4, we sought to determine whether the natural difference between spatial frequencies of faces and houses were driving the effects seen in Experiments 1 and 3. We spatially filtered the faces and houses so that they were matched. Better rapid detection was again found for faces relative to houses, but we found no benefit of preferentially presenting to the subcortical pathway. Taken together, the results of our experiments suggest a coarse rapid detection mechanism, which was not dependent on spatial frequency, with no advantage for presenting preferentially to subcortical structures. Electronic supplementary material The online version of this article (10.3758/s13414-019-01877-3) contains supplementary material, which is available to authorized users.

Background Large maxillofacial venous malformation (VM) lesions can affect the craniofacial skeleton, causing occlusal and craniofacial deformity. Few studies have discussed the management of these skeletal disorders. It is unclear whether orthodontic treatment and orthognathic surgery are necessary after such a VM lesion has been significantly reduced. Methods A 13-year-old boy with a large, extensive maxillofacial VM lesion, severe facial asymmetry, macroglossia, and lower lip hypertrophy visited our department in 2010. He received more than 100 sclerotherapy treatments and 20 laser treatments in the past 8 years. Results The patient's cosmetic disfigurement greatly improved, and the VM lesion diminished by more than 80%. Changes in the bite and craniofacial skeleton progressed from "normal" to "open bite with skeletal deformity" and finally to "spontaneously close to normal". Conclusions During the progression of VM, removal of pathogenic factors can inhibit the aggravation of open bite deformity and promote the spontaneous improvement, thereby circumventing the need for complicated osteotomy, orthodontic intervention and/or orthognathic surgery.

Purpose: In survivors of orbital embryonal rhabdomyosarcoma (ERMS), late effects include facial deformation and asymmetry. We sought to quantify orbital asymmetry in ERMS survivors and characterize the dose effect of radiation to the orbital bones. Methods and Materials: We evaluated the most recent follow-up magnetic resonance imaging (MRI) in 17 children (≤21 years old) with stage 1 group III orbital ERMS treated with proton therapy between 2007 and 2018. For all patients, the orbital socket volumes were calculated and compared with the contralateral, unirradiated orbital socket. Patient age, orbital tumor quadrant, and the radiation dose delivered to the major orbital bones (maxillary, frontal, and zygomatic bones) were recorded and correlated with the orbital socket volume difference. Results: The mean age at diagnosis was 5.4 years old (range, 1.1-9.7 years). All patients received a prescription dose of 45 GyRBE. The mean time interval between radiation and MRI was 2.9 years (range, 0.8-3.2 years). The mean age at most recent MRI was 8.4 years (range, 2.3-12.9 years). In 16 of 17 patients, the volume of the ipsilateral orbit was significantly smaller than the contralateral orbit on follow-up MRI (P ≤ .0001). In one patient with nonviable tumor in situ, the irradiated orbit was larger. The volume difference increased with follow-up time and did not correlate with age at treatment or age at MRI. A dose >40 GyRBE to all bones of the orbital rim was associated with a significant decrease in orbital volume (P < .05), but an isolated dose of >40 GyRBE to either the frontal, maxillary, or zygomatic bone was not. Conclusions: Despite the dosimetric precision of proton therapy, orbital asymmetry will develop after >40 GyRBE to multiple bones of the orbital rim. These data may be used to guide treatment planning and counsel patients on expected cosmesis.

Background Lips and mouth are the most recognizable parts of the lower face. The morphometry of the facial organs is important for the balance of the face. Besides congenital anomalies occur on the lips, some kinds of deformities might be seen because of trauma or carcinoma. In this respect, lips are in the study of plastic surgery, maxillofacial surgery and orthodontics. Lip morphology also takes an important role in forensic facial reconstruction (facial approximation). Materials and methods Twenty parameters on the soft tissue and 12 parameters on the hard tissue were measured on three dimensional (3D) computed tomography (CT) images belonging 50 individuals (25 female, mean age 35.40 ± 9.97; 25 male, mean age 34.32 ± 11.06). Results Statistical significance was observed on 4 parameters measured at soft tissue and 6 parameters measured in hard tissue. Statistical significance was not seen between the measurements taken bilaterally. Fourteen equations were developed in order to estimate the lip morphometry using the morphometric traits of hard tissue. Conclusion We hope that the results of current study will be useful at surgery and forensic sciences.

