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Objectives: Introduce a novel method for objectively evaluating attentional bias to peripheral facial deformities using an established metric of attention., Methods: The SMI eye-tracker system (SensoMotoric Inc., Boston, MA) was used to record the eye movement patterns, called scanpaths, of eight naïve observers gazing at pictures of faces with or without peripheral surgical deformities. The scanpaths of observers gazing on those novel faces were compared, and the fixation durations for different facial regions were compared between faces., Results: There were statistically significant differences in the mean fixation times between the faces considered normal and those considered abnormal (those with an obvious defect). When multivariate analysis of variance was performed with dependent variables total fixation time, fixation time in central triangle, and fixation time in the defect region and the independent variable face, all four tests were highly statistically significant. When univariate analysis of variance was performed to test the hypothesis that defect fixation times varied by face, the results were highly statistically significant (F = 8.79, P = .0003)., Conclusions: Observers gazing on faces typically focus their attention on discriminating features, such as eyes, nose, and mouth. The well-established method of eye movement recordings was applied in a novel way to provide quantitative data showing changes in observer gaze patterns to focus on deformities. These gaze patterns are a direct reflection of observer attention. This is the first objective method to quantify the amount of distraction caused by peripheral facial deformities and may provide insight into the perception of facial deformity.

According to the result of retrospective studies for patients who have not taken medical treatment, most patients experience late enophthalmos and perceive their facial asymmetry. Thus, correct diagnosis method and concrete operative indication were required for medial orbital wall fracture. Retrospective investigation on all patients with facial trauma, who had visited the emergency room between January 1, 2000 and December 31, 2006, was made. Height and longitudinal length of the defect were obtained, and computed tomographic scan of the defect area was obtained. The degree of enophthalmos was measured, and investigation on enophthalmos and presence of facial asymmetry perceived by the patients was made. When the defect area of medial orbital wall fracture was 0.55 cm, late enophthalmos of 1 mm occurred, and patients with late enophthalmos of 1 mm or more perceived their enophthalmos and facial asymmetry. In conclusion, medial orbital wall fracture whose defect area is 0.55 cm or more requires operation.

The goal of this study was to investigate the possible relationship between established measures of body and brain asymmetries and individual differences in paranormal beliefs. In addition to behavioural measures of cerebral laterality, measures of facial features and finger length were taken to calculate body asymmetry scores and indicators of fluctuating asymmetry (average absolute differences between left and right body features). Both the direction and degree of laterality measures were used. In addition to that, quantitative measures of inconsistency of cerebral lateralization were obtained. Results indicated that a stronger belief in paranormal phenomena was associated with fluctuating asymmetry of finger length, and that this aspect of body asymmetry may be related to greater intraindividual variability in the degree of 'atypical' functional lateralization. This intraindividual variability index, in turn, significantly predicted strength of belief in the paranormal. Belief in the paranormal was also higher in women than men and it was negatively correlated with the education level. In sum, these findings suggest that a part of the variance of strength of belief in paranormal phenomena can be explained by patterns of functional hemispheric asymmetry that may be related to perturbations during fetal development.

Objective: Evaluation of the Dutch Child Oral Health Impact Profile (COHIP), assessing the level of concordance between parents and children. The internal consistency and the predictive validity of the COHIP for self-reported general health were examined., Methods: Sample size was 35 pairs of parents and children age 11 to 14 with craniofacial conditions. Cronbach alphas were calculated and the level of concordance between parents and children was studied using t tests and intraclass correlations. Predictive validity was assessed using Pearson correlations and linear regression analyses., Results: The COHIP and its subscales, except for one, had satisfactory to high Cronbach alphas (.59 to .94). Parents and children did not differ significantly. Correlations between parents and children were high (.62 to .91). Only "Oral symptoms" proved to be a significant predictor of general health, but only in the parent sample., Conclusions: In spite of the high level of concordance found, proxy reports have to be considered complementary to the reports of the children themselves. The Dutch version of the COHIP performs adequately, but could use some further psychometric evaluation and revision. It does not seem advisable to use the subscales separately as predictors in the same regression model, since they are strongly intercorrelated. For use in craniofacial patients, further validation is needed on a larger sample and some items need to be revised or removed. Finally, given the small number of cases, conclusions must be drawn with caution.

