• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.17.1-17.11
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• 2020

Background: To evaluate the facial asymmetry, three-dimensional computed tomography (3D-CT) has been used widely. This study proposed a method to quantify facial asymmetry based on 3D-CT. Methods: The normal standard group consisted of twenty-five male subjects who had a balanced face and normal occlusion. Five anatomical landmarks were selected as reference points and ten anatomical landmarks were selected as measurement points to evaluate facial asymmetry. The formula of facial asymmetry index was designed by using the distances between the landmarks. The index value on a specific landmark indicated zero when the landmarks were located on the three-dimensional symmetric position. As the asymmetry of landmarks increased, the value of facial asymmetry index increased. For ten anatomical landmarks, the mean value of facial asymmetry index on each landmark was obtained in the normal standard group. Facial asymmetry index was applied to the patients who had undergone orthognathic surgery. Preoperative facial asymmetry and postoperative improvement were evaluated. Results: The reference facial asymmetry index on each landmark in the normal standard group was from 1.77 to 3.38. A polygonal chart was drawn to visualize the degree of asymmetry. In three patients who had undergone orthognathic surgery, it was checked that the method of facial asymmetry index showed the preoperative facial asymmetry and the postoperative improvement well. Conclusions: The current new facial asymmetry index could efficiently quantify the degree of facial asymmetry from 3D-CT. This method could be used as an evaluation standard for facial asymmetry analysis.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.29.1-29.7
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• 2015

Facial asymmetry is found in patients with or without cosmetic facial alterations. Some patients have facial asymmetry that manifests underlying skeletal problems, while others have only limited soft-tissue facial asymmetry. Orthognathic surgery brings about a dermatic change, as soft tissue covers underlying bones. Limited soft-tissue asymmetry, meanwhile, is difficult to correct. The treatment modalities for the creation or restoration of an esthetically pleasing appearance were autogenous fat grafts, cartilage graft, and silicon injections. A young female patient had right-side facial asymmetry. The clinical assessment involved visual inspection of the face and palpation to differentiate soft tissue and bone. Although the extra-oral examination found facial asymmetry with skin atrophy, the radiographic findings revealed no mandibular atrophy or deviation. She was diagnosed as localized scleroderma with muscle spasm. In conclusion, facial asymmetry patients with skeletal asymmetry can be esthetically satisfied by orthognathic surgery; however, facial atrophy patients with skin or subdermal tissue contraction need treatment by cosmetic dermatological surgery and orthodontic correction.

• Imaging Science in Dentistry
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• v.37 no.1
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• pp.45-51
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• 2007

Purpose : This study aimed to identify the range of normal facial asymmetry using three-dimensional CT and to develop a simple method of diagnosis of facial asymmetry. Materials and Methods : Twenty eight adults with normal occlusion (16 males and 12 females; mean age 24 years and 1 month) were selected whose faces were assessed to be symmetric by an orthodontist. Three-dimensional reconstructions were obtained utilizing spiral CT scans and an oral and maxillofacial radiologist evaluated nineteen anatomic landmarks in three-dimensional coordinates. Facial asymmetry index of each landmark was caluculated. Results : The range of normal facial asymmetry of each landmark was identified using mean and standard deviation of facial asymmetry index. Conclusions : The range of normal facial asymmetry identified in this study may be used as a diagnostic standard for facial asymmetry analysis.

• Archives of Craniofacial Surgery
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• v.15 no.3
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• pp.109-116
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• 2014

Background: Infants with deformational plagiocephaly (DP) usually present with cranial vault deformities as well as facial asymmetry. The purpose of this study was to use three-dimensional anthropometric data to evaluate the influence of cranial deformities on facial asymmetry. Methods: We analyzed three-dimensional computed tomography data for infants with DP (n=48) and without DP (n=30, control). Using 16 landmarks and 3 reference planes, 22 distance parameters and 2 angular parameters were compared. This cephalometric assessment focused on asymmetry of the orbits, nose, ears, maxilla, and mandible. We then assessed the correlation between 23 of the measurements and cranial vault asymmetry (CVA) for statistical significance using relative differences and correlation analysis. Results: With the exception of few orbital asymmetry variables, most measurements indicated that the facial asymmetry was greater in infants with DP. Mandibular and nasal asymmetry was correlated highly with severity of CVA. Shortening of the ipsilateral mandibular body was particularly significant. There was no significant deformity in the maxilla or ear. Conclusion: This study demonstrated that the cranial vault deformity in DP is associated with facial asymmetry. Compared with the control group, the infants with DP were found to have prominent asymmetry of the nose and mandible.

