See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/342209960

Assessment of Facial Asymmetry in Patients Reporting for Orthodontic

Treatment

Article in Indian Journal of Public Health Research and Development · December 2019
DOI: 10.37506/v10/i12/2019/ijphrd/192388

CITATION READS
1 106

3 authors:

Niha Naveed A.Sumathi Felicita

Saveetha Dental College and Hospital Saveetha Institute of Medical and Technical Sciences
47 PUBLICATIONS 62 CITATIONS 37 PUBLICATIONS 671 CITATIONS

SEE PROFILE SEE PROFILE

Kannan Sabapathy
Sree Balaji Dental College and Hospital
16 PUBLICATIONS 18 CITATIONS

SEE PROFILE

All content following this page was uploaded by Niha Naveed on 12 November 2021.

The user has requested enhancement of the downloaded file.

 Indian Journal
Indian of Public
Journal Health
of Public Research
Health &&
Research Development,
DOI Number:November
Development, December 2019,
2019, Vol.10,
Vol. 10,No.
No. 11 385
10.37506/v10/i12/2019/ijphrd/192388
12 2467

Assessment of Facial Asymmetry in Patients Reporting for

Orthodontic Treatment

Niha Naveed1, A. Sumathi Felicita2, Kannan Sabapathy3

PG Student, Department of Orthodontics and Dentofacial Orthopedics, Sree Balaji Dental College and
1

Hospital, Chennai; 2Associate Professor, Department of Orthodontics and Dentofacial Orthopedics,

Saveetha Dental College and Hospital, Chennai; 3Professorand Head, Department of Orthodontics and
Dentofacial Orthopedics, Sree Balaji Dental College and Hospital, Chennai

ABSTRACT
Aim and Objective: To evaluate the prevalence of facial symmetry in patients and its correlation with
different morphometric and skeletal malocclusions among those reporting for orthodontic treatment.
Background: Facial asymmetries exist in all individuals. It is commonly stated that the right side of the
face is not an ideal replica of the left side. Facial asymmetry can be associated with different types of
malocclusion and growth patterns. Significant facial asymmetry causes both functional as well as aesthetic
problems. Hence this study was undertaken to evaluate the prevalence of asymmetry in patients reporting
for orthodontic treatment.
Materials and Method: This study was conducted on 162 patients in the Department of Orthodontics,
Saveetha Dental College and Hospitals, Chennai, within the age group of 14 to 26 years. Extra-oral
photographs of the frontal view of patients were taken in a standardised manner. The Rule of fifth was
modified and a midline was marked through the sagittal section of the face. The parts on the left and right side
of the face were measured in pixels and compared. The deviations were noted in each part and statistically
analysed to correlate with the type of malocclusion and growth pattern.
Results: All the three parts in the face were not equal on either side. Facial asymmetry was more concentrated
on the lateral part when compared to the other two parts. Asymmetry is seen more in patients with class II
malocclusion, horizontal and average growth patterns when compared to other malocclusion and growth
patterns.

Keywords: Facial asymmetry, malocclusion, growth pattern.

