Does facial growth pattern affect the perception of lower facial asymmetry?

OBJECTIVES: To investigate the influence of vertical facial type on esthetic perception of lower facial asymmetry as evaluated by orthodontists, dentists, and laypeople. MATERIALS AND METHODS: Three adult females were selected with normal growth patterns (NGP), vertical growth patterns (VGP), and horizontal growth patterns (HGP). Frontal photographs were made symmetric and digitally altered, rotating the lower facial third clockwise, ranging from 0° to 6° in 1° increments. A web-based survey was designed with 24 images (eight images for each model) in random order. Each image was rated using a scale ranging from 0 (unattractive) to 10 (the most attractive) by 75 orthodontists, 73 dentists, and 78 laypeople. Kruskal-Wallis test was used to determine whether differences among groups were significant. Pairwise comparisons were made with Mann-Whitney U test. The significance level was set at P = .05. RESULTS: In NGP, orthodontists and dentists could recognize slighter deviations (2°), while deviations in VGP and HGP under 3° were not recognized by all groups. Severe deviations (≥4°) were distinguished better in HGP by orthodontists and laypeople. In VGP and NGP, there was no significant difference over 4°. CONCLUSIONS: Growth pattern has a significant influence on perception of lower facial asymmetry. Less severe asymmetry can be detected better in NGP. In severe degrees, increments of asymmetry can be perceived more in HGP by orthodontists and laypeople.

Does mandible ramus height asymmetry affect postoperative skeletal stability in orthognathic surgery patients?

BACKGROUND: Relapses following orthognathic surgery have been reported to exceed 2% to 50%, depending on multiple factors. This study aimed to analyze the stability after orthognathic surgery in patients with mandibular ramus height asymmetry through 3D reconstruction using Cone-beam CT. METHODS: This retrospective cohort study investigated patients who underwent mandibular setback surgery using bilateral sagittal split ramus osteotomy. Three-dimensional CT scans were taken at three different time points. Evaluation of the postoperative stability involved measuring changes in the x, y, and z axes as well as roll and yaw rotations of the mandible at specific landmarks (B point, mental foramen) on 3D CT scans obtained immediately after surgery and 6-12 months postoperatively. They were categorized into four groups based on bilateral mandibular height asymmetry through Asymmetry index (AI). The one-way ANOVA was implemented to compare the intergroup differences and Tukey's post hoc test was employed. Additionally, the Pearson correlation coefficient was also calculated. RESULTS: A total of 24 patients were included in this study. The corresponding AI, representing the degree of asymmetry in both mandibles, were calculated as Group 1 was 1.25 ± 0.64%, Group 2 was 2.89 ± 0.47%, Group 3 was 5.03 ± 0.51%, and Group 4 was 9.40 ± 1.99%. The x-axis change in Group 4 was significantly larger at 1.71 mm compared to Group 1 at 0.64 mm. The mandibular roll, Group 4 showed a statistically significant increase at 1.33° compared to Group 1 at 0.35°. And there was a significant positive correlation observed between x-axis change and AI (p = 0.019), as well as between mandibular roll and AI (p = 0.025). CONCLUSION: After orthognathic surgery, stability was influenced by numerous factors, with the findings of this study suggesting that the degree of ramus height asymmetry in the mandible can be considered one contributing factor.

Comprehensive analysis of alar base inclination and lip line cant following orthognathic correction of maxillomandibular asymmetry: A retrospective study.

This paper examines the relationship between roll rotation of the jaws and changes in alar base or lip line asymmetry in the coronal plane following orthognathic correction. The study involved patients with preoperative frontal alar base and lip line asymmetries greater than 0.5° (because it corresponds to the minimum asymmetry perception threshold) and underwent bimaxillary orthognathic surgery without (Group I) or with (Group II) genioplasty. The alar base angle (ABA), lip line cant angle (LLCA), maxillary cant angle (MxCA), and mandibular cant angle (MnCA) were measured using preoperative and 12 months postoperative cone beam computed tomography (CBCT) images. Thirty-four patients were included in the study. Significant correlations were found between changes in MxCA and ABA besides between changes in MnCA and LCA in Groups I (P = 0.016, P˂0.001, respectively) and II (P = 0.002, P˂0.001, respectively). The mean of the change in ABA/the change in MxCA and the change in LLCA/the change in MnCA ratios for Group I were 0.59 ± 1.57 and 0.73 ± 0.94, respectively, while those for Group II were 0.46 ± 3.70 and 0.39 ± 2.00, respectively. Angular measurements from jugular and mental foramina points, aligned with the bony midline, offer a convenient tool for predicting alar base and lip symmetry during bimaxillary orthognathic surgery planning.

