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Three-dimensional investigation of facial surface asymmetries in skeletal malocclusion patients before and after orthodontic treatment combined with orthognathic surgery

Dreidimensionale Untersuchung von Gesichtsoberflächenasymmetrien bei Dysgnathiepatienten vor und nach kombinierter kieferorthopädisch-kieferchirurgischer Therapie

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Abstract

Objectives

The goal of the following study was to quantify facial soft-tissue asymmetry in patients with pronounced skeletal malocclusion anomalies before and after orthodontic treatment combined with orthognathic surgery. In addition, the facial attractiveness of these patients was rated by dental specialists and laypersons both before and after treatment based on the three-dimensional (3D) data.

Patients and methods

An optical sensor was used to noninvasively capture the 3D facial surface data of 60 adult patients including two groups of 20 patients with skeletal Class II or III anomalies and a control group of another 20 subjects with Class I relationships. Facial surface asymmetries were evaluated immediately before the surgical procedure and 1 year thereafter. In addition, subjective ratings of facial attractiveness were obtained based on a questionnaire from orthodontists, maxillofacial surgeons, and laypersons.

Results

No differences in facial soft-tissue asymmetry were observed between the Class II and III patients either pre- or postoperatively, but asymmetry was found to be more pronounced in the skeletal malocclusion groups than in the Class I control group both pre- and postoperatively. The subjective ratings of facial attractiveness by the various rater groups yielded more favorable results for the post- than preoperative patient images, reflecting differences that reached overall statistical significance.

Conclusion

Quantitative analysis of facial soft-tissue asymmetry and calculating a cutoff value allowed us to distinguish patients with skeletal malocclusion from a control group solely on the basis of asymmetry. Combined regimens of orthodontic treatment and orthognathic surgery go some way in reducing asymmetry toward the levels seen in untreated control subjects, while the asymmetry pattern characteristic of this type of malocclusion will persist. Nevertheless, the asymmetry reduction is noticeable enough to result in more favorable ratings of attractiveness.

Zusammenfassung

Ziel

Ziel der Untersuchung war die Quantifizierung dreidimensionaler (3-D-)Asymmetrien der Gesichtsweichteile von Patienten mit ausgeprägten Dysgnathien vor und nach kombiniert kieferorthopädisch-kieferchirurgischer Therapie. Zusätzlich erfolgte prä- und postoperativ die Attraktivitätsbeurteilung der Patienten anhand von 3-D-Daten durch Experten und Laien.

Patienten und Methodik

Die 3-D-Daten der Gesichtsoberfläche von 60 erwachsenen Patienten wurden nichtinvasiv mittels eines optischen Sensors erfasst. Von diesen wiesen 20 Patienten eine Klasse-II-, 20 Patienten eine Klasse-III- sowie 20 Kontrollprobanden eine Klasse-I-Anomalie auf. Die Asymmetrie der Gesichtsoberflächen wurde direkt prä- und 1 Jahr postoperativ berechnet. Zusätzlich erfolgte die subjektive Analyse des Aussehens der Patienten mittels Fragebogen durch Kieferorthopäden, Mund-, Kiefer-, Gesichtschirurgen und Laien.

Ergebnisse

Patienten mit Klasse-II-Anomalie unterschieden sich hinsichtlich der Asymmetrie der Gesichtsweichteile weder prä- noch postoperativ von Patienten mit Klasse-III-Anomalie. Dagegen wiesen die Dysgnathiepatienten sowohl prä- als auch postoperativ eine größere Asymmetrie auf als die Kontrollgruppe mit Klasse-I-Anomalie. Insgesamt wurde eine signifikant positivere Bewertung des Aussehens der postoperativen Patienten im Rahmen der subjektiven Analyse nachgewiesen.

Schlussfolgerungen

Durch klinischen Einsatz der Berechnung der Asymmetrie der Gesichtsweichteile ist eine Differenzierung von Dysgnathiepatienten gegenüber einer Kontrollgruppe allein anhand der Asymmetrie möglich. Eine kombiniert kieferorthopädisch-kieferchirurgische Therapie führt zu einer Reduktion der Asymmetrie der Gesichtsweichteile und zur Annäherung an die Symmetrie einer unbehandelten Kontrollgruppe. Es verbleibt jedoch eine für die Dysgnathie charakteristische Asymmetrie der Gesichtsweichteile. Allerdings hat die Reduktion der Gesichtsasymmetrie eine positivere Attraktivitätseinschätzung zur Folge.