Introduction evaluation of the craniofacial region. Facial asymmetry

Facial asymmetry is defined as the inconsistency in
size, shape and arrangement of oneside of the face from
the opposite side when viewed in relation to the medial
sagittal plane. Facial asymmetry is important in aesthetic
Corresponding Author:
Dr. A. Sumathi Felicita
Associate Professor,
Department of Orthodontics and Dentofacial Orthopedics,
Saveetha Dental College and Hospital, Chennai
Email: sumifeli@hotmail.com
within limit is recognized as normal, but, severe
asymmetry of the facial features is not acceptable.1
Many human body parts undergo development
with bilateral symmetry. This implies that the right and
left sides can be divided into identical mirror images.
However, due to biological factors inherent to processes
of development as well as environmental disturbances,
perfect bilateral symmetry is rarely found.2
The face often presents with a mild degree of
asymmetry. It derives from the fact that the lower
and midface develop from the medial and lateral
nasal processes as well as maxillary and mandibular
2468386 Indian
Indian Journal
Journal of Public
of Public Health
Health Research
Research & Development,
& Development,
December
processes, and despite being intrinsically coordinated,
these structures might imply failure of development or
maturation of such embryonic processes.3
In the literature, a number of causal factors
have been highlighted in the development of facial
asymmetries.asymmetries could have pathological,
traumatic, functional or developmental causal factors(4).
The etiology of facial asymmetry can be grouped into
hereditary factors of prenatal origin and acquired factors
of postnatal origin(5).the causes of facial asymmetry can
be grouped into three main categories: (I) congenital,
of prenatal origin; (II) acquired, resulting from injury
or disease; and (III) developmental, arising during
development and of unknown etiology(3).
As for the classification of craniofacial asymmetries,
the structures involved and established that asymmetries
could be classified as dental, skeletal, muscular or
functional(1).
Based on skeletal analysis of deviation of the chin
and bilateral difference between mandibular rami length,
asymmetry is classified into 4 types. The four types of
asymmetry would be as follows: patients with deviation
of the chin and bilateral difference between mandibular
rami length; patients with bilateral difference between
mandibular rami length, only; patients with deviation of
the chin, only; and patients with changes in volume on
one side of the mandible, only, without deviation of the
chin or discrepancy between mandibular rami length.(6)
Clinical examination allows asymmetry to be
assessed in sagittal, coronal and vertical dimensions, and
it is the most important diagnostic tool in assessing the
condition(3).At smiling, analysis should assess whether
dental midlines coincide with facial midline, inclination
of the occlusal plane and the amount of bilateral gingival
exposure. Intraoral clinical examination should focus on
assessing malocclusion, tipping of posterior and anterior
teeth, crossbite and the presence of functional deviation
of the mandible.(3,7)
In order to determine patient’s facial midline,
specific soft tissues landmarks and structures are used
as reference. Thus, sagittal facial midline corresponds
to a line perpendicular to the ground, passing through
the glabella. Other landmarks of the upper and midface
can also be used as reference, since these regions are
less likely to present with bilateral asymmetry. Half the
interpupillary distance, the subnasal point or the philtrum
November
2019,
2019, Vol. 10,Vol.10,
No. 12No. 11
can also be used as reference to determine the midline
in cases with some sort of imbalance near the glabella.
Patient’s tip of the nose and chin, however, present with
greater variation(6).
In order to have asymmetry assessed, patients must
be in upright position, looking forward, with teeth in
normal occlusion and relaxed lips. Additionally, having
patient’s upper and lower views often aids in determining
asymmetry. A common procedure is the use of a piece of
dental floss stretched from the region of the glabella to
the lower chin, passing through the philtrum.9 Another
procedure used to assess inclination of the occlusal
plane in vertical direction is asking the patient to bite a
wooden sheet, so as to determine how the latter relates to
the pupillary plane on both sides.
Clinical examination shall be supplemented
with other diagnostic tools like casts, photographs,
radiographs, tomography and bone scintigraphy. They
help to locate and measure precisely the structures
involved in asymmetry(8)
Different methods of radiographic assessment are
available to locate and measure the magnitude of facial
asymmetry. Lateral cephalogram provides limited
information, as structures on the right and left sides are
overlapped.
Thus, at present, the examination most often
