phenylephrine-hydrochloride and Facial-Asymmetry

Facial trauma commonly produces trauma to the nose and perinasal area. In this review, emphasis is on the treatment of the severely deviated nose in terms of excessive shift of the bony dorsum and bony pyramid. In particular, we focus on the problem of centering the severely deviated bony dorsum and when we believe it is helpful to move the entire bony dorsum as a unit, utilizing the transverse osteotomy in addition to traditional osteotomies.

Topics: Adult; Facial Asymmetry; Female; Humans; Male; Nasal Bone; Nose; Nose Deformities, Acquired; Osteotomy; Rhinoplasty; Skull Fractures; Young Adult

The understanding of the bilateral cleft lip and associated nasal deformity has evolved over the last 30 years to a point where there now exists general agreement regarding the goals, principles, and strategies for operative repair. This article presents modern tenets for repair of bilateral cleft lip and describes a logical approach to correction of the different possible subtypes.

Topics: Cleft Lip; Esthetics; Facial Asymmetry; Humans; Infant, Newborn; Maxillofacial Development; Nose; Oral Surgical Procedures; Plastic Surgery Procedures

In the past two decades, presurgical nasoalveolar molding has been applied increasingly in the care of patients with a cleft to improve nasal symmetry and facilitate closure of the lip and secondary rhinoplasty. Many cleft centers do not apply presurgical molding, because its effect is disputed. This review aims to quantify the effect of nasal symmetry in the long term.. A systematic review of the literature with the intention of performing a meta-analysis was performed. The search terms "cleft" AND ("molding" OR "moulding") were used in three databases. Twelve studies met the following inclusion criteria: (1) participants were humans with nonsyndromic unilateral cleft; (2) data concerning the effect of nasoalveolar molding on symmetry of the nose are reported or can be deduced; (3) article was written in English, German, or Dutch.. The heterogeneity of the study designs, outcome variables, outcome variable expressions, follow-up periods, and inadequate data reporting made it impossible to calculate effect sizes and to perform a meta-analysis. All studies had a low Grading of Recommendations Assessment, Development and Evaluation level. Five studies reported exclusively positive effects on nasal symmetry, six studies reported mixed effects, and one study reported exclusively no effects.. Results of studies of nasoalveolar molding are inconsistent regarding changes in nasal symmetry; however, there is a trend toward a positive effect. Studies concerning nasoalveolar molding in unilateral cleft lip, jaw, and palate are heterogeneous and lack adequate reporting. Recommendations for future research were provided to construct a consensus about the effect of nasoalveolar molding.. Therapeutic, III.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Combined Modality Therapy; Facial Asymmetry; Humans; Infant; Nose; Orthopedic Procedures; Plastic Surgery Procedures; Treatment Outcome

In the era of evidence-based medicine, new treatment protocols and interventions should be routinely evaluated for their efficacy by reviewing the available evidence. In the cleft literature, nasoalveolar molding has garnered attention over the last decade as a new option for improving nasal form and symmetry before primary surgical repair. Systematic review of the evidence is, however, currently lacking. This review evaluates whether nasoalveolar molding can improve nasal symmetry and form toward the norm, as well as whether nasoalveolar molding demonstrates advantages over other protocols in achieving this goal. A literature search of five databases plus relevant reference lists retrieved 98 articles regarding nasoalveolar molding, 21 of which reported objective outcome measures of nasal symmetry and form, and six of which were able to be given evidence level ratings, all in the unilateral cleft population. Statistical analysis was not possible given the range of techniques and outcomes. Studies of bilateral cleft were not given evidence level ratings, given the inability to separate the effects of nasoalveolar molding from other primary nasal interventions in studies that would have otherwise been rated. In unilateral cleft lip-cleft palate, there was some evidence that nasoalveolar molding may improve nasal outcomes, though comparison with other techniques was limited. Despite a relative paucity of high-level evidence, nasoalveolar molding appears to be a promising technique that deserves further study.

Topics: Alveolar Process; Cleft Lip; Cleft Palate; Evidence-Based Medicine; Facial Asymmetry; Humans; Mandibular Reconstruction; Nose; Plastic Surgery Procedures; Rhinoplasty

The impact of facial asymmetry on nasal deviation is an accepted but poorly understood part of plastic surgery and rhinology training. Recently, an increased understanding of the specific structural issues underlying this deformity has led to improved surgical techniques and patient outcomes.

Topics: Biomechanical Phenomena; Cleft Lip; Facial Asymmetry; Female; Humans; Male; Maxillofacial Development; Nose; Nose Deformities, Acquired; Patient Care Planning; Referral and Consultation; Rhinoplasty

The deviated nasal dorsum is a complex problem with a variety of proposed solutions. Straightening the deviated nose should be focused on maximizing cosmetic outcome while preserving or improving nasal function. Deviations can occur in one or a combination of the nasal thirds. A simple approach to treatment is to develop a strategy for each third of the nose. Tailoring maneuvers to alleviate problems in each specific third helps the surgeon deal with deviations in an effective and straightforward manner.

Topics: Esthetics; Facial Asymmetry; Humans; Nose; Rhinoplasty; Treatment Outcome

Successful management of the persistently crooked nose after a previous trauma or surgery is best achieved through careful analysis of the problem and clear communication with the patient regarding his or her goals of revision surgery. To address the nose in a systematic fashion, the surgeon should divide the crooked nose into horizontal thirds with appropriate management directed toward the structural abnormality in each third. A review of the treatment of the postrhinoplasty and posttraumatic crooked nose is presented with an emphasis on re-establishing structural support and improving appearance while preserving or creating a functional nasal airway.

Topics: Facial Asymmetry; Humans; Nose; Nose Deformities, Acquired; Osteotomy; Patient Satisfaction; Plastic Surgery Procedures; Prostheses and Implants; Reoperation; Rhinoplasty

Repair of the twisted nose presents a challenge, as often functional problems as well as aesthetic deformities must be addressed. Traditional correction of the deviated nose involves septal correction, separation of both upper lateral cartilages from the septum and bony pyramid manipulation after osteotomies. Nowadays autogenous cartilage grafts are being used for repositioning, reinforcement, recontouring and reconstruction of virtually every component of the nasal skeleton. These restructuring techniques follow the modern principles mentioned above and may well be applied to the deviated asymmetric nose. The grafting manoeuvres increase the stability of the realigned cartilaginous nasal framework, including the nasal septum, but may also be used for camouflaging purposes. The large number of possible individual anatomic variations including facial asymmetry does call for a systematic approach based on succinct individualised analysis.

Topics: Adult; Bone Transplantation; Facial Asymmetry; Female; Humans; Male; Nasal Septum; Nose; Rhinoplasty

Saethre-Chotzen syndrome is an autosomal acrocephalosyndactyly syndrome whose gene has been assigned to chromosome 7p (TWIST). A case of a 13-year-old girl with Saethre-Chotzen syndrome (ACS III) is described. The features of the syndrome include: turriplagiocephaly with a cranial circumference of 52 cm, facial asymmetry, low hairline, proptosis, antimongoloid slanting of palpebral fissures, nasal deviation with high bridge, angled ears, scoliosis and torticollis, clinodactyly of the fourth and fifth toes, large halluxes, and neurosensorial hypoacusia. For correction of the deformity, a cranioorbital remodeling was performed. The craniofacial approach with remodeling of the frontal bar and reduction of the turricephaly resulted in a satisfactory morphological and functional outcome, with complete three-dimensional reshaping and remodeling of the frontonasoorbital area.

Topics: Acrocephalosyndactylia; Adolescent; Chromosomes, Human, Pair 7; Craniosynostoses; Exophthalmos; Eyelids; Facial Asymmetry; Female; Frontal Bone; Humans; Nose; Orbit; Treatment Outcome

Unilateral nostril agenesis together with ipsilateral alterations of the eye, ear, and face make up a spectrum of anomalies. The aim of this study is to report a case in a Japanese girl, 14 years, 5 months of age. Cephalometric analysis is provided, and orthodontic treatment is discussed.. Lateral and frontal cephalograms were compared to a Japanese control group. Outcome of the orthodontic treatment was evaluated by comparing cephalograms taken before and after orthodontic treatment.. The lateral cephalometric analysis showed a severely hypoplastic maxilla in both sagittal and vertical dimensions, coupled with a decreased posterior cranial base. The mandibular rami were asymmetric. The frontal cephalogram showed decreased cranial width and maxillary alveolar width, together with an increased interorbital distance.. Serial lateral cephalograms during the orthodontic treatment from the age of 14 to 20 years demonstrated no significant maxillary growth and some mandibular growth, coupled with labial tipping of the maxillary central incisors.

Topics: Abnormalities, Multiple; Adult; Cephalometry; Combined Modality Therapy; Ear, External; Eye Abnormalities; Facial Asymmetry; Female; Humans; Models, Dental; Nose; Orthodontics, Corrective

Fronto-facio-nasal dysplasia is a rare cause of facial clefts. The syndrome is characterized by paramedian facial clefts which involve the nose and palpebral fissures resulting in defects of the alae nasi and blepharophimosis, lagophthalmos, and S-shaped palpebral fissures. In addition affected children have ocular malformations such as epibulbar dermoids and colobomata of the iris or optic disk and may have a posterior encephalocele; these features distinguish this condition from fronto-nasal dysplasia and early amnion rupture sequence. We describe a child with unilateral features. Unilateral craniofacial clefts are usually assumed to have a low recurrence risk. However, fronto-facio-nasal dysplasia is an autosomal recessive condition and must be considered in any child with paramedian facial clefts.

Topics: Abnormalities, Multiple; Craniofacial Abnormalities; Encephalocele; Eye Abnormalities; Facial Asymmetry; Genes, Recessive; Humans; Infant, Newborn; Male; Nose; Syndrome

Frontonasal malformation (FNM) is a developmental field defect representing abnormal morphogenesis of the frontonasal eminence. The oculoauriculovertebral spectrum (OAVS) has been used to describe a broader range of first and second branchial-arch defects including hemifacial microsomia and Goldenhar's syndrome. A combination of FNM and OAVS has been described in the literature in 13 cases. This condition has been labeled as the oculoauriculofrontonasal syndrome, as well as ophthalmofrontonasal dysplasia. We have evaluated four patients with both FNM and OAVS. The pattern of malformation involves only the craniofacies: they have no vertebral defects, heart disease, or encephaloceles. The categorization of these four individuals and those in the literature raises interesting issues regarding syndrome classification. Originally, it was suggested that perhaps this disorder was a variation of Goldenhar's syndrome. However, now that it has become evident that FNM and OAVS are malformation patterns of etiologic and presumably pathogenetic heterogeneity, a more likely hypothesis is that when these two defects occur together, this represents a unique syndrome pattern. The purpose of this article is to suggest that the combination of OAVS and FNM may be a distinct entity, representing a discreet subset of patients.

Topics: Adolescent; Child, Preschool; Craniofacial Abnormalities; Ear, External; Eyelids; Facial Asymmetry; Female; Frontal Bone; Goldenhar Syndrome; Humans; Male; Nose; Syndrome

Asymmetric embryopathies--severe malformations and disruptions--that affect the craniofacial region are discussed, including anomalies of the eye, nose, mouth, and ear. Asymmetric Tessier clefts are also discussed.

Topics: Cleft Lip; Cleft Palate; Ear, External; Eye Abnormalities; Facial Asymmetry; Humans; Infant, Newborn; Mouth Abnormalities; Nose; Skull

The premature fusion of unilateral coronal suture can cause a significant asymmetry of the craniofacial skeleton, with an oblique deviation of the cranial base that negatively impacts soft tissue facial symmetry. The purpose of this study was to assess facial symmetry obtained in patients with unilateral coronal synostosis (UCS) surgically treated by 2 different techniques. We hypothesized that nasal deviation should not be addressed in a primary surgical correction of UCS.. Consecutive UCS patients were enrolled in a prospective study and randomly divided into 2 groups. In group 1, the patients underwent total frontal reconstruction and transferring of onlay bone grafts to the recessive superior orbital rim (n = 7), and in group 2, the patients underwent total frontal reconstruction and unilateral fronto-orbital advancement (n = 5). Computerized photogrammetric analysis measured vertical and horizontal axis of the nose and the orbital globe in the preoperative and postoperative periods. Intragroup and intergroup comparisons were performed.. Intragroup preoperative and postoperative comparisons showed a significant (all P < 0.05) reduction of the nasal axis and the orbital-globe axis in the postoperative period in the 2 groups. Intergroup comparisons showed no significant difference (all P > 0.05).. Facial symmetry was achieved in the patients with UCS who underwent surgery regardless of surgical approach evaluated here. Our data showed a significant improvement in nasal and orbital-globe deviation, leading us to question the necessity of primary nasal correction in these patients.

Topics: Adult; Aged; Bone Transplantation; Child; Cranial Sutures; Craniosynostoses; Craniotomy; Facial Asymmetry; Female; Humans; Male; Middle Aged; Nose; Orbit; Osteotomy; Photogrammetry; Plastic Surgery Procedures; Postoperative Period; Prospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Unnecessary Procedures

To evaluate the impact of a crooked nose on observer perceptions of facial asymmetry and attractiveness and the ability of rhinoplasty to minimize it. We hypothesized that the presence of a crooked nose would penalize symmetry and attractiveness ratings as compared to normal faces. We further hypothesized that straightening rhinoplasty would restore symmetry and improve attractiveness.. Randomized controlled experiment.. A group of 39 naïve observers viewed pictures of patients with crooked noses before and after straightening rhinoplasty, and normal patients. Observers rated the overall asymmetry and attractiveness, and the asymmetry of facial subunits using a survey with a rating scale of 1 to 10 for each category.. For asymmetry, patient group (preoperative, postoperative, normal) was statistically significant by multivariate analysis of the variance. Post-analysis of variance showed significant differences in asymmetry scores for overall, nose subunit, and mouth subunit. Pairwise testing then showed significantly different overall asymmetry scores between normal and preoperative (P < .001), and preoperative and postoperative (P < .001), but not between normal and postoperative (P = .215) groups. Mixed linear regression analysis showed that decreasing nasal asymmetry by 1 point increases attractiveness by 0.18 points or 0.082 attractiveness standard deviations (P < .001).. Faces with crooked noses were rated less symmetrical overall and less symmetrical at the nose and mouth subunits as compared to normal and postoperative faces. Straightening rhinoplasty diminished overall facial asymmetry and subunit asymmetry scores. Decreasing nasal asymmetry led to significant improvements in facial attractiveness. These data provide objective evidence supporting the idea that a straightening rhinoplasty can improve attractiveness.

Topics: Adult; Beauty; Body Image; Facial Asymmetry; Facial Expression; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Patient Satisfaction; Photography; Retrospective Studies; Rhinoplasty; Surveys and Questionnaires; Young Adult

Facial directional asymmetry research, including age-related changes, is crucial for the evaluation of treatment of craniofacial malformations/trauma in orthodontics, facial surgery and forensic sciences. The aim was to describe facial directional asymmetry (DA) in different age categories of adults using 3D methods. According to our hypothesis, facial shape DA (1) depends on sex; (2) differs among age groups; and (3) has wider variability in older age.. A cross-sectional sample of healthy Czech adults without craniofacial trauma or anomalies consisted of 300 3D facial models (151 females). The age-range in the study was between 20-80 years. The shape asymmetry of 28 3D landmarks was evaluated using geometric morphometrics and multivariate statistics.. The manifestation of DA was similar in both sexes and in each age category; however, there were some statistical differences. In contrast to the ideal symmetrical face, the mean asymmetrical faces tended to create a slightly bent "C" shape of the midline. Therefore, the upper face was rotated slightly clockwise and the lower face counter-clockwise. The right eye was located slightly higher, with the nasal tip and mandibular region tilting to the left. Sex differences in facial DA were significant before the age of 40. DA was more significant in the youngest males than in the oldest, while the women's DA did not change.. The DA patterns were similar in both sexes and in all age categories (a slightly bent C shape of the midline); however, some significant local differences between male age groups were found. A significantly more pronounced asymmetry compared to other age groups was found only in the youngest males from 20 to 40 years. Moreover, significant sexual dimorphism of DA rapidly decreased after middle age, likely caused by the same age-related changes of the face during aging.

Topics: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Facial Asymmetry; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Nose; Sex Characteristics; Young Adult

To compare dynamic nasolabial movement between end-of-treatment cleft and a matched non-cleft group in adult patients.. Thirteen treated adult participants with unilateral cleft lip and palate had images taken using a facial motion capture system performing a maximum smile. Seventeen landmarks were automatically tracked. For each landmark pair, on either side of the midline, changes in the x, y, and z directions were used to analyze the magnitude of displacement and path of motion. An asymmetry score was developed at rest, mid-smile, and maximum smile to assess the shape of the mouth and/or nose.. At maximum smile, displacement of right and left cheilion was clinically and statistically (p < 0.05) less in the cleft group. The lip asymmetry score was greater (p < 0.05) at each time point in the cleft group using the clinical midline. Using Procrustes superimposition, the differences were significant (p < 0.05) only at rest and mid-smile. The alar bases were displaced significantly less (p < 0.05) in the z direction in the cleft group. The asymmetry score of the alar base was significantly higher using the clinical midline than using Procrustes superimposition in patients with cleft conditions (p < 0.001). In the cleft group, at maximum smile, the right and left cristae philter moved significantly less (p < 0.05) in the x and z directions.. There was an increase in asymmetry score of the corners of the mouth and alar bases from rest to maximum smile. The lips were similar in shape but oriented differently in the faces of patients with cleft conditions than in individuals without those conditions.

Topics: Adult; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Imaging, Three-Dimensional; Motion Capture; Nose

This study aimed to assess the correlation of social smile symmetry with facial symmetry.. In this cross-sectional study, frontal view photographs were obtained from 169 eligible patients at rest and smiling with a camera at the level of their nose tip. Several landmarks were selected for facial symmetry and measured at rest and social smiling at the two sides of the face. The respective formula was used to calculate the asymmetry index (AI). The mean values for each AI were calculated, and the correlation between the criteria for a symmetric smile in a social smile with the criteria for facial symmetry, and the correlation between the difference in symmetry criteria at rest and social smiling with facial symmetry criteria were analyzed.. Significant correlations were noted between Oc-b AI (smile) and Sn-B (rest) facial AI (P = 0.046), An-a (smile) AI and Gn-a (rest) facial AI (P = 0.002), An-b (smile) AI and Sn-b (rest) facial AI (P < 0.001), Pog-a (smile) and Sn-a (rest) facial AI (P < 0.001), Nt-a (smile) and Sn-a (rest) facial AI (P < 0.001), Nt-b (smile) and Sn-b (rest) facial AI (P < 0.001), Ph-a (smile) and Sn-a (rest) facial AI (P < 0.001), Ph-b (smile) and Sn-b (smile) facial AI (P = 0.007), Oc-b AI (difference) and Gn-b (rest) facial AI (P = 0.031), Oc-Pog (difference) AI and Gn-b (rest) facial AI (P = 0.041), An-b (difference) AI and Sn-b (rest) facial AI (P < 0.001), Nt-a (difference) and Sn-a (rest) facial AI (P = 0.006), Nt-b (difference) and Sn-b (rest) facial AI (P < 0.001), and Ph-b (difference) and Sn-b (rest) facial AI (P < 0.001).. A significant correlation exists between social smile symmetry and facial symmetry.

Topics: Cross-Sectional Studies; Facial Asymmetry; Humans; Nose; Smiling

Assessing facial asymmetry is important to prevent unsatisfactory results in rhinoplasty. There has yet to be a consensus on reference lines for determining asymmetry. This study aimed to determine ideal reference lines to assess facial asymmetry and identify predictors of subjective perceptions of facial asymmetry.. Preoperative photographs of 47 patients who underwent rhinoplasty were adjusted according to two reference lines (vertical line from the mid-glabella to Cupid's bow and horizontal interpupillary line). In total, 94 photographs were generated, randomly ordered, and evaluated by two independent observers for anthropometric measurements including six distances (distances from the midline to the medial and lateral canthi, ala, oral commissure, width of midface at maximum distance, and mandible width) and three angles (lateral canthal, lateral alar, and lip margin angles). Photographs were rated by 18 independent observers for subjective perceptions of facial asymmetry.. Observers perceived faces as asymmetric if accompanied by nasal deviation, irrespective of the reference line (p < 0.001). Based on the horizontal reference line, subjective perceptions of asymmetry were correlated with the midline to lateral alar margin distance (r = 0.489, p = 0.003) and sum of the distance ratios (r = 0.354, p = 0.037). None of the objective parameters correlated with subjective perceptions when adopting the vertical reference line. A deviated nose and lateral alar angle were significant predictors of subjective perceptions of facial asymmetry.. To assess facial asymmetry, the horizontal reference line should be determined first followed by the perpendicular vertical line. The nose is the most important feature determining overall facial asymmetry. LEVEL OF EVIDENCE V: "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 ."