Facial asymmetry outcome of orthognathic surgery in mild craniofacial microsomia compared to non-syndromic class II asymmetry.

OBJECTIVES: To compare the facial asymmetry after bimaxillary surgery between mild craniofacial microsomia (CFM) and non-syndromic class II asymmetry. MATERIALS AND METHODS: Cone-beam computed tomography scans of adults with Pruzansky-Kaban types I and IIA CFM (CFM groups, n = 20), non-syndromic skeletal class II asymmetry (Class II group, n = 20), and normal controls (control group, n = 20) were compared. The area asymmetry of lower face and jaw bones was quantified. Landmark-based method was used to evaluate the lower facial asymmetry regarding midline, cants, and contour. RESULTS: There were no significant postoperative differences in the hemi-facial and hemi-jaw area asymmetry between CFM and Class II groups, both of which were significantly larger than the control group. No significant difference was found in the midline deviation and lip and occlusal cants between CFM and Class II groups. The vertical contour asymmetry in CFM group became significantly larger than Class II group. Compared to the control group, the deviation of pronasale, subnasale, and soft-tissue menton, lip and occlusal cants, and sagittal and vertical contour asymmetry in CFM group were significantly larger, as were the deviation of subnasale and soft-tissue menton and vertical contour asymmetry in Class II group. CONCLUSIONS: The vertical contour asymmetry of mild CFM was significantly larger than non-CFM class II after surgery, while the area asymmetry, midline deviation, cants, and sagittal contour asymmetry of lower face showed no significant difference. CLINICAL RELEVANCE: Be aware that correcting vertical asymmetry of contour, lip, and dentition in CFM is still challenging.

Cross-Sectional Study on Self-Perception of Dento-Facial Asymmetry.

Background and Objectives: Facial symmetry is a key component of facial beauty and attractiveness. However, perfect symmetry is rare, and slight asymmetries, also known as natural asymmetries, are common and contribute to the uniqueness of each face. The perception of facial asymmetry varies among individuals and can be influenced by several factors. This study aimed to investigate the self-perception of dento-facial asymmetry among a sample of Romanian individuals, focusing on their awareness, the extent to which it bothers them, and their desire for correction. Materials and Methods: A cross-sectional analytical study was conducted with 283 participants from Romania between January and February 2024. Participants completed a questionnaire designed to assess their self-perception of facial asymmetry and socio-demographic characteristics. The questionnaire included 10 questions on self-perception of facial asymmetry and 8 questions on socio-demographic data. Statistical analysis was performed using SPSS 26.0, and the Pearson Chi-square test was used for comparative analysis. Results: The sample was predominantly female (75.3%) with an average age of 32.24 years. Most participants were from urban areas (80.6%) and had university degrees (58.7%). About 28.7% of participants observed facial asymmetry, with dental asymmetry being the most frequently reported, followed by asymmetries in the eyebrows and eyelids. The right side of the face was more commonly perceived as asymmetric. Although 24.4% of participants were bothered by their asymmetry, 39.2% expressed a desire to correct it. Conclusions: One-third of participants identified dento-facial asymmetry, with the dental level being the most reported. A significant portion of participants expressed a desire to correct their asymmetries, highlighting the importance of understanding self-perception in the context of facial aesthetics. This study underscores the subjective nature of facial asymmetry perception and the varying thresholds for what is considered bothersome or in need of correction.

Changes in 3-Dimensional Measurements of Masseter Muscle After Orthognathic Surgery in Patients with Facial Asymmetry.

