Using the anterior cranial base to provide a reliable reference plane for patients with or without facial asymmetry.

Introduction: This study aimed to investigate the midsagittal reference plane (MSP) reliability derived from the 3-dimensional characteristics of patients with or without facial asymmetry in the anterior cranial base (ACB).
Methods: We divided the cone-beam computed tomography (CBCT) images of 60 adult patients into maxillofacial symmetry and asymmetry groups. The ACB models were 3-dimensionally constructed, and then symmetrical characteristics were evaluated with surface asymmetry for each group. The reliability of the MSP derived from the symmetry of the anterior cranial base (MSP _ACB ) was assessed in comparison with the true craniofacial symmetry plane determined using the morphometric method.
Results: The ACB was symmetrical, as demonstrated by slight surface asymmetry. The MSP _ACB was reliable for maxillofacial asymmetrical analysis as the intraobserver and interobserver measurements using the MSP _ACB were of excellent agreement, and there was no significant difference between MSP _ACB and morphometric method in asymmetrical measurements in both groups. The MSP _ACB remained stable (maximum deviation <0.32 mm) when cranial landmark identification errors (1 mm and 4 mm) were simulated.
Conclusions: MSP _ACB is reliable for patients with or without facial asymmetry in maxillofacial asymmetry analysis, which is beneficial to patients with severe midfacial asymmetry or trauma when conventional landmarks are displaced or disappear. When using MSP _ACB for patients with cranial malformations or those whose ACBs differ from normal dimensions, caution should be taken.
(Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)