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Hemifacial hyperplasia is a developmental disorder characterized by marked unilateral facial asymmetry. It involves the hard and soft tissues of the face. The cause is unknown, although several predisposing factors have been described. A case report of an 8-year-old boy with hemifacial hyperplasia is presented to highlight the clinical and imaging findings.

This is a report of an additional patient affected by hemifacial myohyperplasia (HMH). We postulate that this condition originates around the fourth gestational week at any step of cranial muscle development from somitomeres to branchial arches, most probably due to prolonged period of proliferation during cranial muscle development, subsequent abnormal contact between cranial neural crest (CNC) cells and cranial myoblasts, and an impaired interaction among CNC cells and cranial myoblasts derivatives. HMH may represent another example of somatic mosaicism and its features can be explained by a combination of morphostatic and morphodynamic mechanisms of pattern formation during development. Here we suggest that HMH is a sequence in which the primary defect is hyperplasia of the facial muscles and the other findings are secondary to this., ((c) 2010 Wiley-Liss, Inc.)

Analysis of previous data suggested the hypothesis that temporomandibular joint (TMJ) eminence shapes develop ideally to minimize joint loads. Hence, we tested this hypothesis in nine females and eight males in each of two groups, with and without TMJ disc displacement. Participants provided anatomical data used in a joint load minimization numerical model to predict, and jaw-tracking data used to measure, eminence shapes. Coordinate data (x,y) of shapes were fit to third-order polynomials for two sessions, sides, and methods (predicted, measured) for each participant. Inter-session data were reliable and averaged. Those with, compared with those without, disc displacement had higher measured shape range (5:1) and left-right asymmetry prevalence (4:1). In 29 symmetrical individuals, ANCOVA and Bonferroni tests compared vertical dimensions (y) at 11 postero-anterior points (x), 0.5 mm apart. Model-predicted and measured shapes were significantly different (P < or = 0.01) near the eminence crest, but joint load minimization was consistent with eminence shape for x < 3.0 mm.

Aim: The aim of this study was to evaluate facial asymmetry and the thickness of the masticatory muscles in young children with normal occlusion and functional posterior crossbite., Methods: The sample comprised 72 children of both genders (64.71±7.04 months) in the primary and early mixed stage of dentition, divided into four groups: primary-normal occlusion (PriN; N=19), primary-crossbite (PriC; N=19), mixed-normal occlusion (MixN; N=27), and mixed-crossbite (MixC; N=16). The thickness of the masseter and anterior portion of the temporalis muscle at rest and during maximal clenching were assessed by ultrasonography. Facial morphology and asymmetry were evaluated by standardized front-view photographs, in which the following measurements were recorded: anterior face height (AFH), bizygomatic facial width (BFW), angle of the eye (AE) and angle of the mouth (AM) (interpupillary and commissure planes in relation to mid-sagittal plane, respectively)., Results: The results showed that muscle thickness did not differ significantly between the sides of the dental arches in all groups (paired t-test). Only the groups with normal occlusion presented significant positive correlation between AE and AM (Pearson's correlation test). In PriN, only body weight was significantly related to masseter thickness; in MixN, facial morphology contributed significantly to masseter thickness at rest and maximal clenching, while the covariates weight, height and age did not relate to muscle thickness (stepwise backward multiple regression)., Conclusion: In the studied sample, children with crossbite presented greater facial asymmetry than those with normal occlusion, and a greater masseter thickness was related to larger faces in the mixed dentition.

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

Objective: To determine morphological and functional effects on masticatory system of early treatment of functional posterior crossbite in young children., Study Design: 23 children were divided into two groups: deciduous (DecG, n = 11) and early mixed dentition (MixG, n = 12), which received slow maxillary expansion. Maximal bite force, ultrasonographic masticatory muscle thickness and facial asymmetry were evaluated in three stages: before the start of treatment (s1), after three months of retention (s2), and after three months of observation (s3). The results were analyzed by Mann-Whitney U-test, correlation test, repeated measures ANOVA and backward stepwise multiple regression., Results: Bite force and temporalis thickness increased from s1 to s2 and s3 in both groups (p < 0.05). Body mass index (BMI) increased significantly from s1 to s3 only in the MixG, but the masseter thickness did not differ among the stages. The correlation between the angle of the eye and the angle of the mouth in relation to the mid-sagital plane increased from s1 to s3. Masticatory muscle thickness contributed significantly to bite force magnitude in all stages, whereas age and BMl showed no significant contribution to its variation., Conclusion: Bite force and temporalis muscle thickness increased significantly in children after early treatment of functional crossbite.