It was aimed to determine the change of facial asymmetry resulting from nasal septal deviation (SD) depending on age, gender, degree of deviation and the affected area besides the effect of SD on somatotype and craniofacial morphology.171 volunteers (90 males, 81 females), 27 individuals aged 9-13, 44 individuals aged 14-18, 44 individuals aged 19-23 and 56 individuals in control group participated in the study conducted in otorhinolaryngology polyclinic.11 photometric, 16 anthropometric measurements were taken from the participants.SD affects facial asymmetry formation, although not statistically significant compared to healthy individuals asymmetry rates (p˃0.05). It was determined that the degree of SD affected asymmetry only between the ages of 14-18 (in adolescence) and the development of asymmetry in all SD patients was not statistically dependent on age and gender (p˃0.05). Photometric measurements demonstrated asymmetries in horizontally-extending parameters of 1/3 middle part of face. There was no statistically significant difference in the cranial anthropometric measurements of the upper and lower 1/3 of the face compared to the control group (p˃0.05). The order of the most asymmetrical parameters is Alare-Zygion, Alare-Subnasale, Cheilion-Gonion, Exocanthion-Cheilion, Midsagittal plane-Zygion, Zygion-Cheilion, Zygion-Gonion, Subalare-Cheilion, Glabella-Exocanthion. In all participants were determined that endomorph somatotype was dominant in female and mesomorph somatotype was dominant in male besides SD did not affect somatotype and somatotype did not alter with age.The development of facial asymmetry due to SD is not affected by age and gender furthermore SD does not affect craniofacial asymmetry and somatotype.

Summary Background Defining three-dimensional (3D) normal craniofacial morphology in healthy children could provide craniofacial surgeons a reference point to assess disease, plan surgical reconstruction, and evaluate treatment outcome. The purposes of this study were to report normal craniofacial form and quantify craniofacial asymmetry of healthy children in Taiwan by implementing the 3D stereophotogrammetry technique. Methods Healthy Taiwanese elementary school children (n = 652) aged 6–12 years with no known craniofacial anomaly were recruited. After the 3dMD scanning procedure, 32 landmarks were manually placed on the 3D cranial images. Thin plate spline algorithm based on landmarks and closest point matching was applied to deform a symmetric 3D template into the scale of each scanned images. Skull asymmetry and facial asymmetry were calculated using 3dMD vultus and MATLAB. Average head shape models were also presented. Results Overall, the mean head transverse width, height, anteroposterior length, and circumferences were 163.02, 220.79, 179.07, and 526.55 mm, respectively. On average, the skull asymmetry and facial asymmetry were 2.47 ± 1.26 mm and 0.96 ± 0.53 mm, respectively, with no significant (all p > 0.05) differences found when comparing males and females. In the average head shape model, certain craniofacial areas on the right side were found to be more protruded than those on the left side. Conclusions This study shows that the baseline craniofacial form of the Taiwanese elementary school children is asymmetric with a tendency of more protrusion of the head on the right side.

Summary Background Tissue expanders can lead to bone deformity as well as bone resorption. Not all changes in the cranial bone can be completely normalised after tissue expander extraction. This study aimed to investigate the potential factors for persistent forehead deformities after tissue expansion. Patients and methods Cases of forehead tissue expansion performed from 2011 to 2015 were retrospectively reviewed. Demographic and clinical data were collected. Two plastic surgeons (Y.Q. and C.Q.) evaluated changes in the forehead by comparing preoperative and most recent postoperative photographs. The Fisher exact, chi-square and Student t tests, and univariate and multivariate logistic regression analyses were performed in this study. Results Sixty-seven patients underwent forehead expanded flap reconstructions and continuous follow-ups were done in the outpatient service. The mean duration of the follow-ups after expander removal was 33.86 months. Overall, 28 (41.8%) patients had forehead changes. Age, sex, indications for tissue expansion and follow-up time were not associated with forehead changes. There were significant differences in the total injection volume and expansion period between patients with forehead changes (41.8%) and those without (58.2%). No significant negative correlation was found between the duration of pressure bandage usage post-operatively and the occurrence of forehead changes. Conclusions Our recommendations for performing tissue expansion in the skull area are as follows: (1) always choose expanders with the largest base dimension; (2) perform tissue expansion as quickly as possible and (3) do not cause overexpansion. In addition, there was no proven benefit of using pressure bandages when skeletal changes occurred.

