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Article

Morphological Evaluation of Cranium Facial Asymmetry in Class III Malocclusion Patients

by
Sayumi Ono
1,†,
Chie Tachiki
1,*,†,
Taiki Morikawa
1,
Yasuo Aihara
2,
Satoru Matsunaga
3,
Keisuke Sugahara
4,
Akira Watanabe
5,
Takakazu Kawamata
2 and
Yasushi Nishii
1
1
Department of Orthodontics, Tokyo Dental College, Chiyoda, Tokyo 101-0061, Japan
2
Department of Neurosurgery, Tokyo Women’s Medical University, Shinjuku, Tokyo 162-8666, Japan
3
Department of Anatomy, Tokyo Dental College, Chiyoda, Tokyo 101-0061, Japan
4
Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Chiyoda, Tokyo 101-0061, Japan
5
Department of Oral & Maxillofacial Surgery, Tokyo Dental College, Chiyoda, Tokyo 101-0061, Japan
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Appl. Sci. 2023, 13(11), 6533; https://doi.org/10.3390/app13116533
Submission received: 26 April 2023 / Revised: 22 May 2023 / Accepted: 25 May 2023 / Published: 27 May 2023
(This article belongs to the Special Issue Present and Future of Orthodontics)
Browse Figures
Versions Notes

Abstract

:
The maxillofacial region of patients with facial asymmetry is deformed not only in the mandible but also in the maxilla, suggesting that the head region may also be deformed. Therefore, in this study, skeletally originated mandibular prognathism with facial asymmetry was evaluated in relation to cranial morphology. The cranial morphology of patients who visited the Chiba Dental Center of Tokyo Dental College and were diagnosed with skeletal mandibular prognathism with facial asymmetry (asymmetry group: ANB 0° or less; Menton deviation 4 mm or more; 30 subjects) and without facial asymmetry (symmetry group: ANB less than 0°; Menton deviation less than 3 mm) was measured and evaluated. As a method, the length and area of the cranium were measured using axial cephalometric radiographs. In the asymmetry group, there was a significant difference in the left–right difference in the long diameter of the posterior part of the cranium compared to the symmetry group (p = 0.009). The asymmetry group also had significant differences in the central and occipital areas of the cranium on the left and right sides compared to the symmetry group (p < 0.001). In the asymmetry group, the direction of Menton deviation and the direction of head region deviation coincided in about 70% of the cases. There was also a positive correlation between head deviation and the amount of Menton deviation. The results of this study suggested that patients with facial asymmetry had greater head deformity than patients without facial asymmetry.

1. Introduction

Many patients present to the orthodontic practice with complaints of facial asymmetry as well as bite malfunction. For such patients, frontal, lateral, and axial cephalometric radiographs are taken, and cephalometric analysis is performed to find the cause of the asymmetry. Skeletal malocclusion with significant malpositioning of the jawbone, either vertically or horizontally, is diagnosed as a jaw deformity and is an indication for orthodontic treatment with surgical intervention. Facial asymmetry is also included in the diagnosis of jaw deformity [1]. Kobayakawa [2] and Lee et al. [3] reported that asymmetry of the jaw angle has the greatest influence on the judgment of the symmetry of frontal appearance by a third party other than a dentist, and Kukita et al. [4] reported that the difference in the bulge of the contour line from the chin to the left and right jaw angle is involved in asymmetry. Indeed, patients themselves often point to mandibular asymmetry as a factor in their perception of asymmetry. However, in the process of diagnosis, the maxillofacial surface of patients with facial asymmetry is often deformed in three dimensions, not only in the mandible but also in the entire maxillofacial region, including the maxilla. Therefore, to understand the morphology of facial asymmetry, it is essential to measure the maxillofacial region centered on the upper and lower jawbones as well as the mandible [5,6,7]. Maeda et al. reported that more than half of the studied patients with facial asymmetry had deformities of the maxillofacial region, including the maxilla [8]. On the other hand, patients with facial asymmetry often have deformities not only in the maxillofacial region but also in the head region.
The head region consists of the cerebral cranium and the facial cranium. The cerebral cranium is further divided into the cranial base, which supports the brain from below, and the cranial crown, which surrounds the brain from the outside. The cranial base grows via growth at the cartilaginous joints, bone addition at the sutures, and bone remodeling on the inner and outer surfaces of the basal bone. On the other hand, the cranial crown shows sutural growth and periosteal growth on the external and internal surfaces of the bone [1]. The cranial crown, which surrounds the brain from the outside, includes the temporal bone that forms the mandibular fossa [9,10]. The mandibular fossa is part of the structure of the temporomandibular joint, which develops at 8 weeks of fetal age and is shaped by fetal jaw movement. During postnatal growth, the mandibular fossa becomes visible from infancy to childhood, i.e., with the eruption of the primary teeth. The position of the mandibular fossa in the temporomandibular joint is also known to be involved in the anteroposterior, lateral, and vertical position of the mandible [11]. In cranial studies, it was also reported that children attempt to compensate for abnormal head structures, such as cranial asymmetry and plagiocephaly, with a displacement of normal organs. [12] Abnormal structures of the head, if present, cause damage to the mouth and vestibule. When accompanied by distortion of the orbit, this creates pressure on the suborbital muscles and nerves, causing sensorimotor deficits. One study also reported that anterior and posterior deformities of the cranium might cause deviations in the surrounding structures, including the temporomandibular joint, and that mechanisms may be at work to compensate for this [13]. Some studies have also compared such left–right skull deformities by measuring left–right differences in skull distance and area [14,15]. Thus, it has been suggested that there may be a close relationship between cranial deformity and deformation of the maxillofacial region and mandible.
However, there are only scattered reports on the relationship between facial asymmetry and cranial deformity, and much remains unknown. On the other hand, horizontal asymmetry has been reported to be more common in patients with skeletal mandibular prognathism than in those with skeletal maxillary prognathism [6,16]. Therefore, in this study, the relationship between maxillofacial morphology and cranial morphology in skeletal mandibular prognathism with facial asymmetry was evaluated.