recommended to overcome the aforementioned
disadvantages and allow thorough assessment of
craniofacial asymmetries is computed tomography,
especially cone-beam computed tomography (CBCT)(9).
In dentistry, cone beam CT (CBCT) is used widely
because of less radiation dose and low cost. Also,
becauseCBCT ensure high-dimensional accuracy in
measurement of the facial structures,CBCT is an excellent
method for evaluation of facial asymmetry(10). previous
3D studies in patients with mandibular prognathism
paid attention to the morphology of the mandible such
as ramal height, body length and ramal inclination, and
showed a result that mandible is a dominant factor in
facial asymmetry(11).
In general, skeletal deviation more than 4 mm is
mandatory to make asymmetry visible in an individual’s
face(5,12,13,14).Whenever the degree of asymmetry is
lower, the condition tends to be considered mild and
unperceivable. Nevertheless, asymmetry perception or
 Indian Journal
Indian of Public
Journal Health
of Public
Health
blinding will also depend on individual characteristics,
such as soft tissue thickness in that region. For this
reason, other authors consider an asymmetrical face
as having bone deviations equal to or greater than 2
mm(15,16,17).
The purpose of the present study was to investigate
asymmetry in soft tissue by means of rule of five with a
modification in standardised frontal photographs.
Materials and Method
Selection of Subject: The study was performed on 162
subjects reporting to the Department of Orthodontics,
Saveetha Dental College and Hospitals, Chennai. The
chosen patients were within the age group of 14 to 26
years. All the selected subjects had a normal appearance
with no obvious deformities. Subjects with history
of orthodontic treatment, congenital abnormalities,
trauma, cyst, tumours or any pathological abnormalities
and missing molars were excluded. The subjects’ age,
malocclusion type and growth pattern were recorded.
Photographic Technique: A small rectangular mirror
was attached to the top of the camera such that the
lower border of the mirror was horizontal. The camera
was placed on a standard adjustable tripod stand. The
arms and adjustable plates of the tripod stand were set
so that the camera was horizontal. In this study, a Sony
Alpha SLT-A58 digital camera was used which stores
the photographs digitally that can be later transferred
to the computer. The camera has a resolution of 20.1
Mega pixels with APS HD CMOS Sensor. The inbuilt
motorized zoom lens with a lock-on autofocus range to
infinity and auto object framing ensured that the images
were of high quality. Frontal view photographs in natural
head position (NHP) were taken using the digital camera
under standardised conditions:
Shutter speed: 1/40 sec
Exposure program: Normal program
F-stop: f/5.6
Aperture value: f/5.6
Max Aperture value: f/5.6
ISO speed ratings: 3200
Focal length: 50.0 ± 5.0 mm
Research
&&
Research Development,
Development,November
December 2019,
2019, Vol.10,
Vol. 10,No.
No. 11
12 387
2469
Lens: DT 18-55mm f3.5-5.6 SAM II
Pixel dimension X: 2352 ± 230
Y: 2780 ± 195
Orientation: Normal
Resolution X: 775 ± 50
Y: 775 ± 50
Resolution unit: Inch
Compressed bits per pixel: 1
Colour space: sRGB
The Camera was placed at a distance of 90 cms in
front of the subject. The height of the camera was so
adjusted such that the lower border of the mirror attached
to the top of the camera coincided with the subjects’ eye
level. This ensured that the level of each subject’s eyes
was constant in relation to the lens. Earrings and eye
glasses were removed and long hairs were tied back.
The photographic method is a quantitative method that
is not only valid and reproducible but also non-invasive,
convenient to use, less technique sensitive, low cost
and takes soft tissue morphology into consideration
compared to radiographic method.
Photographic Analysis: The digital photographs are
transferred from the camera to the computer for analysis
of facial asymmetry. The following divisions were made
on the photographs:
1. Right postaurale- right exocanthion (pa r-ex r),
2. Right exocanthion- Right endocanthion (ex r-en r),
3. Right endocanthion- midline (en r-m),
4. Midline- left endocanthion (m-en l),
5. Left endocanthion- left exocanthion (en l-ex l),
6. Left exocathion- left postaurale (ex l-pa l)
This is a modification of the Rule of Fifths where the
middle fifth of the face is divided into two by a midline
passing through the sagittal section of the face. Thus the
face is divided into median, middle and lateral parts on
the right and left side of the midline. This is to note the
deviation in the left and right sides of the midline in the
middle portion of the face which cannot be analysed
using the original rule of fifths. Vertical lines were drawn
2470388 Indian
Indian Journal
Journal of Public
of Public Health
Health Research
Research & Development,
& Development, November
December 2019,
2019, Vol. 10,Vol.10,
No. 12No. 11