This study proposes a high-precision surgical technique that combines both computer-aided design/computer-aided manufacturing (CAD/CAM) and the screw-track transfer technique for condylar and occlusal reconstruction.A 43-year-old male patient with facial asymmetry, limited mouth opening, and malocclusion underwent condylar and occlusal reconstruction surgery. An autogenous cor-onoid process graft was performed by combining CAD/CAM and the screw-track transfer technique.The surgical plan was transformed successfully from preoperative virtual surgical planning to actual surgery; this was confirmed by merging the postoperative computed tomography images with the preoperative three-dimensional surgical design. The patient recovered well and had better occlusion and facial symmetry, as well as an increased degree of mouth opening post-surgery. No complications were observed.CAD/CAM combined with the screw-track transfer technique is a precise and feasible method that can be applied to autogenous coronoid process grafts. This approach can be used to reconstruct the condylar process and achieve a good occlusal relationship.

The aim of the current study was to evaluate the effect of the use of computer-guided surgical templates in association with mandibular distraction osteogenesis to correct mandibular asymmetry. In the study group a simulation process was conducted to restore the exact position of the chin skeletally by planning the osteotomy orientation, distractor vector, pin positions, and distraction distance calculation. The Control group was treated with conventional distraction in which an oblique osteotomy was done, and distraction was performed until the midline coincided. Patients were randomly allocated into two groups, study and control. The study included (12) young patients; ten males participated and two females (average age 14 ± 6 years) (Range = 6-23 years)). There was a statistically significant (P = 0.02) improvement in smile orientation in the study with 63.7% ± 19% improvement compared to control, which had only 37% ± 14%. There was a statistically significant (P = 0.02) improvement in ramus height in the study with 93% ± 9% improvement compared to control, which had only 74% ± 16%. There was a non-significant (P = 0.2) improvement in chin deviation in the study with 42% ± 26% improvement compared to control, which had only 25% ± 15%. The secondary outcome results showed that there was statistically significant (P = 0.0001) improvement in smile orientation post distraction 50% ± 21%, there was statistically significant (P= P=0.002) improvement of ramus height post distraction osteogenesis 82% ± 16%, and there was statistically significant (P = 0.0001) improvement in chin deviation 33% ± 22% post distraction osteogenesis. Overall, the current research recommends the use of computer planned distraction instead of conventional planned distraction in order to achieve better symmetry. Distraction failed in correction of chin asymmetry; thus, the authors recommend performing genioplasty post distraction after the patient reaches puberty for more optimum results regarding the chin.

Objective: To evaluate the development of the craniofacial region in healthy infants and analyze the asymmetry pattern in the first year of life. Methods: The participants were grouped by sex and age (1, 2, 4, 6, 9, and 12 months) to receive three-dimensional (3D) photographs. Stereoscopic craniofacial photos were captured and transformed into a series of craniofacial meshes in each group. The growth patterns of the anthropometric indices and the degree of craniofacial asymmetry were measured, and average craniofacial meshes and color-asymmetry maps with craniofacial asymmetry scores were calculated. Results: A total of 373 photographs from 66 infants were obtained. In both genders, the highest and lowest growth rates for all anthropometric indices were noted between 1 and 2 months and between 9 and 12 months, respectively. Overall, male infants had higher anthropometric indices, head volume, and head circumference than female infants. The craniofacial asymmetry score was presented with a descending pattern from 1 to 12 months of age in both sex groups. Both sex groups showed decreased left-sided laterality in the temporal-parietal-occipital region between 1 and 4 months of age and increased right frontal-temporal prominence between 6 and 12 months of age. Conclusions: A longitudinal evaluation of the craniofacial growth of healthy infants during their first year of life was presented.

Objective The present study aimed to determine the site and severity of maxillomandibular asymmetry before and after orthognathic surgery in asymmetric patients. Materials and methods Presurgery and postsurgery cone beam computed tomography (CBCT) data of 21 facial asymmetry patients (7 males and 14 females, mean age: 23.0 ± 3.36 years) with soft tissue chin deviation ≥ 3 mm who had undergone bimaxillary surgery were evaluated. Seven midline and twenty bilateral hard tissue landmarks were identified for the evaluation of facial asymmetry and outcomes were assessed against age- and gender-matched control subjects. Results In the asymmetry group, bilateral landmarks exhibited significant deviation in the mandible and midface regions. Before surgery, asymmetry was more severe at the mandibular midline and sites close to it, in the asymmetry group. Bimaxillary surgery proved to be highly effective, with a significant correction of the menton to a clinically normal value (2.90 mm, p p = 0.001) in the R-L direction. Moreover, significant asymmetry persisted at the sigmoid notch (p = 0.001) in the S-I direction. Conclusions Mandibular midline landmarks and chin peripheral regions contribute significantly to overall facial asymmetry characteristics. Despite significant correction after bimaxillary surgery, asymmetry persisted at several sites, thereby requiring secondary correction. Comprehensive 3D presurgical planning is central for asymmetry correction in a single surgery. Clinical relevance The present study specifies the location of residual asymmetry sites and advocates the correction of those sites during initial surgery.