2. Materials and Methods

2.1. Research Subjects and Materials

A total of 60 patients, comprised of 30 patients diagnosed with skeletal mandibular prognathism with facial asymmetry (asymmetry group) and 30 patients diagnosed with skeletal mandibular prognathism without facial asymmetry (symmetry group) who visited the Chiba Dental Center of Tokyo Dental College between 2010 and 2020, were included. In all patients, cephalometric X-ray photographs in the lateral, frontal, and axial positions were taken, which were used for cephalometric analysis. The inclusion criteria were skeletal mandibular prognathism cases with ANB (ANB: an evaluation item of the anteroposterior position of the maxillary and mandibular alveolar bases) of less than 0° [17] and a Wits appraisal (Wits: an evaluation item of the relative position of the maxilla and mandible) of less than 0 mm [18,19] in the cephalometric analysis using lateral cephalometric radiographs. In addition, Menton (Menton: the extreme inferior point of the chin) deviation on postero-anterior cephalometric radiographs was defined as 4 mm or more in the asymmetry group and 3 mm or less in the symmetry group [6,20,21]. Patients with hereditary or congenital diseases, endocrine and metabolic abnormalities, severe trauma to the maxillofacial cranium, or severe TMJ disorder were excluded. A breakdown of the target population is shown in Table 1.
The sample size required for this study was considered based on preliminary studies. The effect size was calculated from the measured area, and standard deviation in the cranium, and a significance level of 0.05 and a power of 0.75 were set, resulting in a sample size of 30. Further referencing similar studies, a sample size of 30 was determined to be adequate [20,21]. Samples were measured for cranial morphology using axial cephalometric radiographs taken before the start of preoperative orthodontic treatment. Axial cephalometric radiographs were taken in the following settings (X-ray tube voltage, 95 kV; X-ray tube current, 100 mA; X-ray irradiation time, 0.16 s). The obtained images were output in DICOM format, and cephalometric analysis and measurements of distances and areas were carried out digitally using cephalometric analysis software (Quick Ceph Studio, Sarasota, FL, USA) and maxillofacial treatment simulation software (Siemens Erlangen, DEU). Measurements in this study were taken by the same evaluator. After 4 weeks, the reference points and reference lines were remeasured, and the intraclass correlation coefficient (ICC; 1, 0, 0.84) was calculated. The study was approved by the Tokyo Dental College Ethics Committee (Approval No.916).