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References

  1. Bastian BT, Lisson JA (2003) Genauigkeit der Vorhersage von Weichteilveränderungen durch orthognathe Chirurgie. Kieferorthop 17:121–131

    Google Scholar 

  2. Becker M (2003) Gesichtsform und Attraktivität. Diplomarbeit, Psychologie, Saarland

  3. Benz M (2005) Ergebnismodellierung und Qualitätskontrolle kraniofazialer Operationen auf Basis optischer Messtechnik. Dissertation, Universität Erlangen-Nürnberg

  4. Bill JS, Reuther JF, Dittmann W et al (1995) Stereolithography in oral and maxillofacial operation planning. Int J Oral Maxillofac Surg 24:98–103

    Article  PubMed  Google Scholar 

  5. Braun C, Gründl M, Marberger C et al (2009) Beautycheck. Ursachen und Folgen von Attraktivität. Universität Regensburg. http://www.beautycheck.de. Accessed 11 June 2013

  6. Bongartz JR (2002) Hochauflösende dreidimensionale Gesichtsprofil-vermessung mit kurzgepulster Holographie. Dissertation, Düsseldorf

  7. Burstone CJ (1998) Diagnosis and treatment planning of patients with asymmetries. Semin Orthod 4:153–164

    Article  PubMed  Google Scholar 

  8. Dahan J (1968) Die Diagnose der Gesichts- und Schädelasymmetrien. Ein kephalometrisches Problem. Fortschr Kieferorthop 29:289–333

    Article  PubMed  Google Scholar 

  9. Douglas TS (2004) Image processing for craniofacial landmark identification and measurement: a review of photogrammetry and cephalometry. Comput Med Imaging Graph 28:401–409

    Article  PubMed  Google Scholar 

  10. Ehmer U, Wegener A (1993) Zur Validität von Asymmetriegraden computerunterstützter Analyse der Fernröntgenfrontalaufnahme. Fortschr Kieferorthop 54:134–142

    Article  PubMed  Google Scholar 

  11. Farah MJ, Wilson KD, Drain M et al (1998) What is “special” about face perception? Psychol Rev 105:482–498

    Article  PubMed  Google Scholar 

  12. Farkas LG, Cheung G (1981) Facial asymmetry in healthy North American Caucasians. An anthropometrical study. Angle Orthod 51:70–77

    PubMed  Google Scholar 

  13. Ferrario VF, Sforza C, Miani A et al (1993) Craniofacial morphometry by photographic evaluations. Am J Orthod Dentofacial Orthop 103:327–337

    Article  PubMed  Google Scholar 

  14. Ferrario VF, Sforza C, Poggio CE et al (1994) Distance from symmetry: a three-dimensional evaluation of facial asymmetry. J Oral Maxillofac Surg 52:1126–1132

    Article  PubMed  Google Scholar 

  15. Good S, Edler R, Wertheim D et al (2006) A computerized photographic assessment of the relationship between skeletal discrepancy and mandibular outline asymmetry. Eur J Orthod 28:97–102

    Article  PubMed  Google Scholar 

  16. Grammer K, Thornhill R (1993) Human (Homo sapiens) facial attractiviness and sexual selection. The role of symmetry and averageness. J Comp Psychol 108:233–242

    Article  Google Scholar 

  17. Guest E, Berry E, Morris D (2001) Novel methods for quantifying soft tissue changes after orthognathic surgery. Int J Oral Maxillofac Surg 30:484–489

    Article  PubMed  Google Scholar 

  18. Hajeer MY, Millet DT, Ayoub AF et al (2004) Applications of 3D imaging in orthodontics: part I. J Orthod 31:62–70

    Article  PubMed  Google Scholar 

  19. Hajeer MY, Ayoub AF, Millett DT (2004) Three-dimensional assessment of facial soft-tissue asymmetry before and after orthognathic surgery. Br J Oral Maxillofac Surg 42:396–404

    Article  PubMed  Google Scholar 

  20. Haraguchi S, Takada K, Yasuda Y (2002) Facial asymmetry in subjects with skeletal Class III deformity. Angle Orthod 72:28–35

    PubMed  Google Scholar 

  21. Hartmann J, Meyer-Martcotty P, Benz M et al (2007) Reliability of a method for computing facial symmetry plane and degree of asymmetry based on 3D-data. J Orofac Orthop 68:477–490

