• The korean journal of orthodontics
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• v.30 no.5 s.82
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• pp.535-542
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• 2000

The purpose of this study was to find the characteristics of the frontal natural head position(NHP) of patients with facial asymmetry, and to contribute to the diagnosis of facial asymmetry in the clinical examination of orthodontic patients. Twenty adult patients who had apparent facial asymmetry and no severe sagittal skeletal discrepancy were selected as the asymmetry group, and 21 young adults who had symmetric faces were selected as the symmetry group. Frontal cephalograms were obtained in the state of NHP using a pivot-mounted fluid level device. The degree of the menton deviation was defined as the angle between the line drawn through crista galli and anterior nasal spine and the line drawn through crista galli and menton. The following angles were measured and each of them was compared with the degree of the menton deviation one is the angle between the true vertical line and the supra-orbital line which is a tangent line to the extreme cranial point on the supra-orbital margin, and the other is the angle between the true vertical line and the cervical line drawn through the midpoint of atlas and the 4th cervical vertebra. Through the statistical analysis, following results were obtained. 1. The angle between the supra-orbital line and the true vertical line was much mote deviated from the right angle in the asymmetry group than in the symmetry group. 2. The angle between the cervical line and the true vertical line in the asymmetry group showed greater tendency than in the symmetry group, but the difference was not statistically significant. 3. In the asymmetry group, the degree of the menton deviation was positively correlated with the angle between the supraorbital line and the true vertical line. The above results suggest that racial asymmetry patients show the tendency to have the tilted NHP to compensate the deviation of menton position.

• Korean Journal of Cleft Lip And Palate
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• v.15 no.1
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• pp.1-10
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• 2012

Parry-Romberg syndrome(PRS) is a degenerative disease characterized by progressive hemifacial atrophy. A 10-year-old girl who had been treated for linear scleroderma at the dermatologic department visited the orthodontic department. The frontal facial photograph showed mild facial asymmetry. On the left side, mild atrophy of soft tissue, enophthalmos, cheek depression, and dry skin with dark pigmentation were observed. The radiograph showed the hypoplasia of both the maxilla and mandible on the left side. This case report describes the treatment of a patient with PRS for 7 years. To minimize the effect of progressive atrophy on the facial growth, a hybrid appliance was used. The facial photos and radiographic records were periodically taken to analyze the progression of PRS. Although it is impossible to prevent the progression of facial asymmetry, it appears to be possible to limit the atrophic effect. After the stabilization of PRS, the orthodontic treatment by the fixed appliance was performed. Additionally, autologous fat graft was performed three times at 6 month intervals. After the treatment, the patient had a confident smile and facial asymmetry was improved.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.4
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• pp.351-358
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• 2010

A 31-year-old woman with hemifacial microsomia presented to the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. The patient was previously treated with distraction osteogenesis device to elongate right maxilla and mandibular ramus. But, the result was not satisfactory, to correct residual facial asymmetry due to hemifacial microsomia we planned costochondral graft for reconstruction of ramus and condyle, Le Fort I osteotomy and sagittal split ramus osteotomy for facial asymmetry. The right mandibular condyle and ramus was reconstructed with right eleventh costochondral graft via submandibular approach. Using costochondral graft and orthognathic surgery the facial asymmetry in hemifacial microsomia patient was corrected. 1-stage treatment consists of costochondral graft and orthognathic surgery can achieve function and esthetics at the same time, is timesaving to both patient and surgeon.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.6
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• pp.546-553
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• 2008