Background: The therapeutic uses of botulinum toxin have been expanding due to deeper knowledge of its molecular behaviour and different mechanisms of action., Objective: To present suggested doses of Botox and Dysport for controlling the muscle hyperkinetic activity in facial palsy in the perioral area and to review other uses., Methods: An extensive updated literature review on the success and limits of the botulinum neurotoxin (BoNT) therapeutic treatments., Results/conclusion: BoNT can be considered to be the preferred single method for many disorders; it has substituted for some conventional surgical methods and it can be associated with other therapies to increase overall treatment performance. Depending on the disorder, the lack of permanent effect causes no major inconvenience.

Introduction: We report a rare case of Proteus syndrome which presented with dysphagia due to unilateral tonsillar hypertrophy., Case Report: Our case had involvement of multiple organs in addition to bony deformities, namely, enlarged right parotid gland and right testis, verrucous naevus, varicose veins and abdominal lipoma. The features unique to this case were a larger right optic disc and expansion of the inner table of the skull., Discussion: A literature review revealed less than 100 bona fide, published cases which fit the revised diagnostic criteria proposed by Turner., Summary: The ENT manifestations of Proteus syndrome are high arched palate, gingival hypertrophy, malocclusion and overcrowding of teeth, hyperostosis of the external auditory meatus, and low nasal bridge. Our patient had a unilateral enlargement of the tonsil causing dysphagia, which was relieved by tonsillectomy.

Ratings of physical attractiveness are related to degree of facial symmetry. Acute alcohol consumption affects ratings of physical attractiveness and also attenuates aspects of visual perception. We tested the hypothesis that increases in ratings of attractiveness associated with alcohol intoxication can be attributed at least in part to a reduced ability to discern facial asymmetry due to reductions in levels of visual perception. We examined whether alcohol intoxication reduces ability to detect asymmetry in approximately symmetrical images. Sober and intoxicated subjects were shown a series of simple geometric images to which they responded on whether they perceived each one to be symmetrical or asymmetrical. Intoxicated subjects were significantly less able to detect asymmetry than were sober subjects, providing support for the hypothesis.

This case report describes the orthodontic treatment of a 43-year-old man with Class III malocclusion and crossbite of the maxillary anterior teeth. Treatment options included orthognathic surgery, nonextraction treatment, premolar extractions, and mandibular incisor extraction. The patient opted for nonsurgical treatment that included the extraction of a mandibular central incisor.

Introduction: The purpose of this study was to determine the means and the ranges of the thresholds of cephalometric indexes by which orthodontists subjectively differentiate patients needing treatment for facial asymmetry from those who do not. The study was performed at the Departments of Orthodontics and Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry in Nagoya, Japan, in 2004., Methods: Ten orthodontists subjectively evaluated the frontal photographs of 100 subjects and classified them into 2 groups. The subjects in group A showed good or clinically acceptable levels of asymmetry and did not require treatment. Those in group B showed marked asymmetry, and treatment was recommended. The frontal cephalographs were also analyzed with 5 indexes related to the mandible. For each orthodontist, the threshold was determined by means of the discriminant analysis., Results: As the number of subjects who were judged to require treatment increased, the threshold of cephalometric indexes became smaller, and the discriminant accuracy was reduced. Among the 5 indexes evaluated, the distance of menton (mean, 4.28 mm), maxillomandibular midline angle (mean, 4.31 degrees ), and the distance of L1 (mean, 2.78 mm) showed relatively high accuracy in all observers., Conclusions: The distance of menton, the maxillomandibular midline angle, and the distance of L1 appeared to be relevant indexes for the subjective evaluation of facial asymmetry. The thresholds determined in this study could contribute to the planning and evaluation of orthodontic treatments.