Purpose: The purpose of the present study was to investigate the correlations between lip cant change after bimaxillary orthognathic surgery and the ratio of lip cant change and occlusal cant change after surgery., Patients and Methods: The subjects for the present study were obtained from a group of 25 patients who underwent bimaxillary orthognathic surgery for occlusal cant correction at the Department of Oral and Maxillofacial Surgery, Samsung Medical Center (Seoul, South Korea) from January 2000 to December 2005. To be included, a patient's chart had to contain a resting frontal facial photograph in the natural head position and a corresponding posteroanterior cephalogram in occlusion on the same day before surgery and postoperatively 6 months later. The lip cant change was assessed by the angle of each labial commissure and the bi-pupillary reference line. The occlusal canting change in the frontal plane was assessed with the angle between each maxillary first molar occlusal surface and the bi-frontozygomatic suture reference line., Results: With the angular measurement, the average occlusal cant change was 3.09 degrees (standard deviation [SD] 1.05 degrees), and the average lip cant change was 1.56 degrees (SD 1.05 degrees). With the linear measurement, the average occlusal cant change was 2.41 mm (SD 2.75), and the average lip cant change was 1.18 mm (SD 0.43). The lip cant correction ratio to occlusal cant correction was 51.5% +/- 8.4% in the angular measurement and 48.8% +/- 9.1% in the linear measurement. With Pearson's correlation analysis, the Pearson correlation coefficient was 0.869 for the angular measurement and 0.887 for the linear measurement. A high correlation was shown between the occlusal cant change and lip cant change., Conclusions: Bimaxillary orthognathic surgery can correct lip cant and occlusal cant. The average amount of lip cant correction and occlusal cant correction in our study was 51.5% +/- 8.4% and 48.8% +/- 9.1%, respectively., (Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: To test the hypothesis that young people's esthetic perception of dentition midline deviation or the threshold below which they find the deviation "acceptable" depends on the gender and face type of the person with the deviation and the gender of the evaluator., Materials and Methods: Facial images of six young subjects with three different face types were captured, and their dentition midlines were altered digitally. The images were evaluated by young people with no dental training. Statistical analysis was carried out to determine the threshold for acceptable dentition midline deviation and factors influencing perception., Results: The mean value for the threshold below which a deviation was judged "acceptable" was 2.403 mm (95% confidence interval, 2.315-2.491). The preferences of evaluators did not significantly depend on the direction of the deviation. Both male and female evaluators were significantly less tolerant of deviation in female subjects than in male subjects. However, female evaluators were significantly more tolerant of midline deviations in male subjects than were male evaluators. In addition, the same degree of deviation was most noticeable in male subjects with a tapered face type and least noticeable in female subjects with a square face type., Conclusions: The gender and face type of an individual with dentition midline deviation and the gender of the evaluator do affect young people's esthetic perception of a dentition midline deviation and the threshold below which they find the deviation "acceptable."

Introduction: Mandibular lateral displacement (MLD) is clinically characterized by deviation of the chin, facial asymmetry, dental midline discrepancy, crossbite in the posterior region, and high prevalence of internal derangement of the temporomandibular joint. Morphologic and functional characteristics of MLD should be clarified to correct and prevent this malocclusion., Methods: We examined the morphologic features, occlusal scheme, and functional behavior of MLD in 116 patients. Facial morphology was examined with posteroanterior cephalograms, occlusion guidance on the articulator after face-bow transfer, and condylar movement with the condylograph., Results: The superiorly inclined occlusal plane was associated with mandibular deviation in the same direction. The posterior occlusal plane on the shifted side was significantly steeper than that on the nonshifted side. Functional analysis of condylar movement showed a close relationship between the direction of MLD and the direction of condylar lateral shift during opening and closing, and protrusion and retrusion. The occlusal guidance inclination in the buccal segment of the nonshifted side was steeper than that in the shifted side., Conclusions: The results suggested that reduced vertical height of the dentition on 1 side induced mandibular lateral adaptation with contralateral condylar shift (asymmetry); this leads to condylar lateral shift during functional movement., (Copyright (c) 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

The aims of this study were to evaluate condylar, ramal, and condylar plus ramal mandibular vertical asymmetry in a group of cleft lip and palate (CLP) patients and compared with subjects with a 'normal' occlusion. Mandibular asymmetry index (condylar, ramal, and condylar plus ramal) and gonial angle measurements were examined on panoramic radiographs. The study groups comprised 20 unilateral cleft lip and palate (UCLP) patients (10 males and 10 females; mean age 13.03 +/- 3.33 years), 20 bilateral cleft lip and palate (BCLP) patients (10 males and 10 females; mean age 13.73 +/- 3.53 years), and a control group of 20 subjects (9 males and 11 females; mean age 14.35 +/- 2.46 years) with a normal occlusion. Kruskal-Wallis one-way analysis of variance was used to determine statistically significant differences between the groups for condylar, ramal, and condylar plus ramal asymmetry index measurements at the 95 per cent confidence interval. None of the investigated groups showed statistically significant gender differences for posterior vertical height measurements (P > 0.05). Asymmetry indices were similar, with no statistically significant differences found in any of the groups. However, gonial angle showed statistically significant differences (P < 0.05) in the UCLP group and condylar height (CH) in the BCLP patients (P < 0.001). Except for CH measurement in the BCLP group, CLP patients have symmetrical mandibles when compared with a normal occlusion sample.

Osteochondroma of the mandibular condyle has been found in the oral and maxillofacial region rarely. This paper describes a case of osteochondroma of the mandibular condyle in a 20-year-old woman, who was referred to our service with facial asymmetry, prognathic deviation of chin, cross-bite to the contralateral side, changes in condylar morphology, limited mouth opening, and malocclusion. Computed tomography (CT) was performed for better evaluation to the pathological conditions on the temporomandibular joint. Based on the clinical examination, patient history, and complementary exams, the hypothesis of osteochondroma was established. Condylectomy was performed using a preauricular approach with total removal of the lesion. After 3 years of postoperative follow up and orthodontic therapy, the patient is symptom-free, and has normal mouth opening with no deviation in the opening pattern.