and the measurements were made using a digital ruler in
the MWSNAP 3.0 version software in pixels.
Statistical Analysis: Statistical analyses were performed
using SPSS version 22.0. If p-value was less than 0.05
then it was statistically significant. One way ANOVA
tests were performed to compare the mean differences
between parts, to compare the mean differences between
growth patterns in each part separately and to compare
the mean differences between parts in each growth
pattern separately, to compare the mean differences
between malocclusion types in each part separately and
to compare the mean differences between parts in each
malocclusion type separately. Tukey HSD Post Hoc
Tests were performed for multiple comparisons.
Results
Comparison of Asymmetry in Three Parts:
Asymmetry between the mean value measurements of
the three parts are given in table1 and 2. Relation of
Asymmetry with skeletal malocclusions and growth
patterns are given in tables 3,4 and 5,6

Table 1: Comparing the median, middle and lateral parts

Part N Mean Difference Std. Dev F-Value P-Value*

Median part 162 5.78 4.061
Middle part 162 3.71 3.332
27.375 <0.001*
Lateral part 162 8.19 7.839
Total 486 5.89 5.737
*p<0.05 is statistically significant

Table 2: Comparing the right and left of the median, middle and lateral parts

Part Side N Mean Std. Dev t-Value P-Value

Right Side 162 48.18 8.760
Median part 1.486 0.139
Left Side 162 47.36 9.107
Right Side 162 79.18 14.266
Middle part 1.441 0.152
Left Side 162 78.62 14.024
Right Side 162 85.43 15.077
Lateral part 2.585 0.011*
Left Side 162 87.69 13.685
*p<0.05 is statistically significant
Comparison of Asymmetry in Different Malocclusions:

Table 3: Comparing the median, middle and lateral parts with the type of malocclusion

Malocclusion type Part N Mean Difference Std. Dev F-Value P-Value

Median part 75 5.67 3.625
Middle part 75 4.23 3.885
Class-1 14.893 <0.001*
Lateral part 75 9.69 9.646
Total 225 6.53 6.741
Median part 76 5.62 4.046
Middle part 76 3.29 2.722
Class-2 12.525 <0.001*
Lateral part 76 6.70 5.607
Total 228 5.20 4.503
Median part 11 7.73 6.405
Middle part 11 3.09 2.773
Class-3 3.279 0.052
Lateral part 11 8.18 5.582
Total 33 6.33 5.515
*p<0.05 is statistically significant
 Indian Journal
Indian of Public
Journal Health
of Public Research
Health &&
Research Development,
Development,November
December 2019,
2019, Vol.10,
Vol. 10,No.
No. 11
12 389
2471

Table 4: Comparing the right and left of the median, middle and lateral parts with the type of malocclusion

Malocclusion type Part Side N Mean Std. Dev t-Value P-Value

Right Side 75 49.32 9.117
Median part 1.190 0.238
Left Side 75 48.40 9.281
Right Side 75 80.27 13.839
Class-1 Middle part 0.785 0.435
Left Side 75 79.75 14.267
Right Side 75 85.12 16.523
Lateral part 2.124 0.037
Left Side 75 88.39 13.755
Right Side 76 46.78 7.627
Median part 0.745 0.459
Left Side 76 46.18 8.722
Right Side 76 77.55 14.411
Class-2 Middle part 1.244 0.218
Left Side 76 76.95 13.473
Right Side 76 85.28 12.967
Lateral part 0.987 0.327
Left Side 76 86.26 12.911
Right Side 11 50.09 12.462
Median part 0.563 0.586
Left Side 11 48.36 10.376
Right Side 11 83.00 16.031
Class-3 Middle part 0.428 0.678
Left Side 11 82.45 15.877
Right Side 11 88.55 19.154
Lateral part 1.499 0.165
Left Side 11 92.73 17.822

