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In spite of the widespread use of functional appliances, broad variations were applied the treatment response. The aim of this study is to investigate the pre-treatment cephalometric predictors on the chin advancement of twin-block in growing Chinese patients with class II malocclusion. After screening, 90 patients treated by twin-block were included in the study. The treatment outcome was assessed by the alterations in the distance of skeletal pogonion (Pog) to the vertical reference plane perpendicular to the Frankfurt plane (ΔPog-VRP). Moreover, ΔPog-VRP was divided by the cranial growth indicated by the Nasion to Basion changes (ΔN-Ba) to minimize the growth discrepancy among individuals (adjΔPog-VRP). Patients with ΔPog-VRP/adjΔPog-VRP above the median value were categorized into good response group (GRG/adjGRG, N = 45), while the rest were poor response group (PRG/adjPRG, N = 45). Independent t -test was used to compare the pre-treatment cephalometric measurements between GRG/adjGRG and PRG/adjPRG. Stepwise multivariate regression models were used to determine the pre-treatment cephalometric predictors for the chin advancement. Generally, there were not any significant differences between GRG/adjGRG and PRG/adjPRG regarding age, gender and cervical stage before twin-block treatment. Patients from GRG had significantly reduced cephalometric measurements in the vertical dimensions, including ∠N-Go-Me, ∠Mandibular plane-Occlusal plane (∠MP-OP) and the sum of angles ( p < 0.05) in comparison to PRG. When the individual growth was taken account, similar findings were observed. The patients from adjGRG had a significantly lower ∠Sella Nasion line-MP (∠SN-MP), ∠Ar-Go-Me and ∠N-Go-Me, as well as an increased Posterior facial height (PFH)/Anterior facial height (AFH) ( p < 0.05) compared with their counterparts. ∠N-Go-Me variable was the independent predictor on Pog advancement with (β = -0.26, 95% CI: -0.06 to -0.01, p = 0.01) and without (β = -0.29, 95% CI: -0.06 to -0.01, p < 0.01) adjustments on individual growth. The results of this study showed that patients with a reduced N-Go-Me angle are more likely to experience a greater chin advancement following twin-block treatment., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Introduction: This study aimed to assess the bony and soft tissue parameters at mandibular symphysis among skeletal Class III patients with different vertical growth patterns, using cone-beam computed tomography (CBCT)., Materials and Methods: CBCT images of 60 skeletal Class III non-growing patients were evaluated (mean age 24.9 ± 8.4 years). Study samples were classified into three facial types based on the mandibular plane angle (SN-MP angle): low, normal, and high angle. The bony and soft tissue parameters at the mandibular symphysis were evaluated., Results: Among hard tissue variables, symphysis and pogonion width were significantly narrower in the high-angle group (P < .05). The thickness of the buccal cortex at pogonion was also significantly thinner in subjects with high angles (P < .01). Symphysis height showed an increasing tendency from the low-angle to the high-angle group. However, no significant differences were found in chin width and height according to vertical patterns. Across all soft tissue measurements, the low-angle group exhibited the highest thickness, which gradually decreased in the high-angle group. Statistically significant differences in soft tissue thickness were observed at Menton (Me) and Gnathion (Gn) (P < .05). A significant negative correlation was observed between the SN-MP angle and the thickness of both hard and soft tissues., Conclusions: In skeletal Class III subjects, significant differences existed in both hard and soft tissues at the mandibular symphysis, depending on the vertical patterns. These results provide a comprehensive evaluation of symphyseal area, which can aid clinicians in identifying appropriate treatment approaches, especially for combined orthognathic and orthodontic treatment., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The determining effect of facial hard tissues on soft tissue morphology in orthodontic patients has yet to be explained. The aim of this study was to clarify the hard-soft tissue relationships of the lower 1/3 of the face in skeletal Class II-hyperdivergent patients compared with those in Class I-normodivergent patients using network analysis., Methods: Fifty-two adult patients (42 females, 10 males; age, 26.58 ± 5.80 years) were divided into two groups: Group 1, 25 subjects, skeletal Class I normodivergent pattern with straight profile; Group 2, 27 subjects, skeletal Class II hyperdivergent pattern with convex profile. Pretreatment cone-beam computed tomography and three-dimensional facial scans were taken and superimposed, on which landmarks were identified manually, and their coordinate values were used for network analysis., Results: (1) In sagittal direction, Group 2 correlations were generally weaker than Group 1. In both the vertical and sagittal directions of Group 1, the most influential hard tissue landmarks to soft tissues were located between the level of cemento-enamel junction of upper teeth and root apex of lower teeth. In Group 2, the hard tissue landmarks with the greatest influence in vertical direction were distributed more forward and downward than in Group 1. (2) In Group 1, all the correlations for vertical-hard tissue to sagittal-soft tissue position and sagittal-hard tissue to vertical-soft tissue position were positive. However, Group 2 correlations between vertical-hard tissue and sagittal-soft tissue positions were mostly negative. Between sagittal-hard tissue and vertical-soft tissue positions, Group 2 correlations were negative for mandible, and were positive for maxilla and teeth., Conclusion: Compared with Class I normodivergent patients with straight profile, Class II hyperdivergent patients with convex profile had more variations in soft tissue morphology in sagittal direction. In vertical direction, the most relevant hard tissue landmarks on which soft tissue predictions should be based were distributed more forward and downward in Class II hyperdivergent patients with convex profile. Class II hyperdivergent pattern with convex profile was an imbalanced phenotype concerning sagittal and vertical positions of maxillofacial hard and soft tissues., (© 2024. The Author(s).)

Objective: To examine the patterns of pretreatment facial soft tissue shape in orthodontic cases with premolar extraction using artificial intelligence (AI) and to investigate the corresponding changes., Methods: One hundred and fifty-two patients who underwent orthodontic treatment with premolar extraction were enrolled. Lateral cephalograms were obtained before and after the treatment. For each record, the outlines of the nose-lip-chin profile and corresponding 21 cephalometric variables were extracted. The AI method classified pretreatment records into three subject groups based on the feature variables extracted from the outline. Dentoskeletal and soft tissue facial form changes observed after treatment were compared statistically (P < 0.05) between the groups using ANOVA. Multivariate regression models were used for each group., Results: Group 1 (n = 59) was characterized by Class II high-angle retrognathic mandible with an incompetent lip, group 2 (n = 55) by Class I malocclusion with retruded and thin lips, and group 3 (n = 38) by Class I malocclusion with an everted superior lip before treatment. The ratios of anteroposterior soft tissue to hard tissue movements in Group 1 were 56% (r = 0.64) and 83% (r = 0.75) for the superior and inferior lips, respectively, whereas those in Group 2 were 49% (r = 0.78) and 91% (r = 0.80), and 40% (r = 0.54) and 79% (r = 0.70), respectively, in Group 3., Conclusions: The modes of facial form changes differed depending on the pre-treatment profile patterns classified by the AI. This indicates that the determination of the pre-treatment profile pattern can help in the selection of soft tissue to hard tissue movement ratios, which helps estimate the post-treatment facial profile with a moderate to high correlation., (© 2024. The Author(s).)

