Assessing soft-tissue characteristics of facial asymmetry with photographs

doi:10.1016/j.ajodo.2008.08.029

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 138, Issue 1, July 2010, Pages 23-31

https://doi.org/10.1016/j.ajodo.2008.08.029 Get rights and content

Introduction

Precise diagnosis and treatment of facial asymmetry are important in orthodontics. The aims of this study were to determine the soft-tissue characteristics of patients perceived to have severe asymmetry requiring treatment and the soft-tissue factors affecting the subjective assessment of facial asymmetry.

Methods

In the first part of this study, 5 observers examined 1000 photographs of patients receiving orthodontic treatment and selected 100 for further assessment. These photographs showed 50 patients who were considered to have little or moderate asymmetry and 50 who were considered to have severe asymmetry. A pilot study was performed to select the reference photographs representing the most symmetric (score of 0) and the most asymmetric (score of 100). A panel of 9 orthodontists then rated the facial asymmetry of the 100 patients on a 100-mm visual analog scale. The scale was divided into 3 equal regions. Region 1 included patients with the least facial asymmetry; according to the orthodontists, these patients did not require treatment. Region 2 included patients with moderate facial asymmetry who did not require treatment. Region 3 included patients with the most facial asymmetry who did require treatment.

Results

One-way analysis of variance showed that lip canting, chin deviation, body inclination difference, and gonial angle difference had significant differences between the groups. Chin deviation and gonial angle difference were significant factors affecting the assessment of facial asymmetry, according to stepwise linear regression analysis.

Conclusions

These results will help in the diagnosis and treatment planning for patients with asymmetry.

Section snippets

Material and methods

Five observers screened 1000 standardized facial frontal photographs and selected 50 with little or no facial asymmetry and another 50 with moderate or severe facial asymmetry. The inclusion criteria were as follows: over 18 years of age, no congenital abnormalities in the maxillofacial region, no prior surgery for an injury involving the maxilla or the mandible, and standardized facial photographs taken before treatment with sufficient quality for evaluation.

The final sample consisted of

Results

The patients were classified into 3 groups by using the assessment scores of facial asymmetry. Group I included patients with little or no facial asymmetry, not requiring treatment. Group II included patients with moderate facial asymmetry but not requiring treatment. Group III included patients with severe asymmetry, requiring treatment. One-way ANOVA showed that lip canting, chin deviation, body inclination difference, and gonial angle difference were significantly different between the

Discussion

Facial asymmetry was investigated subjectively in relation to the soft-tissue features by using facial frontal photographic measurements.12, 13 Naoya¹⁶ reported a subjective evaluation of facial asymmetry using frontal photographs. In that study, 10 orthodontists classified 100 facial frontal photographs; there was a correlation between the subjective evaluation of facial asymmetry and the cephalometric indexes. However, the author did not report the soft-tissue factors responsible for the

Conclusions

We examined the soft-tissue characteristics of asymmetric patients assessed by orthodontists to determine the soft-tissue factors affecting the recognition of facial asymmetry. In the view of experts, chin deviation, body inclination difference, gonial angle difference, and lip canting had significant differences in the 3 groups according to the assessment of facial asymmetry. In group III, containing patients with severe asymmetry requiring treatment, the mean values were 3.1°, 3.6°, 7.1°, and

References (46)

A. De Smit et al.
Soft tissue profile preference
Am J Orthod
(1984)
V.F. Ferrario et al.
Distance from symmetry: a three-dimensional evaluation of facial asymmetry
J Oral Maxillofac Surg
(1994)
V.F. Ferrario et al.
Craniofacial morphometry by photographic evaluation
Am J Orthod Dentofacial Orthoped
(1993)
N.H. El Mangoury et al.
Landmark identification in computerized posteroanterior cephalometrics
Am J Orthod Dentofacial Orthop
(1987)
J. Dahan
A simple digital procedure to assess facial asymmetry
Am J Orthod Dentofacial Orthop
(2002)
R. Edler et al.
Comparison of radiographic and photographic measurement of mandibular asymmetry
Am J Orthod Dentofacial Orthop
(2003)
R.M. Ricketts et al.
An overview of computerized cephalometrics
Am J Orthod
(1972)
V.F. Ferrario et al.
The effect of sex and age on facial asymmetry in healthy subjects: a cross-sectional study from adolescence to mid-adulthood
J Oral Maxillofac Surg
(2001)
D.J. Howells et al.
The validity and reliability of ratings of dental and facial attractiveness for epidemiological use
Am J Orthod
(1985)
J.B. Schlosser et al.
The effects of computer-aided anteroposterior maxillary incisor movement on ratings of facial attractiveness
Am J Orthod Dentofacial Orthop
(2005)