2.2. Establishment of Reference Points, Reference Lines, and Measurement Items in Cephalometric Radiographs

Cranial measurements were carried out using axial cephalometric radiographs in all 60 selected cases. The anterior margin of the right and left foramen ovale (Fo: right side—FoR; left side—FoL) was set as the reference point in the axial position cephalometric radiograph to perform the measurement. A line passing through the two points (FoR and FoL) was designated as the FoP and was used as the horizontal reference line. The midpoint between the FoR and FoL on the FoP was set as the FoM. The line passing through the FoM and perpendicular to the FoP was designated as the FoVP, the vertical reference line. In order to compare the anteroposterior and lateral differences in all crania, the cranium was divided between the FoP and FoVP into three sections of 30° each side. The lengths from the FoM to the divided cranial limb were designated a–e from the right side. The occiput of the cranium was also divided in a similar fashion into three sections of 30° each on the left and right sides, and the cranium was divided into blocks 1–6 from the right side (Figure 1). The length of a~e and the area of blocks 1~6 in all cases were measured. The following similar studies were used as references for the comparative method of measuring left–right differences in the cranium [22].

2.3. Measurement and Evaluation

2.3.1. Comparison of Left–Right Differences in Distance Measurements of Cranial Morphology between the Facial Symmetry Group and the Facial Asymmetry Group

The distance (a~e) to the cranial limbus set on the axial cephalometric radiographs was measured. Based on the distances, the left–right difference in cranial crown morphology was determined. The left–right difference in cranial crown morphology was expressed as the difference in the distance measurement from the right side to the left side. The left–right difference in the anterior part of the cranium was determined as a–e, and the right–right difference in the posterior part of the cranium was determined as b–d. Because the direction of cranial deformation varied from case to case, the absolute value of the difference in length of the corresponding site on the left and right sides was used to compare the site and degree of cranial deformity in the two groups.

2.3.2. Comparison of Left–Right Differences in Area Measurements of Cranial Morphology between the Facial Symmetry and Facial Asymmetry Groups

The area of the cranial blocks (1~6) set on the axial cephalometric radiographs was measured. Based on the area, the left–right difference in cranial crown morphology was determined. The difference in cranial crown morphology was expressed as the difference in the area measurement from the distance measurement on the right side to the area measurement on the left side. The left–right difference in the anterior part of the cranium was 1–6, the left–right difference in the middle part of the cranium was 2–5, and the left–right difference in the posterior part of the cranium was 3–4. As with the distance measurements, because the direction of cranial deformation differed from case to case, the absolute value of the difference between the corresponding areas of the left and right sides was determined. This value was used to compare the site and degree of cranial deformity in the two groups.

2.3.3. Measurement of Displacement Direction and Amount of Displacement of Menton in Facial Asymmetry Group

In the facial asymmetry group, the side with the larger sum of area at the center and occipital region of the cranium, when compared between the left and right sides, was set as the direction of cranial deviation. The facial asymmetry group was divided into two groups, one in which the direction of Menton deviation was the same as the direction of cranial deviation and another in which the direction of cranial deviation was different. The correlation between the degree of Menton deviation and cranial deformity in both groups was examined in the central and occipital cranial regions.

2.4. Statistical Processing

A t-test was used to compare the symmetry and asymmetry groups in the difference in distance to the cranial limb between the left and right sides and to compare the above two groups in the difference in the area of cranial morphology between the left and right sides. Pearson product-rate correlation analysis was used to examine the correlation between the left–right difference in cranial morphology and the amount of mandibular deviation. Statistical analysis was performed using SPSS version 24.0 (IBM Corporation, Armonk, NY, USA).

3. Results

3.1. Comparison of Facial Symmetry and Facial Asymmetry Groups in Left–Right Differences in Distance Measurements of Cranial Morphology

The calculated difference in the lengths of the corresponding left and right areas of the cranial morphology showed that the asymmetry group had significantly larger values for the difference in the long diameter than the symmetry group. Significant differences were also observed between the asymmetry and symmetry groups, especially in the posterior cranial region (p = 0.009) (Table 2 and Figure 2).

3.2. Comparison of Facial Symmetry and Facial Asymmetry Groups in Left–Right Differences in Area Measurements of Cranial Morphology

The difference between the corresponding areas of the left and right cranial morphology showed significantly larger values for the asymmetry group than for the symmetry group. Significant differences were observed, especially in the central and posterior cranial regions (p < 0.001) (Table 3 and Figure 3).

3.3. Measurement Results of Displacement Direction and Amount of Displacement of Menton in the Facial Asymmetry Group

Among the facial asymmetry group, 73% of the patients had the same direction of Menton and cranial deviation, and 27% of the patients had different directions of Menton and cranial deviation. (Figure 4). A comparison between two groups—one with the same cranial deviation direction and another with a different direction—revealed a weak positive correlation between Menton deviation and cranial deformation at the center of the cranium, regardless of the Menton deviation direction (Figure 5). Similar measurements were carried out in the posterior part of the cranium, but no correlation was obtained between the amount of Menton displacement and cranial deformation (Figure 6).