• The Journal of the Korean dental association
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• v.48 no.10
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• pp.724-728
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• 2010

Accurate analysis of facial asymmetry prior to any orthognathic or orthodontic treatment plan is essential in ensuring good treatment result. Dental CBCT (Cone-beam Computed Tomography) provides as actual three-dimensional measurements of distance and angle without any radiographic magnification as medical CT provides, while its field of view is limited to the oral and maxillofacial area. CBCT is a useful tool for the diagnosis of facial asymmetry. The coordinates of facial landmarks are obtained from the 3D reconstruction software which enables the establishment of perpendicular planes and the identification of the landmarks. Then, the bilateral discrepancies of the landmarks are obtained as spherical polar coordinates which can show the amount of asymmetry and its direction. A method of 3D analysis of facial asymmetry using CBCT is introduced in this report.

• Archives of Craniofacial Surgery
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• v.17 no.4
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• pp.240-243
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• 2016

Perfect facial and body symmetry is an important aesthetic concept which is very difficult, if not impossible, to achieve. Yet, facial asymmetries are commonly encountered by plastic and reconstructive surgeons. Here, we present a case of posttraumatic facial asymmetry successfully treated with a unique concept of facial flap repositioning. A 25-year-old male patient visited our department with severe posttraumatic facial asymmetry. There was deviated nasal bone and implant to the right, and the actual facial appearance asymmetry was much more severe compared to the computed tomography, generally shifted to the right. After corrective rhinoplasty, we approached through intraoral incision, and much adhesion from previous surgeries was noted. We meticulously elevated the facial flap of both sides, mainly involving the cheeks. The elevated facial flap was shifted to the left, and after finding the appropriate location, we sutured the middle portion of the flap to the periosteum of anterior nasal spine for fixation. We successfully freed the deviated facial tissues and repositioned it to improve symmetry in a single stage operation. We conclude that facial flap repositioning is an effective technique for patients with multiple operation history, and such method can successfully apply to other body parts with decreased tissue laxity.

• Journal of Technologic Dentistry
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• v.27 no.1
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• pp.27-39
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• 2005

This study is to show the qualitative analytic methods of facial asymmetry with three-dimensional morphometry and find out asymmetry change resulted from enlarging three local regions. Steel balls (1.2mm in diameter) were attached in twenty seven landmarks of a symmetrical artificial human skull. This artificial human skull was used as experimental materials. Twelve different asymmetrical artificial human skulls were formed by gradually enlarging the mandibular body length, gonial angle, and ramus height of the left hemiface. From the three-dimensional morphometry of each skull type, nine local area measurements and three total sum area measurements(representing the mandibular area, maxillary area, and lower facial area) were acquired and made into the surface area asymmetry degree. Menton deviation itself was used as the surface area asymmetry degree while right-left percentages were used in the other measurements. These surface area asymmetry degrees were compared with each other to find out asymmetry change according to the degree of actual facial asymmetry. Through the statistical analysis, following results were obtained. The results were as follows: 1. Left maxillary area of artificial human skull was 7.13$\pm$0.26% larger while mandibular area was 4.14$\pm$0.12% smaller than each those of right hemiface. After all, left lower facial area was 1.44$\pm$0.07% larger than those of right hemiface.(n=7). 2. Among the reduce rates of surface area asymmetry degree resulted from enlarging three local regions, ramus height was similar to mandibular body length while it was bigger than those of gonial angle. 3. Among the increase rates of menton deviation resulted from enlarging the local regions, ramus height was the biggest, mandibular body length was the second and gonial angle was the smallest. These results suggest that three-dimensional morphometry can be used to qualitatively analyse facial asymmetry and the asymmetry degree is more influenced by enlarging the ramus height, mandibular body length than those of gonial angle.