Background: The chin plays a fundamental role in facial attractiveness. Accordingly, several surgical procedures have been proposed for chin contouring. This study aimed to introduce "B-genioplasty" as a novel genioplasty technique and assess the clinical and cephalometric changes in long-face patients with retrognathia following the novel B-genioplasty., Methods: This is a cross-sectional study. Subjects with class I occlusion increased lower facial height and retrognathia underwent B-genioplasty in this prospective experimental study. Soft and hard tissue cephalometric measurements were made, and the depth of the notch in the lower border of the mandible was measured on lateral cephalograms at 6 months postoperatively and compared with baseline. Patient satisfaction with the outcome was also assessed., Results: Seventeen subjects were studied. Ten (58%) patients underwent rhinoplasty plus genioplasty. All patients were satisfied with the outcome. The step/notch in the lower border of the mandible was not detected in clinical examination in any patient. The mean notch depth was 0.5±0.83 mm on lateral cephalograms. The change in all soft and hard tissue cephalometric parameters was significant at 6 months postoperatively compared with baseline ( P <0.001 for all)., Conclusion: B-genioplasty caused satisfactory clinical and cephalometric changes in long-face patients with retrognathia, including prevention of step/notch in the inferior border of the mandible, significant reduction of gonial angle, correction of the mandibular plane, and reduction of lower facial height., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

The use of dermal fillers for cosmetic procedures has increased rapidly both worldwide and in the Netherlands in recent years, which has led to an absolute increase in reported side effects and complications. Although most of these complications are mild, serious complications such as vascular occlusion can also occur. In this article, we describe a case of a 35-year-old woman who showed signs of reduced tissue perfusion and the early stage of skin necrosis following injection of hyaluronic acid fillers in the chin. This complication was successfully treated by ultrasound-guided injection of hyaluronidase, resulting in a full recovery without residual symptoms. To minimize the risk of serious complications treatment with hyaluronic acid fillers should be carried out by an experienced practitioner.

Soft tissue chondromas are benign tumors, generally of the hands or feet, very rarely of the head and neck region. Repeated microtrauma may be as an initiating factor. The authors describe a case of a soft tissue chondroma of the chin in a 58-year-old male who had used a continuous positive airway pressure face mask for obstructive sleep apnea for 3 years. The patient presented with a hard mass on his chin for 1 year. Computed tomography imaging showed a heterogeneous enhancing mass, with calcification in the subcutaneous layer. Intraoperatively, the mass was beneath the mentalis muscle and abutted the mental nerve, without bone involvement. The diagnosis was a soft tissue chondroma. The patient recovered fully, without recurrence. The primary cause of soft tissue chondromas is unknown. The authors consider that continuous use of a continuous positive airway pressure face mask may play a role in the etiology., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Background: Numb chin syndrome (NCS) is a rare sensory neuropathy involving the mental nerve. Symptoms of NCS are often overlooked because of their apparent innocent nature; however, owing to the frequent association of NCS with malignancies, the opposite should be the rule. Oral health care professionals may be the first to encounter patients with NCS and should be aware of its clinical characteristics in an effort to decrease patient morbidity and mortality., Types of Studies Reviewed: A search in PubMed (MEDLINE) and the Cochrane Library was performed using the terms numb chin syndrome, numb chin, mental neuropathy, mental nerve neuropathy, and malignant mental nerve neuropathy, yielding 2,374 studies. After inclusion and exclusion criteria were applied, 102 studies remained. Descriptive statistics were performed, analyzing the etiology responsible for NCS, characteristics of NCS including associated symptoms, unilateral or bilateral nature, and information on professionals visited and examinations requested to make a diagnosis., Results: NCS was associated with malignancy in 29% through 53% of the published cases. Twenty-eight percent of patients initially consulted an oral health care professional with the symptom of a numb chin. Patients more likely to have NCS were those from the ages of 61 through 70 years; 74% were unilateral; and the most common symptoms reported were numbness (100%), paresthesia (18%), and pain (17%). Forty-seven percent of the NCS cases were associated with a recurrent malignancy, and the most prevalent associated diagnoses were breast cancer (32%) and lymphoma and leukemia (24%)., Conclusions: Oral health care professionals should be aware of the characteristics of NCS as they may be the first health care providers consulted for these symptoms., Practical Implications: A thorough medical and dental history as well as a complete cranial nerve screening should be performed on all patients, especially those with numbness, as this may prevent misdiagnosis and allow a timely referral and a substantial improvement of treatment course and prognosis., (Copyright © 2023 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Abstract: Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare benign tumor composed of skeletal muscle fibers and other mesenchymal-derived cells. The lesions are generally solitary sessile papules or skin tag lesions that occur during childhood. We retrospectively reviewed patients diagnosed with RMH pathologically between January 2001 and June 2020 at a tertiary medical center. A literature review was conducted. Seven plaque-type RMHs on the chin were found, including 6 in adults and one in a 14-year-old boy. The average age was 45.7 years. The onset of the RMH appearance was between several months and years. Pathologically, all patients showed a scattered haphazard arrangement of skeletal muscle bundles in the dermis and/or subcutis. Subcutis replaced by fibrous tissue and skeletal muscle bundles was present in 2 cases. Some skeletal muscles had a periadnexal distribution. This case series demonstrated a distinct clinical presentation of acquired RMH specifically located on the chin., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Accumulation of cervical and chin subcutaneous adipose tissues (SAT) represent known phenotypes of obesity. We aimed to evaluate the sensitivity of these fat storages to long-term weight-loss directed lifestyle-intervention and to assess their relations to bodily-adiposity, insulin-resistance, and cardiometabolic risk; We randomly assigned 278 participants with abdominal-obesity/dyslipidemia to low-fat or Mediterranean/low-carbohydrate diets +/- physical-activity. All participants underwent an 18 month whole-body magnetic resonance imaging follow-up, from which we assessed cervical and chin SAT-areas; Participants (age = 48 years; 90% men; body-mass-index = 30.9 kg/m 2 ) had an 18-month adherence-rate of 86%. Cervical-SAT and chin-SAT decreased after 6-months (-13.1% and -5.3%, respectively, p < 0.001). After 18-months only cervical-SAT remained decreased compared to baseline (-5%, p < 0.001). Cervical and chin-SAT 18-month changes were associated with changes in weight (r = 0.70, r = 0.66 respectively; <0.001 for both) and visceral-adipose-tissue (VAT; r = 0.35, r = 0.42 respectively; <0.001 for both). After adjustment to VAT, waist-circumference, or weight-changes, chin-SAT 18-month reduction was associated with favorable changes in fasting-glucose (β = 0.10; p = 0.05), HbA1c (β = 0.12; p = 0.03), and homeostasis-model-assessment-of-insulin-resistance (β = 0.12; p = 0.03). Cervical-SAT 18-month reduction was associated with decreased triglycerides (β = 0.16; p = 0.02) and leptin (β = 0.19; p = 0.01) independent of VAT; Cervical and chin-SATs are dynamic fat depots that correspond with weight-loss and are associated with changes in cardiometabolic profile. In long-term, chin-SAT displays a larger rebound compared with cervical-SAT. Chin-SAT accumulation is associated with in insulin-resistance, independent of central obesity. (ClinicalTrials identifier NCT01530724).

