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To evaluate non-invasively the morphological features of both lateral pterygoid muscle (LPM) and masseter muscle by using diffusion tensor Imaging on two patients affected by mandibular asymmetry.Two female patients with mandibular excess and asymmetry who underwent Le Fort I osteotomy and bilateral sagittal split osteotomy were recruited for this study. Morphological (TDiffusion tensor imaging was able to identify the muscle geometrical morphology and diffusion microstructural changes. Both at T0 and T1, mean FA values had no significant differences between the right and left side of masseter (at T0: p = 0.91; at T1: p = 0.54) and LPM (at T0: p = 0.92; at T1: p = 0.43), respectively. Both patients reported a significant improvement in FA mean values of the left LPM (p = 0.03) between T0 and T1, whereas no diffusion parameters' changes were observed for the bilateral masseter muscles and right LPM.We found that after the surgery the LPM ipsilateral to the deviation side showed a significant increase of FA compared to the baseline. Although preliminary, our findings suggest that diffusion tensor imaging may represent a promising tool to investigate non-invasively the masticatory muscles in temporomandibular joint disorders.

Class III malocclusions are considered to be one of the most difficult problems to treat. Due to the significant number of patients with Class III malocclusion who cannot undergo orthognathic surgery for different reasons, we have proposed an alternative treatment that we have called surgically assisted rapid palatal expansion (SARPE) + temporary anchorage devices (TADs) which allows solving mild and moderate Class III malocclusion combined with maxillary compression, obtaining acceptable esthetic and functional results. We present a case report of an adult female with skeletal Class III malocclusion with compression in the maxillary and mandibular asymmetry, who was treated with SARPE + TADs. The result is acceptable in terms of occlusion function, esthetic of the smile, and facial esthetics SI

To investigate the prevalence of mandibular asymmetry (MA) within the symptomatic unilateral anterior disc displacement (ADD) patients, and analyze the influence TMJ factors of the MA severity.Patients aged under 20 years old with symptomatic unilateral ADD and asymptomatic volunteers with normal disc-condyle relationship diagnosed by magnetic resonance imaging (MRI) were included in this study. Posteroanterior cephalometric radiographs were taken to measure MA. Condylar height, disc length and disc displacement were measured by MRI. The prevalence and severity of MA were compared between the ADD and the control groups. The correlation between the severity of MA with the amount of condylar height shortage, disc deformity and distance of disc displacement were also evaluated within the ADD group.There were 165 cases in the unilateral ADD group, and 156 cases in the control group. One hundred and nineteen cases had MA which accounted 72.12% (119/165) in the ADD group; while in the control group, only 25.64% (40/156) exhibited MA. The mean horizontal menton deviation and condylar height shortage in the unilateral ADD group were significantly larger than that in the control group (5.62 mm vs. 4.19 mm; 3.14 mm vs. 1.32 mm, p0.01). The severity of MA was significantly correlated with the amount of disc displacement, disc deformity and condylar height shortage (correlation coefficient: 0.80, 0.70, and 0.82).MA is much more common and severe in young unilateral ADD patients. The severity of MA is correlated with the height of condyle and the status of the disc.

Riassunto Obiettivi Scopo del lavoro e fornire gli elementi per diagnosticare correttamente un’asimmetria mandibolare di tipo funzionale. Materiali e metodi Attraverso una revisione della letteratura viene analizzata l’asimmetria funzionale con particolare riferimento alle caratteristiche cliniche e muscolari e alle cause determinanti la malocclusione. Risultati e conclusioni L’asimmetria funzionale e un quadro clinico che si manifesta in soggetti in crescita. L’esame obiettivo, l’analisi radiografica e lo studio dei modelli in gesso permettono di effettuare una diagnosi adeguata al fine di ricondizionare la crescita del paziente in una direzione armonica.

The aim of this study was to describe directional and fluctuating mandibular asymmetry over time in children with Crouzon or Apert syndrome. Mandibular asymmetry of children between 7.5 and 14 years of age with Crouzon syndrome (n = 35) and Apert syndrome (n = 24) were compared with controls (n = 327). From panoramic radiographs, mandibular directional and fluctuating asymmetry was determined for the three groups. Multilevel statistical techniques were used to describe mandibular asymmetry changes over time. Patients with Crouzon and Apert syndromes showed statistically significant more fluctuating asymmetry for mandibular measures than did controls. Between the Crouzon and Apert syndromes groups, no statistical differences were found in directional and fluctuating asymmetry. The control group showed statistically significantly more directional asymmetry than did patients with Crouzon or Apert syndrome. The controls showed no change over time for the directional asymmetry of condylar-ramal height; however, the directional asymmetry of the gonial angle increased. Patients with Crouzon syndrome showed side dominance for only condylar-ramal height; whereas, patients with Apert syndrome did not show dominance for any of the measurements. Apert and Crouzon syndromes showed developmental instability, in contrast to the controls. No statistically significant longitudinal differences were found for either the directional or the fluctuating asymmetry between Crouzon and Apert syndromes. Findings for fluctuating and directional asymmetry for both syndromes may indicate an inability to cope with genetic and environmental stress during development and treatment, compared with untreated nonsyndromic individuals.

