Korean J Orthod.  2023 Nov;53(6):402-419. 10.4041/kjod23.106.

Differences in facial soft tissue deviations in Class III patients with different types of mandibular asymmetry: A cone-beam computed tomography study

• Kim HJ
• Noh HK
• Park HS

• KMID: 2548484
• DOI: http://doi.org/10.4041/kjod23.106

Abstract

Objective
This study assessed the differences in soft tissue deviations of the nose, lips, and chin between different mandibular asymmetry types in Class III patients.
Methods
Cone-beam computed tomography data from 90 Class III patients with moderate-to-severe facial asymmetry were investigated. The sample was divided into three groups based on the extent of mandibular rolling, yawing, and translation. Soft tissue landmarks on the nose, lips, and chin were investigated vertically, transversely, and anteroposteriorly. A paired t test was performed to compare variables between the deviated (Dv) and nondeviated (NDv) sides, and one-way analysis of variance with Tukey’s post-hoc test was performed for intergroup comparisons. Pearson’s correlation coefficient was calculated to assess the relationship between the soft and hard tissue deviations.
Results
The roll-dominant group showed significantly greater differences in the vertical positions of the soft tissue landmarks between the Dv and NDv than other groups (P < 0.05), whereas the yaw-dominant group exhibited larger differences in the transverse and anteroposterior directions (P < 0.05). Moreover, transverse lip cant was correlated with the menton (Me) deviation and mandibular rolling in the roll-dominant group (P < 0.001); the angulation of the nasal bridge or philtrum was correlated with the Me deviation and mandibular yawing in the yaw-dominant group (P < 0.01).
Conclusions
The threedimensional deviations of facial soft tissue differed based on the mandibular asymmetry types in Class III patients with similar amounts of Me deviation. A precise understanding of soft tissue deviation in each asymmetry type would help achieve satisfactory facial esthetics.

Keyword

Cone-beam computed tomography; Facial asymmetry; Mandibular asymmetry type; Soft tissue deviation

Figure

• 

  Figure 1 A, Skeletal landmarks and cranial reference planes. B, Mandibular rolling and yawing based on the mandibular reference planes. FH, Frankfort horizontal; Cg, crista galli; Or, orbitale; Po, porion; Go, gonion; MF, mental foramen; PM, protuberance menti; Me, menton; MFmid, midpoint of the bilateral MF; NDv, nondeviated side; Dv, deviated side; Mn, mandibular; Rt, right; Lt, left; Op, opisthion.

• 

  Figure 2 Skeletal and dental measurements. A, Skeletal distance and angulation. B, Dental vertical distance. FH, Frankfort horizontal; Go, gonion; MSP, midsagittal plane; MFmid, midpoint of bilateral mental foramen; Me, menton; UM, maxillary first molar; NDv, nondeviated side; LM, mandibular first molar; UC, maxillary canine; LC, mandibular canine; Dv, deviated side.

• 

  Figure 3 Soft tissue landmarks investigated in this study. G’, soft tissue glabella; N’, soft tissue nasion; Prn, pronasale; Al, nasal ala; NDv, nondeviated side; Dv, deviated side; Sn, subnasale; Ls, labrale superius; NLF, nasolabial fold; Stms, stomion superius; Stmi, stomion inferius; Ch, cheilion; Li, labrale inferius; B’, soft tissue B point; Midchin, chin point at the level of midpoint of Ch and Subchin; Subchin, 15 mm lateral to Me’ on the lower chin contour; Pog’, soft tissue pogonion; Me’, soft tissue menton; Ac, nasal alar curvature; Me, menton.

• 

  Figure 4 Soft tissue measurements. A, Vertical distance. B, Transverse distance (blue, bilateral landmarks; black, midline landmarks). C, Anteroposterior distance. D, Line angulation. FH, Frankfort horizontal; Al, nasal ala; NDv, nondeviated side; Dv, deviated side; Ac, nasal alar curvature; Ch, cheilion; Me, menton; Me’, soft tissue menton; Subchin, 15 mm lateral to Me’ on the lower chin contour; G’, soft tissue glabella; N’, soft tissue nasion; MSP, midsagittal plane; Prn, pronasale; Sn, subnasale; NLF, nasolabial fold; Ls, labrale superius; Stms, stomion superius; Stmi, stomion inferius; Li, labrale inferius; B’, soft tissue B point; Pog’, soft tissue pogonion; Midchin, chin point at the level of midpoint of Ch and Subchin.

• 

  Figure 5 Schematic illustration of soft tissue deviations or differences in the yaw-dominant group (frontal and modified-submentovertex views; *P < 0.05, significantly greater difference than roll- and/or translation-dominant group). Al, nasal ala; Ac, nasal alar curvature; Prn, pronasale; Sn, subnasale; NLF, nasolabial fold; Ch, cheilion; Me’, soft tissue menton; Subchin, 15 mm lateral to Me’ on the lower chin contour; Midchin, chin point at the level of midpoint of Ch and Subchin.

• 

  Figure 6 Schematic illustration of soft tissue deviations or differences in the roll-dominant group (frontal view; *P < 0.05, significantly greater difference than yaw- and/or translation-dominant group). Al, nasal ala; Ac, nasal alar curvature; NLF, nasolabial fold; Ch, cheilion; Me’, soft tissue menton; Subchin, 15 mm lateral to Me’ on the lower chin contour.

• 

  Figure 7 Schematic illustration of soft tissue deviations or differences in the translation-dominant group (frontal view). Al, nasal ala; Ac, nasal alar curvature; NLF, nasolabial fold; Ch, cheilion; Me’, soft tissue menton; Subchin, 15 mm lateral to Me’ on the lower chin contour.

• 

  Figure 8 Color maps showing the soft tissue differences in distance between the original and mirrored images based on the midsagittal plane for each mandibular asymmetry type. The color maps were constructed using three-dimensional analysis software (Geomagic Control X; 3D Systems, Rock Hill, SC, USA). When original soft tissues were positioned out of or lateral to the mirrored images, yellow to red colors were mapped based on the distance, and pale blue to blue colors were mapped for the mirrored images relative to the original images. Line angulations that presented a significant correlation with menton (Me) deviation (*P < 0.05, **P < 0.01, ***P < 0.001). Ch, cheilion.

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