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Open Access 01-12-2023 | Research

Subjective evaluation of facial asymmetry with three-dimensional simulated images among the orthodontists and laypersons: a cross-sectional study

Authors: Mingjin Zhang, Liang Lyu, Jing Li, Huichun Yan, Yujia Zhu, Tingting Yu, Yong Wang, Yijiao Zhao, Yanheng Zhou, Dawei Liu

Published in: BMC Oral Health | Issue 1/2023

Abstract

Objectives

We used three-dimensional (3D) virtual images to undertake a subjective evaluation of how different factors affect the perception of facial asymmetry among orthodontists and laypersons with the aim of providing a quantitative reference for clinics.

Materials and methods

A 3D virtual symmetrical facial image was acquired using FaceGen Modeller software. The left chin, mandible, lip and cheek of the virtual face were simulated in the horizontal (interior/exterior), vertical (up/down), or sagittal (forward or backward) direction in 3, 5, and 7 mm respectively with Maya software to increase asymmetry for the further subjective evaluation. A pilot study was performed among ten volunteers and 30 subjects of each group were expected to be included based on 80% sensitivity in this study. The sample size was increased by 60% to exclude incomplete and unqualified questionnaires. Eventually, a total of 48 orthodontists and 40 laypersons evaluated these images with a 10-point visual analog scale (VAS). The images were presented in random order. Each image would stop for 30 s for observers with a two-second interval between images. Asymmetry ratings and recognition accuracy for asymmetric virtual faces were analyzed to explore how different factors affect the subjective evaluation of facial asymmetry. Multivariate linear regression and multivariate logistic regression models were used for statistical data analysis.

Results

Orthodontists were found to be more critical of asymmetry than laypersons. Our results showed that observers progressively decreased ratings by 1.219 on the VAS scale and increased recognition rates by 2.301-fold as the degree of asymmetry increased by 2 mm; asymmetry in the sagittal direction was the least noticeable compared with the horizontal and vertical directions; and chin asymmetry turned out to be the most sensitive part among the four parts we simulated. Mandible asymmetry was easily confused with cheek asymmetry in the horizontal direction.

Conclusions

The degree, types and parts of asymmetry can affect ratings for facial deformity as well as the accuracy rate of identifying the asymmetrical part. Although orthodontists have higher accuracy in diagnosing asymmetrical faces than laypersons, they fail to correctly distinguish some specific asymmetrical areas.

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Baudouin JY, Tiberghien G. Symmetry, averageness, and feature size in the facial attractiveness of women. Acta Psychol (Amst). 2004;117(3):313–32. https://doi.org/10.1016/j.actpsy.2004.07.002.CrossRefPubMed

Wang TT, Wessels L, Hussain G, Merten S. Discriminative thresholds in facial asymmetry: a review of the literature. Aesthet Surg J. 2017;37(4):375–85. https://doi.org/10.1093/asj/sjw271.CrossRefPubMed

Lum V, Goonewardene MS, Mian A, Eastwood P. Three-dimensional assessment of facial asymmetry using dense correspondence, symmetry, and midline analysis. Am J Orthod Dentofacial Orthop. 2020;158(1):134–46. https://doi.org/10.1016/j.ajodo.2019.12.014.CrossRefPubMed

KazemiAshtiani A, Azarbakhsh M, Hafezi F, Naghibzadeh B. Anthropometric analysis of the human skull for developmental left-sided asymmetry New Finding. Aesthetic Plast Surg. 2020;44(1):186–90. https://doi.org/10.1007/s00266-019-01526-y.CrossRef

Farkas LG, Cheung G. Facial asymmetry in healthy North American Caucasians an anthropometrical study. Angle Orthod. 1981;51(1):70–7. https://doi.org/10.1043/0003-3219(1981)051%3c0070:Faihna%3e2.0.Co;2.CrossRefPubMed

Ebner NC, Luedicke J, Voelkle MC, Riediger M, Lin T, Lindenberger U. An adult developmental approach to perceived facial attractiveness and distinctiveness. Front Psychol. 2018;9:561. https://doi.org/10.3389/fpsyg.2018.00561.CrossRefPubMedPubMedCentral

Dobai A, Markella Z, Vízkelety T, Fouquet C, Rosta A, Barabás J. Landmark-based midsagittal plane analysis in patients with facial symmetry and asymmetry based on CBCT analysis tomography. J Orofac Orthop. 2018;79(6):371–9. https://doi.org/10.1007/s00056-018-0151-3.CrossRefPubMed

Chen YF, Vinayahalingam S, Bergé S, Liao YF, Maal T, Xi T. Three-Dimensional Analysis of the Condylar Hypoplasia and Facial Asymmetry in Craniofacial Microsomia Using Cone-Beam Computed Tomography. J Oral Maxillofac Surg. 2021;79(8):1750.e1-.e10. https://doi.org/10.1016/j.joms.2021.03.015.CrossRefPubMed

Blasi A, Nucera R, Ronsivalle V, Candida E, Grippaudo C. Asymmetry index for the photogrammetric assessment of facial asymmetry. Am J Orthod Dentofacial Orthop. 2022;162(3):394–402. https://doi.org/10.1016/j.ajodo.2021.04.030.CrossRefPubMed

10.

Huang CS, Liu XQ, Chen YR. Facial asymmetry index in normal young adults. Orthod Craniofac Res. 2013;16(2):97–104. https://doi.org/10.1111/ocr.12010.CrossRefPubMed

11.

Fan Y, He W, Chen G, Song G, Matthews H, Claes P, et al. Facial asymmetry assessment in skeletal Class III patients with spatially-dense geometric morphometrics. Eur J Orthod. 2022;44(2):155–62. https://doi.org/10.1093/ejo/cjab034.CrossRefPubMed

12.