Background: This study was undertaken to investigate the facial skeletal features associated with chin deviation., Methods: Twenty-five patients (14 males and 11 females) diagnosed with chin deviations of more than 2 mm were recruited. Fifteen skeletal landmarks, including median and lateral points, were located on posteroanterior cephalograms. The CG-ANS (crista-galli of the ethmoid-anterior nasal spine) line and the perpendicular line through the CG were used as references. The differences between the distances from paired lateral points to reference lines were examined with intraclass correlation coefficients to analyze the symmetry of facial skeletal tissue. The factors associated with the amount or direction of chin deviation were analyzed by multiple regression analysis or by logistic regression analysis., Results: Seventeen subjects (68%) showed chin deviation to the left side and 8 subjects (32%) to the right side. Sixty-eight percent of subjects presented with Angle Class III malocclusion. Horizontal distances of all paired lateral points to the y-axis, in mandibular body length and effective length, showed a low grade of symmetry. Only vertical distances of paired zygomaticofrontal sutures and zygonion points to the x-axis were asymmetric. However, there were no significant asymmetries of the gonial angle, ramus height, and vertical distances from other paired lateral points to the x-axis. The amount of chin deviation was associated with the absolute differences of the left and right antegonion to the y-axis and zygomaticofrontal suture to the x-axis. The direction of chin deviation was significantly associated with the difference in the effective length of bilateral mandibular halves., Conclusion: Facial skeletal asymmetry exists in patients with chin deviation. This should be considered when planning treatment for both the nonsurgical and surgico-orthodontic cases with chin deviation.

Purpose: Despite its pathogenic heterogeneity, it is often assumed that the small mandible in a neonate with Robin sequence will not grow normally. The purpose of this study was to determine mandibular length and position in patients with nonsyndromic versus syndromic Robin sequence., Patients and Methods: Lateral cephalograms of 51 children with Robin sequence were analyzed. Group I consisted of nonsyndromic (NS) subjects and group II consisted of subjects with the 4 most common syndromic (S) diagnoses. Cephalometric measurements included sella-nasion-A point (SNA), sella-nasion-B point (SNB), sella-nasion-pogonion (SNPg), articulare-gonion-pogonion (ArGoPg), temporomandibular joint-pogonion (TmPg), articulare-gonion (ArGo), and gonion-pogonion (GoPg). Differences between groups and subgroups were compared using t test., Results: There were 26 NS patients (mean age, 6.8 yrs) and 25 S patients (mean age, 8.7 yrs); mean age was statistically different between groups (P = .04); therefore, cephalometric measurements were compared with age-matched normal values. Syndromes included Stickler (n = 10), bilateral facial microsomia (n = 8), velocardiofacial (n = 4), and Treacher Collins (n = 3). SNA was statistically different from normal in both groups (NS, P = .017; S, P = .007); however, SNB was not different from normal for either group (NS, P = .175; S, P = .537). SNPg (0.007) was significantly greater than normal in NS (P = .007) but not in S (P = .702) patients. SNA, SNB, and SNPg were not significantly different between groups. In both groups, mandibular length was short (P = .00), especially in S patients (P = .049), mandibular body was small (NS, P = .00; S, P = .00), and the gonial angle more obtuse (NS, P = .006; S, P = .000) than normal. Ramus length was significantly shorter than normal only in S patients (P = .019). Mandibular length (TmPg) was smaller than normal in all S subgroups but with wide variability. There were statistically significant differences among S subgroups with respect to mandibular sagittal position (SNB, P = .00; SNPg, P = .00) and mandibular length (TmPg, P = .008). There were no differences in S subgroups with respect to age, SNA, ArGo, GoPg, and ArGoPg., Conclusion: Mandibular morphology and position are variable in Robin sequence, based on the presence and type of associated syndromic diagnosis.

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

Introduction: The purpose of this study was to investigate the change of lip-line cant (LLC) after 1-jaw orthognathic surgery in mandibular asymmetry patients., Methods: Preoperative and postoperative data of 22 patients having 1-jaw orthognathic surgery, with menton deviation over 2 degrees before the surgery, were our subjects. LLC was measured in the preoperative and postoperative frontal photographs, and its change was correlated with various craniofacial measurements obtained from preoperative and postoperative frontal cephalograms and maxillofacial 3-dimensional computed tomography images., Results: Although these subjects had 2.4 degrees of LLC on average before surgery, LLC improved to 0.5 degrees after surgery, and the change (1.9 degrees ) was statistically significant. In the correlation analysis, preoperative LLC showed positive correlations with menton deviation and mandibular anterior occlusal plane cant. In the correlation analysis of LLC change, it had positive correlations with preoperative LLC and mandibular anterior occlusal plane cant and preoperative and postoperative change of menton deviation., Conclusions: These results suggest that LLC is present with chin deviation, even without significant maxillary canting, and can be improved considerably by 1-jaw surgery alone.