Retrognathia (recessed chin) and prognathism (prominent chin) often present as signs of an underlying condition. Accurate clinical definitions are important. Yet their definitions were according to "clinical impression", or to seldom used X-ray criteria. We propose a statistical and anthropometric definition of retrognathia and prognathism based upon the ratio between the goniomaxillar length (distance between the gonion at the mandible angle and the subnasale and the goniomandibular length (distance between the mandible angle and the most anterior point of the bony chin). We assumed that an increase in the ratio indicates retrognathia and a decrease reflects prognathism. We conducted a prospective, observational, anthropometric study in 204 consecutive healthy term infants. Measurements took place on the second day of life, using sliding calipers. Mean ± SD of goniomandibular length (5.1 ± 0.3 cm), goniomaxillar length (5.4 ± 0.3 cm), were calculated. All measurements correlated significantly with gestational age, and with infant birthweight. The mean ± SD goniomaxillar length/goniomandibular length ratio was 1.06 ± 0.05. We defined a normal ratio as being within 2 SD of the mean, that is, between 0.96 and and 1.16. This ratio correlated with neither gestational age nor with birthweight. We conclude that the goniomaxillar length/goniomandibular length ratio can be calculated whenever retro - or prognathism is suspected. A ratio outside of the 95% confidence interval should help in making this diagnosis. An increase in this ratio beyond 2 SD above the mean (1.16) could be interpreted as retrognathia and a decrease beyond 2 SD below the mean (0.96) as prognathism., (© 2020 Wiley Periodicals LLC.)

The aim of our study was to compare soft tissue measurements with 3D imaging methods in individuals with untreated skeletal and pseudo-Class III malocclusions. The study sample consisted of 75 patients (38 males, 37 females, mean age 12.41 ± 2.35 years) with pseudo- and true skeletal Class III malocclusions and skeletal Class I malocclusions. Soft tissue evaluations of all patients were performed using 3D stereophotogrammetric facial images. In our study, 26 landmarks, 17 linear measurements, 13 angular measurements, and 5 volume measurements were made using the 3dMD Vultus software. The significance was determined to be p < 0.05 in ANOVA, Tukey tests. No significant differences were found among the groups in terms of demographic data (p > 0.05). The skeletal Class I control group had a significantly more extended upper lip and vermillion length as compared to the Class III groups. The soft tissue convexity angle and upper nasal angle were found to be wider in the Class III malocclusion group compared to those in the Class I control group. While the pseudo-Class III group had a significantly lower midface volume, chin volume was significantly higher in the skeletal class group. Upper lip volume was significantly higher in the Class I group. Using 3dMD for guiding clinicians in the differential soft and hard tissue diagnosis of pseudo-Class III malocclusions, differences were revealed in Class I patients in the middle part of the face. In the differential diagnosis of true Class III malocclusions, chin volume was found to be different from that of Class I patients.

Phymatous rosacea is a rare and severe form of rosacea that manifests as disfiguring soft-tissue hypertrophy and sebaceous gland hyperplasia and fibrosis. Most cases are surgically treated; surgical modalities vary, however, ranging from cryosurgery to conventional excision, and consensus guidelines for surgical management do not exist. The Versajet II Hydrosurgery System (Smith-Nephew) is a high-pressure, pulsatile lavage system. We present the case of a 75-year-old man with severe phymatous rosacea of the nose, cheeks, and chin who was successfully treated with the Versajet II Hydrosurgery System, yielding excellent contouring.

Background/objectives: Functional appliances are commonly used to correct Class II malocclusion. This study aimed to compare the facial soft tissue changes in Caucasians between pre-treatment and with the construction bite versus pre-treatment and completion of treatment with a modified Twin-block appliance (MTBA)., Materials and Methods: Fifty-eight Caucasian subjects with Class II division 1 malocclusion had 3D stereophotogrammetric images captured pre-treatment (T1), with the construction bite (T2), and on completion of MTBA treatment (T3). Twenty-six landmarks were located on each image and 10% were re-landmarked 1 month later. Soft-tissue linear and volumetric changes (T1-T2 and T1-T3) were analyzed using linear mixed effect models (SAS® Version 9.4, www.sas.com)., Results: Forty-seven subjects [mean age 13.2 (SD 1.7) years] completed treatment [mean duration 9.8 (SD 3.8) months]. Differences between the changes from T1 to T2 versus T1 to T3 for upper facial and upper lip landmarks were insignificant (all P > 0.05) except for nasion, orbitale right, pronasale, and subnasale. For the same comparisons, lower lip and chin landmarks changed significantly (all P < 0.05) as did facial soft tissue volume (P< 0.0001)., Limitations: There was no control group., Conclusion: The facial soft tissue changes from pre-treatment to with the construction bite were considerably more than those from pre-treatment to completion of treatment with a MTBA., Implication: With MTBA treatment, the soft tissue changes from pre-treatment to with the construction bite in situ, overestimate those from pre- to post-treatment.

Introduction: Previous studies have looked at a variety of dental and facial asymmetries and compared their detection by dental professionals with those of laypersons. However, few studies have analyzed the diagnosis and perception of chin asymmetries. In this study, we assessed whether dental professionals can recognize and diagnose facial asymmetries of the chin better than laypeople., Methods: Chin asymmetries were analyzed through a series of edited frontal photographs of 2 subjects (male and female). The transverse position of the chin was digitally altered from 0° (no alteration) to 6° (most severe alteration). Participant responses were collected from laypersons (n = 64), nonorthodontist dentists (n = 58), and orthodontists (n = 145). Participants graded the photographs according to esthetic appeal using a visual analog scale. Statistical analysis produced diagnostic threshold levels for identifying chin asymmetries., Results: Nonorthodontist dentists and orthodontists were better able to diagnose transverse chin asymmetry in the female subject at a lower threshold level of 2° of deviation, compared with laypersons at a 3° deviation. Orthodontists could diagnose transverse chin asymmetry in the male subject at a lower threshold level of 1° of deviation, compared with laypersons and nonorthodontist dentists at a 2° deviation. All 3 groups of raters graded very small or no chin asymmetries (1° and 0°) as more attractive, whereas high degrees of chin asymmetries (5° and 6°) were graded as most unattractive by all 3 groups., Conclusions: Transverse asymmetries of the chin influence the perception of facial attractiveness by laypersons, nonorthodontist dentists, and orthodontists. Subjects with small asymmetries are graded as most attractive, and subjects with large asymmetries are graded as least attractive. Orthodontists were the harshest graders, followed by the nonorthodontist dentists, whereas laypersons were the most lenient. The accuracy of diagnosing chin asymmetries varied among laypersons, nonorthodontist dentists, and orthodontists. Laypersons were the least accurate in diagnosing transverse chin asymmetries in a female subject, and they were just as accurate as nonorthodontist dentists when diagnosing this asymmetry in a male subject. Nonorthodontist dentists were just as accurate as orthodontists when diagnosing transverse chin asymmetries in a female subject, and orthodontists were the most accurate in diagnosing transverse chin asymmetries in a male subject., (Copyright © 2018 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