Purpose: The purpose of this study was to estimate validity of posterior anterior cephalometric and 3D-CT for orbital canting analysis. Materials and methods: Three trained observers classified two patients group using standardized frontal photographs of facial asymmetry patients. Group A consisted of patients with facial asymmetry and orbital canting(n=19), and group B consisted of patients with only facial asymmetry(n=43). Orbital canting was measured with line of bilateral inferior orbitale. Orbital canting measurement was done with posterior anterior cephalometric and 3D-CT. Each horizontal reference line was established by bilateral GWSO(cephalometric), FZS(3D-CT). Maxillary canting and mandibular deviation angle were also measured and analyzed with orbital canting. Results: The mean orbital canting was $3.03{\pm}1.00^{\circ}$ in Group A and $1.11{\pm}0.76^{\circ}$ in Group B in frontal photograph. The mean orbital canting was $1.20{\pm}0.74^{\circ}$ in group A and $1.22{\pm}0.65^{\circ}$ in group B by cephalometric analysis(p>0.05). In 3D-CT, orbital canting was almost paralleled with horizontal reference line. The orbital canting, maxillay canting and mandibular deviation between two groups showed no significant differences except madibular deviation in 3D-CT. Conclusion: Common analysis of posterior anterior cephalometric and 3D-CT is not valide method to evaluate orbital canting for facial asymmetry patients with orbital canting.

• The korean journal of orthodontics
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• v.24 no.4 s.47
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• pp.787-798
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• 1994

The purpose of this study was three-fold: i) to investigate the degree of asymmetry in Angle's Class III malocclusion patients and normal adults; ii) to determine the nature of difference existed between two groups; and iii) to investigate the correlationship between the degree of asymmetry and ANB and overbite in Angle's Class III malocclusion patients. The subjects consisted of 25 Angle's Class III malocclusion patients and 25 normal adults and the mean ages were 22.0 and 24.5 years, respectively. Their posteroanterior and lateral cephalograms were traced and analysed with three-dimensional approach. The results were as follows: 1. Asymmetry of Angle's Class III malocclusion group was significant in all regions except cranial base. Their horizontal asymmetry was seen in mandibular angle, maxillary and mandibular 1st molar, mandibular midline and menton. Vertical asymmetry was observed in maxillary 1st molar and mandibular shape and anteroposterior asymmetry in mandibular angle. 2. Nine variables indicating asymmetry were selected and each variable had similar discriminant score. 3. There was a little correlationship between An and asymmetric variable(MSR-B6) and its correlation coefficients was 0.3564. 4. There was no significant correlationship between overbite and asymmetric variables.

• Journal of Dental Rehabilitation and Applied Science
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• v.27 no.1
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• pp.63-71
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• 2011

Major type of facial asymmetry results from facial deformity and needs surgical correction. To diagnose facial asymmetry and set a treatment plane for patients, setting a sagittal reference plane is crucial. The purpose of this study is comparison of measurements of sagittal soft tissue reference point to three different sagittal planes. The subjects are 25 of asymmetry patients (M:15, F:10) and 19 of normal people. There are differences in point Gnathion and Stomion. Most of measurement of sagittal reference points showed within 1 mm difference from sagittal reference plane. Deviation of point Pronasale in Sa1 plane revealed significant difference among 3 reference planes. The deviation of Gnathion was proportional to the deviation of Stomion in all 3 reference planes.

• Journal of the korean academy of Pediatric Dentistry
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• v.45 no.3
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• pp.378-385
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• 2018

Mandibular fractures occur with high incidence among various fractures in maxillofacial region in children. Jaw fractures in children should be approached differently than in adults because bone growth continues throughout childhood. As far as displacement of the fragment is not severe, or if it is condyle that is fractured, closed reduction and additional intermaxillary fixation can be considered. Functional exercise is also required to prevent ankylosis of temporomandibular joint. Several complications, particularly malocclusion and facial asymmetry due to growth disturbances, can occur after condylar fractures. If growth disturbances take place after mandibular fractures, catch-up growth may occur in some patients, thus, periodic observation is necessary. In case of persistent growth disturbances, functional devices may be used to prevent severe facial asymmetry. This case report describes the long-term follow-up of two patients with facial asymmetry after mandibular fracture.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.48.1-48.7
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• 2019