Fat grafting is a widely adopted method for reconstructing upper lip asymmetries. However, most surgical techniques are difficult to reproduce, and none follow anatomical principles.The aim of this study was to assess the clinical outcomes of upper lip contour asymmetry and lip cant correction by anatomical upper lip fat grafting using the subunit and fat compartment principles.A prospective analysis was conducted of 113 consecutive patients who underwent anatomical upper lip fat grafting using the subunit and fat compartment principles for the management of lip cant and/or upper lip contour (volumetric) asymmetry. Quantitative photogrammetric upper lip symmetry and lip cant measurements were blindly performed preoperatively and at 3 and 12 months postoperatively. A panel assessment (by 8 blinded external plastic surgeons and 8 laypersons) was obtained to grade the qualitative upper lip symmetry. Bivariate and multivariate analyses were performed to identify independent variables associated with the 12-month postoperative lip cant change.There was significant (all P0.05) postoperative quantitative and qualitative upper lip symmetry and lip cant enhancement (preoperativepostoperative) after a single upper lip fat grafting procedure, and the outcomes were maintained (all P0.05) from 3 to 12 months postoperatively. Parry-Romberg syndrome was negatively associated (P0.05) with the 12-month postoperative lip cant change.Anatomical upper lip fat grafting, using the subunit and fat compartment principles, improves lip cant and symmetry in patients with unilateral upper lip asymmetries.

Craniofacial microsomia (CFM) is a variable craniofacial malformation, related to the development of the structures originated from the first and second brachial arches, affecting skeletal tissue, soft tissue, and neuromuscular components. In the situation of subcutaneous tissue and chewing muscles hypoplasia, free tissue transfer is a treatment option. Dermal-fat graft allows easy modeling during surgery, volumetric gain and improvement of asymmetry. The aim of this study was to evaluate the facial contour and the percentage of symmetry after the use of dermal-fat graft in patients with CFM, who had already submitted to osteotomies, attended at the Associate Center for Cleft Lip and Palate (CAIF) during 2001 to 2018. For analysis, the authors selected 17 patients who fulfilled the above prerequisites. The symmetry study was done by the analysis of preoperative and postoperative photographs in the Image J software. Two standard points were used: nasal base and upper lip limit. On the nasal base, the preoperative analysis showed a hypoplastic side with a median of 93.00% of the normal side size, rising to 97.78% in the postoperative period. On the upper lip limit, the preoperative analysis showed a median of 87.80% and, in the postoperative period, 98.15%. Analysis of the interaction between the operative moments and the modified Pruzansky classification showed that there were no significant differences between grades. Long-term evaluation demonstrated that the use of a dermal-fat graft for correction of facial symmetry was effective and close to 100%, regardless of the degree of hypoplasia of the patient.

The mandibular proximal ramus segments should be moved and rotated during orthognathic surgery-based skeletofacial reconstruction for the correction of challenging patients with facial asymmetry and malocclusion, but quantitative data regarding this rotation were not sufficient to date. This 3D computer-assisted study measured the proximal ramus segment rotation after 3D simulation-guided two-jaw surgery in patients with facial asymmetric deformity and class III malocclusion (n = 31). Using 3D mandible models and a reliable proximal ramus segment-related plane, angular changes in pitch, roll and yaw directions were measured before and one month after surgery. Significant rotational changes (p

Summary Despite being one of the most pervasive debilitating skeletal problems in the craniofacial region, surgical-orthodontic management of long-standing asymmetric Class II dentofacial deformities is often a unique challenge posed to the clinicians. This case report describes the encouraging results of systematically sequenced and staged therapeutic approach adopted for successful rehabilitation of an adult patient with asymmetric Class II dentofacial deformity with mandibular micrognathia secondary to unilateral TMJ ankylosis. Concurrent gap arthroplasty and bilateral distraction of mandibular body were performed during the first operation for functional restoration of mandibular movements and correction of mandibular micrognathia and associated asymmetry. After 13 months of post-distraction orthodontic treatment, Le Fort I osteotomy for inferior repositioning and sagittal advancement of maxilla was performed during the second operation, in conjunction with adjunctive alloplastic reconstruction of inferior border of mandible for optimization of facial aesthetics. Postsurgical orthodontic detailing facilitated achievement of stable, balanced interdigitation. The total active treatment period was 29 months. After treatment, both the skeletal disharmony and the functional stability were significantly improved with establishment of functional occlusion. The morphological and functionally acceptable results were reasonably well-maintained during three-year follow-up. The merits of mandibular osteodistraction vs. conventional mandibular orthognathic surgery and the potential advantages of staged surgical approach are discussed.