A 42-year-old man presented himself with a complaint of recurrent swelling of the chin. After clinical and radiographic examination, it was shown to be an injury caused by the use of an insufficiently disinfected mouthpiece when diving at an exotic destination. Oral injuries caused by diving mouthpieces are widely known. It is less well known that an untreated injury can ultimately lead to tooth loss.

Objective: Sialoblastoma is a rare salivary gland tumor mainly located in parotid. In this article, we aimed to review the clinical manifestations and treatments of sialoblastoma, especially to provide effective chemotherapy regimens to instruct internal medicine therapy for unresectable or recurrent tumors., Method: We reported a 1-year old girl who presented a left-sided firm facial mass and subsequently diagnosed as sialoblastoma. Afterwards, we reviewed and analyzed relevant literatures., Results: Sixty-four cases of pediatric sialoblastoma were reviewed. Of them, surgical excision was the basic treatment, 17 cases received chemotherapy, and 15 cases got good response. Lung metastasis was reported in six patients, all of whom had good response to chemotherapy., Conclusion: Chemotherapy may play an important role in residual, extensive, metastatic and relapsed cases. In addition, lung metastasis was unlikely to exert a significant effect on prognosis., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: We studied longitudinally the associations of craniofacial morphology, mouth breathing, orthodontic treatment, and body fat content with the risk of having and developing sleep disordered breathing (SDB) in childhood. We hypothesized that deviant craniofacial morphology, mouth breathing, and adiposity predict SDB among children., Materials and Methods: The participants were 412 children 6-8 years of age examined at baseline and 329 children aged 9-11 years re-examined at an average 2.2-year follow-up. An experienced orthodontist evaluated facial proportions, dental occlusion, soft tissue structures, and mode of breathing and registered malocclusions in orthodontic treatment. Body fat percentage was assessed by dual-energy X-ray absorptiometry and SDB symptoms by a questionnaire., Results: Children with SDB more likely had convex facial profile, increased lower facial height, mandibular retrusion, tonsillar hypertrophy, and mouth breathing at baseline and convex facial profile, mandibular retrusion, and mouth breathing at follow-up than children without SDB at these examinations. Male gender and body adiposity, mouth breathing, and distal molar occlusion at baseline were associated with SDB later in childhood. Adipose tissue under the chin, mandibular retrusion, vertically large or normal throat and malocclusion in orthodontic treatment at baseline predicted developing SDB during follow-up of among children without SDB at baseline., Limitations: We could not conduct polysomnographic examinations to define sleep disturbances. Instead, we used a questionnaire filled out by the parents to assess symptoms of SDB., Conclusions: The results indicate that among children, deviant craniofacial morphology, mouth breathing, body adiposity, and male gender seem to have implications in the pathophysiology of SDB.

Mental nerve neuropathy is usually due to local trauma or dental causes, but may be a manifestation of malignancy. A patient with virologically controlled human immunodeficiency virus (HIV) infection presented with a 'numb chin' on the background of long-standing night sweats, malaise and weight loss, worsening respiratory symptoms, and lymphadenopathy. Burkitt non-Hodgkin lymphoma was diagnosed from histology of a lymph node. Imaging (magnetic resonance imaging and 18 fluorodeoxyglucose [FDG]-positron emission tomography-computed tomography [PET-CT]) showed abnormal intracranial enhancement of the right mandibular nerve and extensive 18 FDG-avid lymphadenopathy above and below the diaphragm, focal lesions in the spleen and within the right mandible. The patient received chemotherapy and remains in clinical and radiological remission seven years later. This case highlights the need for clinicians to maintain a high index of suspicion for underlying malignancy when an HIV-infected patient presents with new onset of a 'numb chin'. Additionally, it demonstrates the importance of functional 18 FDG-PET-CT and neuroimaging in order to identify site(s) of pathology.

Vascular complications after hyaluronic acid (HA) filling of the chin have rarely been reported. In this report, two cases of vascular occlusion after HA augmentation of the mentum are presented. The first case involved local skin necrosis that resulted from a massive microcirculatory embolism and/or external compression of the chin skin microvasculature. The second case involved vascular compromise in the tongue that resulted from HA injection in the chin. The diagnosis was established on the basis of interventional angiography findings. Concerning the pathogenesis, we hypothesized that the filler embolus flowed into the branches of the deep lingual artery through the rich vascular anastomoses among the submental, sublingual, and deep lingual arteries, after being accidentally injected into the submental artery (or its branches). Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

According to a great desire for facial rejuvenation, dermal filler is promising for improving people's appearance without surgery. In a society of plastic surgery, injection of dermal filler is one of the most common procedures for a younger appearance. An increase in patients who have filler injection has been paralleled by a rise in various adverse reactions. Formation of inflammatory or infected nodules is one of the most common long-term complications. Infections can be increased because of improper disinfection of the patient's skin, a poor injection technique, decreased general immunity, and the presence of pathogens. The majority of bacteria are aerobic or facultative aerobic bacteria. This expectation of pathogens is critical for deciding on the antibiotic treatment before confirming the pathogen by microbial culture. The authors experienced unusual culture results in a patient with a chronic inflammatory nodule with abscess formation. The authors report a unique Aspergillus-cultured infection after filler injection.