    Article  PubMed  Google Scholar 

  22. Hell B (1995) 3D sonography. Int J Oral Maxillofac Surg 24:84–89

    Article  PubMed  Google Scholar 

  23. Karbacher S (1997) Rekonstruktion und Modellierung von Flächen aus Tiefenbildern. Dissertation, Universität Erlangen-Nürnberg

  24. Kawai T, Natsume N, Shibata N et al (1990) Three-dimensional analysis of facial morphology using moire stripes. Part I. Method. Int J Oral Maxillofac Surg 19:356–358

    Article  PubMed  Google Scholar 

  25. Khambay B, Nebel JC, Bowman J et al (2002) 3D stereophotogrammetric image superimposition onto 3D CT scan images: the future of orthognathic surgery. A pilot study. Int J Adult Orthodon Orthognath Surg 17:331–341

    PubMed  Google Scholar 

  26. Kobayashi T, Ueda K, Honma K et al (1990) Three-dimensional analysis of facial morphology before and after orthognathic surgery. J Craniomaxillofac Surg 18:68–73

    Article  PubMed  Google Scholar 

  27. Landes CA, Zachar R, Diehl T et al (2002) Introduction of a three-dimensional anthropometry of the viscerocranium. Part II: evaluating osseous and soft tissue changes following orthognathic surgery. J Craniomaxillofac Surg 30:25–34

    Article  PubMed  Google Scholar 

  28. Legan HL (1998) Surgical correction of patients with asymmetries. Semin Orthod 4:189–198

    Article  PubMed  Google Scholar 

  29. Marsan G, Oztas E, Kuvat SV et al (2009) Changes in soft tissue profile after mandibular setback surgery in Class III subjects. Int J Oral Maxillofac Surg 38:236–240

    Article  PubMed  Google Scholar 

  30. Masuoka N, Momoi Y, Ariji Y et al (2005) Can cephalometric indices and subjective evaluation be consistent for facial asymmetry? Angle Orthod 75:651–655

    PubMed  Google Scholar 

  31. McCance AM, Moss JP, Fright WR et al (1997) Three-dimensional analysis techniques-Part 3: color-coded system for three-dimensional measurement of bone and ratio of soft tissue to bone: the analysis. Cleft Palate Craniofac J 34:52–57

    Article  PubMed  Google Scholar 

  32. Meyer-Marcotty P, Stellzig-Eisenhauer A (2009) Dentofacial self-perception and social perception of adults with unilateral cleft lip and palate. J Orofac Orthop 70:224–236

    Article  PubMed  Google Scholar 

  33. Meyer-Marcotty P, Kochel J, Boehm H et al (2010) Face perception in patients with unilateral cleft lip and palate and patients with severe Class III malocclusion compared to controls. J Craniomaxillofac Surg 39:158–163

    Article  PubMed  Google Scholar 

  34. Meyer-Marcotty P, Gerdes ABM, Stellzig-Eisenhauer A et al (2011) Visual face perception of adults with unilateral cleft lip and palate in comparison to controls- an eye tracking study. Cleft Palate Craniofac J 48:210–216

    Article  PubMed  Google Scholar 

  35. Meyer-Marcotty P, Gerdes ABM, Reuther T et al (2010) Persons with cleft lip and palate are looked at differently. J Dent Res 89:400–404

    Article  PubMed  Google Scholar 

  36. Meyer-Marcotty P, Alpers GW, Gerdes A, Stellzig-Eisenhauer A (2010) Impact of facial asymmetry in visual perception: a 3-dimensional data analysis. Am J Orthod Dentofacial Orthop 137:168e1–168e8

    Google Scholar 

  37. Nkenke E, Maier T, Benz M et al (2004) Hertel exophthalmometry versus computed tomography and optical 3D imaging for the determination of the globe position in zygomatic fractures. Int J Oral Maxillofac Surg 33:125–133

    Article  PubMed  Google Scholar 

  38. Nkenke E, Langer A, Laboureux X et al (2003) Validation of in vivo assessment of facial soft-tissue volume changes and clinical application in midfacial distraction: a technical report. Plast Reconstr Surg 112:367–380

    Article  PubMed  Google Scholar 

  39. Nkenke E, Vairaktaris E, Kramer M et al (2008) Three-dimensional analysis of changes of the malar-midfacial region after LeFort I osteotomy and maxillary advancement. J Oral Maxillofac Surg 12:5–12

    Article  Google Scholar 

  40. O’Grady KF, Antonyshyn OM (1999) Facial asymmetry: three-dimensional analysis using laser surface scanning. Plast Reconstr Surg 104:928–937