4. Discussion

4.1. Cranial Deformities in Patients with Facial Asymmetry

The results of this study showed that the asymmetry group had significantly greater values than the symmetry group for the difference in distance between the corresponding areas of cranial morphology. The asymmetry group also had significantly greater values than the symmetry group in the difference in the area of the corresponding sites of cranial morphology. These results suggest that patients with facial asymmetry have greater left–right differences, or cranial deformities, than patients with facial symmetry. In the left–right difference in the distance measurement, a significant difference was found between the asymmetry and symmetry groups in the posterior part of the cranium. In the left–right difference in the area measurement, there was a significant difference between the asymmetry and symmetry groups in the central and posterior cranial regions. The mandibular fossa is located around the area where significant differences were found. The mandibular fossa is located on the temporal bone and constitutes the temporomandibular joint [23]. Cranial crown growth reaches 92% of adult growth by age 6 [24]. On the other hand, bone accretion around the mandibular fossa, including the articular tubercle, continues until around age 12, and it is known that the volume of the mandibular fossa after the permanent dentition is established is approximately twice that at the time of permanent tooth eruption [9,24]. Thus, three-dimensional deformities and asymmetries of the cranial crown may affect the formation of the mandibular fossa. Since mandibular growth occurs primarily in the condylar region, any deviation in the mandibular fossa present in the temporal bone will affect the position of the mandibular head and cause lateral deviation of the mandible. Previous studies have suggested that cranial base morphology and cranial crown growth may be closely related to mandible growth [25,26,27,28]. Additionally, the mandibular deviation has been reported to be associated with a contralateral head slant and an increase in temporal muscle volume. It has been suggested that cranial deformity is a cause of facial asymmetry and that such deviation may occur in the temporalis muscle [29]. In light of the above, it can be speculated that cranial deformation during growth may influence future deformation of the mandible morphology.

4.2. Relationship between Cranial Deformity and Menton Deviation in Patients with Facial Asymmetry

In the present study, 70% of the cases in the facial asymmetry group had the same direction of Menton deviation and cranial deviation. In one study of facial asymmetry, it was reported that with posterior and lateral deformity of the cranial crown, the mandibular fossa is also located posteriorly and laterally [21]. In that report, the mandibular fossa on the untransformed side of the cranium was located more anteriorly, and the mandibular fossa on the backward cranially deformed side was located more posteriorly. Thus, in 80% of the study subjects, the mandible tended to deviate in the direction of the backward cranial deformity. The results of the present study are comparable to those findings. There is a relationship between the direction of mandibular deviation and the direction of cranial deformation in patients with facial asymmetry, suggesting that they tend to deviate in the same direction. In the central part of the cranium, there was a weak but positive correlation between the amount of Menton deviation and the amount of cranial deformation, regardless of the direction of Menton deviation. This suggested that deformity in the central region near the mandibular fossa may have affected the degree of Menton deviation. Since few studies have reported a relationship between mandibular deviation and the amount of Menton deviation, it is necessary to further pursue the related factors in the future.