Intellectual disability affects 2% - 3% of the general population, with a chromosomal abnormality being found in 4% - 28% of these patients and a cryptic subtelomeric abnormality in 3% - 16%. In most cases, these subtelomeric rearrangements are submicroscopic, requiring techniques other than conventional karyotype for detection. They may be de novo or inherited from an affected parent or from a healthy carrier of a balanced chromosomal abnormality. The aim of this study was to characterize patients from our medical genetics center, in whom both a deletion and duplication in subtelomeric regions were found.Clinical and cytogenetic characterization of 21 probands followed at our center, from 1998 until 2017, with subtelomeric rearrangements.There were 21 probands from 19 families presenting with intellectual disability and facial dysmorphisms. Seven had behavior changes, five had epilepsy and 14 presented with some other sign or symptom. Four had chromosomal abnormalities detected by conventional karyotype and four were diagnosed by array-comparative genomic hybridization. In four cases, parental studies were not possible. The online mendelian inheritance in man classification was provided whenever any of the phenotypes (deletion or duplication syndrome) was dominant.Patients and relevant family members were clinically and cytogenetically characterized. Although rare, subtelomeric changes are a substantial cause of syndromic intellectual disability with important familial repercussions. It is essential to remember that a normal array-comparative genomic hybridization result does not exclude a balanced rearrangement in the parents.Parental genetic studies are essential not only for a complete characterization of the rearrangement, but also for accurate genetic counselling and screening of family members at risk for recurrence.Introdução: O défice intelectual afeta 2% – 3% da população geral, sendo encontrada uma alteração cromossómica em 4% – 28% dos casos e uma alteração subtelomérica em 3% – 16%. Estas alterações subteloméricas são, na maioria dos casos, submicroscópi- cas, não sendo detetadas no cariótipo convencional. Podem ser de novo ou herdadas de um progenitor afetado ou de um progenitor saudável portador de um rearranjo equilibrado. O objetivo deste estudo foi caracterizar os doentes seguidos no nosso centro de gené- tica médica com uma deleção e uma duplicação nas regiões subteloméricas. Material e Métodos: Caracterização clínica e citogenética de 21 probandos com alterações subteloméricas seguidos no nosso centro entre 1998 e 2017. Resultados: Foram caracterizados 21 probandos que apresentavam défice intelectual e dismorfia facial, pertencentes a 19 famílias. Sete tinham alterações do comportamento, cinco epilepsia e 14 outro sinal ou sintoma. Quatro tinham alterações no cariótipo e quatro foram diagnosticados por array-comparative genomic hybridization. Em quatro famílias não foi possível o estudo dos progenitores. Quando um dos fenótipos era dominante (síndrome de deleção ou duplicação), foi atribuída a classificação online mendelian inheri- tance in man. Discussão: Foi realizada classificação dos doentes e das famílias. As alterações nas regiões subteloméricas são, apesar de raras, uma causa substancial para défice intelectual sindrómico com repercussões familiares importantes. É essencial lembrar que um array- comparative genomic hybridization normal não exclui um rearranjo equilibrado familiar. Conclusão: O estudo dos progenitores é essencial não só para caracterização completa do rearranjo mas também para um aconse- lhamento genético preciso e identificação de familiares em risco de recorrência.

The purpose of this study was to assess the objective and subjective outcomes of lower face volumetric (contour) asymmetry correction with isolated fat grafting in skeletally immature patients.A prospective analysis was conducted of skeletally immature patients (n = 73) with craniofacial microsomia and Parry-Romberg syndrome who underwent isolated fat grafting (with no previous or concomitant bone surgery) using anatomical surgical principles (facial subunits and fat compartments) for the reconstruction of lower face volumetric asymmetry. Objective ultrasound and photogrammetric lower face symmetry analyses were blindly performed preoperatively and at 3 and 12 months postoperatively. A panel assessment of blinded surgical professionals and laypersons was also obtained to grade the subjective lower face symmetry.There were significant (all P0.05) postoperative objective and subjective lower face symmetry enhancements (preoperativepostoperative) after isolated fat grafting, with no differences (all P0.05) between 3 versus 12 months' postoperative comparisons.Growing patients with unilateral lower face volumetric asymmetries presented with improvement of objective and subjective symmetry after a single isolated fat grafting procedure.