Dong T, Ye N, Yuan L, Wu S, Xia L, Fang B. Assessing the Influence of Chin Asymmetry on Perceived Facial Esthetics With 3-Dimensional Images. J Oral Maxillofac Surg. 2020;78(8):1389–96. https://doi.org/10.1016/j.joms.2020.03.017.CrossRefPubMed

13.

Duran GS, Taşdelen F, Dindaroğlu F. Effect of facial profile convexity on the perception of mandibular asymmetry using three-dimensional stereophotogrammetric images. Orthod Craniofac Res. 2020;23(1):110–7. https://doi.org/10.1111/ocr.12349.CrossRefPubMed

14.

Chou PY, Denadai R, Chen SH, Tseng HJ, Hsu CK, Wang SW, et al. Identifying three-dimensional facial fluctuating asymmetry in normal pediatric individuals: a panel assessment outcome study of clinicians and observers. J Clin Med. 2019;8(5):648. https://doi.org/10.3390/jcm8050648.CrossRefPubMedPubMedCentral

15.

Augsburger RH. Occlusal plane relation to facial type. J Prosthet Dent. 1953;3(6):755–70. https://doi.org/10.1016/0022-3913(53)90144-9.CrossRef

16.

Jarosz KF, Bosio JA, Bloomstein R, Jiang SS, Vakharia NS, Cangialosi TJ. Perceptions of chin asymmetries among dental professionals and laypersons. Am J Orthod Dentofacial Orthop. 2018;154(2):201–12. https://doi.org/10.1016/j.ajodo.2017.11.029.CrossRefPubMed

17.

Martins JM, Costa LG, Carvalho AL, Manso MC, Gavinha S, Herrero-Climent M, et al. The impact of dental midline on asymmetric faces: perspective of laypersons and dentists. Int J Environ Res Public Health. 2021;18(24):12904. https://doi.org/10.3390/ijerph182412904.CrossRefPubMedPubMedCentral

18.

McAvinchey G, Maxim F, Nix B, Djordjevic J, Linklater R, Landini G. The perception of facial asymmetry using 3-dimensional simulated images. Angle Orthod. 2014;84(6):957–65. https://doi.org/10.2319/120213-888.1.CrossRefPubMedPubMedCentral

19.

Hohman MH, Kim SW, Heller ES, Frigerio A, Heaton JT, Hadlock TA. Determining the threshold for asymmetry detection in facial expressions. Laryngoscope. 2014;124(4):860–5. https://doi.org/10.1002/lary.24331.CrossRefPubMed

20.

Naini FB, Donaldson AN, McDonald F, Cobourne MT. Assessing the influence of asymmeftry affecting the mandible and chin point on perceived attractiveness in the orthognathic patient, clinician, and layperson. J Oral Maxillofac Surg. 2012;70(1):192–206. https://doi.org/10.1016/j.joms.2010.12.055.CrossRefPubMed

21.

Wu Z, Gao X, Long H, Lai W. Quantitative analysis of facial symmetry by using three-dimensional technology. BMC Oral Health. 2022;22(1):277. https://doi.org/10.1186/s12903-022-02315-x.CrossRefPubMedPubMedCentral

22.

Yurdakurban E, Duran GS, Görgülü S. Evaluation of an automated approach for facial midline detection and asymmetry assessment: a preliminary study. Orthod Craniofac Res. 2021;24(Suppl 2):84–91. https://doi.org/10.1111/ocr.12539.CrossRefPubMed

23.

Meyer-Marcotty P, Stellzig-Eisenhauer A, Bareis U, Hartmann J, Kochel J. Three-dimensional perception of facial asymmetry. Eur J Orthod. 2011;33(6):647–53. https://doi.org/10.1093/ejo/cjq146.CrossRefPubMed

24.

Berssenbrügge P, Berlin NF, Kebeck G, Runte C, Jung S, Kleinheinz J, et al. 2D and 3D analysis methods of facial asymmetry in comparison. J Craniomaxillofac Surg. 2014;42(6):e327–34. https://doi.org/10.1016/j.jcms.2014.01.028.CrossRefPubMed

25.

Lim SW, Jeon JB, Moon RJ, Oh S, Park A, Oh MH, et al. Association of the three-dimensional skeletal variables with self-recognition of facial asymmetry in skeletal Class III patients. Angle Orthod. 2022;92(4):512–20. https://doi.org/10.2319/072221-579.1.CrossRefPubMedPubMedCentral

26.

Haraguchi S, Iguchi Y, Takada K. Asymmetry of the face in orthodontic patients. Angle Orthod. 2008;78(3):421–6. https://doi.org/10.2319/022107-85.1.CrossRefPubMed

27.

Tereshenko V, Maierhofer U, Dotzauer DC, Laengle G, Schmoll M, Festin C, et al. Newly identified axon types of the facial nerve unveil supplemental neural pathways in the innervation of the face. J Adv Res. 2023;44:135–47. https://doi.org/10.1016/j.jare.2022.04.009.CrossRefPubMed

Title: Subjective evaluation of facial asymmetry with three-dimensional simulated images among the orthodontists and laypersons: a cross-sectional study
Authors: Mingjin Zhang
Liang Lyu
Jing Li
Huichun Yan
Yujia Zhu
Tingting Yu
Yong Wang
Yijiao Zhao
Yanheng Zhou
Dawei Liu
Publication date: 01-12-2023
Publisher: BioMed Central
Published in: BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI: https://doi.org/10.1186/s12903-023-03167-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Subjective evaluation of facial asymmetry with three-dimensional simulated images among the orthodontists and laypersons: a cross-sectional study

Abstract

Objectives

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

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