Tyler (1998 Nature 392 877) proposed that 'painters centre one eye in portraits', and that this is a hidden aesthetic principle used implicitly by artists and by viewers of portraits. We assess that hypothesis in three related studies: a Monte-Carlo analysis of eye placement in synthetic faces randomly placed within a frame; a survey of eye position in 786 painted portraits from Western art of the past six centuries; and an experimental study in which fifty subjects were asked which of two versions of 60 pairs of portraits they preferred, in only one of which the eye was precisely centred. Taken together, the three studies showed no evidence to support Tyler's hypothesis, and in particular there was no evidence for subjects having an aesthetic preference for a centred eye in portraits. We conclude that one eye tends to be relatively close to the vertical midline because of geometric constraints on the placing of a relatively large object, the head, within a pictorial frame.

Symmetry, averageness, and sexual dimorphism (femininity in female faces, masculinity in male faces) are attractive in faces. Many have suggested that preferences for these traits may be adaptations for identifying healthy mates. If they are, then the traits should be honest indicators of health and their attractiveness should result from their healthy appearance. Much research has focused on whether these traits honestly signal health. Here we focused on whether the appeal of these traits results from their healthy appearance. Specifically, we tested whether the attractiveness of symmetry, averageness, and sexual dimorphism is reduced or eliminated when perceived health is controlled, in two large samples of Western faces and a large sample of Japanese faces. The appeal of symmetric faces was largely due to their healthy appearance, with most associations between symmetry and attractiveness eliminated when perceived health was controlled. A healthy appearance also contributed to the appeal of averageness and femininity in female faces and masculinity in male faces, although it did not fully explain their appeal. These results show that perceptions of attractiveness are sensitive to a healthy appearance, and are consistent with the hypothesis that preferences may be adaptations for mate choice.

Background: Research over the past 20 years has shown that judgments of facial attractiveness are universal; people from all cultures and backgrounds rank and rate faces for attractiveness the same. As such a model for objectively rating facial attractiveness is theoretically plausible, if designed, it would have many uses, including outcomes analysis in plastic surgery of the face. The authors tested a schematic facial composite/prototype mathematical model (the phi mask created by Dr. Stephen Marquardt) as a method for measuring facial attractiveness in an objective manner., Methods: Thirty-seven male and 35 female faces of 18- to 30-year-old whites of European extraction were rated, as were 31 composite faces of each sex using both Internet and direct survey judges. The faces were tested against the phi mask model analyzing deviations of facial anthropometric points from corresponding phi mask nodal points using equivalent weightings, and weightings arrived at by way of multiple linear regression., Results: The deviation from the phi mask significantly correlates with attractiveness, explaining from 25 to 75 percent of the variance in attractiveness judgments, depending on the methodology used., Conclusions: The phi mask model supports averageness or prototypicality of the face as being the major component of the facial attractiveness gestalt and is a first step in producing an objective system for measuring facial attractiveness.

The purpose of this study was to investigate the relationship between the subjective evaluation of facial asymmetry and seven cephalometric indices. Ten orthodontists subjectively evaluated the frontal photographs of 100 subjects and categorized them into three categories, ie, category I--symmetrical view; category II--a little asymmetry not requiring treatment; and category III--marked asymmetry requiring treatment. Seven indices that were used to evaluate facial asymmetry were determined using frontal cephalographs of these patients. Interobserver agreement was assessed using Cohen's kappa statistic. Agreement among the observers for category III was higher than for categories I and II. To define the characteristics of each category, the cephalometric indices, which at least eight observers agreed on, were compared between the categories. No differences were found in any of the indices between categories I and II. Five indices showed differences between category III and the other categories. Among them, the distance of Me from the vertical reference line was the most relevant index for the subjective evaluation of facial asymmetry. When a discrepancy is found between skeletal measurements and a subjective evaluation, the influence of soft tissue structures should be considered in facial asymmetry.