Topics: Face; Facial Asymmetry; Humans; Nose; Rhinoplasty; Treatment Outcome

Topics: Facial Asymmetry; Humans; Nose; Rhinoplasty

Quantification and visualization of the location and magnitude of facial asymmetry is important for diagnosis and treatment planning. The objective of this study was to analyze the asymmetric features of the face for skeletal Class III patients using spatially-dense geometric morphometrics.. Three-dimensional facial images were obtained for 86 skeletal Class III patients. About 7160 uniformly sampled quasi-landmarks were automatically identified on each face using template mapping technique. The pointwise surface-to-surface distance between original and mirror face was measured and visualized for the whole face after robust Procrustes superimposition. The degree of overall asymmetry in an individual was scored using a root-mean-squared-error. Automatic partitioning of the face was obtained, and the severity of the asymmetry compared among seven facial regions.. Facial asymmetry was mainly located on, but not limited to, the lower two-thirds of the face in skeletal Class III patients. The lower cheek and nose asymmetry were detected to have more extensive and of a greater magnitude of asymmetry than other facial anatomical regions but with various individual variations. The overall facial asymmetry index and the regional facial asymmetry indices were higher in males and patients with chin deviation.. Soft tissue asymmetry is predominately presented in the lower-third of the face in skeletal Class III patients and with various variations on other facial anatomical regions. Morphometric techniques and computer intensive analysis have allowed sophisticated quantification and visualization of the pointwise asymmetry on the full face.

Topics: Cephalometry; Chin; Face; Facial Asymmetry; Humans; Imaging, Three-Dimensional; Male; Nose

To validate a newly developed method for capturing 3-dimensional (3D) images of the nasolabial region for assessing upper lip scarring and asymmetry in surgically managed unilateral cleft lip and palate (UCLP) cases.. Validation study, single cohort.. Eighteen surgically managed UCLP cases were recruited, the nasolabial region of each face was scanned using an intraoral scanner (IOS) to produce 3D images. The images were manually segmented to allow the calculation of surface area of the scar and upper lip asymmetry. Five professionals and 5 lay assessors subjectively evaluated the same images and graded the upper lip scarring and asymmetry at 2 separate occasions. The relationship between the subjective and objective assessments was evaluated.. Moderate correlation was found between subjective and objective evaluations of the upper lip scarring and total asymmetry. The captured 3D images were of good quality for the objective measurements of lip asymmetry and residual scarring. Moderate to strong correlations were detected between the 2 panels (T ranging between 0.5 and 0.9) with no significant difference (. The IOS is a useful tool for the capture of the nasolabial morphology. The captured 3D images are a reliable source for measuring lip asymmetry and scar surface area. The method has sufficient validity for routine clinical use and for objective outcome measures of the surgical repair of cleft lip.

Topics: Cleft Lip; Cleft Palate; Face; Facial Asymmetry; Humans; Imaging, Three-Dimensional; Lip; Nose

In rhinoplasty and nasal reconstruction, achieving symmetry is critical for optimal patient outcomes and reducing re-operation rates. Assessing nasal asymmetry is challenging, both pre- and intra-operatively, if based on only a surgeons' visual perception to assess and adjust the small distances important to cosmesis (<2-3 mm). To measure nasal symmetry, we first developed an algorithm to analyze lateral nasal deviation on facial three-dimensional (3D) scans captured by external surface scanning. In this, nasal deviation is measured by first registering a 3D facial scan to orthogonal axes in order to remove tilt. The lateral position of the nasal midline is then found across transverse planes along the dorsum and nasal tip regions by probing midpoints 1 and 2 mm back from the local maximum projection. The nasal deviation measurement algorithm was validated on a simulated asymmetrical nose model with known nasal deviation. Simulated deviations were applied to the symmetrical average nose using an exponential twist away from the face, with control of the maximum deviation and degree of curvature. Modeled deviations were evaluated with the algorithm at clinically negligible (0.02-0.06 mm) average differences and for small lateral deviations (1-5 mm). Nasal deviation using the algorithms was then measured for the 100 multi-ethnic subjects in the Binghamton University 3D Facial Expression database. Average values for maximum lateral deviation, deviation across the whole nose, and deviation at the nose tip were measured to provide context to deviation measurements in surgical planning. This research presents a new nasal assessment tool that can be useful in improving symmetry in rhinoplasty and reconstruction.

Topics: Algorithms; Anatomic Landmarks; Facial Asymmetry; Female; Humans; Imaging, Three-Dimensional; Male; Nose; Nose Deformities, Acquired; Patient-Specific Modeling; Rhinoplasty

Facial asymmetry is considered a reason for patient dissatisfaction with the outcome of rhinoplasty.. The aim of this study was to evaluate the impact of facial asymmetry on patient postoperative satisfaction with crooked nose and to investigate the relationship between visual perception of asymmetry and anthropometric measurements.. In this retrospective study, 61 rhinoplasty patients with crooked noses were assessed. Utilizing frontal view photos, pre- and postoperative nasal deviation angles were calculated. The patients were divided into 2 groups based on the visual presence of facial asymmetry. Moreover, anthropometric characteristics of the face were evaluated utilizing facial soft tissue landmarks. Patient satisfaction with surgery outcomes, including both aesthetic and functional aspects, was assessed employing the Persian version of the Standardized Cosmesis and Health Nasal Outcomes Survey.. Based on the observations, 19 (30.2%) and 44 (69.8%) patients had I-type and C-type noses, respectively. In both groups, the deviation angle decreased significantly postoperatively (P < 0.001). Regarding the subjective evaluation of facial asymmetry, 22 (34.9%) and 41 (65.1%) cases had symmetric and asymmetric faces, respectively. Anthropometric measurements were also consistent with visual assessments of asymmetry. Satisfaction scores were significantly higher after surgery in all patients; however, there was no significant difference in the mean aesthetic improvement between symmetric (15.83 ± 2.68) and asymmetric faces (15.23 ± 4.46) (P = 0.531). The power of study was 97.8%.. Rhinoplasty in patients with deviated noses and asymmetric faces may have comparable results with symmetric ones.

Topics: Case-Control Studies; Facial Asymmetry; Humans; Nasal Septum; Nose; Retrospective Studies; Rhinoplasty; Treatment Outcome

Accurate assessment of facial symmetry is a key component of successful rhinoplasty surgery but is often overlooked by both surgeon and patient. Up to three-quarters of patients with a significantly crooked nose have been found to have concurrent marked facial asymmetry. Whilst not a contraindication to rhinoplasty, provided that facial asymmetry is identified in advance and expectations realistic, the correction of nasal deformities can improve perceived facial asymmetry. In the aging face, aside from soft tissue and bony resorption that can amplify facial asymmetry, there are specific surgical challenges to the aging nose; the normal tip support mechanisms deteriorate with age giving rise to distinctive changes to the aging nose-typically tip ptosis and a hanging columella; bone quality becomes more brittle and skin overlying this area becomes thinner. There is also weakening of the external nasal valve thus causing functional impairment too. As a result, rhinoplasty techniques used in younger patients may not be suitable in the aging nose. In this article, the authors describe their experience and outline the evidence on the management of the aging patient with facial and nasal asymmetry.

Topics: Aging; Facial Asymmetry; Humans; Nose; Nose Deformities, Acquired; Rhinoplasty

Augmentation rhinoplasty had become increasingly popular among Asians. Failure to recognize nasal deviation before surgery may engender unsatisfactory outcomes because the deviation becomes prominently visible after surgery due to the central position of the nose. Ideal nasal radix positioning has yet to be addressed. The head position affects facial asymmetry judgements; however, its effect on rhinoplasty has never been studied. This study determined the ideal nasal radix position in facial fluctuating asymmetry and investigated the effects of the natural head position (NHP) on nasal deviation perceptions.. A survey was conducted to compare different head and nasal radix horizontal positions using images of patients who underwent augmentation rhinoplasty. Images were retouched using editing software to adjust the head and nasal radix positions. The survey was performed using questionnaires involving 3 plastic surgeons and 3 laypersons, who were asked to determine the presence of nasal deviation and select the ideal nasal radix position among the retouched images.. Twenty patients who underwent primary rhinoplasty were included in this study. The recognition of nasal deviation was significantly higher in the NHP than in the compensatory head position. The surgeons and the laypersons considered the midsagittal line the most appropriate position of the nasal radix.. Facial analysis for augmentation rhinoplasty should be performed with the patient's head in the NHP to prevent nasal deviation masking. The preferred nasal radix position in facial fluctuating asymmetry is the midsagittal line.Level of Evidence: Level V, descriptive study.

Topics: Face; Facial Asymmetry; Humans; Nose; Nose Deformities, Acquired; Rhinoplasty

Topics: Adult; Facial Asymmetry; Female; Humans; Lipoma; Nose; Nose Neoplasms

 Surgical management of crooked nose is challenging even for experienced rhino surgeons, although numerous techniques for correction have been described. Not infrequently, there is a facial asymmetry in addition to the crooked nose influencing the aesthetic results of the operation. Therefore, the purpose of this study was to determine how often there is an asymmetry of the face in addition to a crooked nose..  Retrospectively the data of 607 patients with a crooked nose (304 women, 303 men, mean age 30 years) were evaluated. The preoperative photos of the face were anthrometrically assessed based on angle measurements..  382 of the 607 patients had a c-shaped (63 %) and 225 an i-shaped (37 %) crooked nose. More than three-quarters of the patients had facial asymmetry in respect to the connecting line of the pupils and nasal base line. 49 % of patients reported a history of nasal trauma, but this had no relevant influence on the frequency of facial asymmetry..  Pre-existing facial asymmetry is very common in patients with crooked nose and can significantly affect the aesthetic outcome of nasal surgery. This should be addressed as part of the informed consent. In particular, it should be mentioned that the surgical outcome can remain below the patient's aesthetic expectations. Not rarely, a revision surgery may be necessary..  Das chirurgische Management der Schiefnase stellt selbst für erfahrene Rhinochirurgen eine Herausforderung dar, obwohl zahlreiche Techniken zur Korrektur beschrieben sind. Nicht selten besteht zusätzlich zur Schiefnase eine Asymmetrie des Gesichtes, die das ästhetische Ergebnis der Operation beeinflusst. In dieser Studie sollte festgestellt werden, wie häufig bei Patienten mit einer Schiefnase zusätzlich eine anthrometrische Asymmetrie des Gesichtes besteht..  Hierzu wurden retrospektiv die Daten von Patienten mit Schiefnasen (n = 607, 304 Frauen, 303 Männer, mittleres Alter 30 Jahre) ausgewertet. Die präoperativen Fotos des Gesichtes wurden standardisiert anthrometrisch anhand von Winkelmessungen ausgewertet..  382 der 607 Patienten hatten eine C-förmige (63 %) und 225 eine I-förmige (37 %) Schiefnase. Mehr als Dreiviertel der Patienten wiesen eine Gesichtsasymmetrie bezüglich der Pupillenverbindungs-/Nasenbasislinie auf. 49 % der Patienten gaben ein Nasentrauma in der Vorgeschichte an, dieses hatte jedoch keinen relevanten Einfluss auf die Häufigkeit einer Gesichtsasymmetrie..  Eine vorbestehende Gesichtsasymmetrie ist sehr häufig und kann das ästhetische Operationsergebnis erheblich beeinträchtigen. Dies sollte im Rahmen der präoperativen Aufklärung angesprochen werden. Insbesondere sollte erwähnt werden, dass das Operationsergebnis bei Schiefnasen ästhetisch erheblich hinter den Erwartungen bleiben kann und nicht selten eine Revisionsoperation notwendig werden kann.

Topics: Adult; Facial Asymmetry; Female; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Retrospective Studies; Rhinoplasty; Treatment Outcome

Longitudinal evaluation of asymmetry of the surgically managed unilateral cleft lip and palate (UCLP) to assess the impact of facial growth on facial appearance.. Prospective study.. Glasgow Dental Hospital and School, University of Glasgow, United Kingdom.. Fifteen UCLP infants.. The 3-D facial images were captured before surgery, 4 months after surgery, and at 4-year follow-up using stereophotogrammetry. A generic mesh which is a mathematical facial mask that consists of thousands of points (vertices) was conformed on the generated 3-D images. Using Procustean analysis, an average facial mesh was obtained for each age-group. A mirror image of each average mesh was mathematically obtained for the analysis of facial dysmorphology. Facial asymmetry was assessed by measuring the distances between the corresponding vertices of the original and the mirror copy of the conformed meshes, and this was displayed in color-coded map.. There was a clear improvement in the facial asymmetry following the primary repair of cleft lip. Residual asymmetry was detected around the nasolabial region. The nasolabial region was the most asymmetrical region of the face; the philtrum, columella, and the vermillion border of the upper lip showed the maximum asymmetry which was more than 5 mm. Facial growth accentuated the underlying facial asymmetry in 3 directions; the philtrum of the upper lip was deviated toward the scar tissue on the cleft side. The asymmetry of the nose was significantly worse at 4-year follow-up ( P < .05).. The residual asymmetry following the surgical repair of UCLP was more pronounced at 4 years following surgery. The conformed facial mesh provided a reliable and innovative tool for the comprehensive analysis of facial morphology in UCLP. The study highlights the need of refining the primary repair of the cleft and the potential necessity for further corrective surgery.

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Imaging, Three-Dimensional; Infant; Nose; Prospective Studies; United Kingdom

To assess improvement of soft-tissue facial symmetry in children surgically treated for unicoronal synostosis (UCS) in infancy, to correlate pre- and postsurgical facial asymmetry and to evaluate whether the improvement was visually recognizable.. Case-controlled follow-up.. Eleven Danish children diagnosed with UCS were included, 3 of whom had tested positive for Muenke mutation. Preoperative computed tomography scans and postoperative 3dMD surfaces were available for measurements. A control group of healthy children matched for age and sex was employed.. Pre- and postsurgical facial asymmetry was analyzed using a computerized method capable of objective and spatially detailed quantification in 3-dimension (transverse, vertical, and sagittal directions). Asymmetry was evaluated in the facial region and 6 subregions (forehead, mouth, eyes, nose, cheek, and chin).. The largest significant improvement was seen in the sagittal direction of the facial (1.9 mm), forehead (2.0 mm), and cheek (3.4 mm) regions. Small but significant improvements were also seen in the mouth, chin, and eye regions. No significant improvement was seen in the nose region. Significant correlations were found between the pre- and postsurgically calculated facial asymmetry and between calculated asymmetry and clinical validation scores.. All patients presented with improved facial symmetry after surgery and the improvements were visually recognizable. However, only 1 (9.1%) of the 11 patients reached a level of facial asymmetry as low as that seen in the control group. The best outcome was, in general, seen in cases with mild facial asymmetry presurgically.

Topics: Child; Craniosynostoses; Facial Asymmetry; Forehead; Humans; Imaging, Three-Dimensional; Nose; Tomography, X-Ray Computed

The purpose of this study was to investigate the differences in facial profile development between unoperated adult cleft palate (UACP) patients and normal controls and to analyse the reasons for the differences.. A total of 50 individuals with a unilateral cleft palate and 20 normal controls were selected to undergo angular measurement of their facial profiles. Data with significant differences between the two groups were analysed.. Seven angle measurements of the facial profile showed that the mid-facial protrusion of the UACP patients had no significant differences from the control group (p > 0.05). But their angle of the medium face (N'-Trg-Sn) was significantly lower than the non-cleft controls (p < 0.05), suggesting a worse vertical development of the middle face. A significantly larger nasal tip angle (Cm-Sn/N'-Prn) for UACP patients suggested they had a rounder and blunter nasal tip (p < 0.05). The soft tissue facial angle and chin-lip angle of UACP patients had significant differences from non-cleft controls (p < 0.05), but the head position angle (Sn-Sm-THP) had no significant difference between two groups (p > 0.05), which suggested a steep mandibular plane for UACP patients but without severe retraction of the chin.. The development of facial protrusions in UACP patients is similar to that in normal adults, but the vertical development in the middle face is insufficient. Such hypoplasia may be related to the intrinsic deficiency of the maxilla. There is a tendency for flat nasal growth and insufficient development of the chin in UACP patients.. 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 .

Topics: Adult; Case-Control Studies; Cephalometry; China; Cleft Palate; Face; Facial Asymmetry; Facial Muscles; Female; Hospitals, University; Humans; Male; Nose; Orthognathic Surgical Procedures; Patient Selection; Plastic Surgery Procedures; Reference Values

Discrepancy of the upper dental midline to the facial midline plays an important role in smile aesthetic assessment. This study presents different reference points to quantify the deviation of upper dental midline to the facial midline in 2D frontal photographs. The aim was to find the most accurate, precise, and practical reference points to measure dental midline discrepancy in 2D photographs.. A modified headset with a protractor was developed in order to achieve photographs in nine standardised head positions. Six reference points were used to detect the facial midline in the 2D photographs (eyebrows "EB", inner-canthus of the eyes "ICE", alae of the nose "AN", columella "C", nasolabial folds "NLF", and the philtrum "PH"). The deviation of the maxillary dental midline from the facial midline was measured and compared with clinical measurements.. Standard deviations (SD), Root Mean Square Error (RMSE), Method of Moments' Estimator (MME), 2-way repeated measures ANOVA, and multi-level linear model were used to estimate the true errors.. The different reference points responded significantly differently to changes in head position and all showed measurement errors, which increased with greater head rotation. Alae of the nose showed the least measurement error and the greatest precision in all head positions.. The alae of the nose are the recommended reference points to identify the facial midline in order to quantify dental midline deviation from frontal photographs.

Topics: Anatomic Landmarks; Dental Arch; Esthetics, Dental; Face; Facial Asymmetry; Humans; Incisor; Lip; Malocclusion; Maxilla; Nose; Photography, Dental; Smiling; Tooth Abnormalities

Asymmetric facial features such as a deviated nose and chin are common and known to affect smile esthetics. When presented with these asymmetries, the clinician must consider the impact they will have on the smile design parameters-especially the placement and angulation of the dental midline, which is a common starting point for a case involving smile design. The purpose of this article is to determine if the nose and chin deviations affect the perception of dental midline angulation.. An asymmetric facial model (AFM) was created from a digital symmetric facial model, used in a previous study by digitally deviating the nose and chin to the same side. Eight different pictures of this AFM were created, each with different degrees of maxillary midline angulation (both in and against the direction of the deviated nose and chin). Using a visual Likert scaled delivered via Websurvey in the private practice setting, one hundred and ninety-six randomly selected laypersons were asked to evaluate each image according to their own notions of beauty.. A minor axial dental midline angulation of 3.5° can be perceived independently of the direction of the cant. All pictures where the midline was canted pointing in the opposite direction of nose and chin deviations presented lower rating mean values.. Off-center noses and chins can influence the perceived attractiveness of a smile with a canted dental midline. The degree and direction of a canted midline can influence the harmony between the smile and overall face, with canting in the same direction of the asymmetric features being rated as more attractive.. The dental midline should be as vertically straight as possible. If a midline cant is present, however, it is more favorable to have a dental midline angulation which points in the same direction as nose and chin deviations, rather than in the opposite direction.

Topics: Esthetics, Dental; Face; Facial Asymmetry; Humans; Nose; Smiling

Lip asymmetry after a unilateral cleft lip repair can be perceived as an unsatisfactory result. The objective of this study is to determine the degree of upper lip asymmetry and/or nasal alar hooding required for recognition of asymmetry in a simulated model of unilateral cleft lip.. A model of unilateral cleft lip was created using digital morphing software to simulate asymmetries in vermilion height and nasal hooding in photographs of children. Volunteers were shown photographs for different time intervals and with varying degrees of asymmetry. Ability to detect facial asymmetry was recorded and analyzed.. This study was conducted by surveying layperson volunteers in public community settings.. 108 layperson volunteers were randomly surveyed.. The primary outcome measure was a reported lip or nose asymmetry by the volunteers. Proportions and corresponding 95% confidence intervals were obtained to estimate the probability of reporting an asymmetry at 3- and 10-second intervals.. After 3- and 10-second exposure, labial asymmetry was perceived by ≥50% of subjects at 2 mm (62%, P = .001) and 1 mm (89%, P < .0001), respectively. Nasal asymmetry was detected by <50% of subjects at 3 seconds, but ≥50% perceived a 3-mm alteration at 10 seconds (64%, P < .0001). Photographs with combined nasal and labial modification did not lower the threshold for asymmetry perception compared to either deformity alone.. This study is the first to determine a predictable millimeter threshold for perceived asymmetry in cleft lip deformity using a digital model.