Comparison of Asymmetry in Different Growth Patterns:

Table 5: Comparing the median, middle and lateral parts with the type of growth pattern

Growth pattern Part N Mean Difference Std. Dev F-Value P-Value

Median part 57 5.67 3.627
Middle part 57 3.54 2.605
Horizontal 13.205 <0.001*
Lateral part 57 9.53 9.959
Total 171 6.25 6.739
Median part 24 5.46 4.549
Middle part 24 4.29 3.085
Vertical 0.801 0.453
Lateral part 24 5.58 3.922
Total 72 5.11 3.888
Median part 81 5.96 4.238
Middle part 81 3.65 3.838
Average 14.589 <0.001*
Lateral part 81 8.01 6.818
Total 243 5.88 5.418
*p<0.05 is statistically significant
2472390 Indian
Indian Journal
Journal of Public
of Public Health
Health Research
Research & Development,
& Development, November
December 2019,
2019, Vol. 10,Vol.10,
No. 12No. 11

Table 6: Comparing the right and left of the median, middle and lateral parts with the type of growth pattern

Growth pattern Part Side N Mean Std. Dev t-Value P-Value

Right Side 57 47.81 8.524
Median part 0.333 0.740
Left Side 57 47.51 9.345
Right Side 57 79.32 14.982
Horizontal Middle part 1.785 0.080
Left Side 57 78.30 15.070
Right Side 57 85.02 16.765
Lateral part 1.948 0.056
Left Side 57 88.47 13.552
Right Side 24 50.29 11.638
Median part 2.535 0.019*
Left Side 24 47.00 9.978
Right Side 24 78.79 15.379
Vertical Middle part 0.267 0.792
Left Side 24 79.08 14.873
Right Side 24 86.88 12.875
Lateral part 0.000 1.000
Left Side 24 86.88 12.522
Right Side 81 47.81 7.941
Median part 0.561 0.577
Left Side 81 47.36 8.781
Right Side 81 79.20 13.580
Average Middle part 0.840 0.403
Left Side 81 78.70 13.157
Right Side 81 85.28 14.572
Lateral part 1.815 0.073
Left Side 81 87.37 14.231
*p<0.05 is statistically significant

