ORTHODONTICS
Original Article
SOFT-TISSUE FACIAL ASYMMETRY BEFORE AND AFTER ORTHOGNATHIC SURGERY : APPLICATION OF A NEW 3D PROTOCOL
Filippo Da Pozzo 1 , 2a , Francesca M . E . Rusconi 1b , Giada Anna Beltramini 2c , Daniele M . Gibelli 1d , Valentina Pucciarelli 1e , Aldo Bruno Giannì 2 , 3f , Chiarella Sforza 1g
1
LAFAS , Laboratory of Functional Anatomy of the Stomatognathic System , Department of Biomedical Sciences for Health , Università degli Studi di Milano , Milan , Italy
2
Maxillofacial and Dental Unit , Fondazione IRCCS Ca ’ Granda Ospedale Maggiore Policlinico di Milano , Milan Italy
3
Department of Biomedical , Surgical and Dental Sciences , University of Milan , Milan Italy a
MD b
DDS c
MD , PhD d
MD , PhD , ORCID 0000-0002-9591-1047 e
MBiothec , PhD , ORCID 0000-0002-9165-133X f
MD , PhD g
MD , PhD , ORCID 0000-0001-6532-6464
ABSTRACT DOI : 10.25241 / stomaeduj . 2018.5 ( 2 ). art . 3
Introduction : Skeletal Class III patients often present a major facial asymmetry . In the current investigation , a quantitative method to assess 3D facial asymmetry was applied to an orthognathic surgery patient to quantify possible postsurgical modifications . Methodology : Soft-tissue facial scans of a 20-year-old man with skeletal Class III , candidate to orthognathic surgery , were collected in the pre-surgery stage and 6 , 12 , 24 months post-surgery with a stereophotogrammetric system . Soft tissue asymmetry was calculated in the facial thirds according to a published protocol ( J Craniomaxillofac Surg 2017 ; 45 ( 1 ): 76-81 ), and the relevant time-related modifications described . The results were also compared to normal values from a group of 23 control subjects ( 10 men , 13 women , mean age 26 ) by using z-scores . Results : The longitudinal analysis of the soft-tissue facial asymmetry showed a marked difference in the analysed time points : orthognathic surgery did reduce facial symmetry in the present patient . The comparison between the patient and the control subjects by using z-scores highlighted a clear difference in all-time points : the patient with facial dysmorphia had a higher degree of asymmetry than healthy subjects . Conclusion : The measurements of soft-tissue facial asymmetry using 3D optical digitisers can provide clinically useful information . The graphical representation of results can help in the patient ’ s understanding of the treatment phases , thus increasing compliance . Keywords : face , soft tissues , orthognathic surgery , symmetry .
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license .
Peer-Reviewed Article
Citation : Da Pozzo F , Rusconi FME , Beltramini GA , Gibelli DM , Pucciarelli V , Giannì AB , Sforza C . Soft-tissue facial asymmetry before and after orthognathic surgery : application of a new 3D protocol . Stoma Edu J . 2018 ; 5 ( 2 ): 98-101 .
Academic Editor : Constantinus Politis , MD , DDS , MM , MHA , PhD , Professor & Chairperson , University of Leuven , Leuven , Belgium
Received : January 25 , 2018 Revised : March 14 , 2018 Acccepted : June 06 , 2018 Published : June 07 , 2018
* Corresponding author : Professor Chiarella Sforza , MD , PhD , Department of Biomedical Sciences for Health , University of Milan , Milan , Italy , via Mangiagalli 31 , I-20133 Milano , Italy , Tel : + 39 – 02 503 15385 , Fax : + 39 – 02 503 15387 , e-mail : chiarella . sforza @ unimi . it
Copyright : © 2018 the Editorial Council for the Stomatology Edu Journal .
1 . Introduction Facial dysmorphoses are not common in the western world . According to US studies , dentoskeletal Class III patients can be found in 0.6 % of the general population , a much smaller value than that reported for dentoskeletal Class II patients , which is around 10 % [ 1 ]. Nonetheless , Class III patients often present more complex situations than Class II ones , with a much more altered facial function and aesthetics , and the percentage of patients undergoing surgical interventions is approximately 6-7 times larger in Class III than in Class II subjects ( about 33 % vs . 5 %) [ 1 ]. Apart from the restoration of a sound functionality and a normal occlusion , aesthetics and facial symmetry are among the most important aspects in modern orthognathic surgery [ 2 ]. The successful attainment of an aesthetically acceptable result starts from correct skeletal and dental positions [ 3-5 ], but it needs a thorough evaluation of the facial soft tissues [ 1,2 ]. The external appearance of the face is also the key point for a fruitful dialogue among the surgeons , the orthodontists and the patients , allowing the best compliance especially for treatments that require several interventions , and that need a middle term follow up to show their final results [ 6,7 ]. Current technology offers a wide range of computerized optical scanners that can be used to assess facial soft tissues not invasively , providing a 3D , quantitative reproduction of the patients ’ characteristics [ 8 ]. The digital images can be evaluated longitudinally to appreciate the effects of the various phases of the treatment [ 6 ] and can be compared to those obtained from normal subjects of comparable age , sex and ethnicity . Indeed , the need for reference values is important , as a slight facial asymmetry is also present in healthy subjects [ 9-11 ], and even the best surgical and orthodontical approaches cannot restore a perfectly symmetrical appearance . In the present study , we evaluated the soft tissue facial asymmetry of a patient undergoing a combined surgical-orthodontic treatment to correct a Class III dento-skeletal malocclusion . 3D
98
Stoma Edu J . 2018 ; 5 ( 2 ): 98-101 http :// www . stomaeduj . com