OBJECTIVE: The aim of this study was to quantitatively evaluate morphological and volumetric changes in the masseter muscle using 3-dimensional analysis of facial asymmetry patients and to identify factors influencing these changes before and after orthognathic surgery. METHODS: [Reviewer1 (2)]A single-center retrospective cohort study was conducted on twenty-two patients with deviation of the chin > 4 mm. Masseter muscle volume and morphology were measured at different periods during long-term follow-up (mean 15 ± 3.2 months). Factors related to changes in masseter muscle cross-sectional area and volume analyzed were also analyzed. RESULTS: [Reviewer1 (2) and (9)]The volume and cross-sectional area of the masseter muscle on the non-deviated side reduced by 13.5% (P < 0.05) and 16.4% (P < 0.05), respectively, after orthognathic surgery. The length of the masseter muscle increased by 13.9% on the deviated side (P < .05) but decreased by 11.7% on the non-deviated side (P < 0.05). The width decreased on the deviated side from T1 to T2 (13.51 ± 2.09 mm vs. 12.04 ± 1.39 mm), but the non-deviated side showed an opposite tendency (10.81 ± 1.31 mm vs. 12.69 ± 2.37 mm). The difference in masseter muscle length and width between the two sides significantly reduced after surgery (P < 0.05). There was a noticeable decrease in the asymmetry in the muscle in proportion to the degree of the occlusal plane angle. CONCLUSION: Masseter muscle asymmetry exists in patients with facial asymmetry, but it could be improved with maxilla-mandible correction. Atrophy of the masseter muscle after orthognathic surgery was greater in patients with a large inclined occlusal plane angle due to improved dental compensation. LEVEL OF EVIDENCE IV: 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 .

Surgery-early approach combined with condylectomy for correction of severe facial asymmetry with mandibular condylar hyperplasia: a case report.

In patients with unilateral mandibular condyle hyperplasia, whether to perform condylectomy and orthognathic surgical procedures at the same time or orthognathic surgery in two stages for remains controversial. Reported here is a case of facial asymmetry with mandibular condyle hyperplasia, for which condylectomy and orthognathic surgery procedures were performed at the same time. A 28-year-old woman was presented to our department with chief complaints of left deviation of the mandible and right temporomandibular joint (TMJ) noise. Findings obtained in several imaging examinations led to a diagnosis of facial asymmetry associated with right mandibular condyle hyperplasia. Following 3 months of preoperative orthodontic treatment, in October 2018 under general anesthesia the patient underwent a right mandibular condylectomy, Le Fort I osteotomy, right mandibular sagittal split ramus osteotomy, and left mandibular inverted L ramus osteotomy. In examinations up to 3 years after surgery, good results were noted. For this case of severe facial asymmetry with mandibular condyle hyperplasia, early surgery and condylectomy were performed simultaneously to significantly shorten the total treatment time. The effectiveness of a surgery-early approach was confirmed by no postoperative findings indicating abnormalities in the TMJ or retroversion.

Correcting facial asymmetry through guided plate assisted mandibular angle osteotomy.

Background: Asian women prefer a smooth and narrowed mandibular appearance. The purpose of the retrospective cohort study is to evaluate guide plate-assisted mandibular angle ostectomy (MAO) in improving mandibular symmetry for Asian female patients with mandibular angle hypertrophy (MAH) with normal occlusal relationship. Methods: We retrospectively examined 11 patients with asymmetry MAH with normal occlusal relationship who received MAO at Shanghai Ninth People's Hospital between September, 2020, and January, 2022. Preoperative plans were designed based on CT data and executed using metal guide plate during the operation. Preoperative and one-week postoperative CT scans were used to assess measurements including Height_Go, Divergence_Go, ∠ZyZy-GoGo, and osteotomy volume, to evaluate symmetry. For precision, compare the postoperative CT with the preoperative design, assessing osteotomy distance, angle, and volume error. Patient satisfacation was evaluated with Likert Scale in 6-month follow-up. Secondary lipofilling procedures were given as appropriate. Statistical analysis was performed using paired t-tests in SPSS. Results: The mean age of the 11 patients was 28.5 years (range 23-34 years). 2 of these underwent lipofilling procedures. No complications were observed during the following-up. Postoperative results were not statistically different from the design, demonstrating a precision of within 2 mm. Height_Go disparity within 5 mm get corrected notably, reducing asymmetry from 15.09% preoperatively to 2.74% postoperatively. Patients satisfaction was rated at 4.5 out of 5 in 6 month follow-up. Conclusions: Guide plate-assisted mandibular angle osteotomies achieve effective and precise surgery. This approach demonstrates a safe option for correction for mandibular asymmetry, achieving patient satisfaction.