4.3. Research Methods

In orthodontic practice, maxillofacial morphology is often diagnosed with lateral and postero-anterior cephalometric radiographs. In the lateral cephalometric examination, the anteroposterior positioning of the maxillary and mandibular bones and the inclination of the maxillary and mandibular anterior teeth can be easily determined. The postero-anterior cephalometric radiographs can be used to evaluate the amount of mandibular deviation and inclination of the occlusal plane due to the position of Menton. However, detailed mandibular morphology and diagnosis of deviation are often unclear from lateral and postero-anterior cephalometric measurements alone. Axial cephalometric measurements are useful for evaluating cranial morphology, the position of the mandible relative to the maxilla, and detailed morphological features of the mandible, as well as for determining the factors contributing to mandibular deviation. In the surgical treatment of facial asymmetry, axial cephalometry radiographs are important for proper diagnosis and treatment planning regarding the amount and direction of mandibular displacement and postoperative stability [30]. The foramen ovale, which was used as the reference point for the axial cephalometric radiographs in this study, is considered to be relatively unaffected by cranio-maxillofacial deformity because of its stable shape [31]. In addition, skeletal mandibular prognathism cases were used in this study. Facial asymmetry is more common in patients with skeletal mandibular prognathism than in patients with skeletal maxillary prognathism [32], and it has been reported that it is often accompanied by lateral mandibular deviation, a horizontal as well as anteroposterior abnormality [33,34]. In assessing facial symmetry, the American Association of Oral and Maxillofacial Surgeons criteria define facial asymmetry as a mandibular midline deviation of 3 mm or more [19]. Haraguchi et al. reported that the critical distance between facial symmetry and asymmetry was approximately 4 mm from the median sagittal plane [6], and Masuoka et al. reported that the mean distance of Menton from the median sagittal plane was 3.45 to 4.89 mm on cephalograms of patients whose orthodontists judged that they needed surgical orthodontic treatment because of facial asymmetry [20]. Therefore, in the material of this study, cases in which Menton deviated more than 4 mm laterally to the mid-sagittal plane on the postero-anterior cephalometric radiographs were considered as the facial asymmetry group. Although this study used two-dimensional materials such as cephalometric radiographs, in recent years, three-dimensional information has been increasingly used for diagnosis and treatment in the field of dentistry. Particularly in the treatment of jaw deformities, the use of CT images has made it possible to evaluate the morphology and structure of the jawbone, which are difficult to quantify and analyze with two-dimensional images such as the cephalometric radiographs and orthopantomographs used in this study. As a future challenge, it is necessary to evaluate the relationship between cranial deformity and mandibular morphology in three dimensions.

4.4. Cranial Deformities (Positional Plagiocephaly and Craniosynostosis)

Previous reports suggest that cranial asymmetry occurs during infancy [35]. Such infants with cranial asymmetry include those with positional plagiocephaly and craniosynostosis. Craniosynostosis may be syndromic, with or without associated syndromic fingers of the extremities, and facial complications and malformations. The type of suture that is fused can be frontal (triangular cranial), coronal (unilateral oblique cranial or bilateral short cranial), or sagittal (navicular), and the degree of fusion (complete or incomplete) depends on whether single or multiple sutures are used to create the characteristic morphology of each. Non-syndromic craniosynostosis occurs in 1 in 2100 to 2500 births, and syndromic craniosynostosis occurs in 1 in 30,000 to 100,000 births [36]. Some believe that the morphological change known as positional plagiocephaly “affects normal tissue deformation and remodeling”, but it does not affect brain growth and development. A Dutch study of 7609 infants examined positional preferences and found that 8.2% of the infants were biased to one side during the first month of life; at the 6–8-month follow-up, 47% of the infants were complicated by asymmetric deformities in the occipital region, and 23% had progressed to asymmetric deformities in the forehead. The study noted that among them, about 3% of the infants were diagnosed with very severe positional plagiocephaly. The details of positional cranial deformity are not known in general or in the medical community, and population-based Japanese research reports on its effects and prevalence are very limited [37]. Malformations associated with positional plagiocephaly include congenital or acquired muscle plagiocephaly, abnormal eye position, deformity and abnormal juxtaposition of the external surface of the ear, orbital asymmetry, and facial deformity causing strabismus and other visual disturbances. In the present study, cranial deformities were found on axial cephalometric radiographs in patients with facial asymmetry. This suggests that cranial deformity in infancy may contribute to mandibular deviation and facial asymmetry in the future and requires further investigation.

5. Conclusions

Patients with facial asymmetry were suggested to have greater cranial deformity as well as mandibular deformity. In patients with facial asymmetry, Menton and cranial deviation tended to deviate in the same direction. In the central cranial region, the results suggest a positive correlation between the direction of Menton deviation and the amount of cranial deformation. Few studies have reported the relationship between mandibular and cranial deformities, and further investigation of the related factors is needed.

Author Contributions

Conceptualization, S.O., C.T., T.M., Y.A., S.M., K.S., A.W., T.K. and Y.N.; methodology, S.O., C.T., T.M., Y.A., S.M., K.S., A.W., T.K. and Y.N.; validation, S.O., C.T., T.M., Y.A., S.M. and K.S.; formal analysis, S.O., C.T., T.M., Y.A., S.M. and K.S.; investigation, S.O., C.T., T.M., Y.A., S.M. and K.S.; resources, S.O., C.T., T.M., Y.A., S.M., K.S., A.W., T.K. and Y.N.; data curation, S.O.; writing—original draft preparation, S.O.; writing—review and editing, S.O., C.T., T.M., Y.A., S.M. and K.S.; visualization, S.O., C.T., T.M., Y.A., S.M. and K.S.; supervision, S.O., A.W., T.K. and Y.N.; project administration, S.O., C.T., T.M., Y.A., S.M., K.S., A.W., T.K. and Y.N. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