BL. Padwa et al.

Occlusal cant in the frontal plane as a reflection of facial asymmetry

J Oral Maxillofac Surg

(1997)

B. Grayson et al.

The three-dimensional cephalogram: theory, technique, and clinical application

Am J Orthod Dentofacial Orthop

(1988)

D.C. Baldwin

Appearance and aesthetics in oral health

Community Dent Oral Epidemiol

(1980)

J.S. Ahn et al.

Relationship between perception of facial asymmetry and posteroanterior cephalometric measurements

Korean J Orthod

(2001)

B.N. Epker et al.

(1986)

E.J. Foster

Profile preferences among diversified groups

Angle Orthod

(1973)

K.L. Erickson et al.

Analysis model surgery

S.M. Shah et al.

An assessment of asymmetry in the normal craniofacial complex

Angle Orthod

(1978)

M. Kobayakawa

The experimental evaluation of facial asymmetry of mandibular prognathic patients

Jpn J Oral Maxillofac Surg

(1990)

S.W. Robinson et al.

Soft tissue profile change produced by reduction of mandibular prognathism

Angle Orthod

(1972)

W.R. Proffit et al.

Who seeks surgical-orthodontic treatment?

Int J Adult Orthod Orthognath Surg

(1990)

N. Masuoka et al.

Can cephalometric indices and subjective evaluation be consistent for facial asymmetry?

Angle Orthod

(2005)

L.G. Farkas

Examination

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However, there are few reports on the relationships between the lip-line and mandible asymmetry in the natural state of young adult patients with jaw deformity at home and abroad. Previous studies on lip-line mostly adopted two-dimensional methods such as posteroanterior cephalogram and frontal face photograph etc. (Choi et al., 2016; Kang et al., 2016; Lee et al., 2010; Lee, et al., 2019; Lee, et al., 2019; Song et al., 2007). In recent years, it was noted that CBCT three-dimensional (3D) reconstruction had significant advantages in evaluating the symmetry of soft and hard tissues of jaw deformity (Damstra et al., 2013; Lee et al., 2014; Lee, et al., 2019; Nur et al., 2016).
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Original articleAssessing soft-tissue characteristics of facial asymmetry with photographs

Introduction

Methods

Results

Conclusions

Section snippets

Material and methods

Results

Discussion

Conclusions

Am J Orthod

J Oral Maxillofac Surg

Am J Orthod Dentofacial Orthoped

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod

J Oral Maxillofac Surg

Am J Orthod

Am J Orthod Dentofacial Orthop

J Oral Maxillofac Surg

Am J Orthod Dentofacial Orthop

Appearance and aesthetics in oral health

Community Dent Oral Epidemiol

Relationship between perception of facial asymmetry and posteroanterior cephalometric measurements

Korean J Orthod

Profile preferences among diversified groups

Angle Orthod

Analysis model surgery

An assessment of asymmetry in the normal craniofacial complex

Angle Orthod

The experimental evaluation of facial asymmetry of mandibular prognathic patients

Jpn J Oral Maxillofac Surg

Soft tissue profile change produced by reduction of mandibular prognathism

Angle Orthod

Who seeks surgical-orthodontic treatment?

Int J Adult Orthod Orthognath Surg

Can cephalometric indices and subjective evaluation be consistent for facial asymmetry?

Angle Orthod

Examination

Original article
Assessing soft-tissue characteristics of facial asymmetry with photographs