Topics: Child; Child, Preschool; Cleft Lip; Esthetics; Facial Asymmetry; Female; Humans; Infant; Male; Nose; Photography; Software; South Carolina

To compare 3-dimensional nasal symmetry in patients with UCLP who had either rotation advancement alone or nasoalveolar molding (NAM) followed by rotation advancement in conjunction with primary nasal repair.. Pilot retrospective cohort study.. Nasal casts of 23 patients with UCLP from 2 institutions were analyzed; 12 in the rotation advancement only group (Iowa) and 11 in the NAM, rotation advancement with primary nasal repair group (New York). Casts from patients aged 6 to 18 years were scanned using the 3Shape scanner and 3-dimensional analysis of nasal symmetry performed using 3dMD Vultus software, Version 2507, 3dMD, Atlanta, GA. Cleft and noncleft side columellar height, nasal dome height, alar base width, and nasal projection were linearly measured. Inter- and intragroup analyses were performed using t tests and paired t tests as appropriate.. A statistically significant difference in mean-scaled 3-dimensional asymmetry index was found between groups with group 1 having a larger measure of asymmetry (4.69 cm. This study suggests the NAM followed by rotation advancement in conjunction with primary nasal repair approach may result in less nasal asymmetry compared to rotation advancement alone.

Topics: Adolescent; Child; Cleft Lip; Cleft Palate; Esthetics; Facial Asymmetry; Female; Humans; Imaging, Three-Dimensional; Iowa; Male; New York; Nose; Orthopedic Procedures; Pilot Projects; Retrospective Studies; Rhinoplasty; Software; Treatment Outcome

The biological relatives of offspring with nonsyndromic orofacial clefts have been shown to exhibit distinctive facial features, including excess asymmetry, which are hypothesized to indicate the presence of genetic risk factors. The significance of excess soft tissue nasal asymmetry in at-risk relatives is unclear and was examined in the present study. Our sample included 164 unaffected parents from families with a history of orofacial clefting and 243 adult controls. Geometric morphometric methods were used to analyze the coordinates of 15 nasal landmarks collected from three-dimensional facial surface images. Following generalized Procrustes analysis, Procrustes ANOVA and MANOVA tests were applied to determine the type and magnitude of nasal asymmetry present in each group. Group differences in mean nasal asymmetry were also assessed via permutation testing. We found that nasal asymmetry in both parents and controls was directional in nature, although the magnitude of the asymmetry was greater in parents. This was confirmed with permutation testing, where the mean nasal asymmetry was significantly different (p < .0001) between parents and controls. The asymmetry was greatest for midline structures and the nostrils. When subsets of parents were subsequently analyzed and compared (parents with bilateral vs. unilateral offspring; parents with left vs. right unilateral offspring), each group showed a similar pattern of asymmetry and could not be distinguished statistically. Thus, the side of the unilateral cleft (right vs. left) in offspring was not associated with the direction of the nasal asymmetry in parents.

Topics: Adult; Case-Control Studies; Cleft Palate; Facial Asymmetry; Female; Genetic Predisposition to Disease; Humans; Male; Middle Aged; Nose; Parents

This study was carried out on 26 unilateral cleft lip and palate (UCLP) cases with mean age 3.6 ± 0.7 months.3D facial images were captured for each infant 2-3 days before the repair of cleft lip and at 4 months following surgery at a mean age of 8.2 ± 1.8 months, using a stereophotogrammetry imaging system. An iterative closest point (ICP) algorithm was used to superimpose the 3D facial model to its mirror image using VRMesh software. After the superimposition, the face model was divided into seven anatomical regions. Asymmetry of the entire face and of the anatomical regions was calculated by measuring the absolute distances between the 3D facial surface model and its mirror image. Colour maps were used to illustrate the patterns and magnitude of the facial asymmetry before and after surgery. There were significant decreases in the asymmetry scores for the nose, upper lip and the cheeks as a result of the surgical repair of cleft lips. Surgery did not change the magnitude of the asymmetry scores for the lower lip and chin. Residual nasolabial asymmetries were detected. The main outcome of the findings of this innovative study is to inform the required surgical refinement of primary repair of cleft lip in order to minimise facial asymmetry. We have presented a sensitive tool that could be used for comparative analysis of lip repair at various cleft centres and to guide secondary corrective surgery when required.

Topics: Cheek; Chin; Cleft Lip; Cleft Palate; Face; Facial Asymmetry; Humans; Imaging, Three-Dimensional; Infant; Lip; Nose; Photogrammetry

Many rhinoplasty patients present with a chief complaint of nasal deviation and are unaware of any inherent facial asymmetries; however, recognizing and discussing the interrelation between the deviated nose and facial asymmetry is an important consideration in surgical planning. The objective of this study was to evaluate whether a surgeon's subjective assessment of facial analysis in the setting of nasal deviation correlates with objective anthropometric measurements. In addition, this study sought to further quantify the frequency of facial asymmetry associated with nasal deviation to highlight important anatomical trends for the rhinoplasty surgeon. Finally, this study presents the senior author's (R.J.R.) method of addressing a deviated nose on an asymmetric face. In this study, the authors demonstrated that nasal deviation is closely related to facial asymmetry. Furthermore, the authors demonstrated that objective facial analysis closely correlates to anthropometric facial measurements. In addition, the wide side of the face correlates to the short side of the face and the nose tends to deviate away from the wide side of the face. During surgical correction of the deviated nose in the setting of facial asymmetry, the surgeon's goal should be to obtain nasal symmetry and center the nose on a line between the mid glabella and the mid Cupid's bow. This may reduce the perception of a facial asymmetry, leading to increased patient satisfaction.. Diagnostic, IV.

Topics: Adult; Anthropometry; Facial Asymmetry; Female; Humans; Male; Middle Aged; Nose; Rhinoplasty; Treatment Outcome; Young Adult

This study was aimed to evaluate the nasal deviation in patients with asymmetric mandibular prognathism.. Thirty-five patients with skeletal class III malocclusion were included in the study. Significant mandibular asymmetry of >4 mm menton deviation in three-dimensional (3D) reformatted cone beam computed tomography images was defined as asymmetry group (n = 20). Patients without mandibular asymmetry served as control group (n = 15). The mandibular asymmetry was evaluated pre- and postoperatively.. Nasal tip was significantly shifted to the deviated side of the mandible (short side) in the asymmetry group, as compared to the control group (1.5 ± 0.9 degree, P < 0.01). Alar base angle (ABA) was significantly narrower in nondeviated side (long side) than in the deviated side in asymmetry group. However, control group showed no bilateral difference in ABA. Correction of deviated mandibular prognathism by isolated mandibular surgery resulted in change in the ABA but not the columella base position or nasal asymmetry. ABA on nondeviated side significantly decreased in proportion to the amount of transverse menton movement by surgery (r = -0.560, P < 0.01).. Our results showed that mandibular chin deviation was accompanied by nasal deviation. Isolated mandibular surgery can potentially influence the alar base position on the contralateral side of deviation but not the nasal tip asymmetry. Therefore, clinicians should inform patients preoperatively of the fundamental limitation of mandibular surgery in cases with preexisting nasal asymmetry.

Topics: Cohort Studies; Cone-Beam Computed Tomography; Facial Asymmetry; Humans; Malocclusion, Angle Class III; Nose

In this study, the authors aimed to identify facial and nasal parameters, which may create an anatomic disposition toward obstruction in patients with primary acquired nasolacrimal duct obstruction.. Forty-eight patients (14 males and 34 females) who presented to the ophthalmology outpatient clinic and were diagnosed with primary acquired nasolacrimal duct obstruction between January 2014 and January 2015 were included in the study. The control group comprised 59 patients (38 females and 21 males) without nasolacrimal duct obstruction. Measurements of nasal height, length, and depth, presence of a nasal hump, alar width and alar angle, distance between the maxillary bone nasal notches, and right and left distances between outer canthi and corners of the mouth were made using photographs of the patients. The presence of facial asymmetry was also assessed.. Facial asymmetry (P = 0.014) and nasal hump (P = 0.048) were more common in the patient group. The patient group had smaller nasal radix depth (P < 0.001), nasal length (P = 0.001), and alar width (P < 0.001), larger distance between maxillary bone nasal notches (P < 0.001), and smaller alar angle (P < 0.001).. In the current study, the authors found that primary acquired nasolacrimal duct obstruction occurred more frequently on the side of the face with shorter facial measurements. Smaller nasal radix depth, nasal length, and alar base width, presence of a nasal hump and longer distance between maxillary bone nasal notches may form an anatomic basis for nasolacrimal duct obstruction. Based on our results, the authors believe that primary acquired nasolacrimal duct obstruction is associated with facial structure.

Topics: Adult; Aged; Case-Control Studies; Facial Asymmetry; Female; Humans; Lacrimal Duct Obstruction; Male; Middle Aged; Mouth; Nasolacrimal Duct; Nose

The purpose of this project was to develop objective computer-based methods to measure nasal asymmetry and abnormality in children undergoing treatment of unilateral cleft lip (UCL) and to determine the correlation of these measures to clinical expectations.. Thirty infants with UCL undergoing cleft lip repair; 27 children with UCL aged 8 to 10 years who had previously undergone cleft lip repair; 3 control infants; 3 control children aged 8 to 10 years.. To measure nasal symmetry, we used a process of depth mapping and calculated the Depth Area Difference. To measure abnormality, we used the reconstruction error from Principle Component Analysis (PCA) that was based upon characteristics of a dataset of over 2000 images of normal control subjects.. Depth Area Difference and PCA Reconstruction Error for cleft type, changes with surgery, and individual subjects ranked according to cleft severity were assessed.. Significant differences in Depth Area Difference and PCA Reconstruction Error were found between cleft types and found before and after surgery. Nasal symmetry and normalcy scores for infants with UCL approached those of controls after surgery, and there was a strong correlation with ranked cleft severity. For older children, measures of nasal symmetry and abnormality were better than infants prior to repair but worse than infants following UCL repair.. Our computer-based 3D analysis of nasal symmetry and normalcy correlated with clinical expectations. Automated processing made measurement convenient. Use of these measures may help to objectively measure cleft severity and treatment outcome.

Topics: Child; Cleft Lip; Facial Asymmetry; Female; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Infant; Male; Nose; Photogrammetry; Principal Component Analysis; Prospective Studies; Treatment Outcome

The Symnose semiautomated assessment of outcome of the appearance of the repaired cleft lip and nose was developed to measure asymmetry. Symnose 2 has been further developed to include quantification of the extent of scar color, intensity, and contour and midline dehiscence, underexpressed in the measurement of asymmetry.

Topics: Child; Cicatrix; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Lip; Nose; Software

Facial attractiveness is an important factor in our social interactions. It is still not entirely clear which factors influence the attractiveness of a face and facial asymmetry appears to play a certain role. The aim of the present study was to assess the association between facial attractiveness and regional facial asymmetries evaluated on three-dimensional (3D) images.. 3D facial images of 59 (23 male, 36 female) young adult patients (age 16-25 years) before orthodontic treatment were evaluated for asymmetry. The same 3D images were presented to 12 lay judges who rated the attractiveness of each subject on a 100mm visual analogue scale. Reliability of the method was assessed with Bland-Altman plots and Cronbach's alpha coefficient.. All subjects showed a certain amount of asymmetry in all regions of the face; most asymmetry was found in the chin and cheek areas and less in the lip, nose and forehead areas. No statistically significant differences in regional facial asymmetries were found between male and female subjects (P > 0.05). Regression analyses demonstrated that the judgement of facial attractiveness was not influenced by absolute regional facial asymmetries when gender, facial width-to-height ratio and type of malocclusion were controlled (P > 0.05).. A potential limitation of the study could be that other biologic and cultural factors influencing the perception of facial attractiveness were not controlled for.. A small amount of asymmetry was present in all subjects assessed in this study, and asymmetry of this magnitude may not influence the assessment of facial attractiveness.

Topics: Adolescent; Adult; Anatomic Landmarks; Attitude to Health; Cheek; Chin; Esthetics, Dental; Face; Facial Asymmetry; Female; Forehead; Humans; Imaging, Three-Dimensional; Judgment; Male; Malocclusion; Nose; Photogrammetry; Reproducibility of Results; Young Adult

The primary objective of this study was to investigate whether growth impairment in children with cleft lip is caused by reconstructing the nostril floor using lateral nasal and premaxillary mucoperiosteal flaps. The effects on growth and symmetry of tip rhinoplasty at the time of initial repair, as well as cleft sidedness are similarly investigated.. An Institutional Review Board approved, retrospective, single-center study at an academic children's hospital from July 2005 to 2010 was designed. Seventy-four patients with unilateral cleft lip ± palate were followed postsurgical repair of the cleft lip deformity. Serial digital photographs from clinical encounters were analyzed. Anthropometric measurements of 10 soft tissue landmarks were extracted from anteroposterior and submental vertex views at serial visits; growth velocities, defined as c = Δd/Δt, were generated using linear mixed models on selected measurements to study time-related changes on growth. The effects on growth and symmetry of primary tip rhinoplasty on perinasal landmarks and nostril floor reconstruction with medial and lateral nasal mucoperiosteal flaps on perioral and perinasal landmarks were analyzed. Proxies for midfacial height (en-al) and maxillary height (al-ch) were used to evaluate the effect of mucoperiosteal dissection, whereas nostril width, height, and angle were used as proxies to evaluate the effects of tip rhinoplasty.. Seventy-four patients met the inclusion criteria. Midface height (En-Al) growth velocity was 0.014 mm/month and maxillary height (Al-Ch) was relatively stable at -0.0059 mm/month with no difference between the subgroups. Nostril height growth was -0.0046 mm/month, nostril width was 0.03 mm/mo, and nostril angle -0.09 °/mo showed no difference between patient with or without primary tip rhinoplasty. Patients with complete cleft showed more asymmetry than those with incomplete clefts in lip and maxillary landmarks at T0 (P < 0.001).. Mucoperiosteal reconstruction of the nostril floor at the time of lip repair does not affect anthropometric growth velocities over a 5-year follow-up. Within the limitations of the selected landmarks, primary tip rhinoplasty did not significantly improve symmetry at 5 years, but also did not affect the growth of the nose. Patients with complete clefts display more postoperative asymmetry than those with incomplete clefts.

Topics: Anatomic Landmarks; Cephalometry; Child, Preschool; Cleft Lip; Cleft Palate; Cohort Studies; Facial Asymmetry; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Infant; Lip; Male; Maxilla; Nasal Cartilages; Nasal Mucosa; Nose; Periosteum; Photogrammetry; Retrospective Studies; Rhinoplasty; Surgical Flaps; Treatment Outcome; Vertical Dimension

Unilateral cleft lip (UCL) patients have lip and nose deformities that must be addressed during lip repair. Currently, devices to achieve lip and nose improvements have been developed. The most researched presurgical molding device is the nasoalveolar molding (NAM), which has shown favorable results. However, clinical observation shows that unilateral cleft patients, even without molding devices, achieve spontaneous improvements. The aim of this study is to compare morphological and symmetry changes in nose and lip, between patients less than 30-day old and those submitted to cheiloplasty, at 6 months of age.. A total of 27 UCL patients with 2 photographs were selected. The pictures were taken from frontal view and nasal base view at 2 distinct moments: before 30 days of life (t1) and at 6 months of age, during cheiloplasty surgery (T2). Images were analyzed with indirect measurement to assess lip and nose dimensions and nasal symmetry. ImageJ software was used to perform the analyses.. A total of 20 patients (P < 0.05) had an average cleft width reduction of 15% [standard deviation (SD) ± 11%]. A 55% average increase (SD ± 29%) was observed in nostril height of cleft side in 16 of patients (P < 0.05). There was an reduction in facial asymmetry of nostril width (P < 0.05), from 95% (SD ± 90%) (t1) to 59% (SD ± 50) (T2). Also, nasal base width asymmetry (P < 0.05) was decreased from 64% (SD ± 66%) (t1) to 40% (SD ± 29%) (T2).. Facial growth causes a natural improvement on cleft morphological changes and nasal symmetry.

Topics: Cleft Lip; Facial Asymmetry; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Infant, Newborn; Lip; Maxillofacial Development; Nose; Photography; Plastic Surgery Procedures

The first part of this study validated an automated computer-based method of identifying the three-dimensional midfacial plane in children with unrepaired cleft lip. The purpose of this second part is to develop computer-based methods to quantify symmetry and to determine the correlation of these measures to clinical expectations.. A total of 35 infants with unrepaired unilateral cleft lip and 14 infant controls.. Six computer-based methods of quantifying symmetry were developed and applied to the three-dimensional images of infants with unilateral cleft lip before and after cleft lip repair and to those of controls.. Symmetry scores for cleft type, changes with surgery, and individual subjects ranked according to cleft severity were assessed.. Significant differences in symmetry scores were found between cleft types and found before and after surgery. Symmetry scores for infants with unilateral cleft lip approached those of controls after surgery, and there was a strong correlation with ranked cleft severity.. Our computer-based three-dimensional analysis of nasolabial symmetry correlated with clinical expectations. Automated processing made measurement convenient. Use of these measures may help to objectively measure cleft severity and treatment outcome.

Topics: Cleft Lip; Cleft Palate; Face; Facial Asymmetry; Female; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Infant; Lip; Male; Nose; Prospective Studies; Treatment Outcome

Facial asymmetry is prominent with individuals with unilateral bone resorption and can lead to decreased quality of life.. The purpose of this study was to investigate the influence of maxillary obturator prostheses on facial morphology of individuals with unilateral maxillary defects by using 3-dimensional digital stereophotogrammetry.. The facial data of 8 participants with unilateral maxillary defects were acquired with a noncontact 3-dimensional digitizer, both with and without maxillary prostheses. The mid-facial plane was established by overlapping an original facial image with its mirror image. Displacement at 18 measurement points, including 7 bilateral pairs, was compared between the 2 sides, with and without the prostheses. Asymmetry indices of these 7 pairs also were calculated. Multivariate repeated-measures ANOVA was used to determine differences.. Displacements of the lateral and inferior points at the ala of the nose were significantly greater on the defect side than on the normal side. The distances between the ideal and defect side points at the superior ala, the upper lip, and the angle of the mouth decreased significantly with the prosthesis. No significant differences were found in asymmetry indices, but the angle of the upper lip line to the mid-sagittal plane increased significantly with the prosthesis.. The 3-dimensional analyzing method developed in this study can be useful in evaluating facial reconstruction with maxillary obturator prostheses with individuals with unilateral maxillary defects. The prostheses affect the region of the nasal ala, the upper lip, and the angles of the mouth.

Topics: Aged; Anatomic Landmarks; Cephalometry; Dental Prosthesis Design; Eyelids; Face; Facial Asymmetry; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Male; Maxillary Diseases; Middle Aged; Mouth; Nasal Cartilages; Nose; Palatal Obturators; Photogrammetry; Tooth Loss

Assess facial asymmetry in subjects with unilateral cleft lip (UCL), unilateral cleft lip and alveolus (UCLA), and unilateral cleft lip, alveolus, and palate (UCLP), and to evaluate which area of the face is most asymmetrical.. Standardized three-dimensional facial images of 58 patients (9 UCL, 21 UCLA, and 28 UCLP; age range: 8.6-12.3 years) and 121 controls (age range 9-12 years) were mirrored and distance maps were created. Absolute mean asymmetry values were calculated for the whole face, cheek, nose, lips, and chin. One-way analysis of variance, Kruskal-Wallis, and t-test were used to assess the differences between clefts and controls for the whole face and separate areas.. Clefts and controls differ significantly for the whole face as well as in all areas. Asymmetry is distributed differently over the face for all groups. In UCLA, the nose was significantly more asymmetric compared with chin and cheek (P = 0.038 and 0.024, respectively). For UCL, significant differences in asymmetry between nose and chin and chin and cheek were present (P = 0.038 and 0.046, respectively). In the control group, the chin was the most asymmetric area compared to lip and nose (P = 0.002 and P = 0.001, respectively) followed by the nose (P = 0.004). In UCLP, the nose, followed by the lips, was the most asymmetric area compared to chin, cheek (P < 0.001 and P = 0.016, respectively).. Despite division into regional areas, the method may still exclude or underrate smaller local areas in the face, which are better visualized in a facial colour coded distance map than quantified by distance numbers. The UCL subsample is small.. Each type of cleft has its own distinct asymmetry pattern. Children with unilateral clefts show more facial asymmetry than children without clefts.