Purpose Facial asymmetries due to unilateral condylar hyperactivity are often a challenge both for maxillo-facial surgeons and for orthodontists; the current literature shows different opinions about aetiology, classification, treatment approach and timing. We made a retrospective study on patients suffering from unilateral condylar hyperactivity between 1997 and 2015 in our Department; clinical features and treatment options were grouped and compared with literature. Methods The descriptive analysis investigated variables like sex, age, side and direction of the asymmetry, condylar activity and type of intervention. Results The population was composed of 128 patients. The hemimandibular hyperactivity occurs equally in both sexes around the second decade, although the range of the first consultation goes from 7 to 49 y.o. The vertical hyperdevelopment group is almost equal to the horizontal. All the patients with horizontal hyperactivity showed negative scintigraphy and were treated with pre-surgical orthodontics and orthognathic surgery; patients with vertical hyperactivity and positive scintigraphy were treated with condylectomy and post-surgical orthodontics. Conclusion In our group of patients, direction of the hyperactivity and results of the scintigraphy lead to treatment choice and timing. Further studies are necessary to explain why, in our group, all the patients with horizontal involvement are negative to scintigraphy.

Objective: To compare the three-dimensional (3D) morphology of the upper airway in skeletal Class III patients with and without mandibular asymmetry and to investigate the possible underlying correlations between the morphology of the upper airway and mandibular deviation. Materials and Methods: Cone-beam computed tomography images of 54 subjects with skeletal Class III malocclusion (ANB angle ≤ 0.4°, Wits ≤ −5.5°) were taken and 3D upper airway models were reconstructed using Dolphin 3D software. According to the distance (d) from symphysis menti to the sagittal plane, all subjects were divided into a symmetry group (d ≤ 2 mm) and an asymmetry group (d ≥ 4 mm). Based on the severity of mandibular deviation, the asymmetry group was divided into subgroup I (4 mm ≤d Results: Width of the inferior limit of the glossopharynx (P3W), cross-sectional area of the anterior limit of the nasal airway (P5S), and height of the glossopharynx (GPH) in the asymmetry group were significantly larger than in the symmetry group. As for subjects with severe mandibular deviation in subgroup II (d ≥ 10 mm), volume of the glossopharynx (GPV), total volume of the pharynx (TPV), length of the inferior limit of the velopharynx (P2L), and ratio of length to width of the inferior limit of the velopharynx (P2L/P2W) showed significantly negative correlations with mandibular deviation (r > 0.7, P < .05). Conclusions: In Class III subjects with severe mandibular asymmetry, the pharyngeal airway showed a tendency toward constriction and presented a more elliptical shape as mandibular deviation became more severe (P < .01).

Diffuse sclerosing osteomyelitis (DSO) affects adults, exhibits no gender predilection, and often occurs in the jawbone. A 20-year-old male patient presented to our service with "facial pain" and mandibular asymmetry caused by a bone enlargement in the right side. Computerized tomography (CT) scanning showed large, mixed radiolucent and radiopaque areas associated with bone erosions from mandibular condyle to ipsilateral body. Culture and antibiogram analysis were negative. Histopathologic examination demonstrated unspecified bone inflammation signs. After review of the literature, the patient was referred to a rheumatologist and methotrexate in combination with folic acid was initiated on a weekly basis. The patient reports progressive reduction of pain although facial asymmetry still persists. Diagnosis of DSO may be challenging due to nonspecific findings and rarity of the disease. Fibrous dysplasia should be ruled out.