Discussion standardised photographs and the measurements were

Facial asymmetry is evaluated by a number of
methods such as frontal photographs, radiographs,
stereophotogrammetry, 3D photogrammetry etc.(9,14,18–27)
Each method has its own advantages and disadvantages.
Of these methods, frontal photographs are the most
common and easiest methods. This method involves the
identification of land marks and calculated individual
linear measurements between them.
The rule of fifth as introduced by Powell and
Humphries in 1984, had four lines that divided the face into
five segments each with an eye width. However, in such
an analysis, the asymmetry cannot be clearly explained
in the medial part. Hence a midline was introduced in the
rule of fifth, dividing the face into right and left halves and
thereby evaluating the asymmetry. This midline divides
the medial fifth into right and left parts.
This analysis was performed in random patients
reporting for treatment in department of orthodontics in
Saveetha Dental College and Hospitals. This analysis
would depict the prevalence of asymmetry in this
patient population. All measurements were made in
done in computer software to prevent method error.
These measurements were related to the patients’ skeletal
malocclusion and growth patterns.
When the three parts of either side were averaged
and compared, there was significant difference between
the three parts. There was significant difference when the
median part was compared with the middle and lateral
parts. There was significant difference when the middle
part was compared with the median and lateral parts.
Similarly, there was significant difference when the
lateral part was compared with the median and middle
parts. In the lateral part, there was a much significant
difference between their right and left halves.
When the three parts where related with the different
skeletal malocclusion, there was no significant difference
in the linear measurements. In class 1 and class 2, there
was significant difference between the three parts.
When the parts were related to the different growth
patterns, there was significant difference in the horizontal
growth pattern when compared to the vertical and
average growth patterns. In horizontal growth pattern,
 Indian Journal
Indian of Public
Journal Health
of Public
Health
there is significant difference between the right and left
halves of the lateral part.
Conclusion
All the three parts in the face were not equal on
either side. Facial asymmetry was more concentrated
on the lateral part when compared to the other two
parts. Asymmetry is seen more in patients with class 2
malocclusion, horizontal and average growth patterns
when compared to other malocclusion and growth
patterns. Ironically, there is no significant facial
asymmetry in patients with vertical growth pattern or
skeletal class 3 malocclusion. This could be due to the
less sample size of Class 3 and vertical growing patients.
Acknowledgement
Authors wish to thank DST-FIST (Ref no. SR/FST/
College-23/2017) Government of India, New Delhi,
for utilizing the funded research equipment facilities of
Sree Balaji Dental College and Hospital, Pallikaranai,
Chennai, Tamilnadu, India.
Ethical Clearance: Institutional Ethics Committee,
Sree Balaji Dental College and Hospital, Committee
registered with DCGI. (Registration no: ECR/761/Inst/
TN/2015)
Source of Funding: Nil
Conflict of Interest: Nil
REFERENCES
1. Bishara SE, Burkey PS, Kharouf JG. Dental and
facial asymmetries: a review. Angle Orthod. 1994
Apr 1;64(2):89–98.
2. Burstone1998.pdf [Internet]. [cited 2018 Mar
8]. Available from: http://dacemirror.sci-hub.tw/
journal-article/845c6d8f7ec870b54c52665f8a424
4da/burstone1998.pdf
3. Cheong Y-W, Lo L-J. Facial asymmetry: etiology,
evaluation, and management. Chang Gung Med J.
2011;34(4):341–351.
4. Chia MS, Naini FB, Gill DS. The aetiology,
diagnosis and management of mandibular
asymmetry. Orthod Update. 2008;1(2):44–52.
Research
&&
Research Development,
Development,November
December 2019,
2019, Vol.10,
Vol. 10,No.
No. 11
12 391
2473
5. Haraguchi S, Iguchi Y, Takada K. Asymmetry of
the Face in Orthodontic Patients. Angle Orthod.
2008 May;78(3):421–6.
6. Thiesen G, Gribel BF, Freitas MPM. Facial
asymmetry: a current review. Dent Press J Orthod.
2015 Dec;20(6):110–25.