Objective: To develop and refine a technique for measuring the tolerance for deviations in facial appearance., Design: A psychophysical method was administered using photocopies of altered facial photographs to measure tolerances for deviations in eye position and mouth angulation and judges' reaction time., Methods: Stimulus photos were displayed as Kodachrome slides to 76 individuals grouped by their familiarity with craniofacial anomalies, i.e. dental professionals, orthodontic and craniofacial patients, also a group of normal patients., Results: (1) Tolerance for deviation of facial appearance varies inversely with the magnitude of the physical deviations from normal; (2) tolerance varies directly as a function of assumed familiarity with deviation; (3) response and reaction time varied inversely with the tolerance for facial deviation., Conclusion: Significant differences in tolerance and reaction time were found among the groups and depended on whether an isolated feature was judged or if the feature was judged in the context of the whole face.

The term 'phantom bite' is used to describe an uncommon condition in which patients are preoccupied with their dental occlusion, believing that it is abnormal. The condition is remarkable for the nature of the involved explanations and interpretations that the patients give and for their persistence in trying to find a solution to what appears to be a relatively minor problem. Three clinical cases that illustrate the nature of this condition are presented and problems associated with the management of affected patients are discussed. Phantom bite can be a disabling disorder which is difficult to treat. Available evidence suggests that the symptoms cannot be improved by occlusal treatments. It is therefore essential to avoid extensive irreversible restorative treatment. General dental practitioners should refer patients for specialist opinion and management. Psychiatric assessment with recommendations for management should be obtained if possible. The prognosis is poor for symptom elimination but need not necessarily be poor for patients' overall functioning and well-being. It is suggested that emphasis should be placed on building adaptive coping skills. Further research is needed to elucidate the nature of the condition to improve treatment.

One purpose of this study was to assess the perception of (a)symmetry of the face by professionals, lay persons, and sculptors using the ratio estimation scale technique. The other purpose was to compare the perceptions of the faces of patients with those of the controls. Three groups of examiners were involved in this study: lay persons (n = 37), professionals (5 orthodontists and 11 surgeons, n = 16), and sculptors (n = 22). The total number of examiners was 75. All groups agreed on the ordering of the patients according to the severity of the affliction. The stage of asymmetry by group identity interaction effect (lay persons, professionals, and sculptors) was significant (P = 0.004). The between-examiner consensus was high for the original asymmetrical photograph, but the groups diverged further and further over the next steps. The subject identity by stage of asymmetry interaction effect was significant (P = 0.001), whereas the examiner's main effect was not. For all patients, each step resulted in a smaller need for treatment. A need for treatment was not found for any of the control subjects, with 1.5 being the highest need for treatment score for controls. The subject identity effect (patient/control) was significant (P < 0.001). Even at step 5 (the reconstructed symmetrical photograph), all patients were perceived to have an inferior appearance to that of control subjects. It is possible to obtain reliable assessment using the ratio estimation scale technique. Professionals, lay persons, and sculptors have different perceptions of the degree of asymmetry but not of the need for treatment. All patients were scored as asymmetrical compared with controls. Asymmetry of the patients was obvious for all the examiners.

The relations for hand preference with craniofacial asymmetry and ear advantage, and between craniofacial asymmetry and ear advantage were investigated in young healthy subjects. Ear advantage was recorded as duration of hearing, craniofacial asymmetry by computerized tomography in 44 right-handed and 38 left-handed male and female high school students. Right-handers had a right ear advantage and a larger left craniofacial region, whereas left-handers had a left ear advantage and a larger right craniofacial region. These results are consistent with the speculation that hand preference may be related to craniofacial and consequently aural asymmetries.