• Imaging Science in Dentistry
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• v.43 no.1
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• pp.31-36
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• 2013

Purpose: This study aimed to measure the bilateral differences of facial lines in spherical coordinates from faces within a normal range of asymmetry utilizing cone-beam computed tomography (CBCT). Materials and Methods: CBCT scans from 22 females with normal symmetric-looking faces (mean age 24 years and 8 months) were selected for the study. The average menton deviation was $1.01{\pm}0.66$ mm. The spherical coordinates, length, and midsagittal and coronal inclination angles of the ramal and mandibular lines were calculated from CBCT. The bilateral differences in the facial lines were determined. Results: All of the study subjects had minimal bilateral differences of facial lines. The normal range of facial asymmetry of the ramal and mandibular lines was obtained in spherical coordinates. Conclusion: The normal range of facial asymmetry in the spherical coordinate system in this study should be useful as a reference for diagnosing facial asymmetry.

• Journal of Yeungnam Medical Science
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• v.25 no.2
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• pp.108-116
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• 2008

Background : When surgeons plan mandible ortho surgery for patients with skeletal class III facial asymmetry, they must be consider the exact method of surgery for correction of the facial asymmetry. Three-dimensional (3D) CT imaging is efficient in depicting specific structures in the craniofacial area. It reproduces actual measurements by minimizing errors from patient movement and allows for image magnification. Due to the rapid development of digital image technology and the expansion of treatment range, rapid progress has been made in the study of three-dimensional facial skeleton analysis. The purpose of this study was to conduct 3D CT image comparisons of mandible changes after mandibular surgery in facial asymmetry patients. Materials & methods : This study included 7 patients who underwent 3D CT before and after correction of facial asymmetry in the oral and maxillofacial surgery department of Yeungnam University Hospital between August 2002 and November 2005. Patients included 2 males and 5 females, with ages ranging from 16 years to 30 years (average 21.4 years). Frontal CT images were obtained before and after surgery, and changes in mandible angle and length were measured. Results : When we compared the measurements obtained before and after mandibular surgery in facial asymmetry patients, correction of facial asymmetry was identified on the "after" images. The mean difference between the right and left mandibular angles before mandibular surgery was $7^{\circ}$, whereas after mandibular surgery it was $1.5^{\circ}$. The right and left mandibular length ratios subtracted from 1 was 0.114 before mandibular surgery, while it was 0.036 after mandibular surgery. The differences were analyzed using the nonparametric test and the Wilcoxon signed ranks test (p<0.05). Conclusion: The system that has been developed produces an accurate three-dimensional representation of the skull, upon which individualized surgery of the skull and jaws is easily performed. The system also permits accurate measurement and monitoring of postsurgical changes to the face and jaws through reproducible and noninvasive means.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.17 no.2
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• pp.81-89
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• 2022

Objectives This report aimed to investigate the possibility of correcting facial asymmetry using cervical Chuna manipulation treatment and functional cerebrospinal technique and introduce meaningful additional improvement of systemic symptoms of non-surgical Korean medicine treatments through three case studies. Methods Three patients with facial asymmetry were treated using Korean medicine treatments. The effects of the treatments were all measured using photographs, lateral cephalograms, and whole-body radiogram and Likert scale. Results After Korean medicine treatment, there were significant correction effects of asymmetry in photography, cephalography, and whole-body radiogram and meaningful score of Likert scale. Conclusions This study suggested that Korean medicine treatments may be effective in facial asymmetry. Improving muscular asymmetry, including soft tissue asymmetry and functional asymmetry, has meaningful effects on maintaining an overall balance of the body. Facial asymmetry should be treated by making an alignment of the whole body and there should be further well-designed, randomized, and placebo-controlled trials to verify these results.