7. Legan HL. Surgical correction of patientswith
asymmetries. Semin Orthod. 1998 Sep 1;4(3):189–
98.
8. Maeda M, Katsumata A, Ariji Y, Muramatsu A,
Yoshida K, Goto S, et al. 3D-CT evaluation of
facial asymmetry in patients with maxillofacial
deformities. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod. 2006 Sep;102(3):382–90.
9. Hwang H-S, Yuan D, Jeong K-H, Uhm G-S, Cho
J-H, Yoon S-J. Three-dimensional soft tissue
analysis for the evaluation of facial asymmetry in
normal occlusion individuals. Korean J Orthod.
2012;42(2):56.
10. Periago DR, Scarfe WC, Moshiri M, Scheetz
JP, Silveira AM, Farman AG. Linear Accuracy
and Reliability of Cone Beam CT Derived
3-Dimensional Images Constructed Using an
Orthodontic Volumetric Rendering Program.
Angle Orthod. 2008 May;78(3):387–95.
11. Kwon T-G, Park H-S, Ryoo H-M, Lee S-H. A
comparison of craniofacial morphology in patients
with and without facial asymmetry--a three-
dimensional analysis with computed tomography.
Int J Oral Maxillofac Surg. 2006 Jan;35(1):43–8.
12. Masuoka N, Momoi Y, Ariji Y, Nawa H, Muramatsu
A, Goto S, et al. Can cephalometric indices and
subjective evaluation be consistent for facial
asymmetry? Angle Orthod. 2005;75(4):651–655.
13. Baek S-H, Cho I-S, Chang Y-I, Kim M-J.
Skeletodental factors affecting chin point deviation
in female patients with class III malocclusion
and facial asymmetry: a three-dimensional
analysis using computed tomography. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 2007
Nov;104(5):628–39.
14. Lee J-K, Jung P-K, Moon C-H. Three-dimensional
cone beam computed tomographic image
reorientation using soft tissues as reference for
facial asymmetry diagnosis. Angle Orthod. 2014
Jan;84(1):38–47.
 2474392 Indian
Indian Journal
Journal of Public
of Public Health
Health Research
Research & Development,
& Development,
December
15. Ramirez-Yañez GO, Stewart A, Franken
E, Campos K. Prevalence of mandibular
asymmetries in growing patients. Eur J Orthod.
2011 Jun;33(3):236–42.
16. Kusayama M, Motohashi N, Kuroda T.
Relationship between transverse dental anomalies
and skeletal asymmetry. Am J Orthod Dentofacial
Orthop. 2003 Mar;123(3):329–37.
17. Kim J-Y, Jung H-D, Jung Y-S, Hwang C-J, Park
H-S. A simple classification of facial asymmetry
by TML system. J Cranio-Maxillofac Surg. 2014
Jun;42(4):313–20.
18. Inui M, Fushima K, Sato S. Facial asymmetry
in temporomandibular joint disorders. J Oral
Rehabil. 1999;26(5):402–406.
19. Ferrario VF, Sforza C, Pizzini G, Vogel G, Miani
A. Sexual dimorphism in the human face assessed
by euclidean distance matrix analysis. J Anat.
1993;183(Pt 3):593.
20. Haraguchi S, Takada K, Yasuda Y. Facial
asymmetry in subjects with skeletal Class III
deformity. Angle Orthod. 2002;72(1):28–35.
21. Meyer-Marcotty P, Alpers GW, Gerdes
ABM, Stellzig-Eisenhauer A. Impact of facial
asymmetry in visual perception: A 3-dimensional
data analysis. Am J Orthod Dentofacial Orthop.
2010 Feb;137(2):168.e1-168.e8.
22. Olate S, Almeida A, Alister JP, Navarro P,
Netto HD, de Moraes M. Facial asymmetry and
View publication stats
November
2019,
2019, Vol. 10,Vol.10,
No. 12No. 11
condylar hyperplasia: considerations for diagnosis
in 27 consecutives patients. Int J Clin Exp Med.
2013;6(10):937.
23. Damstra J, Oosterkamp BCM, Jansma J, Ren
Y. Combined 3-dimensional and mirror-image
analysis for the diagnosis of asymmetry. Am J
Orthod Dentofacial Orthop. 2011 Dec;140(6):886–
94.
24. Verhoeven TJ, Coppen C, Barkhuysen R,
Bronkhorst EM, Merkx MAW, Bergé SJ, et al.
Three dimensional evaluation of facial asymmetry
after mandibular reconstruction: validation of a
new method using stereophotogrammetry. Int J
Oral Maxillofac Surg. 2013 Jan;42(1):19–25.
25. Ercan I, Ozdemir ST, Etoz A, Sigirli D, Tubbs
RS, Loukas M, et al. Facial asymmetry in young
healthy subjects evaluated by statistical shape
analysis. J Anat. 2008 Dec;213(6):663–9.
26. Dindaroğlu F, Kutlu P, Duran GS, Görgülü
S, Aslan E. Accuracy and reliability of 3D
stereophotogrammetry: A comparison to direct
anthropometry and 2D photogrammetry. Angle
Orthod. 2016 May;86(3):487–94.
27. Codari M, Pucciarelli V, Stangoni F, Zago
M, Tarabbia F, Biglioli F, et al. Facial thirds–
based evaluation of facial asymmetry using
stereophotogrammetric devices: Application to
facial palsy subjects. J Cranio-Maxillofac Surg.
2017 Jan;45(1):76–81.