Facial aesthetics have an important influence on social behaviour and perception in our society. The purpose of the present study was to evaluate the effect of facial symmetry and inter-ocular distance on the assessment of facial aesthetics, factors that are often suggested as major contributors to facial aesthetics. The material consisted of 36 standardized facial photographs of patients (10-17 years of age) attending the orthodontic department. All except one were Caucasian. Eleven of these photographs (all Caucasian) were either left in their original form or modified by: (1) enlargement of the inter-ocular distance by 20 per cent; or (2) mirroring the right part of the face over the left part to obtain symmetry. Three series of 36 slides were composed, each including 11 modified slides or their unmodified counterparts. These were evenly distributed over the three series using a Latin square design. The photographs were assessed for their facial aesthetics using a visual ratio scale by a panel of 50 undergraduate dental and law students. The 11 modified/unmodified photographs enabled calculation of the effect of the modifications undertaken on the assessment of facial aesthetics. The scores of the 25 remaining photographs in each series were used as baseline data in order to estimate the inter- and intra-observer reproducibility. MANOVA and post-hoc t-test revealed significant differences between the unmodified and modified photographs (P < 0.001). The results show that symmetry and inter-ocular distance enlargement have a negative effect on facial aesthetics.

The notion that surface texture may provide important information about the geometry of visible surfaces has attracted considerable attention for a long time. The present study shows that skin texture plays a significant role in the judgment of female facial beauty. Following research in clinical dermatology, the authors developed a computer program that implemented an algorithm based on co-occurrence matrices for the analysis of facial skin texture. Homogeneity and contrast features as well as color parameters were extracted out of stimulus faces. Attractiveness ratings of the images made by male participants relate positively to parameters of skin homogeneity. The authors propose that skin texture is a cue to fertility and health. In contrast to some previous studies, the authors found that dark skin, not light skin, was rated as most attractive.

Objective: Previous psychosocial studies of adults born with cleft lip and palate have provided circumstantial evidence that surgically repaired right-sided unilateral clefts may be more disfiguring than left-sided clefts. The present study asked if such asymmetries are physiognomic asymmetries or arise "in the eye of the beholder," representing perceptual processes in face recognition., Design: Color slides of 160 children (6 years of age) and young teenagers (16 years of age) were rated by subjects for perceived disfigurement. Sixty of the subjects had unilateral complete cleft lip and palate (30 had a right-sided cleft and 30 had a left-sided cleft), 60 had unilateral cleft lip/alveolus (30 right-sided and 30 left-sided clefts), 32 children had bilateral cleft lip and palate, and 8 children had cleft palate only. Faces were shown in normal and in mirror-reversed versions; the order in which faces were shown was randomized, as were other stimulus factors such as cleft type, age, and gender., Setting: The study was conducted as a classroom-type experiment at the Vision Laboratory, Department of Psychology, Oslo, Norway., Participants: Thirty-seven students of psychology at the University of Oslo, who were ignorant of the purpose of the study, acted as subjects., Main Outcome Measure: Subjects rated perceived disfigurement using a visual analog scale., Results: Modest but highly consistent hemifacial asymmetries in judged disfigurement were found, with left-sided unilateral clefts rated as less disfiguring than right-sided unilateral clefts. Unilateral clefts were judged as being less disfiguring than the bilateral clefts, and cleft lip/alveolus was judged as being less disfiguring than cleft lip and palate. The patterns of facial judgments were almost identical in the normal and reversed-slides conditions., Conclusions: Asymmetries between left- and right-sided clefts reside in physiognomic factors rather than in hemispheric asymmetries controlling the perceptual process of face judgment.

Cues of phenotypic condition should be among those used by women in their choice of mates. One marker of better phenotypic condition is thought to be symmetrical bilateral body and facial features. However, it is not clear whether women use symmetry as the primary cue in assessing the phenotypic quality of potential mates or whether symmetry is correlated with other facial markers affecting physical attractiveness. Using photographs of men's faces, for which facial symmetry had been measured, we found a relationship between women's attractiveness ratings of these faces and symmetry, but the subjects could not rate facial symmetry accurately. Moreover, the relationship between facial attractiveness and symmetry was still observed, even when symmetry cues were removed by presenting only the left or right half of faces. These results suggest that attractive features other than symmetry can be used to assess phenotypic condition. We identified one such cue, facial masculinity (cheek-bone prominence and a relatively longer lower face), which was related to both symmetry and full- and half-face attractiveness.