Topics: Alveolar Process; Anatomic Landmarks; Cephalometry; Cheek; Child; Chin; Cleft Lip; Cleft Palate; Face; Facial Asymmetry; Female; Humans; Imaging, Three-Dimensional; Lip; Male; Nose; Photogrammetry

This study investigated the degree and range of recognition of canting of the interpupillary line and deviation of the nose, which were regarded as "normal," "acceptable," and "needing surgical correction," according to different observer groups.. Four different groups (40 each for laypeople, dental students, general dentists, and orthodontists) rated 11 simulated asymmetric images with canted eyes and a deviated nose separately. The raters categorized each image as normal, socially "acceptable" and not requiring correction, or abnormal and would benefit from correction. Survival analysis was used to evaluate the scope of perception.. The degree of recognition for eye-canting and nose deviation was 2.31 and 2.92, respectively. Eye-canting and nose deviation had lower degrees of recognition in the clockwise direction (2.13°) and on the left side (2.65°), respectively. Women showed a lower degree of the "upper limit of the acceptable range" for canted eyes, and men showed a lower "degree of recognition" and "upper limit of the acceptable range" for a deviated nose. Orthodontists showed a larger upper limit of the acceptable range for eye-canting (P < .001).. The perceptions of asymmetry of canted eyes and deviated nose were affected by gender, direction of asymmetry, and observer groups.

Topics: Eye; Facial Asymmetry; Female; Humans; Nose; Observer Variation

The purpose of this article is to determine whether certain facial asymmetries (nose and chin) have an impact on the perception of the maxillary dental midline shift.. From a digitally created symmetric facial model (SFM) constructed in a previous study, a new asymmetric facial model (AFM) was created, with nose and chin deviated to the same side. Modifications were made on the AFM for shifts in the maxillary dental midline in both directions, resulting in a total of eight different images. Through a web survey, 112 randomly selected laypersons were asked to evaluate each image according to their own personal beauty and esthetic criteria using a visual Likert scale.. 1 mm of dental midline shift to the left of the AFM was not noticed; 1 mm of dental midline shift to the right of the AFM had a negative impact on perception of facial attractiveness; 2 and 3 mm of dental midline shift to left or right of the AFM had a negative impact on perception of facial attractiveness.. Facial asymmetries such as nose and chin inclinations have an impact on the perception of maxillary dental midline shift. Direction of dental midline shift can be a major factor in this perception.

Topics: Adult; Aged; Beauty; Chin; Esthetics; Esthetics, Dental; Facial Asymmetry; Female; Humans; Incisor; Male; Maxilla; Middle Aged; Nose; Photography; Smiling; Visual Perception; Young Adult

Mild resting facial asymmetry exists in clinically symmetrical faces, but the effect of smiling on the magnitude of overall facial asymmetry in adults has not been assessed. The aim of the present study was to use stereophotogrammetry to quantify the effect of smiling on overall facial asymmetry in Caucasian adults who presented with Class I incisor relationships and no history of orthodontic treatment.. Twenty male and 20 female Caucasians aged 1 8-30 years with no history of orthodontic treatment, a clinically symmetrical face and a Class I incisor relationship had 3D stereophotogrammetric images captured at rest and on natural and maximal smile (T1). The images were repeated 2-4 weeks later (T2) to assess expression reproducibility. Overall facial asymmetry scores were produced from 27 landmarks using partial Ordinary Procrustes Analysis (OPA) and assessed by an Analysis of Covariance (ANCOVA) model. A random sample of the images was re-examined two months later to calculate intraobserver landmark reproducibility.. Mean landmark error was low (0.41 ± 0.07 mm). Mean overall facial asymmetry scores were not significantly gender different (p = 0.5300); therefore, the male and female data were pooled. Mean overall facial asymmetry scores for maximal (0.91 ± 0.16) and natural smile (0.88 ± 0.18) were higher than at rest (0.80 ± 0.17) (p < 0.0001) and were reproducible across (T1-T2) sessions (p = 0.3204).. Overall 3D facial asymmetry scores for the sampled Caucasian adults with clinically symmetrical faces increased in magnitude from rest to natural and to maximal smile. Clinicians should assess overall facial asymmetry at rest and on natural and maximal smile at baseline, during treatment and as part of a core outcome assessment, particularly for cases with unilateral posterior crossbite, unilateral cleft lip and palate or skeletal asymmetry.

Topics: Adolescent; Adult; Anatomic Landmarks; Chin; Facial Asymmetry; Female; Forehead; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Male; Malocclusion, Angle Class I; Nose; Observer Variation; Orbit; Photogrammetry; Reproducibility of Results; Smiling; Young Adult

To explore three-dimensional (3D) facial asymmetry differences in operated children with oral clefts and to compare the results with a control group.. The sample comprised one hundred and three 8- to 12-year-old children: 40 with unilateral cleft lip and palate (UCLP); 23 with unilateral cleft lip and alveolus (UCLA); 19 with bilateral cleft lip and palate (BCLP); 21 with cleft palate (CP) and 80 sex- and age-matched controls living in the North East of England.. 3D stereophotogrammetric facial scans were recorded for each participant at rest. Thirty-nine landmarks were recorded for each scan. The x, y and z coordinates for each landmark were extracted. Kruskal-Wallis and Mann-Whitney tests were conducted to identify 3D landmark asymmetry differences between the groups.. Statistically significant differences were observed between all the groups. The UCLP and UCLA patients displayed the greatest asymmetry, followed by the BCLP group. The CP group was the least asymmetric among the cleft groups. Asymmetry was present to a lesser extent in the control group.. Shape analysis indicates the possible differences in the aetiology and growth pattern of the CP group compared to UCLA or UCLP and BCLP groups.

Topics: Anatomic Landmarks; Case-Control Studies; Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Ear, External; Facial Asymmetry; Humans; Imaging, Three-Dimensional; Lip; Nasal Cartilages; Nose; Orbit; Photogrammetry

To propose a better statistical method of predicting postsurgery soft tissue response in Class II patients.. The subjects comprise 80 patients who had undergone surgical correction of severe Class II malocclusions. Using 228 predictor and 64 soft tissue response variables, we applied two multivariate methods of forming prediction equations, the conventional ordinary least squares (OLS) method and the partial least squares (PLS) method. After fitting the equation, the bias and a mean absolute prediction error were calculated. To evaluate the predictive performance of the prediction equations, a leave-one-out cross-validation method was used.. The multivariate PLS method provided a significantly more accurate prediction than the conventional OLS method.. The multivariate PLS method was more satisfactory than the OLS method in accurately predicting the soft tissue profile change after surgical correction of severe Class II malocclusions.

Topics: Bias; Cephalometry; Chin; Face; Facial Asymmetry; Female; Forecasting; Genioplasty; Humans; Least-Squares Analysis; Lip; Male; Malocclusion, Angle Class II; Mandibular Osteotomy; Maxillary Osteotomy; Models, Biological; Multivariate Analysis; Nose; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Overbite; Treatment Outcome; Young Adult

Conidiobolomycoses (Conidiobolus coronatus fungal infections) are rare and potentially severe infections prevalent in the tropics. The disease starts in the facial sinus and evolves as a subcutaneous tumor on the mid face. A 19-year-old female patient from Burkina Faso presented with an acquired nasal deformation having evolved for a few months, associated to bilateral nasal obstruction. The patient had no medical or surgical history. The pathological analysis of the surgical exeresis allowed diagnosing a C. coronatus infection.. The C. coronatus lives in decaying vegetation in hot and humid climates. It is a potential human pathogen that infects immunocompetent patients presenting with micro-wounds of the sinus and nasal mucosa. Hundred cases have been reported. The management is specific. The diagnosis should be discussed in case of distorting tumors of the midface.

Topics: Burkina Faso; Conidiobolus; Diagnosis, Differential; Face; Facial Asymmetry; Facial Neoplasms; Female; Humans; Nasal Obstruction; Nose; Young Adult; Zygomycosis

A surgical technique of lateral crus strut graft to correct the deformity of nostril contour and improve asymmetric nostril shape by autologous rib cartilage was reported. Thirty-five patients (20 males and 15 females), with a mean age of 19 years (range of 16-26 years) were included in this study. All of the patients suffered moderate to severe unilateral cleft lip nostril deformity and underwent surgical technique of lateral crus strut graft by autologous rib cartilage to correct the asymmetric nostril contour from 2010 to 2012. The views of the nostril contour on both sides were reviewed and some parameters were measured at different time points (preoperatively, and 3 months and one year postoperatively) including the long axis and short axis of the nostrils. The differences in nostrils including long axis, short axis, elliptical area and eccentricity on the both sides were compared at different time points. The differences in the long axis and eccentricity of the nostrils on the two sides were decreased significantly between the preoperative view and postoperative view (P<0.05). The surgical technique of lateral crus graft with autologous rib cartilage is effective to correct the abnormal nostril contour and improve the asymmetry for unilateral cleft clip patients.

Topics: Adolescent; Adult; Cartilage; Cleft Lip; Facial Asymmetry; Humans; Male; Nose; Patient Satisfaction; Retrospective Studies; Rhinoplasty; Ribs; Transplantation, Autologous; Treatment Outcome; Young Adult

Oculoauriculovertebral spectrum (OAVS) is a rare congenital malformation consisting of epibulbar dermoids, lid colobomas, auricular deformities, hypoplasia of the soft and bony tissues of the face, associated oral deformities and vertebral anomalies. This report presents a child with a choroid of the right eye, coloboma of the upper eyelid, epibulbar dermoid of the left eye, mandibular hypoplasia, facial asymmetry, bilateral complete cleft lip and palate, hypoplasia of the left alar cartilage, appendage of the left nose, butterfly vertebral defects of Th-1, Th-2 and abnormality of rib XI. Widened sulci of frontal and parietal lobes, bilateral white matter density decrease and calcifications of falx cerebelli were noted. Axial hypotony and delayed psycho-motor development were apparent. This rare case presents a range of severe clinical manifestations of oculoauriculovertebral spectrum. Despite a normal cervical vertebral column, tracheostenosis was present. It caused difficulties in tracheal intubation, creating the need for a tracheostomy, and death after a failed attempt at decannulation. This case indicates that in patients with clinical manifestations including cerebral anomalies, a risk of respiratory insufficiency should be always taken under consideration, when planning surgery.

Topics: Cleft Lip; Cleft Palate; Coloboma; Dermoid Cyst; Eye Neoplasms; Facial Asymmetry; Fatal Outcome; Follow-Up Studies; Goldenhar Syndrome; Humans; Infant, Newborn; Male; Mandible; Nose; Psychomotor Performance; Ribs; Thoracic Vertebrae; Tracheal Stenosis

This prospective cross-sectional, case-controlled morphometric study assessed three dimensional (3D) facial morphological differences between average faces of 103 children aged 8-12 years; 40 with unilateral cleft lip and palate (UCLP), 23 with unilateral cleft lip and alveolus (UCLA), 19 with bilateral cleft lip and palate (BCLP), 21 with isolated cleft palate (ICP), and 80 gender and age-matched controls. 3D stereophotogrammetric facial scans were recorded for each participant at rest. Thirty-nine landmarks were digitized for each scan, and x-, y-, z-coordinates for each landmark were extracted. A 3D photorealistic average face was constructed for each participating group and subjective and objective comparisons were carried out between each cleft and control average faces. Marked differences were observed between all groups. The most severely affected were groups where the lip and palate were affected and repaired (UCLP and UCLA). The group with midsagittal palatal deformity and repair (ICP) was the most similar to the control group. The results revealed that 3D shape analysis allows morphometric discrimination between subjects with craniofacial anomalies and the control group, and underlines the potential value of statistical shape analysis in assessing the outcomes of cleft lip and palate surgery, and orthodontic treatment.

Topics: Anatomic Landmarks; Case-Control Studies; Cephalometry; Cheek; Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Face; Facial Asymmetry; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Male; Nose; Photogrammetry; Prospective Studies; Zygoma

This clinical report describes the use of a mandibular repositioning splint and the subsequent prosthodontic treatment of a unilateral dislocated condyle fracture for a patient whose injury resulted in significant mandibular deviation and malocclusion. The use of a mandibular repositioning splint considerably reduced the mandibular deviation, and a stable mandibular position was maintained with the definitive prosthesis.

Topics: Crowns; Facial Asymmetry; Humans; Joint Dislocations; Male; Malocclusion; Mandibular Condyle; Mandibular Fractures; Maxillary Sinus; Middle Aged; Nose; Occlusal Splints; Palate, Hard; Zygomatic Fractures

Fluctuating asymmetry and averageness is correlated with our perception of beauty in human faces. Yet, whether deviations of centrality in the positioning of the eyes, the nose, and the mouth have different effects on our perception of asymmetry in a holistic human face, is still uncertain. In this study we aimed to test the relative effect of decentralising the horizontal position of three sets of paired dots representing eyes, nostrils, or mouth from the vertical midline of ambiguous dot figures, vaguely resembling a face. The figures were ranked according to perceived asymmetry by human observers. When associating the figures with non-facial objects (eg a butterfly), none of the figures' rank distribution differed from each other. However, when observers imagined the figures to represent a human face, the figure with the decentralised pair of dots representing the nostrils was significantly ranked as more asymmetric than the other figures. This result provides indications that the brain may deal with information about facial asymmetry and averageness heavily depending on the centrality of the nasal region.

Topics: Adolescent; Adult; Attention; Beauty; Discrimination, Psychological; Face; Facial Asymmetry; Female; Humans; Imagination; Male; Nose; Orientation; Pattern Recognition, Visual; Perceptual Closure; Young Adult

Frontoorbital advancement (FOA) improves forehead and superior orbital asymmetry associated with unilateral coronal synostosis but has little effect on facial asymmetry. This study compares frontofacial symmetry after FOA and endoscopically assisted suturectomy (ESC) and postoperative helmet therapy.A retrospective review of 2 cohorts of patients with nonsyndromic unilateral coronal synostosis who had either FOA or ESC was undertaken. Choice of procedure was determined by age of patient at referral (younger than 4 months, FOA or ESC; older than 4 months, only FOA). Vectra 3D imaging system (Canfield Imaging Systems, Fairfield, NJ) was used to capture and analyze three-dimensional digital images. Comparative anthropometric measurements were made and statistically analyzed.Twenty-two patients met the inclusion criteria; 11 underwent ESC at mean age of 2 months (range, 1-4 months) and 11 underwent FOA at mean age of 12 months (range, 8-25 months). Mean age at three-dimensional digital imaging was 45.9 months (range, 18-64 months) for the FOA group and 34.5 months (range, 20-66 months) for the ESC group (P = 0.054).There was no difference between the 2 groups with regard to supraorbital symmetry (P = 0.54). The ESC group exhibited better facial symmetry in midline deviation (3.6° vs 1.4°; P = 0.018), nasal tip deviation (5.6° vs 2.3°; P = 0.006), and middle facial depth (6.9 vs 4.4 mm; P = 0.042). Lower facial depth was similar (3.8 vs 2.3 mm; P = 0.54).Early ESC and helmet therapy results in comparable brow symmetry and better overall facial symmetry than FOA done in late infancy.

Topics: Cephalometry; Child, Preschool; Cranial Sutures; Craniosynostoses; Endoscopy; Face; Facial Asymmetry; Female; Follow-Up Studies; Forehead; Frontal Bone; Head Protective Devices; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Infant; Male; Nose; Orbit; Photography; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome

Achieving ideal shape and position of the medial nostril and columellar base is a crucial component of successful rhinoplasty. The lateral border of the basal columella should exhibit slight concavity and a relatively smooth contour. Both nasal aesthetics and functionality may be compromised if such a result is not obtained. Herein, a reproducible technique is described which allows for treatment of this region.

Topics: Facial Asymmetry; Humans; Nose; Rhinoplasty

Relationships between nasal axis deviation and lower midfacial asymmetry or hypoplasia have been established in prior studies. We describe our experience with the subalar grafting technique in addressing nasal tip deviation associated with facial asymmetry. Indications in using this graft in isolation or in conjunction with other tip modification techniques are also investigated.. Retrospective case series.. Academic medical center.. Thirty-seven consecutive patients from a single surgeon (R.W.W.) treated using subalar grafting are evaluated for correction. Various measurements from preoperative and postoperative photographs are analyzed to determine the effectiveness of this intervention.. Statistically significant correlations between improvement in nasal axis and alar-facial angle on base view (AFAB) (P < .001) and between alar-facial angle on frontal view (AFAF) (P = .017) were observed. In addition, a significant correlation between AFAB improvement and AFAF normalization was observed (P < .001). The improved nostril symmetry was significantly correlated with base view correction and was not the result of general improvements in nasal deviation.. While measuring the independent effects of subalar grafting is limited due to contaminant procedures, it can be recognized as a foundation rhinoplasty technique that, in conjunction with septoplasty, provides medialization of the tip in patients with facial asymmetry. Furthermore, aesthetic correction of nostril horizontal dystopia and/or nostril "show" is achieved with the proper application of this technique. This correction represents a unique intervention in rhinoplasty and should be considered a second indication for its use.

Topics: Academic Medical Centers; Adult; Cephalometry; Facial Asymmetry; Female; Humans; Male; Nasal Cartilages; Nasal Septum; New York City; Nose; Nose Deformities, Acquired; Retrospective Studies; Rhinoplasty; Transplants; Treatment Outcome

Objective : Objective measure of scarring and three-dimensional (3D) facial asymmetry after surgical correction of unilateral cleft lip (UCL) and unilateral cleft lip (UCLP). It was hypothesized that the degree of scarring or asymmetry would be correlated with poorer psychological function. Design : In a cross-sectional design, children underwent 3D imaging of the face and completed standardized assessments of self-esteem, depression, and state and trait anxiety. Parents rated children's adjustment with a standard scale. Setting : Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences. Patients : Fifty-one children aged 10 years with UCLP and 43 with UCL were recruited from the cohort treated with the surgical protocol of the CLEFTSIS managed clinical network in Scotland. Methods : Objective assessment to determine the luminance and redness of the scar and facial asymmetry. Depression, anxiety, and a self-esteem assessment battery were used for the psychological analysis. Results : Cleft cases showed superior psychological adjustment when compared with normative data. Prevalence of depression matched the population norm. The visibility of the scar (luminance ratio) was significantly correlated with lower self-esteem and higher trait anxiety in UCLP children (P  =  .004). Similar but nonsignificant trends were seen in the UCL group. Parental ratings of poorer adjustment also correlated with greater luminance of the scar. Conclusions : The objectively defined degree of postoperative cleft scarring was associated with subclinical symptoms of anxiety, depression, and low self-esteem.

Topics: Case-Control Studies; Cephalometry; Cicatrix; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Facial Asymmetry; Humans; Nose

Hemimandibular hyperplasia (HH) and hemimandibular elongation (HE) anomalies present with facial asymmetry and deranged occlusion. Currently, diagnosis and assessment of the facial dysmorphology is based on subjective clinical evaluation, supported by radiological scans. Advancements in objective assessments of facial asymmetry from three-dimensional (3D) facial scans facilitate a re-evaluation of the patterns of facial dysmorphology. Automated, robust and localised asymmetry assessments were obtained by comparing a 3D facial scan with its reflected image using a weighted least-squares superimposition. This robust superimposition is insensitive to severe asymmetries. This provides an estimation of the anatomical midline and a spatially dense vector map visualising localised directional differences between the left and right hemifaces. Analysis was conducted on three condylar hyperplasia phenotypes confirmed by clinical and CT evaluation: HH; HE; and hybrid phenotype. The midline extraction revealed chin point displacements in all cases. The upper lip philtrum and nose tip deviation to the affected side and a marked asymmetry of the mid face was noted in cases involving HE. Downward and medial rotation of the mandible with minor involvement of the midface was seen in the HH associated deformity. The hybrid phenotype case exhibited asymmetry features of both HH and HE cases.