Aim: The aim of this study was to describe hard and soft tissue changes after mandibular advancement surgery and to investigate the possible differences between Class II facial patterns., Materials and Methods: Lateral cephalograms of 109 patients who underwent combined orthodontic treatment and bilateral sagittal split osteotomy (BSSO) were studied. Radiographs were taken within 6 weeks before surgery (T0) and at least 6 months postoperatively (T1). Patients were classified into 3 groups according to the preoperative mandibular plane angle. Hard- and soft-tissue changes were analysed with an x-y cranial base coordinate system. Measurements were evaluated statistically., Results: Soft and hard tissues of the chin moved forward and downward. The position of the upper lip remained unchanged, while the lower lip moved forward and upward and decreased in thickness. The soft tissue points of the chin follow their corresponding skeletal points almost completely, while the change of the lower lip was only 76 per cent of the movement of the underlying hard tissue. The increase of SNB was more evident in the low-angle group, as well as improvement of the facial convexity. Stomium superius moved more forward in the low- and medium-angle cases. Ratios of hard and soft tissue changes showed no differences for different facial patterns., Limitations: Limitations derived from the retrospective study design. Only short-term changes could be addressed. The distinction between surgical changes and changes due to skeletal relapse is difficult to assess. Also, the difficulty to reproduce a relaxed lip position during imaging may influence our results., Conclusion: Class II characteristics improved after mandibular advancement. Soft tissues of the chin follow their skeletal structures almost in a 1:1 relationship, while movement of the lower lip was less predictable. The facial pattern of Class II patients should be considered in treatment planning., (© The Author 2017. Published by Oxford University Press on behalf of the European Orthodontic Society.)

Numb chin syndrome (NCS) is a rare yet potentially ominous sensory neuropathy in the distribution of the mental or inferior alveolar nerve characterized by unilateral hypoesthesia over the lower lip, chin and occasionally gingival mucosa. Recognizing NCS is clinically important as this may be a subtle sign of occult malignancy progression or heralding the relapses. It may also occur in benign disease, both systemic and dental in origin. Current expert opinion is that patients with NCS without apparent cause should be assumed to have a malignant etiology until proven otherwise Lossos and Siegal (1992) [1]. Here we report a relapse of Non-Hodgkin lymphoma with NCS with no evidence of metastasis., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: The aim of this study is to evaluate the experience of patients who have benefited from maxillomandibular advancement surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), and also the morphological modifications measured on pre- and postoperative lateral headfilms., Patients and Methods: Twenty-three patients aged 24 to 64 (M=46.8) who had undergone bimaxillary advancement osteotomy for the treatment of OSAHS filled in a questionnaire concerning their overall satisfaction following surgery, the modification of their facial appearance as perceived by themselves and their family and friends, the change in their smile, and the slimmer and more youthful appearance of their face. Measurements of bone and skin points were also performed on lateral cephalograms before and after surgery so as to assess the advancement of the bony bases (maxillary, mandibular and chin advancement) and the impact on soft tissue by analysis of the skin profile., Results: A total of 91.3% of the patients were satisfied overall following the surgical procedure; 78.3% considered that their faces were improved or unchanged; 39.1% found their faces slimmer and 34.8% thought they looked more youthful. Average maxillary, mandibular and chin advancements with respect to the base of the skull were, respectively, 7.4mm, 11.1mm and 14.1mm. Advancement of the stomion point with respect to the Frankfurt plane was 8.3mm on average, reflecting a significant forward movement of the upper and lower lips., Conclusion: Despite greater maxillary and mandibular advancements than in traditional orthognathic surgery, patients reacted positively to these morphological changes, considering in more than a third of cases that their faces looked slimmer or more youthful. It can thus be concluded that overall satisfaction is high, with a morphological impact that is satisfactory and well-accepted by patients postoperatively., (Copyright © 2016 CEO. Published by Elsevier Masson SAS. All rights reserved.)

A 68-year-old man presented with right-side facial numbness. MRI showed an extra-axial mass infiltrating the right temporal bone. It was debulked surgically, and histopathology revealed metastatic adenocarcinoma. Ga PSMA PET/CT done in view of increased PSA levels and clinically suspicious hard lesion in prostate showed primary lesion in left side of prostate with metastases to the right temporal bone. Primary carcinoma of the prostate and metastases to the right temporal bone were proven histopathologically. Our case highlights the usefulness of Ga PSMA PET/CT in identifying the primary site in suspected prostate cancer and mapping the metastatic sites.

Alloplastic chin implants have been a valuable treatment modality for the correction of microgenia. Their use has provided satisfactory esthetic results by improving facial balance. However, bone resorption under these implants can occur. Case reports of 4 patients with the incidental radiographic finding of the presence of chin implants are presented. All 4 subjects had lateral cephalograms and panoramic x-rays taken as part of their orthodontic evaluation. One had a normal mandibular symphyseal contour, and 3 had bone resorption under the implants. One subject had severe resorption. In addition to panoramic and cephalometric x-rays, the subject with severe resorption also had magnetic resonance imaging and computerized tomography as part of the evaluation workup., (Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: Facial attractiveness is an important factor in our social interactions. It is still not entirely clear which factors influence the attractiveness of a face and facial asymmetry appears to play a certain role. The aim of the present study was to assess the association between facial attractiveness and regional facial asymmetries evaluated on three-dimensional (3D) images., Methods: 3D facial images of 59 (23 male, 36 female) young adult patients (age 16-25 years) before orthodontic treatment were evaluated for asymmetry. The same 3D images were presented to 12 lay judges who rated the attractiveness of each subject on a 100mm visual analogue scale. Reliability of the method was assessed with Bland-Altman plots and Cronbach's alpha coefficient., Results: All subjects showed a certain amount of asymmetry in all regions of the face; most asymmetry was found in the chin and cheek areas and less in the lip, nose and forehead areas. No statistically significant differences in regional facial asymmetries were found between male and female subjects (P > 0.05). Regression analyses demonstrated that the judgement of facial attractiveness was not influenced by absolute regional facial asymmetries when gender, facial width-to-height ratio and type of malocclusion were controlled (P > 0.05)., Limitations: A potential limitation of the study could be that other biologic and cultural factors influencing the perception of facial attractiveness were not controlled for., Conclusions: A small amount of asymmetry was present in all subjects assessed in this study, and asymmetry of this magnitude may not influence the assessment of facial attractiveness., (© The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Recently, a number of modalities have been used for noninvasive fat reduction. Radiofrequency (RF) technology is a promising tool for noninvasive body and face contouring. The aim of this study is to evaluate the efficacy and safety of novel noninvasive RF technology for the reduction of submental fat with 6 months of follow-up. Twenty-one subjects with submental fat accumulation were treated twice at 1-month intervals with monopolar RF, which could also be used to monitor real-time temperature. The submental fat thickness and the circumference were evaluated with ultrasonography and a tape measure, respectively, at baseline followed by 1 and 6 months after the last treatment (0, 2, and 7 months). Pain and adverse effects were documented through a questionnaire. The submental circumference and thickness showed a statistically significant reduction after treatments. There was no subject who was not satisfied with the treatment and a physician's assessment showed that 82.3 and 52.9 % of patients showed above mild improvement at 2 and 7 months. The mean pain score corresponded with discomfort or moderate pain. There were no significant adverse effects such as scars or hyper/hypopigmentation. A novel noninvasive RF technology is shown to be effective and safe for submental fat reduction. The effectiveness of fat reduction was maintained for 6 months after the last treatment.