Symmetry is a major correlate of physical attractiveness across species, including humans. Investigating the nature of this relationship has been difficult, however, for several reasons, including the facts that variance in symmetry is attributable to more than one source and is often correlated with other variables related to attractiveness. This study assessed the role of facial symmetry in relation to perceptions of facial attractiveness. Some of the natural covariates of symmetry were controlled for by comparing the symmetry and attractiveness differentials between monozygotic co-twins, who are genetically, but not developmentally, identical. The more symmetric twin of a pair was consistently rated as more attractive, and the magnitude of the difference between twins in perceived attractiveness was directly related to the magnitude of the difference in symmetry.

Objective: To compare the psychosocial adjustment of children with and without hemifacial microsomia (HFM)., Design: This cross-sectional pilot study investigated psychosocial adjustment of twin pairs in which one twin was affected with HFM and the other was unimpaired. Data were analyzed using paired t tests., Setting: The dental medicine clinic of a large urban children's hospital, serving a multistate area., Participants: Participants were six twin pairs aged 9 to 15 years and their parents. Data were also collected from classroom teachers., Main Outcome Measures: Outcome measures included: the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), the Coopersmith Self-Esteem Inventory (SEI), and a structured self-concept interview (the Self-Interview)., Results: Children with HFM had significantly higher CBCL and TRF total behavior problem scores and lower SEI general self-esteem scores than their unimpaired twins. No differences were found in CBCL competence scores. Interview data revealed concerns among the HFM group related to appearance, negative social responses, and fear of hospital procedures. Children also reported positive aspects of coping with HFM., Conclusions: The results of this study suggest that, similar to other craniofacial conditions, HFM is associated with an elevated risk for childhood psychosocial difficulties. Replication of specific findings with a larger sample is needed. Multicenter, collaborative studies are a crucial next step for this field.

Heterosexual men and women were told they were competing with another same-sex individual for a date with an attractive opposite-sex interviewer. After answering 6 questions, participants were asked to tell the competitor why the interviewer should choose them over the competitor. Participants' videotaped behavior was coded for different behavioral tactics. Men who were more symmetrical and who had a more unrestricted sociosexual orientation were more likely to use direct competition tactics than were less symmetrical and restricted men. Restricted men accentuated their positive personal qualities, presenting themselves as "nice guys." Structural equation modeling revealed that fluctuating asymmetry (FA) was directly associated with the use of direct competition tactics. However, the link between FA and presenting oneself as a nice guy was mediated through sociosexuality. No effects were found for women.

This study examined the effect of hemifacial width on attributions of personality and emotion in normal people with pronounced facial asymmetry. Ten attributions, made by 61 raters to the larger vs smaller hemifacial composites of the same face in 14 resting faces with pronounced asymmetry, were compared. Analysis showed that the smaller hemifaces were rated as exhibiting more intense emotions and as generally having more positive features than the larger hemifaces. The main implication of these findings is that faces with prominent asymmetry do not uniformly affect observers, but response may depend on the features of the hemiface (usually the right hemiface) perceived in the dominant visual field of the observers.

Fluctuating asymmetry (FA) is deviation from bilateral symmetry in morphological traits with asymmetry values that are normally distributed with a mean of 0. FA is produced by genetic or environmental perturbations of developmental design and may play a role in human sexual selection. K. Grammer and R. Thornhill (1994) found that facial FA negatively covaries with observer ratings of attractiveness, dominance, sexiness, and health. Using self-reports, observer ratings, daily diary reports, and psychophysiological measures, the authors assessed the relationship between facial FA and health in 2 samples of undergraduates (N = 101). Results partially replicate and extend those of K. Grammer and R. Thornhill (1994) and suggest that facial FA may signal psychological, emotional, and physiological distress. Discussion integrates the authors' findings with previous research on FA and suggests future research needed to clarify the role of FA in human sexual selection.