Introduction: The purpose of this study was to examine asymmetry of the lips in patients with jaw deformity and facial asymmetry., Methods: Pretreatment and posttreatment frontal facial photographs of 17 patients who had mandibular prognathism with facial asymmetry were analyzed. Linear and angular measurements were made on the photographs to assess the asymmetry of the lips. The upper and lower vermilion borders of the lips were divided into quadrants according to the y-axis, and each was measured. In addition, skeletal deviation (position of menton) was determined from the frontal cephalograms., Results: The pretreatment linear and angular measurements showed asymmetry of the lips, but this significantly improved after treatment, and the lip form was almost symmetrical. The areas of vermilion border in the upper and lower lips became almost even during treatment. The ratio of the areas on the 2 sides was nearly 1.00. There was little correlation between the horizontal skeletal changes of menton and lip form., Conclusions: Asymmetry of the lips caused by deviation of the mandible can be almost completely corrected by orthognathic treatment.

OBJECTIVES - To understand how surgical interventions impact the organization and internal integration of the major components of the skull, we address the functional and developmental relationships during perinatal development. METHODS - A number of methods for quantifying modularity and integration of morphological data are available. Here, measures derived from three-dimensional computed tomographic (CT) images are used to investigate the statistical relationships among measures of the cranial vault, face and cranial base. First, we establish the pattern of associations among quantitative measures in a sample of children unaffected by a craniofacial anomaly. We statistically compare these normative patterns of cranial integration to those of a sample of children with a facial anomaly (complete unilateral complete cleft lip and palate), and to children with a neurocranial anomaly (isolated sagittal synostosis). Finally, we test whether surgery affects the strength and pattern of associations among measures within the cranial base in the affected children. RESULTS - Our analyses reveal strong internal integration of the cranial base in unaffected children and in our samples of unoperated cleft lip and palate, and sagittal synostosis. Post-operatively, the magnitude of integration of the cranial base is reduced relative to the pre-operative condition in both samples of children with craniofacial anomalies. CONCLUSION - Our results show how the cranial base adjusts to its broader structural context, and provides added support for the developmental and structural integration of cranial base with both cranial vault and face.

Objective: Three-dimensional analysis of palate size and shape in 30 patients with complete bilateral cleft lip and palate (BCLPc) at the stage of permanent dentition., Design: Cross-sectional study based on laser scanning., Subjects: Thirty dental casts of boys approximately 15 years old with BCLPc and 28 dental casts of healthy boys of the same age., Interventions: Arched-lip suture with periosteoplasty and push-back of the palate with pharyngeal-flap surgery., Main Outcome Measures: Data on palate height in the 210 defined locations and on palate widths and profile area in 10 transverse sections., Results: The palate in patients with BCLPc was conical and narrower than in control study subjects, much more anteriorly than posteriorly. From the canines posteriorly, the palate was of almost constant height of 10 mm in the midline, being higher than in control study subjects at this location and lower more posteriorly (by 24% to 29% between molars). The area of transverse sections was reduced as compared with control study subjects from the first premolars posteriorly and reached more than 40% between molars. The length of the palate up to the first molars was not changed., Conclusion: BCLPc subjects exhibited narrow, low, and flat palate. Palate size and shape differences indicate a substantial reduction of the space for the tongue.

Objective: To present an updated version of the original Facial Nerve Grading Scale (FNGS), commonly referred to as the House-Brackmann scale., Study Design: Controlled trial of grading systems using a series of 21 videos of individuals with varying degrees of facial paralysis., Results: The intraobserver and interobserver agreement was high among the original and revised scales. Nominal improvement is seen in percentage of exact agreement of grade and reduction of instances of examiners differing by more then one grade when using FNGS 2.0. FNGS 2.0 also offers improved agreement in differentiating between grades 3 and 4., Conclusion: FNGS 2.0 incorporates regional scoring of facial movement, providing additional information while maintaining agreement comparable to the original scale. Ambiguities regarding use of the grading scale are addressed.

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

Background: Both asymmetry and the second and fourth digit ratio (2D:4D) relate to various aspects of human life history. Higher asymmetry with extreme 2D:4D ratios have suggested a link between both processes, indicating that early development determines levels of developmental instability. However, most observed associations may be biased because combinations of the digit lengths are used as both dependent and independent variables., Aim: The present study explored the usefulness of asymmetry in digits 2 and 4 to study this association., Subjects and Methods: A combination of literature review, a small simulation study, and a study of 2D:4D ratios and asymmetry in a total of 100 young males and females is presented., Results: Using asymmetry in digits 2 and 4 results in bias and increased type I error rates, leading to stronger associations between asymmetry and 2D:4D ratios. In spite of low sample sizes, significant associations between asymmetry measured in hands and face and 2D:4D ratios were detected for asymmetries in digits 2 and 4 only., Conclusions: Using asymmetry in digits 2 and/or 4 causes bias. Excluding such results, there is currently little evidence of any association between asymmetry and digit ratios. Future studies should carefully select traits to investigate these correlations further.

Neurofibromatosis, NF, is a group of genetic disorders that primarily affect the cell growth of neural tissues. Cranio-orbital-temporal neurofibromatosis is an uncommon subtype of neurofibromatosis characterized by neurofibromas, cranial defects, and specific bone lesions. This case report presents the signs of cranial defects in a 24-year-old Caucasian woman with type 1 NF. Mandibular malformations due to NF and dental defects caused by intraoral masses and radiographic images are presented.

