Facial asymetries

By: Dr.Adeel Butt

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Facial symmetry, is one element of bodily

symmetry, including fluctuating asymmetry.

Along with traits such as averageness and

youthfulness it influences judgements of

aesthetic traits of physical attractiveness and

beauty, and is associated with fitness-linked

traits including health,[1] It is also hypothesized

as a factor in both interpersonal attraction and

interpersonal chemistry.

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Evaluation of normal symmetry of face include determination of facial height and width.

Facial vertical height:facial vertical height can be evaluated in both

frontal view as well as lateral view of face.

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The easiest way to evaluate the relative width of facial structures is to divide the face into vertical fifths with each fifth being equal to one. The face can be divided into fifths using the width of the eye from corner to corner as a point of measurement. Starting from the very outside edge of one ear to the other -- the face ideally would be 5 eye widths apart. Of course, since we are human and not designed by computers, it is perfectly fine if you are not exactly 5 eye widths a part. The width of the base of the nose, at the nostrils (or ala), should be 1/5 of the face, or one eye widtheye width.

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Other parameters to be evaluated:Lips - Other considerations include the width of the lips, the interlabial gap and the degree of incisor show with smiling. The oral commissures should be located along vertical lines drawn from the medial limbus of the iris. Also, the lower lip should be slightly fuller than the upper lip. When relaxed and with teeth in occlusion, the lips should approximate one another with an interlabial gap of 3 mm being the upper limit of acceptable. When smiling, there should be no gingival show and no more than two thirds of the maxillary incisors exposed

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The length of upper lip is about twice that of lower lip and chin.

The position of upper lip in smile is that it should not be ideally covering more than 1/4th of teeth.

The teeth may be touching the lower lip or there may be a slight gap.

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The width of nose at its base should be approximately the distance between the eyes (medial canthus).

The angle at the bridge of nose should be near the eyelashes.

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Any deviation from the normal symmetry of face leading to the problems associated with aesthetics ,occlusion etc.

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1)Congenital defect:•Facial hemi-trophy or hypertrophy of superfacial tissue ,

muscle & bone.

•Mandibular Condylar hypoplasia due to intrauterine or birth

trauma.

•TMJ Ankylosis, the mandible moves to the affected side.

•Mandibular body or ramus hyperplasia, the mandible moves

to the unaffected side.2)Traumatic:Zygomatic process fracture & followed infra orbital depression.3)Inflammatory:Abscess - cellulitis - cyst

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4)Muscular:a- Atrophy of facial musculature following Bell's palsy.

b- Hyperplasia of masseter muscle in clenching habit.

c- Patients using only one side in chewing5)Salivary Glands:Inflammatory as mumps or neoplastic.6)Neoplastic:Ameloblatoma - lipoma - osteoma

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Congenital, Developmental Disorders Shprintzen-Goldberg craniosynostosis syndrome (15q21.1)

defects in the palate, mild differences in facial features, Cleft palate.

Also named as DiGeorge syndrome (DGS), DiGeorge anomaly,[2][3]

velo-cardio-facial syndrome, Shprintzen syndrome, conotruncalanomaly face syndrome.

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Goldenhar syndrome:

Chief markers of Goldenhar syndrome are incomplete development of the ear, nose, soft palate, lip, and mandible on usually one side of the body. It is associated with anomalous development of the first branchial arch and second branchial arch.

Silver-Russell syndrome:

Russell-Silver syndrome (RSS) is a growth disorder affecting growth of jaws leading to asymmetric growth of mandible.

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Curry-Jones Syndrome:

Curry Jones syndrome is the association of cranio-facial anomalies. Unilateral craniosynostosis and shortness of the base of the skull caused striking asymmetry of the face. Hypertelorism and narrow palpebralfissures are observed as well.

Klipple-Feil syndrome:

cleft palate, associated with abnormalities of the head and face.

AmeloblastomaHemifacial atrophy hemifacial hypertrophy

tmj ankylosis emerg_facialswelling

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Different methods are used to detect the facial asymmetries.

1)frontal analysis (PA ceph)

2)ceph smile.(computerized method)

3)symmeter and symface.

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Landmarks on PA view For frontal ceph:

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This include;

1)dental frontal problem.

2) maxillomandibular relationship.

3) dentoskeletal relationship.

4) craniofacial relationship.

5) inner structural.

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Molar relation:

distance b/w buccal surface of upper and lower molar at occlusal plane level.

normal value is 1.5mm upper molar buccaly.

lower or –ve value means lingual cross-bite.

higher value means buccal cross-bite.

Intermolar width:

distance b/w buccal surface of mand.1st molar at occlusal plane level.

Normal value 55mm for boys and 54mm for girls.

It measures arch width.

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Intercuspid width:

Distance b/w cusps of both mand.cuspids at o.p.

normal value 22.7mm at age 7 and adult is 27.5mm.

determine spcae problem in lower arch.

Denture midline:

space between maxillary and mandibular midlines.

determine co-incidence of midlines.

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Left and right maxillomandibular width:

distance b/w pt.j and frontal facial plane(zr-ga)

normal value is 10mm for average student.

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Maxillomandibular midline:angle b/w midsgital plane and

ANS-Me.determine mandibular

midline deviation and it represent functional or skeletal asymmetry.

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Molar to both jaws:distance b/w buccal surface of mand.1st

molar and frontal maxillomandibular plane.normal value is 6.3mm.an increased value indicate buccal mandibularexpansion.

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Postural symmetry:

difference b/w ZL-

AG-ZA and ZR-GA-AZ

normal value is 0 degree.

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5) inner structural. Nasal width: max. width of nasal cavity and

help to assess mouth breathing if reduces value than normal value 0f 25mm

Nasal height: distance b/w ANS and ZL-ZR plane.

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Maxillary width: distance b/w J points.itindicate max.growth.

Mandibular width: distance b/w AG and GA. Facial width: distance b/w ZA and AZ.

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Symmeter is a web-based system that provides a simple way to measure the symmetry of any person, place or thing that can be rendered through a digital image.

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Treatment options for facial asymmetries include :

1)growth modification.

2)camouflage.

3)orthognathic surgery.

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Growth modification:

mainly achieved in children when growing age is still present by the use of orthopaedica and myofunctional appliances.

Orthodontic camouflage:when skeletal deformity is very mild and any

further change is not expected,camouflage should be considered.Camouflage should not be done at the expense of undesirable facial esthetics though there may be some compensation of the same.

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Conditions with severe skeletal asymmetries are not able to be corrected by orthodontic camouflage and growth modification so surgical procedures are used to correct the deformities or asymmetries.

Before opting orthognathic surgery, pre-surgical

orthodontics have to be done i.e,

• Position the teeth over respective basal bone.

• Allign and level teeth.

• Adjust slight discrepencies.

• Adjust rotations.

• Achieve root parallelling .

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Treatment options include:

mandibular hyperplasia: 1)sagital split osteotmy.2)sub-sigmoid osteotomy.

Mandibular hypoplasia:1)sagital aplit osteotomy with mandibular

advancement.

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Maxillary hypoplasia:

1)Le-forte 1 osteotomywithmax.advancement.

Maxillary hyperplasia:maxillary segmental setback.

Maxillary vertical excess:leforte-1 osteotomy with maxillary impaction.

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Cosmetic surgeries are also used for the correction of facial asymmetries like,

1)rhinoplasty.

2)genioplasty.

3)cheiloraphy.

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The end

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