Background: Soft tissue asymmetry such as lip canting or deviation of the philtrum is an important influencing factor for unbalanced facial appearance. Lip canting could be improved by the correction of the occlusal canting or positional change of the mentum. Although there are many studies about changes of lip canting, however, postoperative changes of philtrum deviation have not been yet reported. In this study, we investigate the positional change of the philtrum after orthognathic surgery and influencing factors. Methods: Positional change of the philtrum was evaluated in 41 patients with facial asymmetry who underwent bimaxillary surgery, in relation to other anatomical soft tissue landmarks using a frontal clinical photo. The surgical movement of the maxillary and mandibular dental midline and canting were measured in postero-anterior cephalogram before and 1 day after surgery. The same procedure was repeated in patients with more than 1.5 mm perioperative change of the mandibular dental midline after bimaxillary surgery. Results: Maxillary dental midline shifting and canting correction did not have a significant correlation with lateral movement of the philtrum midline. However, the mandibular shift had a statistically significant correlation with a lateral movement of the philtrum (p < 0.05) as well as other linear parameters and angle values. Conclusion: The horizontal change of the philtrum is influenced by lateral mandibular movement in patients with facial asymmetry, rather than maxillary lateral movement.

• The korean journal of orthodontics
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• v.47 no.4
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• pp.256-267
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• 2017

Objective: To evaluate transverse skeletal and dental changes, including those in the buccolingual dental axis, between patients with skeletal Class III malocclusion and facial asymmetry after bilateral intraoral vertical ramus osteotomy with and without presurgical orthodontic treatment. Methods: This retrospective study included 29 patients with skeletal Class III malocclusion and facial asymmetry including menton deviation > 4 mm from the midsagittal plane. To evaluate changes in transverse skeletal and dental variables (i.e., buccolingual inclination of the upper and lower canines and first molars), the data for 16 patients who underwent conventional orthognathic surgery (CS) were compared with those for 13 patients who underwent preorthodontic orthognathic surgery (POGS), using three-dimensional computed tomography at initial examination, 1 month before surgery, and at 7 days and 1 year after surgery. Results: The 1-year postsurgical examination revealed no significant changes in the postoperative transverse dental axis in the CS group. In the POGS group, the upper first molar inclined lingually on both sides (deviated side, $-1.8^{\circ}{\pm}2.8^{\circ}$, p = 0.044; nondeviated side, $-3.7^{\circ}{\pm}3.3^{\circ}$, p = 0.001) and the lower canine inclined lingually on the nondeviated side ($4.0^{\circ}{\pm}5.4^{\circ}$, p = 0.022) during postsurgical orthodontic treatment. There were no significant differences in the skeletal and dental variables between the two groups at 1 year after surgery. Conclusions: POGS may be a clinically acceptable alternative to CS as a treatment to achieve stable transverse axes of the dentition in both arches in patients with skeletal Class III malocclusion and facial asymmetry.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.11.1-11.8
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• 2020

Background: The purpose of this study is to compare the skeletal stability of two-jaw surgery via surgery-first approach with conventional two-jaw surgery in facial asymmetry patients by measuring the skeletal changes after surgery from a three-dimensional analysis. From January 2010 to January 2014, 40 patients with facial asymmetry who underwent two-jaw surgery in Pusan National University Hospital were included in this study. They were classified into experimental group (n = 20) who underwent two-jaw surgery via surgery-first approach and control group (n = 20) who underwent conventional two-jaw surgery. After selection of 24 landmarks and the construction of horizontal and sagittal, coronal reference planes, changes in 10 linear measurements and 2 angular measurements were compared between the surgery-first approach and conventional groups in the preoperative, immediate postoperative, and postoperative periods. The paired t test and Student t test were used for statistical analysis. The mean and standard deviation of the measurement were calculated for the experimental and control groups. Results: The statistical analysis showed that changes in skeletal measurements were similar between the surgery-first approach and conventional groups, according to each period. However, U1-SRP measurement showed statistically significant changes in surgery-first approach groups at postsurgical change (T1 to T2). Also, the mean treatment duration in the treatment group was 15.9 ± 5.48 months whereas that in the control group was 32.9 ± 14.05 months. Conclusion: In facial asymmetry patients, similar results were observed in the postoperative skeletal stability when 2-jaw surgery via surgery-first approach was compared with conventional 2-jaw surgery. However, significant lateral deviation of upper incisor midline was observed. In addition, a shorter average treatment duration was observed. To stabilize the unstable occlusion after surgery, increased wearing of the stent and proactive rubber guidance will be needed.