악안면기형의 분석 및 치료에 있어서 두부방사선 계측사진을 기반으로 한 2차원 평면기준 진단 및 치료계획 수립은 약 30년 전부터 현재까지 많은 임상가에 의해 안정적으로 이용되고 있는 방법이다 (1-3). 2차원 기반의 악안면기형의 분석은 장기간의 연구결과가 누적되어 있어 예측이 가능하고 신뢰할 수 있으며, 쉽고 빠르게 적용할 수 있는 장점이 있다. 하지만, 심한 악안면기형의 경우 두부방사선 계측사진 상 구조물의 중첩으로 인해 분석이 어렵고 수술 후 나타나는 3차원적 변화를 2차원 평면에서 예측해야 하기에 경험이 부족한 임상가의 경우 기형이 잔존하는 문제를 만들 수 있다 (4). 또한, 안면비대칭 중 하악골비대칭이 두드러진 경우 2차원을 기반으로 한 분석의 경우 두부규격분석으로 하악각 (gonial angle), 하악지 고경 (ramal height), 하악체 길이 (mandibular body length)등을 비교할 수 있으나, 이러한 값들은 X-ray 조사관으로부터 필름까지의 거리의 차이로 인해 확대율의 차이가 생기고, 따라서 우측 영상과 좌측 영상의 값에 차이가 나타나 잠재적으로 수술 후 비대칭의 잔존 가능성이 증가하게 된다 (5).영상에서부터 얻어지는 3D 영상은 앞에서 언급한 2차원적 분석의 한계에 대한 해결책이 될 수 있을 것으로 보인다. 특히 최근에는 3D에 대한 사회적인 관심이 증가하고 있고, 악안면기형 분야에 있어서도 3차원적인 분석과 연구는 활발하게 이루어지는 중이며 3D를 이용한 기법이 증가하고 있다. 3차원 영상 처리 기법 및 가상수술을 진행할 수 있는 컴퓨터 소프트웨어의 발달에 따라 2차원의 단점을 극복할 수 있는 치료법이 최근 많이 시도되고 있다. 특히 컴퓨터단층촬영 (Computerized tomogra-phy, CT) 영상의 정밀도 향상과 3D 프린팅을 이용한 입체인쇄술의 발달로 환자 두개골, 악골과 악궁의 정밀한 3D 모형의 제작이 가능하고, 최근에는 실제 수술에 적용할 수 있는 guide를 3D printing 함으로써 수술의 정확도를 높이는 수준까지 기법이 발달하였다 (6-8). 본 증례 보고에서는 하악골에 국한된 비대칭에 있어서 현재 적용할 수 있는 3차원 치료 프로토콜을 이용한 실제 환자의 치료과정을 살펴봄으로써 현재의 3D 영상 기술을 통한 가상수술의 임상적용 예를 보고하고자 한다.

Purpose: This study was performed to investigate the relationship between temporomandibular disorders (TMDs) and the asymmetry of the mandibular height. Methods: We compared 100 randomly selected TMD patients diagnosed by the research diagnostic criteria for TMD (RDC/TMD) Axis I with 100 non-TMD control subjects matched with the TMD patients in age and gender. The mandibular heights were measured on an orthopantomogram and the asymmetry index (AI) was calculated as previously described. Results: The absolute AI value of 4.37% turned out to be the least cut-off value defining asymmetry, which showed a significant difference in asymmetry incidence (p Conclusions: Although it does not imply a direct cause-and-effect relationship, asymmetry resulting in more than 4.37% difference between mandibular heights may increase the risk of TMD and correlates positively to the incidence of arthritic change in the temporomandibular joint of TMD patients.

OBJECTIVE: This preliminary study aimed to propose a new analysis of digital panoramic radiographs for a differential diagnosis between functional and morphological mandibular asymmetry in children with and without unilateral posterior crossbite. METHODS: Analysis is based on linear and angular measurements taken from nine anatomic points, demarcated in sequence directly on digital images. A specific plug-in was developed as part of a larger public domain image processing software (ImageJ) to automate and facilitate measurements. Since panoramic radiographs are typically subject to magnification differences between the right and left sides, horizontal linear measurements were adjusted for greater accuracy in both sides by means of a Distortion Factor (DF). In order to provide a preliminary assessment of proposed analysis and the developed plug-in, radiographs of ten patients (5 with unilateral posterior crossbite and 5 with normal occlusion) were analyzed. RESULTS: Considerable divergence was found between the right and left sides in the measurements of mandibular length and position of condyles in patients with unilateral posterior crossbite in comparison to individuals with normal occlusion. CONCLUSION: Although there are more effective and accurate diagnostic methods, panoramic radiography is still widespread, especially in emerging countries. This study presented initial evidence that the proposed analysis can be an important resource for planning early orthodontic intervention and, thus, avoid progression of asymmetries and their consequences. OBJETIVO: esse estudo preliminar teve como objetivo propor uma nova análise de radiografias panorâmicas digitais para o diagnóstico diferencial entre a assimetria mandibular funcional e morfológica em crianças com e sem mordida cruzada unilateral posterior. MÉTODOS: a análise se baseia em medições lineares e angulares, tomadas a partir de nove pontos anatômicos, demarcados em sequência, diretamente nas imagens digitais. Um plugin específico foi desenvolvido para automatizar e facilitar as medições, como parte integrante de um software de processamento de imagem de domínio público (ImageJ). Para maior acurácia, uma vez que as radiografias panorâmicas são sujeitas a distorções entre os lados direito e esquerdo, as medidas lineares horizontais foram ajustadas em ambos os lados, utilizando-se o Fator de Distorção (DF). A fim de fornecer uma avaliação preliminar da análise proposta e do plugin desenvolvido, radiografias de 10 pacientes (5 com mordida cruzada unilateral posterior e 5 com oclusão normal) foram analisadas. RESULTADOS: divergência considerável foi encontrada entre os lados direito e esquerdo nas medições do comprimento do corpo da mandíbula, bem como a posição dos côndilos, em pacientes com mordida cruzada posterior, em comparação a indivíduos com oclusão normal. CONCLUSÃO: apesar de existirem métodos mais eficazes e precisos de diagnóstico, a radiografia panorâmica ainda é muito difundida, especialmente em países emergentes. Esse estudo apresentou evidência preliminar de que a análise proposta pode ser um recurso importante para o planejamento de intervenção ortodôntica precoce, de modo a evitar progressão das assimetrias e suas consequências.