A 51-year-old man was referred by his dentist to a maxillofacial surgeon with complaints of illness and pain in the mandible, associated with a rapidly expanding area of black gingiva and mucosa surrounding the lower front teeth. Clinically and radiographically there was evidence of an infected necrosis of the chin and floor of mouth. Following debridement at the operating room, the patient was treated at the intensive care unit for septic shock leading to prolonged hospitalisation. Investigation of the bone marrow did not provide an explanation for pancytopenia or the severity of the illness. In addition, genetic investigation of thiopurine S-methyltransferase gene showed no mutations. This gene codes for an identically named protein enzyme that contributes in the metabolising of the medicine azathioprine, used daily for an autoimmune disease. A combination of the use of azathioprine, a folic acid deficiency and sepsis led to this exceptional course of illness. Therapeutic intervention consisted of surgical debridement and treatment of the bacteraemia. Afterwards several corrective surgeries were necessary to restore oral functions.

Maxillomandibular dysmorphia may be associated with structural chin pathologies. Three-dimensional jaws displacements have limits. Specific genioplasty is an additional surgical mean for soft tissues profile normalization. Osteotomy line is examined according an incline angle and a possible lateral extension, as chin wing technique, improves facial shape. Cephalometric set-up with R line analyzes surgical chin movements and impact of lower incisors labial inclination on lower lip and mentolabial fold after advancement genioplasty. Micro-implant anchorage is a precious help to find lower incisors good position and optimum lower occlusal plane frontal shift in asymmetric facial pattern. Orthodontics criteria are essential factors to access an aesthetic success in genioplasties procedures., (© EDP Sciences, SFODF, 2016.)

Objective: To determine changes in mandibular position after the treatment of patients presenting with Class II division 2 malocclusions and to test the null hypothesis that there is posterior displacement of the mandible in these patients, in comparison with a control group of Class II division 1 subjects., Materials and Methods: The assessed data consisted of pre- and post-treatment cephalometric radiographs of 77 subjects identified with Class II division 1 and Class II division 2 malocclusions matched according to age, gender and treatment duration. All completed fixed appliance orthodontic treatment. The changes in the position of point B, Pogonion and Articulare were determined at the end of treatment by superimposing the cephalometric radiographs on Sella-Nasion line at Sella. Thirteen cephalometric parameters including the distance between Basion and Articular (Ba-Art) were measured at each stage., Results: In both groups, SNB angle, SNPog angle and Ba-Art distance showed no statistically significant changes. Pogonion was displaced significantly in a forward and downward direction in the growing group, with no significant differences identified between Class I division 1 and Class II division 2 subjects., Conclusion: The null hypothesis that there is posterior displacement of the mandible in Class II division 2 malocclusion is rejected. The growth pattern of the mandible in both divisions of a Class I malocclusion after orthodontic treatment was found to be similar

Aim: The aim of the present study was to investigate and compare the cephalometric effects of a conventional Hyrax expansion screw and a memory screw on the skeletal and dentoalveolar structures and soft tissues of the face., Methods: Thirty-two patients with a maxillary transverse deficiency were divided into two groups. A memory-screw group included 17 patients (nine females and eight males), while a Hyrax-screw group was comprised of 15 patients (eight females and seven males). The mean ages of the subjects in the memory-screw and Hyrax-screw groups were 13.00 ± 1.29 and 12.58 ? 1.50 years, respectively. Lateral cephalograms were taken of the patients at the beginning of the treatment (T1), at the end of expansion (T2) and retention periods (T3). The mean expansion period was 7.76 ± 1.04 days in the memory-screw group and 35.46 ± 9.39 days in the Hyrax-screw group. The Shapiro-Wilk Normality test was used to determine whether the investigated parameters were homogeneous. To determine the treatment changes within the groups, a paired test and Wilcoxon Signed Rank test were applied to the homogeneous and non-homogeneous parameters, respectively. A comparison between the groups was carried out using the Student's t-test for homogeneous parameters and the Mann-Whitney U test for all others., Results: A results summary indicates that mid-palatal sutural opening and subsequent important skeletal and dental expansions were obtained in all patients. The maxilla moved anteriorly and inferiorly in both groups while the mandible rotated inferiorly and posteriorly but to a greater extent in the memory-screw group., Conclusion: The newly-developed memory expansion screw takes advantage of rapid and slow maxillary expansion protocols. The suture is opened and the maxilla expanded with relatively lighter forces over a shorter time. The RME using the memory screw resulted in similar sagittal and vertical changes to those produced by the Hyrax screw.

Aim: To assess the sagittal soft tissue morphology of patients with acromegaly in comparison with a healthy control group., Methods: Twenty-seven patients with acromegaly (11 male, 16 female; mean age 47.3 ± 11.5 years) and 30 healthy subjects (15 male, 15 female; mean age 42.2 ± 17.4 years) were included in the study. Linear and angular measurements were made on lateral cephalograms to evaluate soft tissue and skeletal characteristics. The intergroup comparisons were analysed with the Student's t-test., Results: Facial convexity (p < 0.01) and the nasolabial angle (p < 0.001) were reduced in patients with acromegaly, whereas nose prominence (p < 0.01), upper lip sulcus depth (p < 0.01), upper lip thickness (p < 0.01), basic upper lip thickness (p < 0.01), lower lip protrusion (p < 0.05), mentolabial sulcus depth (p < 0.05) and soft tissue chin thickness (p < 0.001) were increased. Anterior cranial base length (p < 0.05), the supraorbital ridge (p < 0.01), the length of the maxilla and mandible (p < 0.001, p < 0.01, respectively) were significantly increased, and mandibular prognathism was an acromegalic feature (p < 0.05)., Conclusion: Acromegalic coarsening and thickening of the craniofacial soft tissues was identified from lateral cephalograms, which may therefore contribute to early diagnosis when evaluated together with other changes caused by the disease.

Purpose: The purpose of this study was to evaluate the stability of bilateral sagittal split ramus osteotomy (BSSO) setback with rigid internal fixation in a surgery-first approach (SFA) for patients with skeletal Class III malocclusion., Patients and Methods: Twenty-seven consecutive patients with skeletal Class III malocclusion treated with BSSO with the SFA were included in the study. Lateral cephalograms were taken and traced before surgery and 1 and 6 months after surgery. Cephalometric measurements were compared using repeated-measures analysis of variance. A P value less than or equal to .05 was considered significant., Results: The study included 9 men (age, 25.7 ± 2.9 yr) and 18 women (age, 26.6 ± 4.2 yr). Treatment time was 8.4 ± 1.5 months. Horizontally, there were no meaningful anteroposterior changes of the pogonion and B point during the postsurgical period (0.9 and 0.6 mm, respectively). Vertically, the pogonion showed superior movement after surgery (2.4 mm) without major postsurgical change (0.6 mm). The B point showed major superior movement after surgery (2.3 mm) and during the postsurgical period (1.2 mm). The inclination of the lower incisor was increased labially during the postsurgical period (2.4°), although this was not statistically important., Conclusions: In the present study, there was no major horizontal relapse for any variable (<1 mm). Vertically, all variables showed no meaningful changes during the postsurgical period except the B point showed 1.2 mm of superior displacement. BSSO with rigid fixation using the SFA seems to be an effective and predictable procedure in patients with skeletal Class III malocclusion., (Copyright © 2016. Published by Elsevier Inc.)