    Article  Google Scholar 

  41. Peck S, Peck L, Kataja M (1991) Skeletal asymmetry in esthetically pleasing faces. Angle Orthod 61:43–48

    PubMed  Google Scholar 

  42. Proffit WR, Fields HW Jr (2000) Combined surgical and orthodontic treatment. In: Rudolph P (Hrsg) Contemporary orthodontics. Mosby, St. Louis, pp 674–708

  43. Ramm B, Hofmann G, Hahn N (1976) Biomathematik und medizinische Statistik. Ferdinand Enke, Stuttgart, pp 271–275

  44. Ras F, Habets LL, Ginkel FC van et al (1995) Method for quantifying facial asymmetry in three dimensions using stereophotogrammetry. Angle Orthod 65:233–239

    PubMed  Google Scholar 

  45. Rhodes D, Proffit F, Grady JM et al (1998) Facial symmetry and the perception of beauty. Psychon Bull Rev 5:659–669

    Article  Google Scholar 

  46. Samman N, Tong AC, Cheung DL et al (1992) Analysis of 300 dentofacial deformities in Hong Kong. Int J Adult Orthodon Orthognath Surg 7:181–185

    PubMed  Google Scholar 

  47. Scheib JE, Gangestad SW, Thornhill R (1999) Facial attractiveness, symmetry and cues of good genes. Proc Biol Sci 266:1913–1917

    Article  PubMed Central  PubMed  Google Scholar 

  48. Schwenzer M, Ehrenfeld M (o J) Zahn-Mund-Kiefer-Heilkunde, Bd 2 Mund-Kiefer-Gesichtschirurgie. Thieme, Stuttgart

  49. Severt TR, Proffit WR (1997) The prevalence of facial asymmetry in the dentofacial deformities population at the University of North Carolina. Int J Adult Orthodon Orthognath Surg 12:171–176

    PubMed  Google Scholar 

  50. Sforza C, Peretta R, Grandi G et al (2007) Three-dimensional facial morphometry in skeletal Class III patients. A non-invasive study of soft-tissue changes before and after orthognathic surgery. Br J Oral Maxillofac Surg 45:138–144

    Article  PubMed  Google Scholar 

  51. Shah SM, Joshi MR (1978) An assessment of asymmetry in the normal craniofacial complex. Angle Orthod 48:141–148

    PubMed  Google Scholar 

  52. Soncul M, Bamber MA (2004) Evaluation of facial soft tissue changes with optical surface scan after surgical correction of Class III deformities. J Oral Maxillofac Surg 62:1331–1340

    Article  PubMed  Google Scholar 

  53. Thornhill R, Gangestad SW (1999) Facial attractiveness. Trends Cogn Sci 3:452–460

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was financially supported by the Science Fund of the German Orthodontic Society.

Danksagung

Diese Arbeit wurde durch den Wissenschaftsfond der DGKFO finanziell unterstützt.

Compliance with ethical guidelines

Conflict of interest. M. Blockhaus, J. Kochel, J. Hartmann, A. Stellzig-Eisenhauer, and P. Meyer-Marcotty state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Blockhaus, J. Kochel, J. Hartmann, A. Stellzig-Eisenhauer und P. Meyer-Marcotty geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Department of Orthodontics, University Hospital, Pleicherwall 2, 97070, Würzburg, Germany

    M. Blockhaus, J. Kochel, A. Stellzig-Eisenhauer &  P. Meyer-Marcotty

  2. -, Würzburg, Germany

    J. Hartmann

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  1. M. Blockhaus
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  2. J. Kochel
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  3. J. Hartmann
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  4. A. Stellzig-Eisenhauer
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  5. P. Meyer-Marcotty
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Correspondence to P. Meyer-Marcotty.

Additional information

The study results were presented in part, and won the poster award, at the 2010 Annual Meeting of the Germany Orthodontic Society. Ein Teil der Ergebnisse wurde auf der Jahrestagung der Deutschen GEsellschaft für Kieferorthopädie (DGKFO 2010 in Frankfurt präsentiert und mit dem Posterpreis prämiert.

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Blockhaus, M., Kochel, J., Hartmann, J. et al. Three-dimensional investigation of facial surface asymmetries in skeletal malocclusion patients before and after orthodontic treatment combined with orthognathic surgery. J Orofac Orthop 75, 85–95 (2014). https://doi.org/10.1007/s00056-013-0200-x

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