Botulinum toxin treatment for hemifacial spasm: harmonising neurological and aesthetic outcomes.

Hemifacial spasm (HFS) represents a challenging cranial movement disorder primarily affecting the facial nerve innervated muscles, with significant prevalence among Asians. Botulinum toxin type A (BoNT/A) injections, established as a primary therapeutic intervention since FDA approval, offer considerable effectiveness in alleviating spasms, albeit accompanied by challenges such as temporary effects and potential adverse events including facial asymmetry. This comprehensive review underscores the crucial need for harmonising neurological benefits and aesthetic outcomes in HFS management. The discussion delves into the interplay between facial aesthetics and neurological objectives in BoNT/A injections, emphasising precise techniques, dosages, and site considerations. Distinct aspects in neurological and aesthetic domains are also examined, including detailing the targeted muscles and injection methodologies for optimal therapeutic and aesthetic results. Importantly, evidence regarding various BoNT/A formulations, recommendations, and reconstitution guidelines in both neurology and aesthetics contexts are provided, along with a schematic approach outlining the stepwise process for BoNT/A injection in HFS treatment, addressing critical areas such as orbicularis oculi muscle sites, eyebrow correction strategies, mid- and lower-face considerations, contralateral injection sites, and post-injection follow-up and complication management. By highlighting the culmination of neurological efficacy and facial esthetics in BoNT/A treatment for HFS patients, this review proposes a holistic paradigm to achieve balanced symptomatic relief and natural aesthetic expression, ultimately enhancing quality of life for individuals grappling with HFS.

Difference in discrepancies of mandibular incisor compensation relative to Menton deviation between Class III roll- and yaw-dominant asymmetries.

OBJECTIVES: To compare mandibular incisor compensation relative to Menton (Me) deviation between skeletal Class III patients with roll- and yaw-dominant mandibular asymmetries. MATERIALS AND METHODS: Sixty skeletal Class III patients (21.62 ± 2.69 years) with facial asymmetry were divided into roll- or yaw-dominant asymmetry groups. Mandibular skeletal and incisor measurements were carried out using cone-beam computed tomography data, and values were compared between the two asymmetry groups or between moderate and severe asymmetry subgroups using independent t-test or Mann-Whitney U-test. The relationship between skeletal and dental measurements was assessed using Pearson correlation coefficient. RESULTS: Relative to the mandibular midsagittal plane, the yaw-dominant group presented significantly greater mandibular dental midline deviation in distance (LI-mid deviation, 2.15 mm) and angulation (4.20°) toward the nondeviated side than the roll-dominant group (P < .001). The ratio of amount of LI-mid deviation to Me deviation was significantly greater in the yaw-dominant group (26.44%) than in the roll-dominant group (1.76%; P < .001). In the yaw-dominant group, the LI-mid deviation was significantly greater in the severe asymmetry subgroup than in the moderate asymmetry subgroup, and the amount of mandibular incisor compensation was positively correlated with Me deviation and mandibular yaw. CONCLUSIONS: Mandibular incisor compensation differed significantly between the roll- and yaw-dominant asymmetry groups. The yaw-dominant group demonstrated significant mandibular dental midline deviation, and dental compensation of the anterior teeth was positively correlated with Me deviation and mandibular yaw.

Satisfaction Level of Patients with the Outcome of Genioplasty.