Made available in DSpace on 2015-08-06T16:14:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-08-01. Added 1 bitstream(s) on 2015-08-06T16:44:22Z : No. of bitstreams: 1 S2176-94512014000400080.pdf: 408292 bytes, checksum: 216d1dba3abf9cc3c61f324c16ce157c (MD5) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) INTRODUÇÃO:as telerradiografias laterais são tradicionalmente solicitadas para planejamento ortodôntico, mas raramente utilizadas para avaliar assimetrias.OBJETIVO: o objetivo do presente estudo foi utilizar as telerradiografias laterais para identificar as alterações morfológicas esqueléticas e dentoalveolares existentes na má oclusão de Classe II subdivisão e compará-las com a morfologia existente nas más oclusões de Classe I e II.MÉTODOS:noventa telerradiografias laterais iniciais de adolescentes brasileiros de ambos os sexos, com idade cronológica entre 12 e 15 anos, foram divididas em três grupos randomizados e proporcionais: Grupo 1 (Classe I), Grupo 2 (Classe II) e Grupo 3 (Classe II subdivisão). A análise das telerradiografias laterais envolveu mensurações angulares, mensurações lineares horizontais e dois índices de assimetria, estipulados para o presente estudo.RESULTADOS:foi identificada, de acordo com o Índice de assimetria dentária (IAD), uma maior assimetria dentária inferior no Grupo 3. O Índice de assimetria mandibular (IAM) revelou menor assimetria esquelética e dentária no Grupo 2, maior assimetria esquelética no Grupo 1 e maior assimetria dentária inferior no Grupo 3.CONCLUSÃO:o IAD e o IAM mostraram maior assimetria dentária inferior no Grupo 3 do que nos Grupos 1 e 2. Esses resultados estão de acordo com os encontrados em outros métodos de diagnóstico, indicando que a telerradiografia lateral é um método aceitável para avaliar alterações morfológicas esqueléticas e dentoalveolares nas más oclusões. INTRODUCTION:Lateral cephalometric radiographs are traditionally required for orthodontic treatment, yet rarely used to assess asymmetries.OBJECTIVE: The objective of the present study was to use lateral cephalometric radiographs to identify existing skeletal and dentoalveolar morphological alterations in Class II subdivision and to compare them with the existing morphology in Class I and II relationship.MATERIAL AND METHODS:Ninety initial lateral cephalometric radiographs of male and female Brazilian children aged between 12 to 15 years old were randomly and proportionally divided into three groups: Group 1 (Class I), Group 2 (Class II) and Group 3 (Class II subdivision). Analysis of lateral cephalometric radiographs included angular measurements, horizontal linear measurements and two indexes of asymmetry that were prepared for this study.RESULTS:In accordance with an Index of Dental Asymmetry (IDA), greater mandibular dental asymmetry was identified in Group 3. An Index of Mandibular Asymmetry (IMA) revealed less skeletal and dental mandibular asymmetry in Group 2, greater skeletal mandibular asymmetry in Group 1, and greater mandibular dental asymmetry in Group 3.CONCLUSION:Both IDA and IMA revealed greater mandibular dental asymmetry for Group 3 in comparison to Groups 1 and 2. These results are in accordance with those found by other diagnostic methods, showing that lateral cephalometric radiography is an acceptable method to identify existing skeletal and dentoalveolar morphological alterations in malocclusions. State University of São Paulo School of Dentistry PUC State University of São Paulo School of Dentistry Department of Pediatric Dentistry and Orthodontics

The purpose of this study was to investigate the differences in mandibular morphology between the deviated and nondeviated sides in patients with noncongenital skeletal mandibular asymmetry. Divergences from control values were assessed to determine which region of the mandible contributes most to mandibular asymmetry. We measured various dimensions of the mandible in 20 young patients and 20 controls using noninvasive high-quality three-dimensional (3D) volumetric magnetic resonance imaging. Mandibular dimensions including the length of the condylar process were significantly greater on the nondeviated side of patients than the deviated side. Measurements of the deviated side were similar to control values, but measurements of the nondeviated side including condylar process length differed significantly from control values. These findings strongly suggest that overgrowth of the condylar process on the nondeviated side in these patients results in mandibular asymmetry, and therefore needs attention in orthodontic treatment, orthognathic surgery, and follow-up.