Topics: Adult; Cephalometry; Chin; Facial Asymmetry; Female; Humans; Hyperplasia; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Malocclusion; Mandible; Mandibular Condyle; Maxilla; Nose; Open Bite; Orbit; Phenotype; Rotation; Tomography, X-Ray Computed; Young Adult

The scientific literature is sparse on reports that evaluate facial asymmetry after mandibular reconstructive surgery objectively. The aim of this study is to introduce and validate a new method, using three dimensional (3D) stereophotogrammetry, that quantifies soft-tissue facial asymmetry in patients who have undergone mandibular reconstruction. To validate the new method, two observers applied the method on 3D photographs of five patients and five controls. An inter-observer difference of 0.04 mm (-0.08 to 0.17) was found with a measurement error of 0.13 mm. 15 3D photographs of the mandibular reconstructed patients were compared with 24 3D photographs of healthy controls. A significant difference (1.19 mm) in asymmetry was found between patients and controls. It is concluded that this new measuring method is a valid, fast and clinically applicable technique to quantify soft-tissue facial asymmetry. It is concluded that facial symmetry in patients is not restored to the level of the control group with the mandibular reconstruction method applied.

Topics: Adolescent; Adult; Aged; Algorithms; Anatomic Landmarks; Case-Control Studies; Cephalometry; Eyelids; Face; Facial Asymmetry; Female; Frontal Bone; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Mandibular Reconstruction; Middle Aged; Nose; Observer Variation; Photogrammetry; Young Adult

To evaluate the correlation between symmetry of the craniofacial skeleton and aesthetics of the nose and upper lip in children with complete unilateral cleft lip and palate (CUCLP).. Craniofacial symmetry was evaluated on postero-anterior (PA) cephalograms of 54 children (37 boys and 17 girls; mean age = 11.0 years, SD 1.6) with CUCLP repaired with a one-stage closure (Cleft group). Treated subjects were age- and gender-matched with 54 untreated subjects taken from the University of Michigan Growth Study (Control group). Fourteen coefficients of asymmetry (CAs) were calculated and four angles were measured. Four raters assessed the nasolabial appearance on cropped facial and profile photographs with the 5-grade aesthetic index of Asher-McDade (grade 1 means the most aesthetic and grade 5 the least aesthetical outcome) in the Cleft group only. Independent t-tests were used to evaluate the inter-group differences for CAs. Pearson's correlation coefficients were calculated to examine a relationship between particular components of the aesthetical index and CAs. Multiple regression analyses were carried out to explain the nasolabial aesthetics on the basis of craniofacial symmetry.. In the Cleft group, most cephalometric variables demonstrated asymmetry not exceeding 10%. The Cleft and Control groups differed regarding three angular measurements (Se, Ism, and ANS) and 1 CA (Mo-V). Three of the four nasolabial components demonstrated correlation with some cephalometric variables. However, the correlation coefficients were low (range: -0.309 to 0.305).. There is a weak correlation between craniofacial skeletal symmetry and aesthetics of the nose and upper lip in children with CUCLP.

Topics: Cephalometry; Child; Cleft Lip; Cleft Palate; Esthetics; Facial Asymmetry; Facial Bones; Female; Humans; Lip; Male; Nose; Statistics, Nonparametric; Treatment Outcome

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Nose; Orthopedic Procedures

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Nose; Orthopedic Procedures

Comparison of nasal asymmetry between unilateral cleft lip and palate (UCLP) patients with and without nasal correction at primary repair. Assessment of the value of Symnose as a routine research tool.. 75 ten-year-old UCLP patients who underwent primary lip repair by one of two techniques: classical Millard with primary nasal correction (n = 30) or modified Millard without nasal correction (n = 45). Control group of ten-year-old school children (n = 45).. Nasal asymmetry of participants was measured from facial photographs taken in two views: frontal and basal. The Symnose computer program was used to calculate asymmetry for three parameters: front perimeter (FP), base perimeter (BP) and nostrils (N). Total asymmetry was also calculated. Each image was traced on three separate occasions and a mean of the three measurements was calculated.. BP, N and total asymmetry were significantly greater in UCLP patients without nasal correction compared to both controls and patients with correction (BP = 12.73% v 4.90% v 6.75%, N = 47.73% v 15.83% v 30.75%, total = 81.87% v 46.43% v 54.68%, p ≤ 0.001). FP asymmetry was significantly greater in controls than all UCLP patients (22.87% v. 18.18% and 15.07%, p = 0.001 and p = 0.008). BP measurements have a higher degree of repeatability than FP and N (Coefficient of repeatability = 5.99, 17.02 and 16.47, respectively).. Primary nasal correction produces greater nasal symmetry during childhood from the basal view. Symnose is a simple method of objectively measuring asymmetry in UCLP, however improvements are required before it can be considered a useful research tool.

Topics: Cephalometry; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Humans; Image Processing, Computer-Assisted; Male; Nose; Oral Surgical Procedures; Quality of Life; Retrospective Studies

Alveolar bone grafting is known to reduce nasal asymmetry by supporting a defective alar base and a sunken nostril. However, there are no studies which include details of changes to the upper lip with appropriate measurements. The purpose of this study was to measure the change in the upper lip height and nostril sill after alveolar bone grafting, using photogrammetry.. The study included 18 unilateral cleft lip alveolus (UCLA) patients who were diagnosed with unilateral cleft lip and palate (mean age, 9.87 years). The patients underwent alveolar bone grafting with iliac bone between June 2007 and June 2008. The average follow-up period was 16.6 months. The average bone graft volume was 2.39 cm(3). We obtained photographs of the frontal, lateral and basal views using standardised photographic techniques. We defined 14 landmarks and measured the distance of 11 points (distance items) for the determination of upper lip height, upper lip projection and nostril sill elevation. We defined the proportion index as the ratio of the cleft side to non-cleft side or reference line (R). We compared the preoperative proportion index with the postoperative proportion index for each distance items.. The height of the upper lip increased significantly in four of five distance items. The projection of the upper lip was more prominent, but it was not statistically significant. The nostril sill was significantly elevated in all four distance items.. The height of the upper lip was elongated and the nostril sill was elevated after alveolar bone grafting in UCLA patients.

Topics: Adolescent; Alveolar Process; Alveoloplasty; Bone Transplantation; Child; Cleft Lip; Facial Asymmetry; Female; Follow-Up Studies; Humans; Lip; Male; Nose; Photogrammetry; Surgical Flaps; Treatment Outcome

The objective of this study was to evaluate the association between nasolabial symmetry and aesthetics in children with complete unilateral cleft lip and palate (CUCLP). Frontal and basal photographs of 60 consecutively treated children with CUCLP (cleft group: 41 boys and 19 girls, mean (SD) age 11 (2) years) and 44 children without clefts (control group: 16 boys and 28 girls, mean (SD) age 11(2) years), were used for evaluation of nasolabial symmetry and aesthetics. Nasal and labial measurements were made to calculate the coefficient of asymmetry (CA). The 5-grade aesthetic index described by Asher-McDade et al. was used to evaluate nasolabial appearance. Correlation and regression analysis were used to identify an association between aesthetics and CA, sex, and the presence of CUCLP. Ten measurements in the cleft, and 2 in the control, group differed significantly between the cleft and non-cleft (or right and left) sides, respectively. The significantly higher values of 9 of 11 CA in the children with CUCLP indicated that they had more asymmetrical nasolabial areas than children without clefts. However, the regression analyses showed that only a few CA were associated with nasolabial aesthetics. In conclusion, nasolabial aesthetics and nasolabial symmetry seem to be only weakly associated in patients with CUCLP.

Topics: Adolescent; Cephalometry; Child; Cleft Lip; Cleft Palate; Esthetics; Facial Asymmetry; Female; Humans; Male; Nose; Regression Analysis

Asymmetry of the nasal tip is a common finding in the setting of primary and revision rhinoplasty. Careful preoperative analysis is imperative to identify the anatomic etiology of the asymmetry to develop an appropriate surgical plan to correct it. This article describes the anatomic structures that affect the overall appearance of the nasal tip, explains how intrinsic asymmetries can alter nasal tip appearance, and offers a menu of surgical techniques that can be used to correct these asymmetries.

Topics: Cartilage; Facial Asymmetry; Facial Injuries; Humans; Nasal Bone; Nasal Cartilages; Nasal Septum; Nose; Nose Deformities, Acquired; Rhinoplasty; Suture Techniques

Controlling the nasal tip in terms of definition, projection, and rotation requires a firm platform for subsequent scar contracture, healing, and skin thinning. Complications from tip surgery are diverse and range from symmetry, unnatural appearance, graft problems (migration, infection, extrusion), and issues with function. Implants are a large part of untoward results at the tip, and this article will focus on common complications that arise. In general, substantial projection should be pursued with a caudal extension graft rather than simple columellar strut. Compressive forces at the tip are formidable and the caudal septum, or simpler suture techniques, will often not hold up. Cap grafts and tip grafts that are used for projection or definition must be carefully camouflaged, irrespective of the thickness of the overlying skin. Even ethnic patients with thick skin will often reveal the edges of their grafts after several years. Alloplastic implants can be used but only after careful deliberation of risks and alternatives.

Topics: Asian People; Contracture; Facial Asymmetry; Humans; Nasal Cartilages; Nasal Septum; Nose; Postoperative Complications; Prostheses and Implants; Rhinoplasty; Surgical Wound Infection

In traditional Le Fort III distraction, the transport segment is advanced en bloc without addressing differences in the relative retrusion of the facial structure. The authors describe three methods for correcting these asymmetries with differential facial advancement.. Eight patients (age range, 4 to 20 years) with asymmetric facial hypoplasia were treated by Le Fort III midface distraction using an external device. Two patients with nasal bone hypoplasia exceeding midface retrusion were treated with nasal passenger grafts at the time of osteotomy. Two patients with asymmetric rotational midface deformities underwent wire cerclage swing advancement of the affected side to achieve differential advancement. Four patients with central nasomaxillary retrusion exceeding zygomatic retrusion underwent segmental Le Fort III osteotomy with simultaneous zygoma repositioning and Le Fort II distraction.. Differential midface advancement was achieved in all patients. Midface distraction and nasal passenger grafts resolved obstructive sleep apnea, improved globe protection, and improved fit of prescription glasses. After Le Fort III swing advancement, the centric relation and malar asymmetry were corrected with differential advances of 10 and 15 mm compared with the unaffected side. In the segmental osteotomy Le Fort III group, the central face was distracted independently of the zygoma repositioning, thus correcting the shortened retruded central midface without distorting the orbitomalar relationship and improving airway obstruction, anterior open bite, short nose, and proptosis.. Midface distraction techniques have evolved to include the principles of segmentation, graft augmentation, and controlled rotation. The benefits of gradual distraction can be realized without compromising the aesthetic and functional result.

Topics: Adolescent; Bone Wires; Child; Child, Preschool; Craniofacial Abnormalities; External Fixators; Facial Asymmetry; Female; Follow-Up Studies; Humans; Male; Nose; Osteogenesis, Distraction; Osteotomy, Le Fort; Rhinoplasty; Treatment Outcome; Young Adult

The cleft lip nose is a complex 3-dimensional (3D) midfacial soft tissue and bony deformity. The contribution of maxillary hypoplasia to the etiology of this deformity has often been implicated for the suboptimal results of surgical treatment. The dimensions of the maxilla in unilateral cleft lip and palate (UCLP) have not been studied especially in relation to the volumetric and other asymmetries on the either side in unilateral clefts. The purpose of this article is to assess the relevant maxillary parameters of length, width, height, depth, and volume in patients with UCLP and compare the parameters of the cleft and noncleft sides.. Fifteen patients with UCLP were treated by a standard protocol by a single surgeon and orthodontist. The measurements of maxilla were taken using a combination of axial, coronal, lateral, and 3D reconstructed images. The volume of each maxilla was calculated on 3D reconstructions using the technique of manual segmentation, which allowed complete reconstruction of the right and left maxilla individually.. In general, the cleft maxillary length, width, height, depth, and volume have been found to be reduced when compared with the normal sides with significant P values (Wilcoxon signed rank test Z, P < 0.001).. The study demonstrates the anatomy of the maxillary asymmetry existing in UCLP and underlines the importance of correcting the bony deficiency by appropriate techniques to harmonize the results of rhinoplasty in unilateral cleft lip nose deformity. Augmentation of the deficient maxilla by specific contoured bone grafts allows restoration of the symmetry of the nasal platform in unilateral cleft lip nose deformity.

Topics: Case-Control Studies; Child; Child, Preschool; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Humans; Imaging, Three-Dimensional; Infant; Male; Maxilla; Nose; Reproducibility of Results; Rhinoplasty; Statistics, Nonparametric; Tomography, X-Ray Computed; Treatment Outcome

To evaluate nasal morphology, symmetry, and nostril shape in patients with unilateral cleft lip and palate following mixed-dentition alveolar bone grafting.. Prospective stereophotogrammetric study.. Hospital-based.. Thirty-nine patients with a history of repaired unilateral cleft lip and palate who received an iliac crest alveolar bone graft were recruited prospectively to participate in the study. Each patient served as his/her own control.. Partial facial impressions of all patients were acquired before and a minimum of 6 months after the alveolar bone grafting procedure. Image acquisition and analysis of the casts constructed from these models were carried out using three-dimensional stereophotogrammetry.. Surface-based registrations and linear measurements were performed to assess nasal morphology and nostril shape. A modified Procrustes technique was used to determine the change in nasal symmetry. A two-tailed, paired t test and an analysis of covariance were used to assess statistical significance.. Significant side-to-side asymmetry exists in the nasal region of patients with unilateral cleft lip and palate, both before and after alveolar bone grafting. No significant changes were observed between pre-alveolar bone graft and post-alveolar bone graft images based on linear measurements, asymmetry scores, and registrations. Gender and surgeon were not significant factors.. Under the conditions of this study, mixed-dentition alveolar bone grafting appears to have no significant long-term effect on nasal morphology, symmetry, or nostril shape.

Topics: Adolescent; Alveolar Bone Grafting; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Facial Expression; Female; Humans; Ilium; Imaging, Three-Dimensional; Male; Nose; Photogrammetry; Pilot Projects; Prospective Studies; Rhinoplasty; Treatment Outcome

To compare the nasolabial aesthetics for individuals with nonsyndromic complete unilateral cleft lip and palate between the ages of 5 and 12 years.. Retrospective cross-sectional study.. Four cleft centers in North America.. A total of 124 subjects with repaired complete unilateral cleft lip and palate who were treated at the four centers.. After ethics approval was obtained, 124 preorthodontic frontal and profile patient images were scanned, cropped to show the nose and upper lip, and coded. Using the coded images, four nasolabial features that reflect aesthetics (i.e., nasal symmetry, nasal form, vermilion border, and nasolabial profile) were rated by five examiners using the rating system reported by Asher-McDade et al. (1991) . Intrarater and interrater reliabilities were determined using weighted kappa statistics. Mean ratings, by center, were compared using analysis of variance.. Intrarater reliability scores were good to very good and interrater reliability scores were moderate to good. Total nasolabial scores were Center B = 2.98, Center C = 3.02, Center D = 2.80, and Center E = 2.87. No statistically significant differences among centers were detected for both total aesthetic scores and for any of the individual aesthetic components.. There were no significant differences in nasolabial aesthetics among the centers evaluated. Overall good to fair nasolabial aesthetic results were achieved using the different treatment protocols in the four North American centers.

Topics: Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Esthetics; Facial Asymmetry; Female; Humans; Lip; Male; North America; Nose; Outcome Assessment, Health Care; Research Design; Retrospective Studies

In orthodontic diagnosis, facial symmetry is important. The aim of the present study was to analyse the perception of various degrees of facial asymmetry exhibited by carefully designed virtual three-dimensional (3D) material. Three groups of raters (30 orthodontists, 30 maxillofacial surgeons, and 30 laymen) rated, using a six-point scale, the degree of asymmetry of eight randomly presented 3D faces exhibiting incremental soft tissue alterations. The faces were created by gradually transforming the nose or chin in increments of 2 mm away from the computed symmetry plane. Differences between the groups in analysis of facial asymmetry, the rating of facial stimulus, and right and left facial asymmetry were determined using a t-test. The results demonstrated that raters' profession did not influence the point at which they identified asymmetry. Even laymen were able to detect asymmetries when located near the midline of 3D faces. All raters identified asymmetries of the nose as more negative than those of the same degree of the chin. A left-sided deviation of the nose along the facial symmetry plane lead to a more negative rating of facial appearance, whereas a right-sided deviation of the chin was rated as less attractive. Nasal architecture plays a crucial role in the perception of symmetry. These findings provide clinicians with a greater understanding of how faces are perceived, a process which is of particular interest in treating orthognathic patients, and those with congenital anomalies.

Topics: Adult; Chin; Face; Facial Asymmetry; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Male; Nose; Orthodontics; Sensory Thresholds; Surgery, Oral; User-Computer Interface; Visual Perception

The cartilage anchor is a cartilagineous strip inserted subcutaneously in front of the nasolabial fold which allows precise forming and movement of the nasolabial fold in facial palsy. It is taken from ear cartilage. Static and dynamic symmetry can be improved considerably by fixing a free microvascular muscle transplant or a sling plasty to the cartilage anchor. In cases of significant laxity of the paralysed side of the face, the combination of muscle transplant and sling plasty may be helpful.

Topics: Cartilage; Emotions; Esthetics; Facial Asymmetry; Facial Expression; Facial Muscles; Facial Nerve; Facial Paralysis; Humans; Lip; Muscle, Skeletal; Nerve Transfer; Nose; Plastic Surgery Procedures; Smiling

To assess sex- and age-related characteristics in standardized facial movements, 40 healthy adults (20 men, 20 women; aged 20-50 years) performed seven standardized facial movements (maximum smile; free smile; "surprise" with closed mouth; "surprise" with open mouth; eye closure; right- and left-side eye closures). The three-dimensional coordinates of 21 soft tissue facial landmarks were recorded by a motion analyser, their movements computed, and asymmetry indices calculated. Within each movement, total facial mobility was independent from sex and age (analysis of variance, p>0.05). Asymmetry indices of the eyes and mouth were similar in both sexes (p>0.05). Age significantly influenced eye and mouth asymmetries of the right-side eye closure, and eye asymmetry of the surprise movement. On average, the asymmetry indices of the symmetric movements were always lower than 8%, and most did not deviate from the expected value of 0 (Student's t). Larger asymmetries were found for the asymmetric eye closures (eyes, up to 50%, p<0.05; mouth, up to 30%, p<0.05 only in the 20-30-year-old subjects). In conclusion, sex and age had a limited influence on total facial motion and asymmetry in normal adult men and women.

Topics: Adult; Age Factors; Blinking; Chin; Eyelids; Face; Facial Asymmetry; Facial Expression; Facial Muscles; Female; Forehead; Humans; Imaging, Three-Dimensional; Lip; Male; Middle Aged; Mouth; Muscle Contraction; Nose; Sex Factors; Smiling; Video Recording; Young Adult

Developmental dysplasia of the hip (DDH) is a condition that affects the femoral head and the acetabulum and leads to hip subluxation and dislocation. Infants with DDH are usually treated using splints that immobilize their hip joint and are forced on their back for long periods of time. The link between positioning and facial asymmetries is poorly understood.. To compare the facial morphologies of children with DDH to a group of healthy controls.. Fifty-six Finnish patients born with DDH were matched on the basis of gender and age to a control group. Three-dimensional surface images were captured using the 3dMDface system. Using RF6 PP2 software, anthropometric landmarks were plotted and used to calculate asymmetry based on 3D co-ordinates in a reference framework.. There was statistically significant difference between all paired facial shells. Relative to the control group, DDH boys and girls presented a chin-point deviation to the right, a more prominent left orbital ridge, a more protrusive nose and upper lip. The gender-specific subgroups show a similarity of 66.54 and 65.22% in girls and boys, respectively.. Patients with DDH present a facial asymmetry when compared to healthy controls. Gender characteristics are marked whether subjects are affected with DDH or not. Three-dimensional surface imaging is a powerful diagnostic and research tool.