This study examined the role of facial symmetry in the judgment of physical attractiveness. Four experiments investigated people's preference for either somewhat asymmetrical portraits or their symmetrical chimeric composites when presented simultaneously. Experiment 1 found a higher selection rate for symmetrical faces with neutral expression for portraits of old people, and Experiment 2 indicated this may be because symmetry serves as cue for youth in old age. In Experiments 3 and 4 participants examined portraits with emotional expressions. Experiment 3 found a higher selection rate for asymmetrical faces, and Experiment 4 indicated this may be because observers perceived them as more genuine and natural. This study suggests that the low degree of facial asymmetry found in normal people does not affect attractiveness ratings (except for old age), probably because observers are not tuned to perceive it.

Intrafacial differences in speechreading performance were studied measuring 24 subjects' visual recognition of key words within sentences when presented either a left-left-(LL) or right-right-(RR)-sided face of a male speaker with moderate facial asyrnmetry. No significant differences were found as a function of facial side or gender (ns = 12).

Normal subjects rated expressiveness of two posed facial emotions, happy and sad; the photographs were stratified in terms of intensity of expression and were prepared in composite (right-right, left-left), normal, and mirror-reversed facial orientations. The left side of the face was more expressive for intermediate intensity expressions of happiness and for least intense expressions of happiness and sadness. The right side of the face was more expressive for most intense expressions of happiness and sadness.

To integrate neuroimaging, neuropathologic, and neuropsychological findings, computer-assisted morphometry was applied to magnetic resonance images of the corpus callosum in adolescents with Down and Williams syndromes and in control subjects. Callosa of subjects with Down syndrome were distinctively rounded in form, consistent with Down syndrome brachycephaly. These callosa also showed decreased widths throughout their rostral fifth, which serves frontal lobe projections. This finding correlates with the hypocellularity and hypofrontality of neocortex in subjects with Down syndrome and with their neuropsychological profile of frontal lobe dysfunction. Callosa of subjects with Williams syndrome generally resembled control specimens, in congruence with their frontal lobe structure and better preserved frontal lobe function. These results represent a convergence of findings across levels of neuroscientific investigation.

Psychosocial adjustment was evaluated in different groups of children with craniofacial deformities in order to examine the relationships between symmetry, functional impairments, and social adaptation. Thirty patients, ages 6 through 16 years, were assessed using a battery of standard psychologic measures including Human Figure Drawing, Tasks of Emotional Adjustment, and Children's Depression Inventory. Parents and teachers also provided ratings of the children's functioning using the Child Behavior Checklist (parent and teacher forms). Scores on the outcome measures were summarized with descriptive statistics and then multivariate analyses of variance were conducted to determine the differences in psychosocial development between children with symmetric versus asymmetric craniofacial deformities and between the presence or absence of a functional impairment in children with craniofacial deformities. The results indicate that children with symmetric craniofacial deformities score poorer on measures of psychosocial adjustment than children with asymmetric deformities (F = 3.20, p less than 0.015); however, differences among the groups with or without functional impairments were not significant.

A 9-year-old boy was diagnosed as having an unilateral cross-bite with mandibular deviation. This was later found to be due to unilateral hyperplasia of the right condyle. The increased growth activity subsequently led to an extreme facial asymmetry and a serious psychological condition began to develop. Consequently, surgery was performed at the age of 11 years 8 months when removal of the enlarged condyle and an oblique ramus osteotomy on the opposite side was performed. In this way the facial asymmetry was eliminated. No effort during the surgery was made, however, to restore normal occlusion. The post-operative orthodontic treatment was successful in allowing growth to bring about a normalization of the occlusal relationships. Two years after surgery, complete aesthetic and function rehabilitation has been achieved. This has also led to an improvement in the patient's psychological condition. The result was still stable 11 years post-operatively. The case illustrates the value of early treatment and co-operation between orthodontists and oral surgeons.