Introduction: Submental flap is useful for intra-oral reconstructions and reconstructions of the lower two thirds of the face. Dissection is delicate because of a difficult exposure under the lower rim of the mandible, numerous collateral arterial branches and the proximity of the marginal branch of the facial nerve. The aim of our work was to propose anatomical landmarks in order to facilitate the submental flap raising., Material and Method: Ten bodies preserved in Biomet liquid were dissected bilaterally. The anatomic relationships between the marginal branch of the facial nerve and the mandible, the relationships of the submental artery, the amount and the location of its collateral branches were measured by means of a caliper., Results: The highest marginal branch observed was located 0.5 cm above the mandibular lower rim, while the lower one was located 0.6cm below this rim. The mean length measured between the facial artery at its crossing over the mandibular rim at the level of the pre-angular notch and the origin of the submental artery was 1.5cm. The average number of collateral branches was 3.6., Discussion: A skin incision made directly under the mandibular lower rim, as mentioned by some authors, may endanger the mandibular marginal branch of the facial nerve. Three positions of the submental artery in relation to the sub-maxillary gland are reported. The collateral branches are intended for gland, muscle, skin and bone. It is necessary to pay particular attention to the sub-lingual artery, an artery of big diameter that arises at 2.8cm on average from its origin and plunges towards the mouth's floor. It must not be followed at risk of clamping the thin pedicle destined to the digastric muscle. It is important to preserve the fat tissue around the submental pedicle in order to avoid venous congestion of the flap., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: Cephalometric inclination change of the lower incisors during orthodontics is used to assess treatment outcome. The lower border of the mandible is commonly used for measuring inclination change, despite it being subject to remodelling in growing patients. Superimposition of radiographs using Björk's 'stable structures' is intended to exclude these growth changes. We tested whether there is a significant difference for three commonly used methods to assess inclination change induced by orthodontic treatment (Me-Go, Go-Gn, the tangent to the lower border of the mandible) when comparing it to Björk's 'stable structures'., Methods: Björk's superimposition does not allow measuring incisor inclination changes directly; hence, one pre- and mid-treatment cephalogram of 39 growing orthodontic patients were superimposed in this retrospective study. The radiographs were taken at least 1 year apart (120 weeks; SD = 34.4). Patients undergoing growth modification treatment were excluded. Standardized cephalograms were hand traced and changes in lower incisor inclination, using the three mandibular planes, were compared to the changes obtained by anatomical superimposition of Björk's 'stable structures'., Results: Linear regression showed good intra-class correlation (ICC) between all methods. ICC was 0.96 for Me-Go, 0.94 for Go-Gn, and 0.92 for the lower border tangent. ICC for operator reliability was 0.99., Limitations: Measurement errors affect all investigations of both analogue and digital radiographs, but movement artefacts particularly apply to the latter. Cephalometry uses two-dimensional measurements of a three-dimensional subject, which can lead to further inaccuracies. These limitations have to be taken into account when interpreting the results of our investigation., Conclusion: Data obtained from Björk's superimposition did not vary significantly from the other more commonly used techniques (Me-Go, Go-Gn, and the tangent to the lower border of the mandible). Remodelling of the lower border of the mandible was insignificant for the time period investigated., (© The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Hair follicle nevi are rare, benign, congenital hamartomas that usually occur in the distribution of the first brachial arch. Histopathologically, the distinction between hair follicle nevus, trichofolliculoma, and accessory tragus has recently come into question, and it may be that they are all on a spectrum of the same condition. We report the case of a 7-day-old boy who presented with a "tag"-like lesion on his midline chin that had been present since birth. Biopsy of the lesion proved it to be a hair follicle nevus., (© 2016 Wiley Periodicals, Inc.)

Introduction: The aims of this study were to (1) assess lateral facial morphology in children and adolescents with juvenile idiopathic arthritis and moderate to severe temporomandibular joint (TMJ) involvement, (2) compare the lateral facial morphology of these subjects with and without TMJ involvement using cephalograms and 3-dimensional (3D) facial photographs, and (3) compare and correlate the results of the 3D photographic and cephalometric analyses., Methods: Sixty patients with juvenile idiopathic arthritis were included and grouped as follows: group 1, juvenile idiopathic arthritis patients without TMJ involvement; group 2, juvenile idiopathic arthritis patients with moderate to severe unilateral TMJ involvement; and group 3, juvenile idiopathic arthritis patients with moderate to severe bilateral TMJ involvement. Lateral cephalograms were used to assess and compare lateral facial morphologies between the groups. Lateral projections of oriented 3D photographs were superimposed on the lateral cephalograms. The results of the lateral 3D photographic analysis were correlated with those of lateral cephalometric analysis., Results: Group 3 showed the most severe growth disturbances, including more retrognathic mandible and retruded chin, steep occlusal and mandibular planes, and more hyperdivergent type (P <0.01). Group 2 showed similar growth disturbances, but to a lesser extent than did group 3. Photographic variables were significantly correlated with the soft tissue and skeletal variables of cephalograms (0.5 < r < 0.9; P <0.001)., Conclusions: Subjects with juvenile idiopathic arthritis and unilateral or bilateral moderate to severe TMJ involvement had significant growth disturbances. Early intervention is recommended for these patients to prevent unfavorable facial development. Furthermore, with proper orientation, 3D photographs can be used as an alternative to conventional lateral cephalograms and 2-dimensional photographs., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: Bicortical screw fixation systems and miniplate with monocortical screw fixation systems have been reported mainly in bilateral sagittal split ramus osteotomy (BSSO). This study compared postoperative stability between these 2 fixation systems by an intraoral approach., Materials and Methods: This was a retrospective cohort study. The study sample was composed of patients treated by BSSO at the authors' institute from January 2006 through December 2012. All cases had facial symmetry and were performed by setback surgery. The predictor variable was treatment group (intraoral screw fixation [SG] vs intraoral miniplate fixation [MG]), and the primary outcome variable was stability defined as the change in the position of point B. Other outcome variables were stability defined as the change in the position of the menton, blood loss, incidence of postoperative temporomandibular joint disorder, and nerve injury. Descriptive and bivariate statistics were computed and the P value was set at .05., Results: Seventy-five patients (35 men and 40 women; mean age, 25.8 yr) were divided into 2 groups (39 SG cases and 36 MG cases). Postoperative changes at point B and the menton in the 2 fixation groups were not statistically different. Lingual nerve injury occurred only in SG cases. Moreover, total blood loss was greater in SG cases., Conclusion: An intraoral miniplate with monocortical screw fixation system is recommended over intraoral bicortical screw fixation for bone segments in setback BSSO in patients without facial asymmetry., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Marked class II dentofacial deformity associated with centrofacial protrusion may be difficult to treat successfully. The purpose of this article was to report on Le Fort II setback osteotomy (LIISBO) to correct Naso-Ethmoido-Maxillary Protrusion (NEMP), to describe its indications and surgical techniques, and to analyze aesthetic and occlusal changes., Materials and Methods: From November 2011 to November 2014, patients with NEMP, treated with LIISBO, were included in the study. Cephalometric analysis of Delaire was performed before and 1 year after surgery. Skeletal and soft tissues movements were measured between preoperative and postoperative lateral cephalographs., Results: Fourteen patients were treated in our department by LIISBO. Ten patients were analyzed and presented a stable class I occlusion with reliable aesthetic results. The mean maxillary setback was -2.8 mm at nasopalatal point (Np), -3.1 mm at A point, and -3.7 mm at Pti (inferior pterygomaxilar point). The mean maxillary impaction was -2.4 mm at Np, -3 mm at A point, and -0.6 mm at Pti. The B, mental, and pogonion points showed an advancement with an average of +7.4, +7.9, and +7.7 mm, respectively. Measured soft tissues variations showed a backward movement of the nasal tip, the subnasal point, and the upper lip of -1.5, -1.6, and -0.7 mm, respectively. The lower lip, sublabial point, and the skin pogonion were advanced by +3.2, +5.4, and +6.2 mm, respectively., Conclusions: Le Fort II setback osteotomy may be regarded as the ideal treatment for adult patient presenting a NEMP syndrome.