Purpose: Development of a maxillofacial surgery simulation software capable of predicting a patient's appearance after surgery., Methods: We have derived a new mass-spring model (MSM) equivalent to a linear finite element (FE) model for cubic elements. In addition, we propose the scaled displacement method as a new method to perform the simulation more realistically., Results: The average error of eight soft tissue landmarks measured between 0.37 and 2.01 mm except from a landmark that had an error of 4.44 mm; values close to those obtained with the linear FE method. On the other hand, the scaled displacement method allows avoiding punctual stress concentration and bending effects making a much more realistic simulation in the region of the bone cut., Conclusions: Good results have been achieved with our two proposed methods. In addition, the simple way in which MSM can be parallelized makes it an interesting alternative to FE method.

This investigation was aimed at the evaluation of the morphometric characteristics of the contralateral sides of the facial cranium in adult men and women, the evaluation of asymmetry manifestation degree and the detection of most frequent zones of its localization. The study was conducted on 180 crania (90--male, 90--female) of the adults of I and II mature age periods. To detect the asymmetry of the facial cranium, the original "fan" principle of morphometry was developed. This approach has shown the asymmetry in the area of localization of different "fans" ("superior", "inferior", "lateral"), i.e., in the different regions of the facial cranium. On the basis of the data obtained, it can be concluded that in order to identify the asymmetry of the facial 1 cranium and to estimate the asymmetry manifestation degree it is expedient to take into account the following parameters: the distance from a nasion point to a point on the lateral edge of apertura piriformis, from a nasion point to a frontomolare-temporale point, from a zygomaxillare point to a lateral point on naso-frontal suture, from a zygomaxillare point to a dacryon point, from a subspinale point to a nazomaxillare point and from a subspinale point to a lateral point on naso-frontal suture. As in the series of the male crania asymmetry of the facial cranium was significantly more expressed than in the series of female ones, it is assumed to be associated with the different tone of mimic muscles.

Condylar hyperplasia is a rare disorder characterized by an increased volume of the condyle, ramus, and mandibular body leading to facial asymmetry. We present three cases of condylar hyperplasia: two women and one man, age range 27 to 34. Clinically, all three patients showed a deviation of the mandible to the opposite side and a protruded position of the chin, hypertrophy of the lower border of the mandible, combined with an elongation of the mandibular ramus, open-bite on the deformed side, and cross-bite on the opposite side. In all three cases, scintigraphy showed an increased uptake. Radiography and CT scanning confirmed the clinical diagnosis and patients were subjected to surgery, comprising high condylectomy on the affected side with access in the pre-tragus area. The surgical piece sent to the Institute of Pathological Anatomy for histological examination revealed a nonuniform picture, in terms of both the depth of cartilage islands and the thickness of the fibrous layer covering the joint surface. Common to all three cases, however, was the apparent evolution of fibrous tissue to cartilage, and of this to compact bone tissue. At two-four years, all cases have maintained a good occlusal response. The asymmetric deformity of the mandible resulting from the rare condition of hemimandibular hyperplasia is presented and the clinical, histopathological and therapeutic aspects discussed.

Dyke-Davidoff-Masson syndrome, or cerebral hemiatrophy, is a pre- or perinatally acquired entity characterized by predominantly neurologic symptoms, such as seizures, facial asymmetry, contralateral hemiplegia, and mental retardation. Psychiatric symptoms are rarely reported. We report the first case of left cerebral hemiatrophy and a late onset of treatment-resistant schizoaffective disorder after a stressful life event. The patient finally responded well to clozapine. The clinical history and results from structural neuroimaging are highlighted to discuss the possible developmental bias for psychotic disorders.

The purpose of this study was to determine the degree of condylar asymmetry in children with juvenile idiopathic arthritis (JIA) using cone-beam computed tomography (CBCT) and analysis software. For 20 patients (14 girls and six boys; mean age 11.21 +/- 3.54 years), resultant cross-sectional images of the left and right temporomandibular joints (TMJs) were semi-automatically segmented, and exact registration of the right, with respect to the flipped left grey-level condyle, was obtained. Visual inspection of the volume images in 360 degree rotation showed a wide variety of condylar destruction patterns, ranging from small erosions within the cortex to almost complete deformation of the condylar head. Because segmentation was restricted to the delineation of the cortical region, possible changes in the deeper zones were not reproduced. Descriptive statistics [median and interquartile range (IQR)] and diagrams (frequency distribution) were used to assess the results. Initial analysis of condylar volume (including both flipped left and right) showed a median value for volume of 0.844 cm(3) (IQR 0.323), while the median value for volume difference between both condyles was 0.051 cm(3) (IQR 0.098). Analysis of the degree of asymmetry showed a median value of 26.18 per cent (IQR 14.46). Using the CBCT-based method, it was shown that condylar asymmetry was a common feature in children with JIA. The degree of asymmetry was variable, but significant in the majority of the subjects.

Aim: The paralysis of the ramus marginalis mandibulae nervus facialis may occur in Hemifacial Microsomia (HM); the combination of both HM and palsy contributes to an elongation of the mandibular body. This study explores a possible correlation between neurological deficit, muscular atony, and structural deficiency., Study Design: Of 58 patients with HM who had come to the University of Rome (Sapienza) Pre-surgical Orthodontics Unit, 4 patients were afflicted with Hemifacial Microsomia and ramus marginalis mandibulae nervus palsy; these patients underwent physical, neurological, opthamologic and systemic examinations. The results were then analysed in order to determine a possible correlation between neuro-muscular and structural deficit., Methods: Electroneurographic and electromyographic examinations were performed to estimate facial nerve and muscles involvement., Results: Neuroelectrographic exam showed a damage of the nervous motor fibres of the facial nerve ipsilateral to HM, with an associated damage of the muscular function, while neuro-muscular functions on the healthy side were normal., Conclusions: The peripheral nervous and muscular deficits affect the function of facial soft tissues and the growth of mandibular body with an asymmetry characterised by a hypodevelopment of the ramus (due to the HM) and by an elongation of the mandibular body (due to ramus marginalis mandibulae nerve palsy), so that the chin deviation is contralateral to HM. In these forms, a neurological examination is necessary to assess the neurological damage on the HM side. Neuromuscular deficiency can also contribute to a relapse tendency after a surgical-orthodontic treatment.