There is a paucity of thorough research on society's reaction to dentofacial anomalies, or to other forms of facial disfigurement. The author reviews the studies of the social effects of dental appearance that do exist, and then reports some results of his own researches into reaction to facial disfigurement. It appears from these studies that facial disfigurement (including dentofacial anomalies) can indeed be a cause of social disadvantage.

The facial expressions of six basic emotions were posed by two groups of right (N = 23) and left (N = 34) brain damaged patients and by a control group of normal subjects (N = 28). The posed expressions were examined by means of the Facial Action Coding System (FACS) which provides analytical and objective scoring, as by a subjective scale of appropriateness of expression. Results indicated no difference between controls and patients with a lesion in the right or left hemisphere. These findings are inconsistent with the hypothesis that the right hemisphere plays a specific role in the control of posed facial expression. No relationship was observed between posed emotional expressions and facial paralysis or the presence of oral apraxia.

In a sample of 53 right-handed, young adult males, asymmetry was examined in the size of 11 facial regions, in total area, and in emotional expression of the face at rest. In the complete sample no evidence was obtained of consistent asymmetry in size of facial regions, in facial area, or in emotional expression. There was, however, an interaction between family history of sinistrality and sighting dominance in facial asymmetry for the pleasantness/unpleasantness of facial expression. The findings suggest that previously established asymmetries in phasic emotional displays are not an outcome of expressive or morphological asymmetries of the face at rest.

The postsurgical psychological status of 25 craniofacial patients, 6 through 16 years of age, was studied using self, teacher, and parent report measures. In contrast to earlier reports of more positive adjustment following corrective surgery, the present study identified several concerns for craniofacial patients, including low self-esteem, impaired peer relationships, and greater dependency on significant adults. Problems were more clearly identified using projective techniques rather than self-report measures. The findings suggest that many children having craniofacial surgery should have supportive psychotherapeutic services. Variables were explored relative to psychosocial functioning. Although few significant correlations were demonstrated, positive psychological adjustment was found to be related to greater physical attractiveness, lower parental stress, and younger age.

It has been suggested that asymmetries in the morphological properties of the face contribute to or produce asymmetries in facial emotional expression. Over 50 years of research on hard tissue, soft tissue, and facial surface asymmetries is reviewed here. Generally, it appears that if consistent asymmetry characterizes facial morphology, it is extremely small in magnitude or characterizes regions yet to be examined. In contrast, marked homology and asymmetry in regional size and area has been noted often. At present, it does not appear that asymmetry in facial morphology is associated with facial expressive asymmetry, with the latter more likely to be an outcome of functional brain asymmetry.

Forty-three children between the ages of 6 and 13 years with congenital facial anomalies underwent psychosocial evaluation prior to surgery. Also evaluated were healthy children matched to the craniofacial subjects by sex, age, intelligence, and economic background. Relative to this comparison group, the craniofacial children were found to have poorer self-concept, greater anxiety at the time of evaluation, and more introversion. Parents of the craniofacial children noted more frequent negative social encounters for their children and more hyperactive behavior at home. Teachers reported more problematic classroom behavior. Examination of these results revealed craniofacial malformations to be associated with psychosocial limitations rather than marked deficits. These children tended to function less well than the comparison children, but with few exceptions, they were not functioning in a psychosocially deviant range. Explanations for the observed circumscribed impact of facial deformity include the use of denial as a coping mechanism, possible diminished significance of appearance for younger children, and the restricted environment experienced by most of the subjects. It can be predicted that time would render these protective influences ineffective, so that adolescent and young adult patients could be at far greater psychosocial risk.