Purpose: The purpose of this article is to determine whether certain facial asymmetries (nose and chin) have an impact on the perception of the maxillary dental midline shift., Materials and Methods: From a digitally created symmetric facial model (SFM) constructed in a previous study, a new asymmetric facial model (AFM) was created, with nose and chin deviated to the same side. Modifications were made on the AFM for shifts in the maxillary dental midline in both directions, resulting in a total of eight different images. Through a web survey, 112 randomly selected laypersons were asked to evaluate each image according to their own personal beauty and esthetic criteria using a visual Likert scale., Results: 1 mm of dental midline shift to the left of the AFM was not noticed; 1 mm of dental midline shift to the right of the AFM had a negative impact on perception of facial attractiveness; 2 and 3 mm of dental midline shift to left or right of the AFM had a negative impact on perception of facial attractiveness., Conclusions: Facial asymmetries such as nose and chin inclinations have an impact on the perception of maxillary dental midline shift. Direction of dental midline shift can be a major factor in this perception.

Objectives: Assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilateral cleft lip and alveolus (UCLA), and unilateral cleft lip, alveolus, and palate (UCLP), and to evaluate which area of the face is most asymmetrical., Methods: Standardized three-dimensional facial images of 58 patients (9 UCL, 21 UCLA, and 28 UCLP; age range: 8.6-12.3 years) and 121 controls (age range 9-12 years) were mirrored and distance maps were created. Absolute mean asymmetry values were calculated for the whole face, cheek, nose, lips, and chin. One-way analysis of variance, Kruskal-Wallis, and t-test were used to assess the differences between clefts and controls for the whole face and separate areas., Results: Clefts and controls differ significantly for the whole face as well as in all areas. Asymmetry is distributed differently over the face for all groups. In UCLA, the nose was significantly more asymmetric compared with chin and cheek (P = 0.038 and 0.024, respectively). For UCL, significant differences in asymmetry between nose and chin and chin and cheek were present (P = 0.038 and 0.046, respectively). In the control group, the chin was the most asymmetric area compared to lip and nose (P = 0.002 and P = 0.001, respectively) followed by the nose (P = 0.004). In UCLP, the nose, followed by the lips, was the most asymmetric area compared to chin, cheek (P < 0.001 and P = 0.016, respectively)., Limitations: Despite division into regional areas, the method may still exclude or underrate smaller local areas in the face, which are better visualized in a facial colour coded distance map than quantified by distance numbers. The UCL subsample is small., Conclusion: Each type of cleft has its own distinct asymmetry pattern. Children with unilateral clefts show more facial asymmetry than children without clefts., (© The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aim: To evaluate the differences in pretreatment and post-treatment characteristics of Class III patients treated with orthodontic camouflage or orthognathic surgery, and to compare the range of skeletal, dental and soft tissue changes that are likely to occur with treatment, with particular reference to the influence of extractions on the resultant incisor angulations., Method: Pretreatment and post-treatment cephalograms of 31 Class III orthodontically-camouflaged patients and 36 Class III surgical patients (without genioplasty) were obtained from one specialist practice. From the surgical group, 26 pre-surgical lateral cephalograms were also obtained. Inclusion criteria for the two groups were at least three of the following: (1) an ANB angle of 1 degree or less, (2) a Wits appraisal less than -4 mm, (3) an incisal overjet ≤ 0 mm, and (14) a Class III molar relationship. All lateral cephalograms were traced and digitised and a number of skeletal, dental and soft tissue variables were measured. The camouflage and surgical groups were also divided into premolar extraction and non-extraction subgroups to allow for a specific analysis of extraction effects., Results: Before treatment, the surgical group demonstrated, on average, a more severe skeletal discrepancy and increased dental compensations, compared with the orthodontically camouflaged group. After treatment, the mean SNA angle was greater, the ANB angle was more positive, the Wits appraisal was closer to ideal and the lower incisors were less retroclined in the surgery group. There was a small mean reduction in horizontal chin projection in the surgery group compared with a small increase in the camouflage group. The mentolabial fold and the lower lip curve were deeper, on average, and the lips less retrusive after surgery. There was a mean increase in upper incisor proclination during treatment in both the surgical and camouflage groups with a greater increase in the camouflage group. There was a significant reduction in upper incisor proclination and a subsequent greater increase in the ANB angle associated with upper premolar extractions in the surgical group compared with the non-extraction group. Lower premolar extractions in the camouflage group resulted only in a deeper mentolabial fold compared with those treated without lower extractions., Conclusions: Class III patients selected for surgical treatment are likely to have more severe pretreatment dental and skeletal discrepancies than those selected for camouflage treatment. Surgical treatment is associated with significant decompensation of the lower incisors but, ultimately, not the upper incisors. Class III patients treated with either camouflage or surgery treatment are likely to finish with slightly proclined upper incisors. Generally, surgical treatment results in greater skeletal change, involving normalisation of the skeletal base relationship, a reduction in chin prominence, fuller lips, and a more favourable lip and chin contour.