Background: We aimed to assess the satisfaction level of patients with the outcome of genioplasty and the influential parameters in this respect. Methods: This retrospective study was conducted on 70 patients between 18 to 59 years, who underwent genioplasty in the Oral and Maxillofacial Surgery Department at Shariati and Sina Hospitals, Tehran, Iran, between 2010 and 2020. Patient records were evaluated and a questionnaire was filled out over the phone to assess the influential parameters on the satisfaction level of patients with the outcome of genioplasty. Data were analyzed by PASS 11 (alpha=0.1). Results: Seventy patients were evaluated including 56 (80%) females and 14 (20%) males. Forty patients (52.6%) had no complaint with regard to the outcome of genioplasty. Postoperative chin deviation (not correcting the initial complaint) (10.52%), postoperative pain in the chin area (10.52%), and lower lip paresthesia (9.21%) were the most common patient complaints. The minimum and maximum satisfaction scores were 22 and 80, respectively. Number of follow-up sessions had a significant effect on satisfaction with the outcome of genioplasty (P=0.076). Patients who underwent advancement genioplasty alone had the highest level of long-term satisfaction with the outcome while those who underwent setback genioplasty alone had the lowest level of long-term satisfaction. Conclusion: Advancement genioplasty had the highest rate of patient satisfaction, and chin asymmetry in the frontal view was the most common patient complaint after genioplasty.

Exploring Non-invasive Therapies for Bell's Palsy: A Case Report.

Unknown in origin, Bell's palsy is a common acute facial nerve paralysis that is usually characterized by unilateral facial weakening or paralysis. People of all ages are affected by this illness, which peaks in the fourth decade of life. Although the precise etiology is yet unknown, viral infections - particularly type 1 herpes simplex virus - are frequently linked to the problem. Based on the evidence of abrupt onset facial weakness and the elimination of other neurological diseases, the diagnosis is essentially clinical. The goals of management techniques are to lessen related symptoms, encourage nerve regeneration, and lessen inflammation. Corticosteroids, antiviral drugs, physical therapy, and supportive measures are available as treatment alternatives. The majority of patients experience spontaneous recovery within weeks to months, and the prognosis is generally excellent. Nonetheless, a portion may experience long-term consequences, highlighting the significance of individualized follow-up care. Bell's palsy is succinctly summarized in this abstract to aid in better comprehension and well-informed clinical practice decision-making.

Differential outcomes of jaw bone position after surgical-orthodontic treatment in three types of skeletal Class III asymmetry patients.

BACKGROUND/PURPOSE: Facial asymmetry is common in Class III patients requiring orthognathic surgery. This study aimed to analyze jaw bone position after surgical-orthodontic treatment in three types of skeletal Class III asymmetry patients. METHODS: The retrospective study included 30 Class III patients who underwent surgical-orthodontic treatment comprising LeFort I osteotomy and bilateral sagittal split osteotomy (BSSO) without genioplasty. Cone-beam computed tomography (CBCT) images obtained before surgery (T1) and after post-surgical orthodontic treatment (T2) were superimposed with voxel-based registration. Patients were classified into three groups based on T1 CBCT scans. Groups 1 and 2 exhibited menton and ramus deviated to the same side. Menton deviation was larger than ramus width asymmetry in group 1, while the reverse was true for group 2. Group 3 had menton deviation contralateral to the side with greater ramus width. RESULTS: Menton deviation after treatment was improved in all groups. Ramus width asymmetry and coronal ramus angle difference decreased in groups 1 and 2. Neither improvement nor deterioration of ramus width asymmetry was noted for group 3. Comparing to groups 1 and 2, group 3 had greater roll and yaw rotations of distal segment, more upward pitch of proximal segment on chin deviation side, and largest inward yaw as well as backward translation of proximal segment on non-deviation side. CONCLUSION: The positional changes of osteotomy segments differed among three types of mandibular asymmetry. Special attention should be given to the atypical mandibular asymmetry with mandibular body and ramus deviating to opposite directions during surgical correction of jaw deflection.

Evaluation of Facial Asymmetry in Patients with Crooked Nose.