Purpose: The purpose of this study was to perform three-dimensional (3D) assessment of facial soft tissue in patients with skeletal Class III and mandibular asymmetry after orthognathic surgery. Methods: Samples consisted of 3D facial images obtained from five patients with A point-nasion-B point angle less than 2 degrees, and more than 5 mm of menton deviation. All patients had been treated at Gangneung-Wonju National University Dental Hospital from 2009 to 2012. They had undergone orthognathic surgery of Lefort I, and sagittal split osteotomy for correction of skeletal deformity, and orthodontic treatment. Facial scanning was performed before treatment (T1) and post-surgical orthodontic treatment (T2). Linear and angle variables of soft tissue landmarks, antero-posterior facial depth, and facial volume were measured. Results: No significant differences in width of the alar base, mouth width, and nasal canting were observed between T1 and T2. However, lip deviation, menton deviation, alar canting, lip canting, and menton deviation angle were significantly reduced at T2. Antero-posterior facial depth on the axial plane parallel to the left cheilion was significantly reduced on the deviated side and significantly increased on the non-deviated side at T2. Volume of the lower lateral and lower medial parts of the face was reduced on the deviated side, and volume of upper lateral and lower lateral parts on the non-deviated side was significantly increased at T2. Conclusion: After orthognathic surgery, facial asymmetry of soft tissue was improved following skeletal changes, especially the mandibular region. Although the length of the alar base and mouth width did not change, lip and soft tissue menton were displaced to the medial side after treatment. Facial depth also became symmetric after treatment. Facial volume showed a decrease on the lower part of the deviated side and that on lateral parts of the non-deviated side showed an increase after treatment.

Mouthparts and genae of the adult females of Doubledaya bucculenta Lewis (Coleoptera: Erotylidae: Languriinae) exhibit distinct directional asymmetry. Females excavate holes with their mandibles on hard internodes of bamboos to deposit their eggs on the inner surface of internodes. To determine the relationship between the spatial distribution pattern of completed oviposition marks (COMs) and the degree of mandibular asymmetry, COMs were counted on the culms and internodes of the bamboo Pleioblastus simonii (Carriere) Nakai (Poaceae), and the survival rate of immature stages was investigated. Another languriine beetle, Anadastus pulchelloides Nakane, exhibits a smaller degree of mandibular asymmetry. For this species, COMs were also investigated on culms and internodes but of the perennial grass Arundinella hirta (Thunb.) Tanaka. Females of the two beetle species selected large basilar internodes of host plant culms for oviposition in the field. The mean number ±SD of COMs per COM-containing inte...

The mandibular asymmetry is important because of its direct effect on facial appearance. Aims: The aim of the present study was to determine the prevalence and severity of mandibular asymmetries between right and left sides. Materials and methods: The sample consisted of 22 males and 23 females having lateral cephalometric and orthopantomographic radiographs. Four linear and two angular measurements were compared between right and left sides of the mandible. These measurements were: ramus height(RH), ramus width(RW), corpus height(CH), corpus length(CL), gonial angle(Go) and condylar angle(Co). Results: The study revealed no significant differences between right and left sides of the mandible, in both gender, regarding the 4 linear measurements. Whereas for the angular measurements there was a significant difference in condylar angle between right and left sides in both male and female groups. Also no significant gender differences were found regarding all measurements except in corpus height. Conclusion: No significant facial asymmetry was found between right and left sides of the mandible for the population being studied in both genders except in condylar angle. In addition it was found out that severe mandibular asymmetry is not so a common occurrence

This chapter describes current evidence regarding early management of posterior crossbites. In order to understand the treatment of posterior crossbite definitions, aetiology, epidemiology and the implications of posterior crossbites will be summarised. Current evidence suggests that there is a need for further long-term epidemiological studies to monitor the effects of a unilateral posterior crossbite (UPXB) and spontaneous correction rate as current evidence is conflicting. In addition, randomised controlled trials comparing competing interventions are justified. These should be methodologically sound, adequately powered and record outcomes that take into account participants’ views and experiences of the treatment. They should also report the proportion of cases whose UPXB is corrected and in the follow-up period, remains stable until the permanent dentition is established. Based on current evidence, there is justification for the early orthodontic treatment of UPXB with mandibular shifts. There is some weak evidence that posterior crossbites with mandibular shifts are associated with temporomandibular dysfunction and reduced bite force and that children and adolescents with UPXB show signs of some degree of mandibular asymmetry. Randomised controlled trials suggest that treatment appears to be stable if undertaken in the mixed dentition. The appliance of choice appears to be the quad-helix appliance because the evidence suggests that treatment is quicker; they are more cost-effective and tolerated better than their alternatives, i.e. expansion plate or arch.