Limited data are available regarding observers' visual attention to faces with congenital difference. We implemented eye tracking technology to examine this issue, as it pertains particularly to faces with cleft deformity.Four hundred three observers assessed 273 clinical images, while their eye movements were unobtrusively tracked using an infrared sensor. Forty-one facial images of the repaired cleft lip, 137 images of other facial conditions, and 95 images of matched controls were assessed. Twenty facial regions of interest ("lookzones") were considered for all images observed. A separate cohort of 720 raters evaluated the images for attractiveness. Observer and image demographic information was collected. Visual fixation counts and durations were computed across all 20 lookzones for all images. The effect of a variety of variables on lookzone fixation was analyzed using factorial ANOVA testing.Cleft-repaired faces were rated as less attractive and drew observers' attention preferentially to the affected upper lip lookzone (p.001). Images rated as less attractive garnered greater visual attention in the cleft-affected lookzones (p.001). The eye tracking methodology demonstrated exquisite sensitivity to laterality of cleft deformity (p.001). Individuals reporting a personal or a family history of facial deformity fixated more on the perioral region of cleft-repaired faces than did naïve observers (p.001).These findings highlight the utility of eye tracking measures for understanding critical variables that influence the visual processing of faces with cleft deformity. The data may provide analytical tools for assessing surgical outcome and direct priority setting during surgeons' conversations with patients.

Objectives: To use three-dimensional (3D) mirroring and surface-to-surface techniques to determine any differences in mandibular functional unit shape and morphology between the crossbite side and non-crossbite side in adult patients with posterior unilateral crossbite who had not received any corrective treatment for malocclusion. Materials and Methods: Cone-beam computed tomography (CBCT) records from 24 consecutive adult white patients (mean age, 27.5 years; range 22.6–39.7 years; 14 women and 10 men) seeking treatment for maxillary transverse deficiency were assessed in this study. The control group comprised CBCT scans from age- and sex-matched patients. Segmentation masks were generated to obtain 3D surface mesh models of the mandibles and analyze the six skeletal functional units, which were further analyzed with reverse engineering software. Results: Statistically significant differences in the mean surface distance when comparing the study sample and the control sample were found at the condylar process, mandibular ramus, angular process (P ≤ .0001), and alveolar process (P ≤ .01); no statistically significant differences were found for the coronoid process, the chin, and the mandibular body (P ≥ .5). Conclusions: The condylar, angular, and alveolar processes plus the mandibular ramus appear to play a more dominant role than did the body, the coronoid, and the chin units in the asymmetry of the mandible in patients with unilateral crossbite.

Hyperplasia of the mandibular condyle is self-limiting, but can lead to facial asymmetry, malocclusion, pain, and dysfunction of the temporomandibular joint (TMJ). Bone scintigraphy, particularly with single photon emission computed tomography (SPECT), is effective in assessing relative condylar uptake, but we know of no standardised methods or values. Our aim, therefore was to validate the values currently used to measure relative condylar uptake in our population. Between December 2015 and June 2018 44 patients had skull SPECT (15 male and 29 female patients, whose ages ranged from 4-33 years). They were having bone scans (hydroxydiphosphonate (HDP) -99MTc, 740 MBq ev) for unrelated reasons and had no known abnormalities of the head, facial asymmetry, or symptoms of the TMJ. Two research workers measured the relative uptake between the condyles using the summed transaxial images. The Hospital Ethics Committee approved the investigation. The maximum difference in condylar uptake was 8.33% with research worker 1 and 8.77% with research worker 2, and the mean (SD) differences were 3.03 (0.17) % and 3.29 (0.18) %, respectively. Data were tested for normality, and the t test and one-way ANOVA were used to assess the significance of differences. None was found in total counts either between sexes or age groups, and there were none between the total counts measured by the two research workers. We conclude that our results are within the published ranges, and the variation in condylar uptake was less than 5% in 37/44 patients, and in none was it 9% or more. When the results indicate less than 10%, but there is a high clinical suspicion of active hyperplasia, surgeons should use their clinical judgement to decide whether condylar surgery is required.