BACKGROUND: This study aims to explore the correlation between facial asymmetry and a crooked nose using objective methodologies. METHODS: The cohort of 57 patients who underwent septorhinoplasty surgery for aesthetic reasons between 2019 and 2022. Patients were categorized based on the type of nasal axis deviation. The analysis involved reviewing patients' photographs and cone beam computed tomography images. We identified various anatomical landmarks and compared measurements across the groups. RESULTS: Among the study population, 21 (36.8%) exhibited Type-I (linear) and 15 (26.3%) demonstrated Type-C nasal axis deviation, while no deviation was detected in 21 (36.8%) patients. Upon evaluating the upper face area, significant differences were found in the glabella-lateral orbit (G-LO) and rhinion-lateral orbit (Rh-LO) parameters (p = 0.002 and p < 0.001, respectively). A statistically significant difference was discovered in all three parameters between the three groups in the middle face area [glabella-zygion (G-Zy) p = 0.04, rhinion-zygion (Rh-Zy) P < 0.001, anterior nasal spine-zygion (ANS-Zy) p < 0.001)]. Further, a statistically significant difference was noted in the soft tissue parameters gonion (Go) and LO (p = 0.008 and P = 0.005, respectively). CONCLUSION: Patients with crooked noses, in particular, exhibit asymmetries in the upper and middle faces. The glabella in the upper face and the anterior nasal spine in the middle face are stable points, and the fact that the parameters derived from these two reference points are significant, when considered in conjunction with other significant parameters, strongly supports the aforementioned statement. LEVEL OF EVIDENCE III: 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 .

Midface asymmetry in non-syndromic unilateral cleft lip-palate: a retrospective cbct analysis.

Purpose: The aim of this study was to determine the relationship between the zygomaticomaxillary complex (ZMC) and infraorbital foramen region (IFR) with facial symmetry in patients with unilateral cleft lip and palate (UCLP) using cone beam computed tomography (CBCT). Materials and methods: In this retrospective study, CBCT images of 30 non-syndromic UCLP patients were included, along with 30 age- and sex-matched control individuals. ZMC symmetry was evaluated in the axial section by comparing the right and left sides. Similarly, symmetry in the IFR was assessed in the coronal section. The significance level was set at p<0.05 for statistical analysis. Results: The study group comprised 12 female and 18 male patients, with ages ranging from 10 to 18 years (mean age 14.1 years). Both ZMC and IFR measurements were significantly lower on the cleft sides of the study group compared to both the non-cleft sides of UCLP patients and the control group (p<0.001, p=0.022, and p=0.036, respectively). Furthermore, IFR measurements were significantly lower in the control group compared to the non-cleft sides of the study group (p=0.04). Conclusion: This study demonstrated that individuals with UCLP exhibit asymmetry in both the ZMC and the IFR. These findings suggest a negative impact on facial aesthetics.

The Crucial Role of Physiotherapy in the Postoperative Case of Temporomandibular Joint Ankylosis for Restoration and Normalization of Functions in a 23-Year-Old Patient.

Ankylosis of the temporomandibular joint (TMJ) is a pathological condition of the joint. The disease manifests as a limitation to total failure of movement of the TMJ, usually following trauma or surgery or due to local infection. The condition may result in difficulty masticating, speaking, structure of the mouth, face, or jaw, and maintaining oral hygiene to a significant degree. A computed tomography (CT) scan is the best method of evaluating the bony anatomy of the TMJ. The present report shows the surgical correction of the TMJ ankylosis. A 23-year-old female attended the hospital, showing severe mouth opening limitation (9 mm). On investigations, left TMJ ankylosis was diagnosed. The surgical approach consisted of distraction osteogenesis of the left side, followed by vigorous physiotherapy. In patients with TMJ ankylosis, restoration of normal function and jaw movement is difficult. This case report highlights the importance of physiotherapy as an emerging adjuvant therapy in the treatment of TMJ ankylosis. There have also been several treatment methods used to improve the patient's self-esteem and confidence, including speech therapy and psychological counseling.

High-Resolution Ultrasound for Complications of Botulinum Toxin Use: A Case Series and Literature Review.

Botulinum toxin (BTX) has revolutionized both aesthetic and therapeutic medicine by selectively inhibiting acetylcholine release at the neuromuscular junction, inducing localized muscle relaxation. However, its use can be associated with various complications. As a diagnostic modality, high-resolution ultrasound can better characterize these complications. Here, we present four clinical cases of complications associated with the application of BTX, along with their corresponding ultrasonographic findings. In this study, cases were selected randomly, irrespective of the timing of BTX injections, to illustrate a spectrum of complications observed in clinical practice. Despite its benefits, BTX can have adverse effects ranging from mild to severe, including aesthetic and functional complications, such as hematoma, ptosis, facial asymmetry, nodules, or pseudoaneurysm. High-resolution ultrasound emerges as a crucial tool in the multidisciplinary management of these complications, allowing for accurate evaluation and effective therapeutic guidance.