Introduction: The objective of this study was to elucidate the influence of extraoral lateral force loading of the mandible on mandibular development., Methods: Thirty growing Wistar rats were divided into 3 groups: control, sham, and experimental. To determine longitudinal developmental changes, each animal was placed under anesthesia and immobilized in a custom-built body retainer to allow microcomputed tomography to be performed before and after the experiment. In the experimental group, a fixing device of aluminum was fitted to the zygomatic arch. Lateral force was then applied to the mandible with an open coil for 2 weeks. Stereoscopic images were constructed from 3-dimensional microcomputed tomography images. Absolute lengths and perpendicular heights from the baseline of the lower border of the mandible were measured. The images were superimposed at the baseline planes in each animal. After the final observation, the rats were killed, and the bilateral condyles excised. The condyles were decalcified by the standard method, stained with hematoxylin and eosin and toluidine blue, and observed under a microscope., Results: Lateral force induced the mandible to shift toward the nonloaded side; absolute mandibular length at menton-condylion on the side where the load was applied was greater than that in the control group. No difference from the control group was noted on the nonloaded side, and there were no significant differences in perpendicular heights. Lateral loading on the mandible resulted in histopathologic changes: (1) on the side where the load was applied, the cartilaginous zone hypertrophied in the highest margin of the condylar head, the erosive zone expanded, and the width of the mandibular neck decreased; (2) the chondrocyte layer shifted to the medial side on the nonloaded side, and cartilaginous ossification occurred in the lateral direction immediately below the chondrocyte layer, which deformed the mandibular neck toward the medial side and caused asymmetric development of the mandible., Conclusions: These results demonstrate that extraoral lateral force loading during the growth stage causes asymmetrical mandibular development.

Purpose: A cant of the maxillary intermolar (M1-M1) plane is a reflection of facial asymmetry and can be measured on an anterior-posterior cephalogram in degrees relative to the true horizontal or directly on the patient as the difference in millimeters between the right and left medial canthi to canine distances. The purpose of this study is to measure the correlation between the maxillary cant measured in degrees and measured in millimeters., Materials and Methods: We hypothesize that the number of degrees of maxillary cant equals the millimeter difference between the lengths of the 2 sides of the maxilla, based upon the trigonometric relationship between the degree of cant, vertical length, and M1-M1 distance. To confirm this hypothesis, we evaluated a range of M1-M1 distances and computed the predicted vertical discrepancy between the 2 sides of the maxilla. Bivariate correlations were used to evaluate the association between the degree of cant and predicted vertical discrepancy., Results: In the range of M1-M1 distances (47.5-61.1 mm) evaluated, cants ranging from 3 to 10 degrees are highly correlated with the vertical difference in millimeters (r = 0.96, P < .01). The mean error between the degree of cant and vertical difference was 9%., Conclusion: The degrees of occlusal cant relative to the true horizontal measured cephalometrically in the frontal plane is equal to the linear millimeter difference between the right and left medial canthi to the right and left canine tips.

Objective: To analyze the aesthetic and functional outcomes in a large series of patients who underwent secondary correction of post-traumatic craniofacial deformities (PTCD) and to highlight the underlying principles and formulate treatment guidelines., Methods: A single surgeon's retrospective case series of 57 patients who underwent correction of PTCD., Outcome Measures: Evaluation by multiple surgeons who assessed aesthetic results and functional parameters after secondary correction of PTCD., Results: A good to excellent aesthetic outcome was achieved in the majority of patients. Traumatic telecanthus, enophthalmos, and occlusal deformity were the deformities most refractory to secondary correction. Aesthetic results were adversely affected by the severity and number of pre-existing abnormalities and by the presence of established deformities (beyond 6 to 12 months)., Conclusions: The basic principles of treatment include an initial major osseous reconstructive surgery to restore an anatomically correct craniofacial architecture followed by selective ancillary procedures to address soft tissue deficits and functional deformities. Soft tissue deformity is the major deterrent to achieving an ideal outcome.

Patients who require orthognathic surgery may have asymmetry of the position of the temporomandibular joints relative to the maxilla, which is impossible to reproduce on the current semiadjustable articulators used for surgical planning. We describe a highly-adjustable spirit level orthognathic face bow that allows records to be made of patients with asymmetrical maxillae. The orthognathic articulator also allows the position of the condylar components of the articulator to be adjusted in three dimensions. The use of the new face bow and articulator made it possible to mount the dental casts of asymmetrical faces to reproduce their clinical appearance. The devices were evaluated by comparing the measurements of anatomical variables obtained from cephalometric radiographs with equivalent values obtained from the orthognathic articulator and casts mounted on the articulator. Although the measurements showed significant intersubject variability, the angle between the horizontal and maxillary occlusal plane, occlusal cant angle, and intercondylar widths, were not significantly different.