Bilateral cleft lip and palate (BCLP) occurs when craniofacial precursors fail to form or fuse properly during development. The aim of this retrospective, cross-sectional investigation was to quantify directional asymmetry (DA) of the facial skeleton of children born with Veau Class IV nonsyndromic BCLP. To accomplish this goal, coordinate values of anatomical landmarks were acquired from three-dimensional cone beam computed tomographic images of the craniofacial skeleton of middle- to late-aged children born with BCLP and age- and sex-matched controls and used to compare patterns of asymmetry variation. Multivariate analyses revealed different patterns of DA variation across samples and identified approximately 30% of DA measures as significantly different. Magnitudes of statistically significant linear distances differ in the craniofacial region, with most smaller DA differences located near the orbits and frontal bone, while larger differences were localized mostly to the midface, alveolar ridge, and nasal borders. Generally, areas of the craniofacial skeleton derived from the maxillary and nasal prominences demonstrated the highest magnitudes of DA. The methods and results presented will be useful to biomedical researchers when identifying the extent to which patients with BCLP diverge from typical developmental expectations. Quantifying DA and assessing local differences across the craniofacial complex can aid medical practitioners when developing treatments to improve BCLP surgical algorithms and outcomes. Anat Rec, 302:1726-1732, 2019. © 2019 American Association for Anatomy.

To evaluate the effects of surgical navigation in zygomaticomaxillary complex (ZMC) fracture reduction. ZMC symmetry was assessed quantitatively.The sample comprised 25 patients who underwent surgical reduction of comminuted ZMC fractures. They were divided into two groups according to the use of surgical navigation. Reduction outcomes were evaluated using three-dimensional computed tomography models. Five pairs of landmarks were identified on all craniofacial models, and asymmetry scores were calculated based on their coordinates. In quantitative analyses, symmetry and orbital volume were compared between groups.All patients recovered uneventfully. Greater symmetry was observed in the navigation group than in the control group for three of the five pairs of landmarks (p 0.05). Although postoperative volumes of the injured orbits were similar between the two groups (p 0.05), reduced orbital volumes were larger in the navigation group, indicating better restoration of the fractured orbits (p 0.05).The use of surgical navigation can increase postoperative symmetry of the bilateral ZMC. The quantitative evaluation of clinical outcomes is precise and highly reliable.

The aims of this study were to evaluate facial bilateral soft tissue thickness in symmetric and asymmetric subjects and to investigate whether soft tissue compensates for skeletal asymmetry.Cone-beam computed tomography (CBCT) scans of 97 subjects were divided into a symmetry group (GSm) and an asymmetry group (GASm). Seven bilateral points were established. Each point involved 3 variables: hard tissue distance (Hard-D), soft tissue distance (Soft-D), and soft tissue thickness (Soft-Th). Measurements were taken from software-generated multiplanar reconstructions. A paired t test was used to assess intragroup differences and an independent t test for intergroup analysis. Pearson coefficient tested correlations between variables.In GASm, significant differences were found in all Hard-D and Soft-D measurements, with higher values observed on the deviated side (P 0.01). As for Soft-Th evaluation, results of only 1 reference point presented statistical significance. Intergroup comparison detected significant differences in all Hard-D and Soft-D variables (P 0.01), but no significant differences in Soft-Th.Asymmetric subjects presented differences in hard and soft tissue distances between deviated and nondeviated sides, although without affecting soft tissue thickness. It can be concluded that soft tissue does not compensate or disguise an underlying skeletal asymmetry.

Purpose To analyze the clinical significance of the periorbital features associated with the facial asymmetry that is common in deformational posterior plagiocephaly (DPP). Patients and methods We identified 32 patients with DPP, photographed their faces and tops of their head, and performed a complete eye examination. Four examiners analyzed the patient's periorbital features on the photographs. Results Median age was 6.5 months (range 3-12 months). Pseudoptosis was identified in 30 patients and pseudo-brow ptosis in 19. Pseudoptosis was marked in 17 patients. Five patients were misdiagnosed with congenital blepharoptosis and received regular follow-ups for amblyopia checks until the diagnosis of pseudoptosis was established. All patients had normal levator function and symmetric eyelid crease. One patient with pseudoptosis and physiologic anisocoria was diagnosed with pseudo-Horner syndrome after a negative 10% cocaine test. None of the patients developed meridional or occlusion amblyopia. Conclusion DPP is the most frequent form of skull deformation in infants. Its main features are occipital flatness and facial asymmetry. Infants with DPP may present with pseudoptosis and pseudo-brow ptosis on the contralateral side of the occipital flatness. The pseudoptosis in DPP is non-amblyogenic, therefore, ophthalmologic intervention and regular follow-ups are not necessary unless other abnormalities co-exist.