Toward 3D facial analysis for recognizing Mendelian causes of autism spectrum disorder.

Recognizing Mendelian causes is crucial in molecular diagnostics and counseling for patients with autism spectrum disorder (ASD). We explored facial dysmorphism and facial asymmetry in relation to genetic causes in ASD patients and studied the potential of objective facial phenotyping in discriminating between Mendelian and multifactorial ASD. In a cohort of 152 ASD patients, 3D facial images were used to calculate three metrics: a computational dysmorphism score, a computational asymmetry score, and an expert dysmorphism score. High scores for each of the three metrics were associated with Mendelian causes of ASD. The computational dysmorphism score showed a significant correlation with the average expert dysmorphism score. However, in some patients, different dysmorphism aspects were captured making the metrics potentially complementary. The computational dysmorphism and asymmetry scores both enhanced the individual expert dysmorphism scores in differentiating Mendelian from non-Mendelian cases. Furthermore, the computational asymmetry score enhanced the average expert opinion in predicting a Mendelian cause. By design, our study does not allow to draw conclusions on the actual point-of-care use of 3D facial analysis. Nevertheless, 3D morphometric analysis is promising for developing clinical dysmorphology applications in diagnostics and training.

Hemifacial microsomia: a scoping review on progressive facial asymmetry due to mandibular deformity.

PURPOSE: This scoping review explores various parameters of the mandible in progressive facial asymmetry (FA) in hemifacial microsomia (HFM) patients, highlighting its relationship with sex, population, and age group. METHODS: The review was based on a comprehensive search of PubMed, EBSCOhost, and Web of Science. Eligible studies that met the inclusion criteria form part of the selection study. The included studies were appraised using screening and quantitative criteria of mixed-method appraisal tools. The authors utilised a pre-set data extraction form to obtain information from the included studies. RESULTS: Eleven studies met the inclusion criteria. The mandible parameters used were angular measurements, chin point, ramal height, body length, and total length. There was no relationship between FA and sex in HFM patients in the included studies. Most of the studies were comprised of European participants (55%), followed by Americans (36%) and Chinese (9%). The age groups included in the selected studies were categorised as dentition age (18%), early-to-middle childhood (18%), and varied ages (64%). The data presented in this review only pertains to the anomalous characteristics recorded on the affected side in HFM patients. No concomitant control data was recorded in this review. CONCLUSION: An assessment of the included studies revealed that FA does not increase with age in HFM. Hence, FA is non-progressive in HFM patients. This information is relevant to diagnosing and managing HFM patients. More reports are needed on the progression of FA in HFM patients.

Navigating Complexity in Mandibular Condyle Aplasia and Temporomandibular Joint Ankylosis in a Five-Year-Old Child: A Case Report.

Mandibular condyle aplasia and temporomandibular joint (TMJ) ankylosis represent complex challenges in diagnosis and management, affecting jaw function and facial aesthetics. This case report presents a five-year-old female child with a right-sided small jaw and facial asymmetry due to left-sided TMJ ankylosis. The coexistence of mandibular condyle aplasia and TMJ ankylosis underscores the need for comprehensive evaluation and tailored treatment approaches. Syndromic associations, such as Goldenhar syndrome and Treacher Collins syndrome, further complicate diagnosis and management. Surgical intervention involving left-side gap arthroplasty and reconstruction using a costochondral graft/temporalis fascia was performed under general anesthesia. However, postoperative complications, including decreased mouth opening and left-sided lower motor neuron facial palsy, necessitated further surgical debridement and drainage of an abscess. The case emphasizes the importance of a multidisciplinary approach in addressing complex craniofacial anomalies, with treatment strategies such as bone grafting and tailored surgical interventions offering promising outcomes. Understanding the multifaceted etiology of mandibular condyle aplasia and TMJ ankylosis is crucial for optimal management, highlighting the collaborative efforts required for achieving favorable patient outcomes.