Topics: Case-Control Studies; Cephalometry; Child; Chin; Color; Face; Facial Asymmetry; Female; Finland; Hip Dislocation, Congenital; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Male; Nose; Orbit; Photogrammetry; Sex Factors; Software

The aim of this study was to evaluate 3-dimensional facial shells by incorporating a population-specific average template with a group of Class III subjects preparing to have orthognathic surgery.. The Class III group included 14 male (MCIII) and 15 female (FCIII) subjects. We used 43 male and 44 female Class I subjects to construct average male (AvM) and female (AvF) faces. Coordinates of 3 points on the facial templates of groups MCIII and FCIII and the templates AvM and AvF were compared. MCIII-AvM and FCIII-AvF superimpositions were evaluated for differences.. Vertical distances (sella to soft-tissue pogonion) were statistically significantly higher for the AvM (9.1%) and MCIII (10.1%) than for the AvF and FCIII, respectively (P < 0.05). The distances of soft-tissue pogonion in the horizontal x-axis were positive in 80% of the FCIII group and 85.7% of the MCIII group. The Class III subjects differed from the average face in the lower two thirds, but, in 50% (MCIII) and 60% (FCIII), they differed also in the upper facial third.. (1) The average and Class III Slovenian male morphologic face heights are statistically significantly higher than those of the female subjects. (2) The Slovenian Class III male and female subjects tend toward a left-sided chin deviation. (3) Differences between Class III patients and a normative data set were determined.

Topics: Adolescent; Adult; Cephalometry; Chin; Face; Facial Asymmetry; Female; Holography; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Male; Malocclusion, Angle Class III; Mandible; Maxilla; Models, Anatomic; Nose; Prognathism; Sella Turcica; Sex Factors; Slovakia; Vertical Dimension; Young Adult

Three-dimensional (3D) laser surface scanning analysis has taken hold in orthodontics, as well as craniomaxillofacial and plastic surgery as a new tool that can navigate away from the limitations of conventional two-dimensional methods. Various techniques for 3D reconstruction of the face have been used in diagnosis, treatment planning and simulation, and outcomes follow-up. The aim of the current prospective study was to present some technical aspects for the assessment of facial changes after orthodontic and orthognathic surgery treatment using 3D laser surface scanning. The technique proposed for facial surface shape analysis represented three-dimensionally the expected surgical changes, and the reduction of the postoperative swelling was verified. This study provides technical information from the data collection to the 3D virtual soft-tissue analysis that can be useful for diagnostic information, treatment planning, future comparisons of treatment stability or facial postoperative swelling, and soft-tissue profile assessment.

Topics: Cheek; Chin; Face; Facial Asymmetry; Facial Muscles; Female; Follow-Up Studies; Holography; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lasers; Lip; Male; Malocclusion; Mandible; Maxilla; Nose; Orthodontics, Corrective; Patient Care Planning; Prospective Studies; User-Computer Interface

Topics: Anthropometry; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Infant; Nose; Photography; Plastic Surgery Procedures; Reproducibility of Results; Treatment Outcome

Facial disfigurement in children with congenital craniofacial defects can lead to decreased self-esteem and poor self-perception. Traditional methods of reconstruction can fail to achieve a normal appearance in patients with severe disfigurements. Composite tissue allotransplantation (CTA) in children could offer a unique reconstructive opportunity. A discussion of the usage of CTA for congenital craniofacial defects is thus warranted. Treatment of severe craniofacial clefts, Treacher-Collins syndrome, hemifacial microsomia, and some vascular anomalies can yield unsatisfactory results, even after multiple surgeries. CTA provides the advantage of intact vascularized bone that would not need to be reshaped to fit the defect, with the correct donor match. CTA also provides reconstruction with similar tissue type in regions of the central midface such as the nose, lips, and eyelids. With advances in transplant immunology to devise mechanisms to decrease immunosuppression and induce donor antigen-specific tolerance, CTA may be a future reality in the pediatric population.

Topics: Child; Cleft Lip; Cleft Palate; Craniofacial Abnormalities; Craniosynostoses; Facial Asymmetry; Facial Transplantation; Humans; Immune Tolerance; Immunosuppression Therapy; Mandibulofacial Dysostosis; Nose; Plastic Surgery Procedures; Tissue Transplantation; Transplantation, Homologous

The purpose of this study was to examine asymmetry of the lips in patients with jaw deformity and facial asymmetry.. Pretreatment and posttreatment frontal facial photographs of 17 patients who had mandibular prognathism with facial asymmetry were analyzed. Linear and angular measurements were made on the photographs to assess the asymmetry of the lips. The upper and lower vermilion borders of the lips were divided into quadrants according to the y-axis, and each was measured. In addition, skeletal deviation (position of menton) was determined from the frontal cephalograms.. The pretreatment linear and angular measurements showed asymmetry of the lips, but this significantly improved after treatment, and the lip form was almost symmetrical. The areas of vermilion border in the upper and lower lips became almost even during treatment. The ratio of the areas on the 2 sides was nearly 1.00. There was little correlation between the horizontal skeletal changes of menton and lip form.. Asymmetry of the lips caused by deviation of the mandible can be almost completely corrected by orthognathic treatment.

Topics: Adolescent; Adult; Cephalometry; Chin; Esthetics, Dental; Eye; Facial Asymmetry; Female; Humans; Image Processing, Computer-Assisted; Lip; Male; Mandible; Nose; Photography; Prognathism; Young Adult

A 40-year experience with a proven protocol of repair for primary bilateral cleft lip/nose is presented. The Dallas surgical protocol for primary bilateral cleft lip/nose repair depends on the anatomy of the deformity. In cases of complete and partial bilaterally symmetric cleft lip, alveolus, and palate, 1-stage lip closure was performed at 3 months of age. In cases of asymmetric or incomplete bilateral clefts, an extremely small prolabium (<6 mm in vertical height), or a displaced or severely projected premaxilla, a 2-stage lip closure is more feasible ("Primary Bilateral Cleft Lip/Nose Repair Part II"). Primary nasal reconstruction was at 1 year of age. Early nasal reconstruction eliminates severe secondary deformity and the need for major early surgery. Orthognathic surgery was performed in approximately 40% of the senior surgeon's bilateral cleft patients to achieve optimal facial balance and aesthetics. Ten completed cases are presented with their long-term outcomes. The long-term outcomes of speech, occlusion, and facial balance are good to excellent in most of our bilateral patients. But in many cases, outcome of the lip/nose is still unsatisfying in the senior author's opinion compared with the results of unilateral cleft patients. These long-term outcomes are determined by the severity of the cleft deformity, primary repair technique, secondary surgery, and, most important, a protocol performed by a multidisciplinary experienced team until growth is complete. This technique should be considered in the treatment of all bilateral clefts, depending on the anatomy and team availability.

Topics: Cleft Lip; Clinical Protocols; Dental Occlusion; Esthetics; Facial Asymmetry; Female; Humans; Infant; Male; Nose; Rhinoplasty; Speech; Texas; Treatment Outcome

The clinical ability to alter dentofacial form requires an understanding of facial aesthetics. This is vital for any clinician involved in treatment that will alter a patient's dentofacial appearance, whether through orthodontics, facial growth modification, corrective jaw surgery or aesthetic dentistry. Part 1 of this article covered the historical and theoretical aspects of facial aesthetics and their importance in contemporary dentofacial treatment. Part 2 covers important aspects of the interview and clinical assessment of patients requiring alterations in their dentofacial appearance, including guidelines used in the assessment of facial proportions and symmetry.. These articles cover the theoretical and clinical aspects of facial aesthetics required by clinicians involved in the treatment of dentofacial deformity.

Topics: Attitude to Health; Cephalometry; Chin; Craniofacial Abnormalities; Esthetics, Dental; Face; Facial Asymmetry; Humans; Incisor; Jaw Abnormalities; Lip; Mandible; Maxilla; Motivation; Nose; Patient Care Planning

Proboscis lateralis is a rare spontaneous congenital anomaly that results from a failure of normal embryological nasal development. The ensuing deformity consists of imbrication of the nasal soft tissues into a tubelike proboscis and can be associated with ipsilateral heminasal aplasia, choanal atresia, and multiple other abnormalities. A case report of a patient with proboscis lateralis is presented, with a 27-year follow-up detailing the complexities of long-term surgical management. After 15 major surgical interventions, there is relatively normal facial symmetry, but abnormalities remain with the underlying craniofacial skeleton and nasopharyngeal airway. Proboscis lateralis is not an isolated soft tissue abnormality but is a craniofacial defect that requires a long-term multidisciplinary approach to the surgical timing and treatment with lifelong follow-up.

Topics: Coloboma; Craniofacial Abnormalities; Dacryocystorhinostomy; Eyelids; Facial Asymmetry; Female; Humans; Infant, Newborn; Lacrimal Apparatus; Nasal Cavity; Nose; Plastic Surgery Procedures; Treatment Outcome

To quantify comparative improvement between osseous and soft tissue asymmetry following primary lip repair.. Retrospective analysis of preoperative and postoperative computed tomography scans of infants with unilateral cleft lip and palate. Sixteen soft tissue landmarks were placed using an exploratory two-/three-dimensional image processing system and compared for asymmetry.. Computed tomography scans were obtained on 26 patients (13 boys, 13 girls) of Chinese ethnicity (mean age = 0.25 years) prior to Millard lip repair. Nineteen of these contributed to follow-up comparative studies prior to palatoplasty at a mean age of 0.92 years. There were 18 left-sided and eight right-sided clefts.. Euclidean distance matrix asymmetry analysis was used to determine the amount of soft tissue asymmetry pre- and postlip repair. Similar analyses of the same scans were performed for 41 osseous landmarks.. Soft tissue landmarks had 36/39 (92%) preoperative and 13/39 (33%) postoperative asymmetric pairs. Osseous distances demonstrated 77/125 (61%) asymmetric pairs preoperatively and 60/125 (48%) postoperatively. Soft tissue and osseous distances of the lip region demonstrated 32% and 39% postoperative asymmetry, respectively. Soft tissue and osseous distances of the nasal region demonstrated 52% and 72% postoperative asymmetry, respectively. Soft tissue and osseous distances of the facial landmarks demonstrated 24% and 34% postoperative asymmetry, respectively.. Primary lip repair appears to effect gains in symmetry in soft tissue and provides sufficient molding forces to cause correlating symmetry changes in underlying osseous structures.

Topics: Cephalometry; Chin; China; Cleft Lip; Eyelids; Facial Asymmetry; Facial Bones; Female; Follow-Up Studies; Frontal Bone; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Infant; Lip; Male; Maxilla; Nose; Retrospective Studies; Tomography, X-Ray Computed; Zygoma

To investigate the laterality of the normal asymmetry of the human face, examining differences in laterality in relation to sex, growth stage, and skeletal classification.. A total of 1800 Japanese subjects (651 males and 1149 females; mean age, 15 years 3 months; range, 4 years 2 months to 59 years 11 months) were selected. Individuals in the sample were categorized according to sex, one of three growth stages, and one of three skeletal patterns. Differences in length between distances from the points at which ear rods were inserted to the facial midline and the perpendicular distance from the soft-tissue menton to the facial midline were measured on a frontal facial photograph. Subjects with a discrepancy of more than 3 standard deviations of the measurement error were categorized as having left- or right-sided laterality.. Of subjects with facial asymmetry, 79.7% had a wider right hemiface, and 79.3% of those with chin deviation had left-sided laterality. These tendencies were independent of sex, age, or skeletal jaw relationships. In this regard, during pubertal growth, the proportion of subjects with wider right hemiface decreased (P < .0001), whereas the proportion of those with a wider left hemiface increased (P < .01), despite a consistent tendency for right-sided dominance.. These results suggest that laterality in the normal asymmetry of the face, which is consistently found in humans, is likely to be a hereditary rather than an acquired trait.

Topics: Adolescent; Adult; Bone Development; Cephalometry; Child; Child, Preschool; Chin; Face; Facial Asymmetry; Female; Growth; Humans; Iris; Japan; Male; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Middle Aged; Nose; Photography; Puberty; Sex Factors

After mandibular unilateral distraction osteogenesis (DO) a gradual reappearance of the vertical asymmetry during growth is observed. A pre- and post-surgical functional-orthodontic treatment was added to our distraction protocol in the attempt to increase long-term stability. In order to evaluate the actual efficacy of such a combined treatment, two samples of children affected by hemifacial microsomia were compared long-term.. Ten children were treated by a combined orthodontic-distraction treatment, seven by distraction only.. Only the vertical changes in the mandible and maxilla in the panoramic and postero-anterior cephalometric X-rays were measured.. All of the patients showed a gradual return of the asymmetry with growth. Occlusal plane correction and, to a much lesser extent, mandibular vertical ramus height correction were better maintained over 5 years post-DO in the orthopaedic group.. Although orthopaedic treatment allows for a more stable occlusal plane and for a slower return of the mandibular vertical asymmetry, it has mainly a dento-alveolar effect. Therefore, the decision of applying an orthopaedic treatment associated with distraction, should be taken by surgeon and orthodontist together, considering both the advantages and the disadvantages of this treatment.

Topics: Cephalometry; Child, Preschool; Combined Modality Therapy; Dental Occlusion; Facial Asymmetry; Follow-Up Studies; Humans; Mandible; Maxilla; Nose; Orbit; Orthodontic Appliance Design; Orthodontic Appliances, Functional; Osteogenesis, Distraction; Radiography, Panoramic; Treatment Outcome; Vertical Dimension

Cranial synostosis is relatively common; however, premature closure of a facial suture is remarkably rare. We describe an adolescent male with zygomaticotemporal synostosis that manifested as progressive midfacial and orbital asymmetry, angulation of the cranial base, and nasal deviation. To our knowledge, this is the first description of this anomaly in the literature.

Topics: Child; Craniosynostoses; Disease Progression; Facial Asymmetry; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Nose; Orbit; Skull Base; Temporal Bone; Tomography, X-Ray Computed; Zygoma

To evaluate the outcome of presurgical nasoalveolar molding (PNAM) therapy in the treatment of patients with nonsyndromic unilateral cleft and palate (UCLP).. A prospective study with blinded measurements.. Twelve patients with UCLP treated from 1997 to 2003.. The starting age for PNAM therapy was 26 days and the average length of the therapy was 110 days.. Measurements of intraoral and extraoral casts were made, and statistical analyses were used to compare the differences between pre- and posttherapy measurements.. After PNAM therapy, there was a statistically significant decrease in both intersegment alveolar cleft distance and columellar deviation (p < .05). There was also a statistically significant increase in cleft nostril height, maxillary width, and columellar width (p < .05). Moreover, although there was no statistically significant reduction of the affected nostril width, it demonstrated on average 1.7-mm reduction after PNAM therapy. The length of the time the patient utilized the appliance and postmolding nostril height were found to have a statistically significant positive correlation (p < .05).. PNAM therapy decreases intersegment alveolar cleft distance while permitting an increase in posterior maxillary arch width. It also increases nasal symmetry by decreasing columellar deviation, increasing nostril height on the affected side, maintaining bialar width of nose, increasing columellar width, and creating more symmetrical nostril heights and widths. The improvement of the height of the cleft nostril was correlated with the time the appliance was applied.

Topics: Alveolar Process; Cephalometry; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Infant; Infant, Newborn; Models, Dental; Nose; Orthopedic Procedures; Palatal Obturators; Preoperative Care; Prospective Studies; Single-Blind Method; Stents; Time Factors; Treatment Outcome

To obtain the best surgical results in orthognathic surgery, treatment planning and the evaluation of results should be performed on measurable three-dimensional reproductions of the face of the patients, and compared to reference subjects.. Seven women aged 18-35 years, all with a skeletal Class III and mandibular asymmetry, were assessed both before (on average, 2 months) and after (on average, 10.7 months) surgical intervention (mandibular reduction by sagittal split osteotomy and LeFort I maxillary advancement). The three-dimensional coordinates of 50 soft tissue facial landmarks (face, eyes, nose, mouth and lips, ears) were collected with a noninvasive, electromagnetic digitizer; facial volumes were estimated, and compared to reference values collected in 87 healthy women of the same age and ethnic group. Inter-individual modifications in facial shape were also assessed.. Before surgery the patients had smaller faces than the reference women, with larger lower lips and noses. A large within-group variability was found. Surgical treatment significantly reduced total facial volume and mandibular volume, increased total and upper lip volumes (Student's t test, p<0.05), and made all values more homogenous within the group. Shape differences were significantly larger before than after surgery. On average, right side gonion was the landmark that moved the most, closely followed by menton, while the tragi and ala nasi moved the least. The three-dimensional approach used in this study enabled quantitative evaluation of the final soft tissue results of surgery, without submitting the patients to invasive procedures.

Topics: Adolescent; Adult; Face; Facial Asymmetry; Female; Humans; Jaw Abnormalities; Lip; Malocclusion, Angle Class III; Mandible; Nose; Plastic Surgery Procedures; Postoperative Period; Preoperative Care; Treatment Outcome

The aim of this study was to assess the outcome of bone grafting using a corticocancellous block of iliac crest to reconstruct the support for the deformed, volume-deficient alar base in treated patients with unilateral cleft lip and palate (UCLP). The main outcome being measured was nasal symmetry.. This was a prospective study using a noninvasive three-dimensional stereophotogrammetry system (C3D) to assess the position of the alar base. Images were captured immediately preoperatively and at 6 months following the augmentation of the alar base with a block of bone graft. These images were used to calculate facial symmetry scores and were compared using a two sample Student's t test to assess the efficacy of the surgical method in reducing facial/nasal asymmetry.. This investigation was conducted on 18 patients with one patient failing to attend for follow-up. The results for 17 patients are presented.. Facial symmetry scores improved significantly following the insertion of the bone graft at the deficient alar base (p=0.005).. 3D stereophotogrammetry is a noninvasive, accurate, and archiveable method of assessing facial form and surgical change. Nasal symmetry can be quantified and measured reliably with this tool. Bone grafting to the alar base region of treated UCLP patients with volume deficiency produces improvement in nasal symmetry.

Topics: Adolescent; Adult; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Humans; Image Processing, Computer-Assisted; Male; Nose; Photogrammetry; Prospective Studies; Statistics, Nonparametric

This paper describes the use of adult facial template in gender-specific facial analysis.. Eighty adults, mean age 24.5, were selected for the study. Laser-scanned images of the subjects were obtained under a reproducible and controlled environment with two Minolta Vivid 900 (Osaka, Japan) optical laser-scanning devices assembled as a stereo-pair. A set of left and right scanned images was taken for each subject and each scan took an average of 2.5 s. These scanned images were processed and merged to form a composite three-dimensional soft tissue reproduction of the subjects using commercially available reverse modelling software. The differences in facial morphology were measured using shell deviation colour maps. The facial template was used to compare differences between males vs. females groups and two subjects with facial disproportions.. The difference between the male and female facial templates was 1.28 +/- 1.02 mm. The areas of greatest deviation were at the nasal, zygomatic area and lower jaw line. The results of the surface deviation maps between the templates and subjects with facial disproportion showed that the results could be applied for orthodontic diagnosis.. The construction of the adult facial templates provides an interesting perspective into measuring changes in groups of patients and also acts as a useful template for the comparison of skeletal disproportion.

Topics: Adult; Algorithms; Cephalometry; Face; Facial Asymmetry; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lasers; Male; Malocclusion, Angle Class III; Mandible; Nose; Sex Factors; Software; Treatment Outcome; Zygoma

To assess the degree of facial symmetry in patients suffering from unilateral cleft lip, alveolus and palate (UCLAP) by determining differences between the cleft and the non-cleft hemifaces from 3D surface data.. In twenty-two 10-year-old UCLAP patients, who had the lip repaired using the Tennison-Randall technique and did not undergo further revisional surgery, differences were determined between landmarks, surface areas of the upper lip vermilion and nostrils and virtual volumes of midface, nose and upper lip for cleft and non-cleft sides, separately, after having established a plane of symmetry calculated from optical 3D facial surface data.. Statistically significant differences could be found between cleft and non-cleft sides for the nasal landmarks G(lat), G(sup) and La(med), the nostril angle and the virtual volume of the nose (p(Glat)=0.011, p(Gsup)<0.0005, p(Lamed)=0.002, p(nostril angle)=0.036 and p(nose volume)<0.0005, resp.).. Analysis of 3D data shows that complete nasal symmetry is difficult to achieve with Tennison-Randall's lip repair without revisional surgery. Further trials on larger populations of patients will allow a more comprehensive and consistent analysis of the consequence of different methods for cp repair in order to identify the techniques with the best outcome in terms of facial symmetry.