Las asimetrías mandibulares son un problema de difícil manejo que precisan de un estudio minucioso para establecer su causa, localización y grado de afección. El presente trabajo investigativo propone el empleo del análisis de Tatis realizado en la radiografía panorámica como una herramienta valiosa para obtener el diagnóstico de las asimetrías mandibulares de manera sencilla, eficiente, económica, con un menor costo biológico y sin requerir otras tomas radiográficas. El objetivo general fue el comparar el diagnóstico sobre asimetrías mandibulares obtenido a partir del análisis frontal de Ricketts en radiografías posteoanteriores y el análisis de Tatis en radiografías panorámicas. Se seleccionaron 50 radiografías digitales panorámicas y 50 posteroanteriores de un mismo paciente, de los registros que pertenecían a los pacientes que acuden a la Clínica Odontológica Cabezas ubicada en la ciudad de Quito. Las radiografías panorámicas fueron estudiadas por el análisis de Tatis a través del software Orthokinetor Plus versión 1.0.228, en tanto que, las radiografías posteroanteriores fueron interpretadas por el estudio frontal de Ricketts mediante el software Dolphin versión 9.0.00.19. Los valores obtenidos fueron tabulados y analizados estadísticamente. Al comparar el diagnóstico obtenido mediante el análisis de Tatis con el del análisis frontal de Ricketts, se encontró una concordancia muy alta al momento de indicar la presencia o ausencia de asimetrías mandibulares, con una proporción de acuerdos del 98% y una concordancia moderada cuando determinan la dirección de la desviación mandibular, con una proporción de acuerdos del 74%.

Background: To present the outcomes for a case of unilateral mandibular subcondylar fracture with dislocation in an 11-year-old female treated with an acrylic splint for functional repositioning of the mandible. Clinical presentation: A splint was placed in the upper arch to restore the functional repositioning of the mandible. The splint’s height was increased up to 5.5 mm on the side of the fracture to stimulate growth on the deficient side. To correct the mandibular asymmetry, a construction bite was made by 4 mm advancing. The total treatment time was 16 months. Long-term five-year follow up showed complete healing. A portion of the ramus appeared lateral with respect to the condylar head, whereas the mandibular deviation to the right side was fully corrected. Conclusion: Conservative treatment may be an appropriate method for children in select cases, as they have an increased potential for spontaneous regeneration. Background: To present the outcomes for a case of unilateral mandibular subcondylar fracture with dislocation in an 11-year-old female treated with an acrylic splint for functional repositioning of the mandible.Clinical presentation: A splint was placed in the upper arch to restore the functional repositioning of the mandible. The splint's height was increased up to 5.5mm on the side of the fracture to stimulate growth on the deficient side. To correct the mandibular asymmetry, a construction bite was made by 4mm advancing. The total treatment time was 16months. Long-term five-year follow up showed complete healing. A portion of the ramus appeared lateral with respect to the condylar head, whereas the mandibular deviation to the right side was fully corrected.Conclusion: Conservative treatment may be an appropriate method for children in select cases, as they have an increased potential for spontaneous regeneration.

Introduction Identifying menton (Me) on posteroanterior cephalograms and three-dimensional (3D) cone-beam computed tomography (CBCT) images is difficult, because the midpoint of the symphyseal area is not identifiable after the mandibular symphysis fuses at an early age. The aim of this study was to evaluate the reliability of the identification of the genial tubercle (GT) in patients with mandibular asymmetry and to compare it with that of the traditional landmark, Me. Methods The samples comprised 20 CBCT images of adults with mandibular asymmetry. Two examiners performed the identifications and measurements. Me and GT were marked, and the anteroposterior, vertical, and transverse distances to the three reference planes were measured on 3D-reconstructed CBCT images. The intra- and inter-examiner reliability of landmark identification of Me and GT were assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots. Results The Me and GT landmarks showed excellent reliability (ICC ≥ 0.993) three-dimensionally. In the transverse evaluation, the ICC values of the GT (range, 0.997-0.999) tended to be slightly higher than those of Me (range, 0.993-0.996). In the Bland-Altman plots for the two separate assessments, Me showed a maximum error of 1.76 mm in the transverse direction, whereas the GT showed a maximum error of 0.96 mm in the 95% limit. Conclusions Our results suggest that both Me and GT are clinically reliable and equally useful landmarks for the evaluation of mandibular asymmetry on CBCT images.

Surgical correction of the patients with mandibular asymmetry by bilateral sagittal split ramus osteotomy (BSSRO) creats remarkable results in the immediate post operative period, but it carries a high risk of relapse by powerful muscle forces and the osteotomized segments. To minimize this risk, literatures highlight the procedure of an intentional osteotomy and stripping of muscles. A prospective study was conducted in Government Dental College, Kottayam, Kerala, to assess the effect of intentional osteotomy of posterior part of distal segment and stripping of medial pterygoid muscle on the proximal segment on affected side in mandibular asymmetry patients treated with BSSRO.20 patients above 18 years with mandibular asymmetry underwent surgical correction by BSSRO setback and rotation. Clinical evaluation and postero anterior cephalogram (PA Ceph) were used to assess relapse. PA cephalogram taken post operatively at 2 weeks, 6 months and 1year were compared using cephalometric parameters by Grummons analysis to assess relapse. Paired t test and Chi-square test was used to analyse quantitative and qualitative parameters respectively with statistical significance ofBarring Methodological errors which is inevitable, the amount of relapse was not statistically significant with respect to dental midline, chin midline and frontal photograph.Intentional osteotomy of posterior part of distal segment and stripping of medial pterygoid muscle on the affected side can prevent relapse in patients who underwent surgical correction of mandibular asymmetry by BSSRO set back and rotation.

