Prevalence of facial asymmetry in Tirupati population: A posteroanterior cephalometric and photographic study

Aesthetic Genioplasty Based on Strategic Categorization

BACKGROUND

Genioplasty is a popular procedure used for lower facial contour correction. Various osteotomy techniques enable us to perform advancement, setback, reduction, or narrowing procedures. Computed tomographic images facilitate preoperative planning in detail. The authors used a novel planning method based on strategic categorization. The analytic results are described.

METHODS

This retrospective study reviewed 208 patients who underwent genioplasty procedures for facial contouring from October of 2015 to April of 2020. During preoperative evaluation of the mandible, the operative procedure selected was one of three types: (1) horizontal segment osteotomy, (2) vertical and horizontal segment osteotomy, and (3) bone graft after repositioning. Adequate osteotomies were followed by rigid fixation using a titanium plate and screws. The follow-up period ranged from 8 to 24 months (average, 17 months). The results were assessed based on medical records, photographs, and facial bone computed tomographic images.

RESULTS

Overall, the patients were satisfied with the outcomes and had responder-based improvement in lower facial contour and balance. Chin point deviations were noted in 176 cases; left-side deviation ( n = 135) was more frequent than right-side deviation ( n = 41). Strategic osteotomies based on precise measurements led to correction of asymmetries. Temporary partial sensory losses reported in 12 cases resolved within an average of 6 months after surgery.

CONCLUSIONS

Each patient's chief complaint and bony structures should be carefully evaluated before genioplasty procedures are performed. During the operation, meticulous osteotomy, precise movement, and rigid fixation are necessary. The strategic process used for genioplasty resulted in aesthetic balance and predictable outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Relationships of Reference Points, Planes and Skull Symmetry on Posterior-anterior Cephalograms in Healthy Young Adults

BACKGROUND

Radiological cephalometry is an important diagnostic tool for analyzing the shape and proportions of the skull. Standardized teleradiography of the skull in posterior-anterior (PA) projection provides orientation data on the symmetry and vertical relations of the skull. The comparison of individual findings with normal values places high demands on the selection of a control group. The aim of this study was to characterize a group to be used as a standard for cephalometric comparisons.

PATIENTS AND METHODS

PA teleradiographs of 23 healthy young adults were analyzed. Distances from reference measuring points to the median sagittal plane and the orbital horizontal plane were made. All individuals showed ideal occlusion. None of the participants had been subjected to orthodontic therapy or craniomaxillofacial surgery.

RESULTS

The measurement results showed a high degree of lateral symmetry of the skeletal reference points and planes. Comparison of the vertical reference lines confirmed the symmetrical constitution of the facial skeleton.

CONCLUSION

The study group is suitable for comparison with the cephalometric evaluations of other study groups.

Analysis of hard tissue facial symmetry after unilateral mandibular reconstruction

Background

This study aimed to determine how successful reconstruction of the mandible can recover the symmetry.

Materials and methods

All patients who underwent surgical treatment for unilateral mandibular reconstruction in 4 years were retrospectively examined. Bilateral differences of gonion (GO) positions were measured in 3 dimensions based on immediate postoperative computed tomography. The data collected was analyzed in 3 ways: First, the comparison of bilateral differences of GO in 3 dimensions. Second, the mean Asymmetry Index in control subjects was used to divide all cases into three groups: “Symmetry,” “Asymmetry,” and “Marked asymmetry.” Third, “maximum normal asymmetry” was calculated, and all cases were categorized as below and above maximum normal asymmetry. The difference between two gonial angles was used to determine the amount of asymmetry.

Results

Forty-seven patients and 47 normal adults were enrolled. The mean bilateral GO difference in the control group was higher than in the study group patients, but it was not statistically significant. The mean Asymmetry Index for the control group was not also significantly higher than the study cases. The study group was “Symmetric” in 78.7% of the cases whereas the control group in 91.4%, 19.1% of the study group and 8.5% of controls were “Asymmetric,” and 2.1% of study cases and 0% of controls were “Markedly Asymmetric.” Maximum normal asymmetry was 82.9% in the study group and 97.8% in the control group. The mean differences between the right and left gonial angles were higher in the study group, but it was not significant (P = 0.1).

Conclusions

Our study’s results showed that bilateral symmetry in mandibular reconstruction patients was satisfactory and similar to the normal individuals.