Topics: Cephalometry; Child; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Face; Facial Asymmetry; Humans; Image Processing, Computer-Assisted; Lip; Nose; Statistics, Nonparametric

Traditionally, the goal of management of unilateral cleft lip-cleft nose deformity has been nasal symmetry, with improved nasolabial and nasofacial relationships and the noncleft side as the reference point. However, symmetry does not always ensure an aesthetically desirable form. The retracted ala is characterized by an alar rim to the long axis of the nostril distance greater than 2 mm on lateral view of the nose. In the management of unilateral cleft lip nose deformity in a patient with a retracted ala of the noncleft side, a simple correction of the deformity symmetric to the noncleft side results in bilateral alar retraction, an aesthetically undesirable result.. The authors present eight cases of managing unilateral cleft lip deformities with retracted alae of the noncleft side between January of 2003 and October of 2004.. Correction of alar retraction of the noncleft side with or without the correction of cleft lip nose deformity yielded better aesthetic results that were maintained throughout the follow-up period.. Aesthetic surgery is the natural evolution of reconstructive surgery; in the reconstruction of selected unilateral deformity, the concept of "as symmetric to the contralateral side as possible" should be changed to the pursuit of an aesthetically pleasing appearance of both sides.

Topics: Adolescent; Adult; Cleft Lip; Congenital Abnormalities; Esthetics; Facial Asymmetry; Female; Follow-Up Studies; Humans; Male; Nose; Nose Deformities, Acquired; Postoperative Complications; Rhinoplasty; Treatment Outcome

The purpose of this study was to apply nasoalveolar molding appliance in infants with cleft lip and plate and to observe the preliminary effects on nasal cartilage and columella.. Ten infants were treated with nasoalveolar molding. The other ten infants without any presurgical orthopedic treatment were chosen as the control group. Each patient was photographed at the initial visit (T0), after nasoalveolar molding (T1), 2 weeks (T2), and half a year (T3) after cheiloplasty. Six measurements were made on the photographs and the nasal symmetry was analyzed with paired t test.. The percentage of the deviation from perfect symmetry was significantly improved at T0-T1, T1-T2 stage (P<0.05), and the improvement relapsed at T2-T3 (P<0.05). There was significant difference between the orthopedic group and the control group with the changes in nasal symmetry in vertical dimension (P<0.01), and there was no significant difference in horizontal dimension (P>0.05).. Nasal asymmetry was significantly improved after nasoalveolar molding. Half a year after the primary cheiloplasty, although there was a relapse tendency of nasal asymmetry, the shape of the nasal dome was ideal.

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Infant; Nose; Rhinoplasty

This article reviews a case of a woman presenting with nasal deformity following childhood nasal trauma and two subsequent rhinoplasties. Discussion for correction of these problems includes tip dome graft, shield and cap graft, superior and inferior cartilage onlay grafts, spreader graft, columellar strut, and lateral osteotomies. Pre- and postoperative photographs are provided with corresponding preoperative diagrams and schematics.

Topics: Adult; Esthetics; Facial Asymmetry; Female; Humans; Nasal Obstruction; Nose; Nose Deformities, Acquired; Reoperation; Rhinoplasty

The OMENS syndrome involves craniofacial maldevelopment of the orbit, ear cranial nerve and soft tissue, while OMENS-plus syndrome also includes extracraniofacial anomalies. These may be skeletal, cardiovascular, gastrointestinal, pulmonary, renal and central nervous system malformations. A fourteen-year-old girl presented with hemifacial microsomia, digital abnormalities and pancreatitis. She was diagnosed as O1M2E0N2S1--plus syndrome. Investigations revealed a type Ic choledochal cyst. The latter has not been reported as a gastrointestinal association earlier in literature to the best of the authors' knowledge.

Topics: Abnormalities, Multiple; Adolescent; Craniofacial Abnormalities; Facial Asymmetry; Female; Fingers; Humans; Mouth Abnormalities; Nose; Syndrome; Toes

To assess nostril symmetry and alveolar cleft width in infants with unilateral cleft lip and palate following presurgical nasoalveolar molding (NAM).. Fifty-seven newborn patients underwent presurgical nasoalveolar molding. Magnified basal view facial photos were taken at four different times: initial visit (T1), before cheiloplasty (T2), 1 month after cheiloplasty (T3), and 1 year of age (T4). Direct measurements from the photos included: (1) nostril width on the affected and nonaffected side; (2) nostril height on the affected and nonaffected side; (3) columella-nasal base angle; and (4) width of the alveolar cleft. Nostril width and height data were used to calculate a ratio of affected to nonaffected side.. Effects of nasal symmetry after presurgical nasoalveolar molding were compared between the affected and nonaffected side. The nostril width ratio was 1.7, 1.2, 1.0, and 1.2 for T1 to T4. The nostril height ratio was 0.5, 0.8, 1.0, and 0.9 for T1 to T4. The angle of the columella was 53.3 degrees , 69.9 degrees , 91.2 degrees , and 86.9 degrees for T1 to T4. The average alveolar cleft width was 8.2 mm at T1 and closed down to 2.4 mm before cheiloplasty (T2) in cases with complete cleft.. Infants with presurgical nasoalveolar molding improved symmetry of the nose in width, height, and columella angle, as compared to their presurgical status. There was some relapse of nostril shape in width (10%), height (20%), and angle of columella (4.7%) at 1 year of age.

Topics: Alveolar Process; Cartilage; Cephalometry; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Follow-Up Studies; Humans; Infant, Newborn; Lip; Male; Nose; Palatal Obturators; Preoperative Care; Prostheses and Implants; Prosthesis Design; Stents

The purpose of this study was to assess the progressive changes of nasal symmetry, growth, and relapse after presurgical nasoalveolar molding and primary cheiloplasty in unilateral complete cleft lip/palate infants. Twenty-five consecutive complete unilateral cleft lip/palate infants were included. All the infants underwent nasoalveolar molding before primary cheiloplasty. Standard 1:1 ratio basilar photographs were taken before and after nasoalveolar molding, 1 week after cheiloplasty, and yearly for 3 years. Linear measurements were made directly on the photographs. The results of this study revealed that the nasal asymmetry was significantly improved after nasoalveolar molding and was further corrected to symmetry after primary cheiloplasty. After the primary cheiloplasty, the nasal asymmetry significantly relapsed in the first year postoperatively and then remained stable and well afterward. The relapse was the result of a significant differential growth between the cleft and noncleft sides in the first year postoperatively. To compensate for relapse and differential growth, the authors recommend (1) narrowing down the alveolar cleft as well as possible by nasoalveolar molding, (2) overcorrecting the nasal vertical dimension surgically, and (3) maintaining the surgical results using a nasal conformer.

Topics: Anthropometry; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Nose; Rhinoplasty

Surgical correction of synostotic frontal plagiocephaly (unilateral coronal synostosis) focuses on the asymmetry of the forehead and orbits. However, there is controversy regarding whether nasal angulation should be addressed during primary fronto-orbital advancement in infancy. This prospective study was undertaken to answer that question. Preoperative and postoperative anthropometric measurements were obtained for 19 infants with nonsyndromic synostotic frontal plagiocephaly. The measurements included nasal angulation, nasion-to-endocanthion distance, nasion-to-exocanthion distance, and exocanthion-to-tragion distance. All patients underwent bilateral parallelogrammatic fronto-orbital correction. Closing wedge nasal ostectomy was performed for group I (n = 14) and was not performed for group II (n = 5). The average age at the time of follow-up assessments was 3 years 8 months (range, 1 to 14 years) in group I and 5 years 5 months (range, 2 to 15 years) in group II. A statistically significant change was observed for patients who underwent primary correction of nasal angulation; the change correlated with improved naso-orbital symmetry, as judged with nasion-to-endocanthion and nasion-to-exocanthion measurements (p < 0.01 and p < 0.05, respectively). Group I patients exhibited an average preoperative nasal angulation of 9.15 +/- 0.8 degrees that decreased to 3.1 +/- 0.6 degrees postoperatively (p < 0.01). Group II patients exhibited an average preoperative nasal angulation of 6.4 +/- 0.7 degrees that was unchanged postoperatively at 7.2 +/- 1 degrees. The improvement in nasal angulation in group I was particularly striking because the patients in group II exhibited, on average, a lesser degree of preoperative nasal deviation (p < 0.01). This prospective comparison of fronto-orbital correction of synostotic frontal plagiocephaly with and without nasal correction confirmed an earlier study and demonstrated that angulation of the nasal pyramid does not self-correct within 5 years after traditional bilateral fronto-orbital repair. Closing wedge nasal ostectomy results in improved nasal angulation and naso-orbital symmetry, without evidence of distortion or inhibition of nasal growth.

Topics: Anthropometry; Facial Asymmetry; Female; Forehead; Humans; Infant; Male; Nose; Plastic Surgery Procedures; Prospective Studies; Skull; Synostosis

To determine the degree of facial asymmetry in infants with unilateral cleft lip and/or palate, and quantify improvements following primary surgery, in three dimensions.. The faces of 20 infants with unilateral clefts (10 UCL; 10 UCLP), and 20 age-matched, non-cleft controls, were captured using the C3D stereophotogrammetry system prior to primary lip/nose repair (at 3 months), at 6 months and at age 1 year.. Procrustes techniques were applied to 3D landmark configurations to its mirror image. Mean squared distances between landmarks and their antimeres were calculated and expressed as asymmetry scores for each 3D configuration. Full-face, nose and lip median scores were compared and changes with time evaluated (P < 0.01).. There were no significant changes in asymmetry scores in the control group from 3 months to 1 year. The UCLP group was more asymmetric than the UCL group, displaying greatest improvement in nasal symmetry following primary repair. The lips continued to improve over time. The UCL group had significant nasal asymmetry, which did not appear to improve with primary surgery.. Immediate improvement in asymmetry scores in children with UCLP is related to the production of a more symmetrical nasal form after primary surgery. In contrast, the nasal asymmetry seen in children with UCL is unchanged despite surgery. Full face asymmetry scores may mask subtle changes over time. Nasal and lip asymmetry should be considered individually.

Topics: Case-Control Studies; Cephalometry; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Infant; Nose; Photogrammetry; Photography, Dental; Prospective Studies; Rhinoplasty; Statistics, Nonparametric

The incidence of deformational posterior plagiocephaly has increased dramatically since 1992. We tested the hypothesis that mandibular asymmetry, associated with this condition, is secondary to anterior displacement of the ipsilateral temporomandibular joint. The response to molding helmet therapy was also evaluated.. A caliper was used to measure mandibular dimensions in 27 infants (16 boys and 11 girls) with deformational posterior plagiocephaly; the mean age was 6.2 months (range, 3 to 12 months). Anthropometric measures included ramal height (condylion-gonion), body length (gonion-gnathion), and condylion-gnathion. Gonial angle was calculated from the law of cosines: C(2) = A(2) + B(2) - 2AB cos c. The position of the temporomandibular joint was accepted as corresponding to auricular position and measured from tragion to subnasal. Cranial asymmetry was measured, in the horizontal plane, from orbitale superius to the contralateral parieto-occipital point at the level of inion. Ten of 27 patients were remeasured 5 months after beginning helmet therapy to evaluate change in mandibular dimensions.. Two thirds of infants (67%) had right-sided and one third (33%) had left-sided deformational posterior plagiocephaly. The mean auricular anterior displacement was 79.7 mm on the affected side and 83.4 mm on the unaffected side. The mean difference of 3.8 mm between the sides was statistically significant (P <.001). Transverse cranial dimension averaged 136.0 mm on the affected side and 146.8 mm on the unaffected side; this was also significant (P <.001). There was a significant positive correlation between auricular displacement and cranial asymmetry [R(23) =.59, P <.01). Auricular (temporomandibular joint) displacement also resulted in an apparent mandibular asymmetry with rotation of the jaw to the affected side. Mean mandibular measurements on the affected and unaffected sides were ramus height of 35.2 and 36.4 mm, body length of 59.0 and 60.3 mm, and gonial angle of 127.1 degrees and 126.8 degrees, respectively. Comparison of the affected with the unaffected sides, using a paired-samples t test, was not statistically significant. Improvement in cranial asymmetry occurred with helmet therapy, but there was no correction of auricular and temporomandibular joint position.. This study supports the clinical observation that the mandibular asymmetry in deformational posterior plagiocephaly is secondary to rotation of the cranial base and anterior displacement of the temporomandibular joint (quantified by anterior auricular position) and not the result of primary mandibular deformity.

Topics: Anthropometry; Cephalometry; Craniosynostoses; Ear, External; Facial Asymmetry; Female; Follow-Up Studies; Head Protective Devices; Humans; Infant; Male; Mandibular Condyle; Mandibular Diseases; Matched-Pair Analysis; Nose; Occipital Bone; Orbit; Orthopedic Procedures; Parietal Bone; Rotation; Statistics as Topic; Temporomandibular Joint

Patients suffering from unilateral cleft lip, alveolus and palate exhibit a varying degree of asymmetry of the midface. Evaluation of this asymmetry can be carried out by means of 3D-CT, or a laser surface scanner.. In this paper, 3D-CT-scan data of 21 patients with unilateral clefts of lip, alveolus and palate were analysed using three-dimensional models. Evaluations of the 3D-models were carried out with the computer-aided 3D-operation simulator 3D-Cosmos.. Asymmetry was found in the orbital, nasal and maxillary regions. The infraorbital rims were displaced craniocaudally and horizontally as well as laterally of the cleft-sided piriform aperture. This asymmetry corresponded to a dislocation of the maxillary segment on the cleft side. A deficit in volume was not reliably found.

Topics: Alveolar Process; Cephalometry; Cleft Lip; Cleft Palate; Computer-Aided Design; Facial Asymmetry; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Infant; Maxilla; Nasal Cavity; Nose; Orbit; Tomography, X-Ray Computed

The study assessed the effects of sex and age on 3-dimensional (3D) soft-tissue facial asymmetry.. The 3D coordinates of selected soft-tissue facial landmarks were digitized on 314 healthy white subjects (40 male and 33 female adolescents, aged 12 to 15 years; 73 female and 89 male young adults, aged 18 to 30 years; and 41 male and 38 female adults, aged 31 to 56 years) by an electromagnetic instrument. Facial asymmetry was quantified by detecting a plane of symmetry and the centers of gravity of the right and left hemifaces and by calculating the distance between the 2 centers of gravity (distance from the symmetry [DFS]). Both absolute (millimeters) and percentage (of the nasion-center of gravity distance) DFS were obtained, as well as the maximum normal asymmetry. The asymmetry of single landmarks was also quantified.. No gender- or age-related differences were found for both absolute and percentage DFS (P > .05). The maximum normal asymmetry was slightly greater in females than in males of corresponding age; within each sex, the largest values were found in the adolescent group. Tragion, gonion, and zygion were the most asymmetric landmarks in all groups (about 10% to 12% of the nasion-facial center of gravity distance), whereas the least asymmetric was endocanthion (4% to 6%).. A slight soft-tissue facial asymmetry was found in normal subjects. The maximum normal asymmetry could be useful in identifying borderline asymmetric patients.

Topics: Adolescent; Adult; Age Factors; Child; Chin; Cross-Sectional Studies; Ear, External; Electromagnetic Phenomena; Eye; Face; Facial Asymmetry; Female; Frontal Bone; Humans; Image Processing, Computer-Assisted; Lip; Male; Middle Aged; Nose; Orbit; Sex Factors; Temporal Bone; Zygoma

The purpose of this study was to describe changes in articulation, resonance, and velopharyngeal function following mandibular distraction osteogenesis.. This is a descriptive, post hoc study comparing the performance of patients on measures of articulation, resonance, and velopharyngeal function before and after mandibular distraction.. The data were collected at a tertiary health care center located in Chicago.. The clinical data from preoperative and postoperative evaluations of seven mandibular distraction patients were used.. The outcome measures were number of articulation errors, severity of hypernasality and audible nasal emission, and velopharyngeal orifice size as estimated using the pressure-flow technique.. Immediately after distraction, 28% (2/7) experienced a temporary deterioration in articulation and 42% (3/7) experienced a deterioration in nasal resonance. But by the long-term follow-up evaluation, all had returned to their preoperative levels. Pressure-flow test results generally support the perceptual findings.. Patients being considered for mandibular distraction surgery should receive preoperative and postoperative speech evaluations and be counseled about risks for changes in their speech following surgery.

Topics: Adolescent; Adult; Child; Child, Preschool; Facial Asymmetry; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Mandible; Nose; Osteogenesis, Distraction; Palate, Soft; Pharynx; Pressure; Reproducibility of Results; Rheology; Speech; Speech Perception; Treatment Outcome; Voice Quality

Individuals with unilateral cleft lip and palate (UCLP) manifest a plethora of phenotypic characteristics, including asymmetric development of the middle and lower facial skeleton. The purpose of this study was to retrospectively investigate the development of cranial base asymmetries in patients with UCLP noted on posteroanterior cephalometric radiographs.. Thirty individuals with UCLP and 64 controls participated in this study. Medial and lateral cranial base asymmetries were analyzed on frontal cephalometric radiographs relative to three developmental stages. Furthermore, the development of horizontal and vertical lower facial asymmetry in these patients with UCLP was assessed in relation to cranial base, nasomaxillary, and dentoalveolar structures.. Individuals with UCLP demonstrated cranial base asymmetries that did not significantly differ from individuals without cleft. In addition, lower facial asymmetry in patients with UCLP correlated with horizontal lower facial and dentoalveolar asymmetries but not with cranial base or nasomaxillary structures.. No significant vertical cranial base asymmetries were detected in patients with UCLP. Horizontal lower facial asymmetry appeared to develop in close relation to the vertical asymmetries of mandibular fossae and dentoalveolus.

Topics: Adolescent; Alveolar Process; Bone Diseases; Cephalometry; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Facial Bones; Female; Humans; Male; Mandible; Maxilla; Maxillofacial Development; Nose; Phenotype; Retrospective Studies; Skull Base; Tooth; Vertical Dimension

We present four clinical cases to show the usefulness of superelastic shape-memory NiTi alloy wires in orthodontics. Martensitic and austenitic states of the alloy facilitate wire insertion in the bracket slot, creating a gently continuous force to move the tooth whatever the deformation of the wire. Use of a more physiological force lessens the risk of therapeutic errors due to misevaluated dysfunction and/or underlying dysmorphism.

Topics: Adult; Elasticity; Facial Asymmetry; Female; Humans; Jaw Abnormalities; Male; Malocclusion; Malocclusion, Angle Class II; Nickel; Nose; Orthodontic Space Closure; Orthodontic Wires; Orthodontics, Corrective; Titanium

Patients born with cleft lip and palate (CLP) present with a variety of nasal deformities. These are either congenital or iatrogenic. Our aim was to establish a correlation between aesthetic and functional nasal impairments in patients with CLP whose nasal reconstruction had been delayed. Fifty-four randomly selected patients with CLP deformities, all of whom had delayed nasal repairs were evaluated objectively, aesthetically in three planes, and functionally for symptoms of nasal obstruction, chronic maxillary sinusitis, and olfactory disturbances. Aesthetically the patients were analysed from 1:1 life-size full face, profile, and submental-vertex photographs, and full skull cephalograms. Nasal patency was assessed by rhinomanometry. The presence of chronic maxillary sinusitis and olfactory disturbances were deduced from the history. The degree of nasal dismorphism correlated with the severity of nasal functional impairments. Delayed nasal repairs in patients with CLP did not produce satisfactory aesthetic or functional results, probably because growth was retarded and midfacial development was disturbed at the time of delayed rhinoplasty and resulted in asymmetry. In CLP the nose should be repaired during the early primary cheilorhinoplasty, as this is essential for the restoration of a normally functioning and aesthetically pleasing nose.

Topics: Adolescent; Adult; Cephalometry; Chronic Disease; Cleft Lip; Cleft Palate; Esthetics; Evaluation Studies as Topic; Facial Asymmetry; Facial Bones; Female; Humans; Iatrogenic Disease; Male; Maxillary Sinusitis; Nasal Obstruction; Nose; Nose Deformities, Acquired; Nose Diseases; Olfaction Disorders; Photography; Postoperative Complications; Pulmonary Ventilation; Rhinoplasty; Time Factors; Treatment Outcome

In bilateral cleft lip repair numerous complicated problems still remain. In our opinion, it is better to begin treatment soon after birth. We start nonsurgical correction of a nasal deformity using a nose retainer and preoperative orthodontics using a palatal plate. Surgical repair of the lip is done within one month of birth, by which time the nose alveolus and projecting prolabium can be adequately changed into the desired form. Primary lip repair is performed in one stage which includes restoration of the muscle union, labial sulcus reconstruction and nasal correction. We use a two straight parallel suture line method for symmetric bilateral cleft lip repair. The distance between the two cupid's peaks is 4 mm. The central tubercle is reconstructed using bilateral cutaneo-mucosal flaps. The tissue volume of both sides is not the same in asymmetric cases so we have refined our method in order to achieve symmetry.