Introduction: Mandibular asymmetry may cause not only esthetic problem but also functional problem as it has a direct role in stomatognathic system. Objective: The objective of this study was to find out the difference between condylar asymmetry ratio in Class II division 1 malocclusion group and normal occlusion group in males and females. Materials & Methods: Orthopantomogram radiographs were selected from the pool of records such that there were 40 Class II division 1 males and females above 20 years of age. Thirty normal occlusion subjects (15 males, 15 females) were enrolled and orthopantomogram records were taken. All the films were hand traced on the acetate paper and the mean condylar, ramal and condylar plus ramal asymmetry index were measured in the normal and Class II Division 1 groups according to the method given by Habets. Independent sample t-test was done to compare between the normal occlusion and Class II Division 1 malocclusion for each male and female group. Result: Significant difference was observed between condylar heights, combined height and condylar asymmetrical ratio. Respectively in females. However, all other asymmetrical ratios were insignificant. Similarly, for males, condylar height, ramus height, combined (condyle and ramus) were all significant respectively. However, the asymmetric ratios were found to be insignificant. There is a significant difference between Class II division 1 malocclusion and normal occlusion group in terms of condylar asymmetry ratio in female subjects. However, it was not significant in case of male subjects. Conclusion: Our study suggests that females with Class II division 1 malocclusion more prone to TMD in comparison to males.

1Class III malocclusion is characterized by anterior posterior dental disharmony, either with or without skeletal discrepancies. Facial esthetics may be compromised to a greater or lesser degree, depending on the magnitude of the discrepancy, and is one of the main factors motivating individuals to seek orthodontic treatment. In adult patients, therapy may be performed by means of dental compensation, in simpler cases, or in more severe situations, by means of association between Orthodontics and Orthognathic Surgery. The present article is a clinical case report of a patient with a vertical facial pattern, Angle Class III malocclusion, with open bite and important facial asymmetry. The patient was treated in a compensatory manner with extractions, using extra-oral appliances on the mandibular arch with high pull, applying the principles of the Tweed-Merrifield technique. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as part of the requisites for becoming a BBO Diplomate.

Objectives: To 1) explore the planar scintigraphic findings in asymmetry patients caused by unilateral condylar hyperplasia (UCH) or asymmetric mandibular hyperplasia (AMH); 2) develop a local agecondylar activity reference norm; and 3) check the accuracy of the new norm and compare with other analytical methods. Material and Method: Chinese patients with mandibular asymmetry and scintigraphic findings available were recruited. Clinical, radiographic records and scintigraphic condylar activity ratio (CAR) were studied. Regression analysis was performed to quantify the relationship between age and CAR to develop a new norm. The sensitivity of condylar activity assessment using a) traditional norm; b) new norm; and c) percentile difference was compared. In patients with serial data available, longitudinal analysis of the scintigraphic changes were checked. Result: 109 patients were eligible for the study. Significant difference in CAR was noted between UCH and AMH patients. Linear relationship was observed between age and CAR. A new norm of the age-CAR was established, which showed improved sensitivity in condylar activity prediction in UCH and AMH when compared with traditional norm. Relative to percentile difference, the sensitivity of new norm was lower in AMH but not in UCH patients. Serial analysis revealed gradual decline in CAR with minimal change in percentile difference. Conclusion and Clinical Relevance: There is difference in scintigraphic condylar activity between UCH and AMH patients. A norm of age-CAR relationship was established, which showed improved sensitivity in condylar activity prediction in UCH patients. Further study is required to confirm the role of scintigraphy in AMH.

Objective : The objective of this article is to introduce a simplified analysis for preliminary diagnosis of mandibular asymmetry using digital OPG. The method described in the article involves vertical and angular measurements of mandible. Utilizing digital OPG for preliminary diagnosis of mandibular asymmetry has a favorable cost-benefit relationship and exposes subjects to relatively low doses of radiation.

