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
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