Topics: Child, Preschool; Cleft Lip; Cleft Palate; Facial Asymmetry; Humans; Infant; Infant, Newborn; Nose; Plastic Surgery Procedures; Surgical Flaps

Secondary nasal correction of cleft patients is acknowledged to be a difficult problem. There are many different operations but few objective assessments of their results. We have evaluated the results of a modified Tajima operation by use of the Bristol computer technique. Eighteen patients were followed up for a mean of 33 months (range 10-56). Measures of asymmetry were obtained for different photographic views, preoperatively and at later postoperative visits. In all views there was a significant improvement in shape in the early postoperative photos. This same improvement was also seen when comparing preoperative to late postoperative results i.e. this initial improvement is maintained over time. There was no significant difference between the early and late postoperative views. In this small series the modified Tajima technique has given statistically significant lasting improvement. However, few other operations have been objectively assessed and hence comparison is difficult. We advocate the use of the computer technique for other procedures to allow meaningful comparisons between them.

Topics: Adolescent; Adult; Child; Cleft Lip; Decision Making, Computer-Assisted; Facial Asymmetry; Humans; Nose; Photography; Retrospective Studies; Surgery, Plastic; Treatment Outcome

A clinical study of the craniofacial features in Apert syndrome is based on our experience with 136 cases. Characteristics included hyperacrobrachycephaly, steep wide forehead, flat occiput, common craniofacial asymmetry, ocular hypertelorism and proptosis, downslanting palpebral fissures, divergent upgaze and esotropic downgaze, a tendency towards large ears, and marked depression of the nasal bridge. The nose is short and wide with a bulbous tip, and the anterior facial height is reduced. Common features during infancy included horizontal grooves above the supraorbital ridges that disappear with age, a break in the continuity of the eyebrows, and a trapezoidal-shaped mouth at rest. Radiographic aspects of Apert syndrome were also assessed. Tables are provided which compare the craniofacial features of Apert and Crouzon syndromes.

Topics: Acrocephalosyndactylia; Craniofacial Dysostosis; Ear, External; Esotropia; Exophthalmos; Eyelid Diseases; Face; Facial Asymmetry; Facial Bones; Forehead; Humans; Hypertelorism; Infant; Mouth Abnormalities; Nasal Bone; Nose; Occipital Bone; Orbit; Radiography; Skull; Strabismus

An unusual variant of Hanhart's syndrome associated with facial asymmetry in a female patient is presented together with surgical treatment of her facial anomalies. Following reconstruction which included bimaxillary osteotomies and osteopericranial and pericranial flaps, a good aesthetic result was achieved which enabled the psychological and social rehabilitation of the patient.

Topics: Abnormalities, Multiple; Adult; Facial Asymmetry; Female; Humans; Limb Deformities, Congenital; Micrognathism; Nose; Syndrome; Tooth Abnormalities

Topics: Culture; Facial Asymmetry; Humans; Nasal Septum; Nose; Rhinoplasty; Turbinates

Periosteal musculoaponeurotic (PMAS) reconstruction is a key objective in primary repair of the cleft lip. The reconstructed muscles provide a sound framework and stimulus for development of the nasolabial region. In this study two primary cleft lip repair techniques were retrospectively studied to determine if one [Delaire (Del)] which involves PMAS repair around the cleft results in more nasolabial symmetry than a technique that does not fully addressed the musculature [modified Rotation-Advancement, (mR-A)].. Four-and 5-year-old children with complete unilateral cleft lip and palate were recalled for study (n = 33 children; Del group, 16; mR-A group, 17). Clinical and photographic records were obtained and anthropometric analyses determined for comparison between groups.. In the mR-A group, noses had more asymmetrical tips, were shorter, projected less, and tended to be flatter or wider. Nasal indices tended to support these findings. Nasal height was similar for the mR-A and Del groups. When comparing cleft versus noncleft sides, alar width and length and nostril length were significantly different for both cleft groups.. It appears from this study that reconstruction of the PMAS of the nasolabial region during primary cleft lip repair may positively influence growth and development of the nose in unilateral cleft lip and palate patients.

Topics: Child, Preschool; Cleft Lip; Facial Asymmetry; Facial Muscles; Humans; Nose; Retrospective Studies; Rhinoplasty; Tendons

Topics: Cephalometry; Chin; Esthetics; Facial Asymmetry; Facial Bones; Humans; Mandible; Nose; Physician-Patient Relations; Rhinoplasty; Self Concept; Surgery, Plastic

Topics: Cheek; Facial Asymmetry; Humans; Nose; Skin Transplantation

A computer-based system of assessing asymmetry was used to compare standardised photographs of primarily corrected cleft noses, uncorrected cleft noses and control (normal) noses. A significant difference was found between control and cleft groups for both upper nasal perimeter (p < 0.001) and nostril outline (p = 0.001), and between uncorrected and corrected noses for upper nasal perimeter (p = 0.03) but not for nostril outline (p = 0.99). Comparing the results achieved by panel assessment (Cussons et al., 1992) with this of the same patients revealed some discordance related to the influence of extraneous factors on panel decisions. Panel assessment is needed in the evaluation of overall appearance, whilst the computer method is able to assess the results of different techniques, and from different centres, on specific features where symmetry is a major objective of surgical technique.

Topics: Attitude of Health Personnel; Child; Cleft Lip; Cleft Palate; Diagnosis, Computer-Assisted; Facial Asymmetry; Humans; Nose; Observer Variation; Treatment Outcome

There is a need to be able to assess the overall result in a significant series of cases of a method of management of the cleft lip and nose deformity in order to avoid "best case" reporting often used to introduce new techniques. The present study was performed by a panel placing standardised base view photographs in rank order. The photographs were of 10-year-old subjects of whom 15 were normal controls, 22 were from the Rikshospitalet, Oslo, all of whom had no primary nasal correction and 25 from Frenchay Hospital, Bristol, who all had radical primary nasal correction. Ranking was performed for upper nasal perimeter symmetry, nostril outline symmetry and for overall aesthetic appearance. Analysis of the results showed a significant difference between the three groups, with the corrected noses showing better symmetry. Inter and intraobserver correlations were very close. The limitations of a ranking and marking method of panel assessment are discussed, and a computerised method is presented in subsequent papers.

Topics: Child; Cleft Lip; Cleft Palate; Esthetics; Facial Asymmetry; Humans; Nose; Photography; Rhinoplasty; Surgery, Plastic; Time Factors

Objective assessment of the results of cleft lip and nose surgery is necessary to quantify differences between alternative surgical techniques. A previously described method of measuring facial asymmetry has been modified to allow a comparison of differently treated cleft noses (radical nasal correction versus no nasal correction). Standardised, inferior view photographs of 10-year-olds were obtained from patient records. These were projected, traced, digitised and analysed using a BBC microcomputer. A method of excluding the ill-defined nasal baseline by obtaining a mirror-image of the upper nasal perimeter is described. The method has a high degree of inter and intra observer reproducibility.

Topics: Child; Cleft Lip; Diagnosis, Computer-Assisted; Facial Asymmetry; Humans; Microcomputers; Nose; Photography; Postoperative Complications; Rhinoplasty

Three children suffering from facial asymmetry were observed annually using facial stereophotogrammetry before, during, and after their general skeletal adolescent growth spurt. Stereophotogrammetry allows accurate three-dimensional measurements between identifiable facial landmarks. Five pairs of bilateral parameters connecting external canthi and angles of the mouth to alae and tip of nose, and to each other, allowed a positive sign (right-side larger) or a negative (left-side larger) assessment of parameter asymmetry. Their total, taking sign into account, assessed mid-facial asymmetry. Serial observation showed that: (1) in patient no. 1 suffering from post-traumatic condylar hypoplasia, the facial asymmetry resolved; (2) in patient no. 2 suffering from unilateral facial hypoplasia, the asymmetry, which was severe, reduced with adolescence, but did not resolve; (3) in patient no. 3 suffering from fibro-osseous dysplasia of left maxilla, the asymmetry was reduced by surgery, but the full effects of the surgery were not measurable until over 1 year after operation; subsequently, the asymmetry began to increase again.

Topics: Adolescent; Age Factors; Cephalometry; Child; Face; Facial Asymmetry; Female; Fibrous Dysplasia of Bone; Humans; Male; Malocclusion; Mandibular Condyle; Maxillary Diseases; Maxillofacial Development; Mouth; Nose; Photogrammetry

When orthognathic surgery is performed to produce functional improvement of the maxillomandibular complex, additional esthetic corrections to harmonize facial proportions are often necessary as well as desired by the patient. Simultaneous profile corrections occur with orthognathic surgery, but rhinoplasty requires a second intubation after the correction of the maxillomandibular complex. In the case of an asymmetric facial deformity, a two-stage procedure is recommended because positioning of the soft tissues is more easily planned after the jaws have healed and are functioning in their new positions. Several examples of soft tissue changes and their respective orthognathic procedures are described.

Topics: Adolescent; Adult; Chin; Esthetics; Face; Facial Asymmetry; Female; Humans; Male; Mandible; Maxilla; Nose; Osteotomy

Patients with Treacher Collins syndrome were studied regarding 10 nasal, 1 orbital, and 4 facial measurements as well as 10 facial proportion indexes. Data from 15 to 24 patients were related to normal values. The most normal feature was found to be the nose, whose basic measurements were optimal. Because harmony between the nose and the face is a basic requirement of aesthetic balance in a healthy face, the nose in these patients is the key for calculating changes in the markedly damaged general framework of the face. Abnormal proportion indexes must be corrected by adjusting the abnormal measurement to its optimal level. Thus, the abnormally short bizygomatic width had to be increased by a mean of 13 to 21 mm. Both the nose and the face were usually normal-long, producing acceptable proportions in these patients. Some size disproportions were found between the root and the soft nose. Their adjustment should be part of the general plan to correct the face of a patient with Treacher Collins syndrome.

Topics: Adolescent; Adult; Anthropometry; Child; Child, Preschool; Facial Asymmetry; Female; Humans; Male; Mandibulofacial Dysostosis; Nose; Rhinoplasty; Surgery, Plastic

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Humans; Male; Nose

A Jewish family is reported in which the proband and her father had congenital hearing loss and unusual facies consisting of facial asymmetry, temporal alopecia with frontal bossing, a broad nasal root and small nasal alae. In addition, both were born with a short frenulum of the tongue. We believe these findings represent a new autosomal dominant deafness syndrome with distinct craniofacial features.

Topics: Abnormalities, Multiple; Adult; Alopecia; Child, Preschool; Facial Asymmetry; Female; Genes, Dominant; Hearing Loss, Sensorineural; Humans; Male; Nose; Syndrome; Tongue

An interpretation of the role of the nasal septum on maxillonasal growth in patients with congenital labiomaxillary clefts is presented. Salient features of the anatomic pathology and resultant dysfunction of the premaxillary-maxillary suture and the position and orientation of the nasolabial muscles relative to the nasal septum are discussed for unilateral and bilateral deformities. The nasal septum plays an important direct role in growth of the premaxilla and an indirect role in growth of the maxilla.

Topics: Cleft Lip; Cleft Palate; Facial Asymmetry; Facial Muscles; Humans; Infant; Maxillofacial Development; Nasal Septum; Nose

The noses of 34 attractive young North American Caucasian women were analyzed quantitatively, based on 19 nasal measurements (6 single and 7 paired linear measurements, 3 angles, and 3 inclinations) and 15 craniofacial measurements (10 linear measurements and 5 inclinations) taken directly from the face of the women. The relationship between the nasal measurements was studied in 16 proportion indices and the relationship between the nasal and the other craniofacial measurements in 13 interareal indices. The findings were also compared with those in 21 women with below-average faces. Two types of facial harmony disruption were identified: disharmony, a normal index with a visually apparent failure of proportionality, and disproportion, an index value outside of the normal range. The percentage of disharmonies and disproportions was significantly higher in the group of 21 women with below-average faces. The study revealed a wide variety of "ideal" noses. Only a small portion of the measurements (12%) and proportion indices (7%) were at the mean value. At least two-thirds of the interareal proportion indices were located in the mean +/- 1 standard deviation portion of the normal range. Only about one-fifth of the interareal indices were disharmonious and 2.8% disproportionate. The disproportions were more areal in the attractive faces and more interareal in the below-average faces. The greatest disproportion in the attractive face was the moderately short columella in relation to the tip protrusion and in the below-average face the long nasal bridge related to the upper-lip height. Disproportions were associated with combinations of normal and abnormal measurements, or with two normal measurements of unequal quality, which resulted in a slightly smaller disfigurement. Analysis of ethnic and racial differences showed the soft nose as the main feature of the most characteristic differences. The study revealed that the key to restoration of facial harmony is the renewal of the uniformity of proportion index qualities by elimination disharmonies and/or disproportionate relationships.

Topics: Adult; Anthropometry; Ethnicity; Facial Asymmetry; Female; Humans; Male; North America; Nose; Racial Groups; Rhinoplasty

Rhinoplasty was performed in 134 non-Caucasians over a 16-year period. The indications and techniques for operative approaches pertinent to achieving facial balance and symmetry in the non-Caucasian are described. Alar flaring is best addressed with alar base resection. Alar base resection does not significantly narrow alar width. Reduction in interalar distance is best performed with interalar reduction. If alar flare and wide interalar distance coexist, one should always consider a secondary or tertiary procedure. Planning a secondary procedure avoids devitalizing tissues and multiple super-imposed incisions and permits minor revisions. A simplified approach to removal of excessive tip fat is discussed. Methods of addressing complications peculiar to non-Caucasian rhinoplasties are described. In order to avoid racial incongruity, one must incorporate an alar narrowing procedure, i.e., interalar reduction or alar sill advancement. The results of this study reemphasize the importance of analyzing the nose with respect to the rest of the face in order to establish guidelines for these often difficult nasal reconstructions.

Topics: Adult; Asian People; Black People; Edema; Facial Asymmetry; Female; Follow-Up Studies; Hispanic or Latino; Humans; Male; Middle Aged; Nose; Postoperative Complications; Rhinoplasty; White People

Twenty craniofacial indices composed of 26 surface measurements taken directly from the head and face were determined in 14 Apert's syndrome patients 18 days to 5 years old (younger subgroup) and 14 patients ages 6 years to 15 years old (older subgroup). All of the patients were North American Caucasians who had undergone early suture release but no facial repair. The indices were compared with those in healthy controls of the same age and sex. The wide intercanthal distance in relation to the narrow soft nose was the most frequent (81.5%) and extensive (17.7% above the maximum normal index value) disproportion. Abnormal indices occurred most often with the combination of one abnormal and one normal measurement (61.0%). All seven of the 16 disproportions seen in both age subgroups increased in frequency nonsignificantly with age: the supernormal cephalic, intercanthal, nasal, and vertical mandibulofacial indices and the subnormal nasofacial, upper face, and jaws' arcs indices. Of the six disproportions that decreased in frequency with age, four changed significantly (the supernormal frontoparietal and frontozygomatic indices and the subnormal mandibulofacial and nasozygomatic indices) and two changed nonsignificantly (the supernormal intercanthoalar and subnormal cheilozygomatic indices). With the exception of two nasal proportions, the extent of the disproportionality decreased in all of the indices that increased with age.

Topics: Acrocephalosyndactylia; Adolescent; Age Factors; Cephalometry; Child; Child, Preschool; Ear, External; Facial Asymmetry; Female; Germany, West; Humans; Infant; Infant, Newborn; Male; Mouth; North America; Nose; Orbit

The importance of skeletal reduction of the interorbital distance in the treatment of patients with teleorbitism is now well recognized. In spite of this, results of surgery are not always as good as one would hope. For this there are two reasons: (1) reduction of the interorbital distance may be followed by deformities such as canthal drift, enophthalmus, pseudoptosis, and so forth; and (2) hypertelorism is frequently associated with a variety of other malformations that become more conspicuous after reduction of the interorbital distance. In this paper attention is focused on the mechanisms responsible for the appearance of new stigmata, on their prevention, and also on the treatment of the associated malformations.

Topics: Abnormalities, Multiple; Adult; Blepharoptosis; Child; Child, Preschool; Craniofacial Dysostosis; Eye Abnormalities; Facial Asymmetry; Female; Humans; Hypertelorism; Lacrimal Apparatus; Male; Nose; Oculomotor Muscles; Orbit; Rhinoplasty; Surgery, Plastic

A new classification of malformations of the face and cranium is proposed, based on embryologic studies and observations concerning a great number of patients seen by the authors. First of all, one should distinguish between cerebral craniofacial (with brain and/or eyes involved) and craniofacial malformations. Craniofacial malformations may be characterized by dysostosis and by synostosis. Malformations with dysostosis may be produced by transformation as well as differentiation defects. Synostosis is always caused by a differentiation defect. A new nomenclature is introduced.

Topics: Craniofacial Dysostosis; Face; Facial Asymmetry; Fibrous Dysplasia of Bone; Humans; Mandible; Maxilla; Nose; Skull; Synostosis; Terminology as Topic

Topics: Child, Preschool; Diagnosis, Differential; Facial Asymmetry; Facial Bones; Female; Follow-Up Studies; Goldenhar Syndrome; Hearing Loss, Conductive; Humans; Infant; Mandibulofacial Dysostosis; Nose; Orbit; Scoliosis

Eight surface measurements of the nose and quality of nostril type and ala shape helped in the classification of 184 nostril asymmetries found in 1312 health North American Caucasians six to 18 years of age. Twenty-one of 1312 persons (1.6%) revealed severe degrees of nostril asymmetry characterized by uneven level of the alar base, asymmetries in the width of the nostril floor and length of the columella, and deviations in the columella and nasal bridge. This variation was most similar to the nasal disfigurement found in noncleft members of cleft families (Fukuhara and Saito, 1963; Tolarová et al., 1971). In order to accept this variation as a microform of the cleft anomaly, further anthropometrical study of the nose of noncleft members of cleft families will be required;

Topics: Adolescent; Cephalometry; Child; Cleft Lip; Cleft Palate; Facial Asymmetry; Female; Humans; Male; North America; Nose; White People

To find answers to the many questions about abnormal postnatal growth and change of the craniofacial skeleton, a series of surgical experiments was carried out in both young and adult animals. The purpose of this review is to relate this information to basic ideas about bone change and some local factors which may or may not affect skeletal changes. No gross regional deformity was noted after resection of sutures in young animals. The growth of bone at sutures was secondary or compensatory to other factors. In young animals, increase in size of the nasal or orbital cavities decelerated considerably after resection of either nasal septum or orbital tissues. With an increase in volume of orbital contents, orbital volume increased. These prominent gross changes in young animals were not noted in adult animals after resection of nasal septum, enucleation of the eye, or intrabulbar injection of silicone. After unilateral resection of the mandibular condyle in both young and adult monkeys, an extreme unilateral facial skeletal deformity developed. The important factor apparently was loss of integrity of the temporomandibular joint rather than loss of a growth site. The craniofacial skeleton, a three-dimensional mosaic of bones and cavities, develops as a result of the synchronous coordination of the differential activities at various sites. The dynamics of the growth and change are a fascinating, complex, incomplete chapter of biology. An understanding of factors that may or may not influence the craniofacial skeleton in both young and adult animals can aid diagnosis and surgical treatment.

Topics: Age Factors; Animals; Cartilage; Facial Asymmetry; Haplorhini; Mandible; Mandibular Condyle; Maxilla; Maxillary Sinus; Maxillofacial Development; Nose; Orbit; Osteotomy; Rabbits; Skull; Tooth Extraction

A child with a lateral trunk replacing one side of the external nose is presented with a detailed X-ray study of the deformed head. In the explanation of the etiology and teratogenesis of this facial anomaly, the modern embryologic development of the head is reviewed and correlated with the findings of this anomaly. It is felt that the lesion responsible for a proboscis lateralis involves the organizer tissue for the naso-face. As a secondary phenomenon, the development of the maxillary process is retarded and a spectrum of defects, common to many mid-face derangements, is identified and explained.

Topics: Embryonic Induction; Eye; Facial Asymmetry; Humans; Infant, Newborn; Male; Maxilla; Nose

Topics: Ethnology; Face; Facial Asymmetry; Functional Laterality; Humans; Hyperplasia; Nose