Purpose To evaluate the position and bilateral difference of mandibular ramus region, specifically the condyle, sigmoid notch, and mandibular angle in skeletal class III patients with mandibular asymmetry. Materials and methods 3D-CT images were performed in 50 patients with skeletal class III malocclusion. According to the severity of mandibular asymmetry, 22 cases were included in the control group and 28 cases were included in the symmetry group. The 3D landmarks were measured relative to 6 reference planes and the outcomes among different groups were compared. Results There are significant differences in the position of mandibular ramus region between both sides in the asymmetry group. The position of condyle was more posterior and internal on the deviated side; and the positions of sigmoid notch and gonion were more posterior, superior, and lateral on the deviated side. Furthermore, the degree of mandibular asymmetry was more highly correlated with the height of ramus and the position of mandibular angle than it was with the height of condyle and the position of sigmoid notch. Conclusion When evaluating mandibular asymmetry and making surgical plans, the position of mandibular ramus should be taken into consideration.

To quantify the surface facial asymmetry in a group of young patients with hemifacial microsomia (HFM) and to investigate differences with a homogeneous sample of healthy subjects, using a novel stereophotogrammetric method.Twelve patients (mean age 13.1 ± 3.1 years) with different degrees of HFM and 15 healthy controls (mean age 12.2 ± 3.5 years) were imaged with a stereophotogrammetric facial scanner. The root mean square error (RMSE) of the distances between the corresponding points of each original photograph and its mirror copy was calculated for the whole face and for each trigeminal third, as defined by the innervation of trigeminal branches. A statistical analysis was performed to compare the RMSE value of all facial areas within each group and between patients and controls.RMSE values progressively increased from the upper to the lower third of face, both in patients and controls. The level of asymmetry was significantly higher in HFM subjects for middle third (p 0.01), lower third (p 0.001) and whole face (p 0.001); no statistically significant differences were found between the groups for the upper third.The reported technique provides an accurate topographic analysis of the facial asymmetry, and is recommended for conditions such as HFM affecting only part of the face.

Orbital asymmetry in unicoronal synostosis impacts craniofacial appearance and can potentiate functional visual disturbances, such as strabismus. Surgical treatment aims to normalize overall cranial morphology, including that of the orbits. The purpose of this study was to compare postoperative changes in orbital asymmetry following 2 common procedures.Preoperative and 1-year postoperative computed tomography scans for patients with isolated, nonsyndromic unicoronal synostosis treated from 2007 to 2012, at 2 academic institutions were analyzed. Only patients treated by endoscopic suturectomy and postoperative helmeting or bilateral fronto-orbital advancement were included. Orbital index, depth, and volume asymmetry were determined for each patient both pre- and 1-year postoperatively. Student's t-tests were used to compare pre- and postoperative asymmetries within each treatment group. Regression analyses were used to examine postoperative change in asymmetry between treatment groups.Scans from 12 patients treated by fronto-orbital advancement and 23 treated by endoscopic suturectomy were analyzed. Differences between synostotic and nonsynostotic orbital index, depth, and volume were statistically significant both pre- and postoperatively. Statistically significant postoperative improvements in asymmetry were observed for orbital index, depth, and volume following suturectomy. Regression analysis indicated that the amount of pre- to postoperative change in all measures of asymmetry did not depend on surgical technique. Residual asymmetry following both procedures was apparent at 1 year postoperatively.Orbital asymmetry is improved, but not resolved following both fronto-orbital advancement and endoscopic suturectomy. Degree of improvement in symmetry is independent of surgical technique used.

Craniofacial microsomia is characterized by an asymmetric hypoplasia of derivatives of the first and second pharyngeal arch, leading to a variety of phenotypic presentations. Studies on surgical correction of patients with craniofacial microsomia have small cohorts, leaving controversial opinions on the optimal treatment modality, the indication for surgery, and the optimal timing of surgery. The purpose of this study was to evaluate the types of, timing of, and total number of surgical corrections performed and the number of surgical procedures in correlation to the severity of the phenotype.A retrospective chart study was conducted including patients diagnosed with craniofacial microsomia from three large craniofacial units. Demographic, radiographic, and clinical information was obtained, including type and number of surgical procedures and age at the time of surgery.A total of 565 patients were included. In total, 443 (78.4 percent) of all patients underwent some form of surgery during their life, varying from skin tag removal to major craniofacial operations. The number of surgical interventions was higher with increasing severity of phenotype, bilateral presentation, and a younger age at the first intervention.Multiple surgical corrections are frequently seen in patients with a more severe or bilateral presentation. Furthermore, those who are treated earlier in life for correction of asymmetry of the mandible will undergo significantly more surgical procedures to correct the asymmetry later on, independent of the Pruzansky-Kaban type mandible. A prospective international multicenter study is designed with a uniform registration and outcome measurement tool to identify the optimal treatment strategy.