Objective: To determine if there is an anatomic basis for subepithelial orbicularis oris muscle defects by directly comparing ultrasonographic images of the upper lip with corresponding histological sections obtained from cadavers., Methods: Ultrasound was performed on the upper lips of previously frozen, unpreserved cadaver heads (n = 32), followed by dissection and sectioning of the upper lips. The ultrasound sequences were scored by a panel of raters, classifying the orbicularis oris muscle as negative, positive, or unknown for the presence of an orbicularis oris discontinuity (subepithelial defect). Based on ultrasound, six lip specimens were chosen for histological sectioning, were stained with hematoxylin-eosin and Gomori trichrome stain, and were evaluated with light microscopy at low (8x) and intermediate (100x) magnification., Results: One cadaver was scored positive for an orbicularis oris muscle discontinuity based on ultrasound; whereas, the remaining cadavers were scored negative. Of the cadavers with negative ultrasound scores, two were noted to have orbicularis oris muscles with "irregular" features (e.g., excessive localized thinning or asymmetry). From histology, the area of discontinuity as visualized on the positively scored ultrasound was characterized by both disorganized orbicularis oris muscle fibers and excess connective tissue within the muscle belly. In contrast, the localized thinning observed on some of the negatively scored ultrasounds was not confirmed by histology., Conclusions: Abnormalities of the orbicularis oris muscle visualized by ultrasound have an anatomic basis as revealed through histology. Ultrasound is a useful tool for noninvasively identifying discontinuities of the orbicularis oris muscle.

Objective: To quantify comparative improvement between osseous and soft tissue asymmetry following primary lip repair., Design: Retrospective analysis of preoperative and postoperative computed tomography scans of infants with unilateral cleft lip and palate. Sixteen soft tissue landmarks were placed using an exploratory two-/three-dimensional image processing system and compared for asymmetry., Patients: Computed tomography scans were obtained on 26 patients (13 boys, 13 girls) of Chinese ethnicity (mean age = 0.25 years) prior to Millard lip repair. Nineteen of these contributed to follow-up comparative studies prior to palatoplasty at a mean age of 0.92 years. There were 18 left-sided and eight right-sided clefts., Main Outcome Measure: Euclidean distance matrix asymmetry analysis was used to determine the amount of soft tissue asymmetry pre- and postlip repair. Similar analyses of the same scans were performed for 41 osseous landmarks., Results: Soft tissue landmarks had 36/39 (92%) preoperative and 13/39 (33%) postoperative asymmetric pairs. Osseous distances demonstrated 77/125 (61%) asymmetric pairs preoperatively and 60/125 (48%) postoperatively. Soft tissue and osseous distances of the lip region demonstrated 32% and 39% postoperative asymmetry, respectively. Soft tissue and osseous distances of the nasal region demonstrated 52% and 72% postoperative asymmetry, respectively. Soft tissue and osseous distances of the facial landmarks demonstrated 24% and 34% postoperative asymmetry, respectively., Conclusions: Primary lip repair appears to effect gains in symmetry in soft tissue and provides sufficient molding forces to cause correlating symmetry changes in underlying osseous structures.

Aim: Presentation of a new technique to determine the plane of symmetry of a face, and to assess the degree of facial symmetry in patients with unilateral cleft lip and palate based on three-dimensional (3D) optical surface data., Patients and Methods: After having determined a plane of symmetry according to optical 3D facial surface data, we identified differences in landmarks, the surface areas of the upper lip vermilion and nostrils and virtual volumes of the midface, nose and upper lip for cleft and unaffected sides in forty 10-year-old patients suffering from complete unilateral cleft lip, alveolus and palate. The children had undergone lip repair via the Tennison-Randall technique and had received subsequent orthodontic treatment (but not secondary osteoplasty)., Results: Statistically significant differences were apparent between cleft and non-cleft sides in terms of the nasal landmarks, nostril angle and virtual volume of the nose. The upper lip was symmetrical when cleft and non-cleft sides were compared., Conclusions: This new technique of symmetry analysis reveals that the noses of 10-year-old patients with complete unilateral cleft lip and palate who had not undergone revisional surgery present a measurable and significant degree of asymmetry, while the upper lip is symmetrical as a consequence of interdisciplinary treatment by orthodontists and oral and maxillofacial surgeons. Further 3D analyses on larger numbers of patients will allow more comprehensive and consistent analysis of the potential and limitations of various surgical and conservative methods so as to identify those techniques with the best outcome in terms of facial symmetry.

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

A 7-month-old baby was born in a village near Iskenderun (Turkey) where "Unertan Syndrome" with quadrupedality and primitive cognitive abilities was discovered. The clinical diagnosis was anencephaly. However, his head did not show the classical symptoms of anencephaly because it was covered with bony structures. The baby has an ape-like, prognasthic head with low-set ears and flapped ear flaps. The other parts of the body were similar to humans with broad shoulders and a short neck. This may be a further example of human devolution, which was first reported by Tan (2005, 2006a,b,c). A genetic defect affecting the head development including brain may be responsible for the reappearance of the ape-like head in a human being. This human devolution, or evolution in reverse, suggests that the same gene or gene-pool as well as the interactions between genes may be responsible for the transition from our ancestors into human beings with regard to an orthognasthic head, and brain development.