Pretreatment diagnosis of mandibular asymmetry in orthognathic surgery patients can be improved by quantitative shape modeling and analysis. The UNC SPHARM-PDM (University of North Carolina Spherical Harmonics-Point Distribution Model) toolbox was applied to a cohort of patients and the results were evaluated.Three-dimensional (3D) virtual surface models are constructed from CBCT scans of each patient in the cohort by segmentation. Mirroring on a sagittal arbitrary plane is used to flip the left and right sides of each image. An automatic voxel-based registration on the cranial base is used to align the volume and its mirror for comparison. SPHARM-PDM is used to compute correspondent models for each hemimandible and the mirror of the contralateral side. Procrustes analysis was used to evaluate discrepancies between each pair of models to assess asymmetry. Mandibular asymmetry was also located and quantified by computing corresponding surface distances between each hemimandible (left and right sides) and the mirror of the contralateral side.There were no statistically significant differences in surrogates for mandibular asymmetry assessment based on right or the left side mirroring. Those surrogates are the rotational and translational differences between each hemimandible and the mirror of the contralateral side in 3 planes of space (the absolute values of Procrustes registration output in 6 degrees of freedom). Absolute and signed distance maps between each hemimandible and the mirror of the contralateral side located and quantified areas of asymmetry diagnosis for each patient. Even though mandibular condyle asymmetry was observed in 8% of the cases and mandibular asymmetry along areas of the ramus and mandibular corpus was noted in 17.8% of the cases, the remaining 74.2% showed generalized morphological and positional asymmetry at the condyle, the ramus and mandibular corpus.Three-dimensional diagnosis of mandibular asymmetry revealed the complex involvement of morphological components of the mandible and the heterogeneous nature of this clinical condition. SPHARM-PDM has a promising role in the individual diagnosis and quantification of mandibular asymmetry.

Temporomandibular joint (TMJ) ankylosis during early childhood always produces alteration of the mandibular growth with facial asymmetry, chin deviation, and malocclusion. The younger the ankylosis happens, the more severe the facial deformity presents. When TMJ ankylosis occurs in infancy, there might be a delay in diagnosis and treatment. In this article, we describe a case of TMJ ankylosis in a 10-month-old boy. The etiology was indistinct. Surgical plan including modified gap arthroplasty, costochondral graft (CCG), temporalis fascial flap, was preformed to this patient. The joint and the mandibular ramus were restored. No severe complication occurred. There was no recurrence of ankylosis and further developing of mandibular asymmetry during 2-year follow-up period.

This study reports an independent audit of two aspects of orthognathic surgery, namely control of inter-alar width and mandibular outline asymmetry. Measurements were taken from standardized photographs of a consecutive series of 27 patients, using an on-screen digitizing program (IPTool). All patients had undergone bimaxillary osteotomies involving maxillary impaction and/or advancement, by one surgeon, using a cinch suture for nasal width control. Nine-twelve months after surgery, inter-alar width had increased by just 0.08 cm mean (SD 0.3). Four patients showed an increase of just over 2mm, whilst six showed a small reduction. Based on ratios of size (area) and shape (compactness) of the right and left mandibular segments, there was a small overall improvement in mandibular symmetry (0.019 and 0.005 respectively). Whilst in most of the patients the need for surgery was primarily the correction of antero-posterior and vertical discrepancies, five patients with demonstrable asymmetry showed a clear improvement. In three patients whose asymmetry scores were very mild pre-treatment, there was a small, measured increase in asymmetry, but not to a degree that would be clinically noticeable. At a time when 3D imaging is still unavailable to many clinicians, the results of this study suggest that appropriate measurements taken from carefully standardized conventional photographs can provide a valid and objective means of assessing treatment outcome.

The aim of this study was to evaluate the effect of different occlusion types on mandibular asymmetry in different anatomical points using posteroanterior cephalometric radiography.This study was retrospectively conducted on 100 patients whose posteroanterior images and malocclusions were registered in a patient database. Asymmetry indices were determined using four linear measurements on images, and the effect of malocclusions, age, and gender on these asymmetry indices was investigated. P0.05 was considered statistically significant.Right and left horizontal plane gonion distance values varied according to gender, right vertical plane condylar distance and left horizontal plane gonion distance values varied according to age, and right vertical plane condylar distance and left horizontal plane gonion distance values varied according to malocclusions.The measured values of some parameters varied according to age, gender, and malocclusion. Although vertical plane gonion asymmetry index and horizontal plane condylar asymmetry index values varied according to gender, there was no relationship between asymmetry index values of all parameters with age and malocclusion.

Cross bite is a condition where one or more teeth may be abnormally malposed buccally or lingually or labially with reference to the opposing tooth or teeth. Cross bite correction is highly recommended as this kind of malocclusion do not diminish with age. Uncorrected cross bite may lead to abnormal wear of lower anteriors and cuspal interference, mandibular shift resulting in mandibular asymmetry and temporomandibular joint dysfunction syndrome. There are several methods for treating this type of malocclusion. In this article, segmental orthodontics has been highlighted by using 2 × 4 appliance therapy and lingual button with cross elastics. This appliance offers many advantages as it provides complete control of anterior tooth position, is extremely well tolerated, requires no adjustment by the patient and allows accurate and rapid positioning of teeth.

Chin deviation is generally the visible reflex of a mandibular asymmetry. The difficulty in obtaining a symmetrical result exists, but it can be minimized with the appropriate surgical technique. This article reports the mentoplasty technique with wedge osteotomy performed in an individual with a right-sided chin deviation. Three osteotomies were performed vertically and equidistantly, forming a bone wedge on the contralateral side of the deviation. Horizontal repositioning associated with the rotation caused by the vertical impaction of the chin after bone wedge removal was effective in solving esthetic problems of facial asymmetry, meeting the patient's main complaint.