Objective: To investigate the laterality of the normal asymmetry of the human face, examining differences in laterality in relation to sex, growth stage, and skeletal classification., Materials and Methods: A total of 1800 Japanese subjects (651 males and 1149 females; mean age, 15 years 3 months; range, 4 years 2 months to 59 years 11 months) were selected. Individuals in the sample were categorized according to sex, one of three growth stages, and one of three skeletal patterns. Differences in length between distances from the points at which ear rods were inserted to the facial midline and the perpendicular distance from the soft-tissue menton to the facial midline were measured on a frontal facial photograph. Subjects with a discrepancy of more than 3 standard deviations of the measurement error were categorized as having left- or right-sided laterality., Results: Of subjects with facial asymmetry, 79.7% had a wider right hemiface, and 79.3% of those with chin deviation had left-sided laterality. These tendencies were independent of sex, age, or skeletal jaw relationships. In this regard, during pubertal growth, the proportion of subjects with wider right hemiface decreased (P < .0001), whereas the proportion of those with a wider left hemiface increased (P < .01), despite a consistent tendency for right-sided dominance., Conclusion: These results suggest that laterality in the normal asymmetry of the face, which is consistently found in humans, is likely to be a hereditary rather than an acquired trait.

In this study, to clarify the influence of the maxillo-mandibular bones and cranium on airway morphology, maxillo-facial morphology in patients with jaw deformation was measured using cephalograms and X-ray CT imaging data. Subjects consisted of 25 adult women in whom cephalograms and X-ray CT were taken to diagnose jaw deformation. The data obtained were classified based on skeletal and facial patterns according to Ricketts analysis, and changes in internal diameter, height and volume of the middle pharyngeal airway were observed. The results showed that the internal diameter of the inferior airway expanded anteriorly when the mandibular bone was in the anterior position, and was slightly constricted and elongated vertically when the mandibular bone was posteriorly rotated. This suggests that airway volume is influenced by the anteroposterior position of the mandibular bone, in that it compensates for decreases in its volume by extending its height inferiorly to cope with posterior deviation of the mandibular bone.

The incidence of deformational plagiocephaly (DP) in primary health care is increasing. Patients are referred and treated by different practitioners. However, reliable and practical assessment tools in clinical practice are lacking. The clinical classification according to Argenta distinguishes 5 types of DP based on severity of asymmetry of the skull, ear position, and face. The aim of this study was to investigate the reliability of this clinical classification of DP. Twenty referred patients aged 0 to 1 year were classified for DP. Raters from 3 different professions (3 infant health care physicians, 3 pediatric physiotherapists, and 3 manual therapists) were used because these professionals are the first ones who see children with DP in clinical practise. Interrater and intrarater reliability was determined for the type of DP (I-V) and each characteristic clinical feature separately. There was a moderate overall interrater agreement for classifying DP (mean weighted kappa, 0.54), whereas intrarater agreement ranged from 0.60 to 0.85, indicating substantial to almost perfect agreement. Kappa scores of the first 4 clinical features of DP (occipital flattening, ear malposition, frontal bossing, and facial asymmetry) ranged from 0.45 to 0.57 for the interrater reliability and 0.47 to 1 for the intrarater reliability, except for 1 score of -0.14. Agreement for the fifth feature (vertical skull growth) was due to chance (kappa approximately 0). The classification according to Argenta is a moderately reliable method for classifying DP in clinical practice.

Mandibles from 13 island and six mainland populations of common shrews from the west coast of Scotland were subjected to geometric morphometric analysis in order to investigate the relationship between genetic diversity and fluctuating asymmetry. Although population mean shape fluctuating asymmetry (FA) and size FA were significantly inversely correlated with population genetic diversity this result was substantially due to one island. Sanda, the smallest island with by far the lowest genetic diversity, also had the highest FA. When Sanda was removed from the analysis, the relationship was not significant. There was no relationship between genetic diversity and FA at the individual level, whether measured as mean locus heterozygosity or d(2). In general, if genetic variation affects FA at all, the effect is weak and may only be of biological interest in very small populations.

Objective: For children born with a unilateral facial skeletal cleft, oral motor function is impaired and skeletal development and growth are asymmetrical with regard to the midsagittal plane. This study was designed to verify that a unilateral skeletal cleft and its dimensions (i.e., depth and width) affect the severity of the asymmetric stress and strain distribution within the maxilla., Methods: A three-dimensional finite element model of a normal maxilla was developed from pediatric, subject-specific computerized tomography scan data. A clefting pattern then was introduced to simulate varying degrees of deformity in geometry, with the bone properties and boundary conditions held constant. The asymmetric index was introduced to quantify the asymmetrical stress and strain distribution within the maxilla with regard to the midsagittal plane., Results: The unilateral skeletal cleft led to a nonuniform, asymmetric stress and strain distribution within the maxilla: intensified on the noncleft side and weakened on the cleft side. As the depth of the unilateral cleft increased, the stress and strain distribution became increasingly asymmetric as measured by the asymmetric index. In contrast, the width of the cleft had minimal effect on the asymmetrical stress and strain distribution., Interpretation/conclusion: These results implied that a child born with a unilateral cleft would be expected to have an asymmetric skeletal development between the noncleft and the cleft sides as a consequence of an asymmetric functional loading pattern.