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Applsci 13 06533 g001 550
Figure 1. Cranial measurement method. FoR: anterior margin of the right foramen ovale; FoL: anterior margin of the left foramen ovale; FoP: tangent to the anterior margins of the left and right foramen ovale; FoM: the midpoint of the FoR and FoL on the FoP; FoVP: the line passing through the FoM and perpendicular to the FoP. The area between the FoP and FoVP was divided into three sections of 30 degrees each on the left and right sides for a total of six blocks. Each block was designated 1–6 from the right side; the distance from the FoM to the cranial edge was designated a–e from the right side.
Figure 1. Cranial measurement method. FoR: anterior margin of the right foramen ovale; FoL: anterior margin of the left foramen ovale; FoP: tangent to the anterior margins of the left and right foramen ovale; FoM: the midpoint of the FoR and FoL on the FoP; FoVP: the line passing through the FoM and perpendicular to the FoP. The area between the FoP and FoVP was divided into three sections of 30 degrees each on the left and right sides for a total of six blocks. Each block was designated 1–6 from the right side; the distance from the FoM to the cranial edge was designated a–e from the right side.
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Figure 2. Difference in length of longitudinal cranial diameter (* p < 0.05). Vertical axis: difference (absolute value) between the lengths of the corresponding areas on the left and right sides in the symmetry and asymmetry groups (mm).
Figure 2. Difference in length of longitudinal cranial diameter (* p < 0.05). Vertical axis: difference (absolute value) between the lengths of the corresponding areas on the left and right sides in the symmetry and asymmetry groups (mm).
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Figure 3. Difference in cranial area (* p < 0.05). Vertical axis: difference (absolute value) in the area of the region (anterior, middle, occipital) corresponding to the left and right sides in the symmetry and asymmetry groups (mm2).
Figure 3. Difference in cranial area (* p < 0.05). Vertical axis: difference (absolute value) in the area of the region (anterior, middle, occipital) corresponding to the left and right sides in the symmetry and asymmetry groups (mm2).
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Figure 4. Relationship between Menton deviation and the direction of cranial deviation. Vertical axis: number of patients (persons).
Figure 4. Relationship between Menton deviation and the direction of cranial deviation. Vertical axis: number of patients (persons).
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Figure 5. Relationship between deformation and the direction and amount of Menton deviation at the center of the cranium. Vertical axis: difference in area of the left and right cranium at the center of the cranium in the asymmetry group (mm2). Horizontal axis: amount of Menton deviation (mm).
Figure 5. Relationship between deformation and the direction and amount of Menton deviation at the center of the cranium. Vertical axis: difference in area of the left and right cranium at the center of the cranium in the asymmetry group (mm2). Horizontal axis: amount of Menton deviation (mm).
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Figure 6. Relationship between deformation and the direction and amount of Menton deviation in the posterior part of the cranium. Vertical axis: difference in the area of the left and right cranium in the posterior part of the cranium in the asymmetry group (mm2). Horizontal axis: Menton deviation (mm).
Figure 6. Relationship between deformation and the direction and amount of Menton deviation in the posterior part of the cranium. Vertical axis: difference in the area of the left and right cranium in the posterior part of the cranium in the asymmetry group (mm2). Horizontal axis: Menton deviation (mm).
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Table
Table 1. Characteristics of patients with skeletal mandibular prognathism with and without asymmetry used in this study (n = 60).
Table 1. Characteristics of patients with skeletal mandibular prognathism with and without asymmetry used in this study (n = 60).
Symmetry
n = 30		Asymmetry
n = 30
Sex
 Male1217
 Female1813
Age (y)
 Mean20.9 ± 3.124.4 ± 3.8
 Range14.9~49.114.2~49.4
Measurement values
 Mean of ANB (°)−2.9 ± 2.6−3.3 ± 1.6
 Mean of Difference in position of Menton (mm)1.8 ± 1.17.9 ± 3.7
 Range of Menton (mm)0.1~2.64.2~14.0
Mean of FMA (°)29.2 ± 4.930.1 ± 3.5
Mean of Wits appraisal (mm)−8.5 ± 2.6−9.3 ± 3.3
Table
Table 2. Measurements of the long diameters of the corresponding areas on the left and right sides of the cranium (mm).
Table 2. Measurements of the long diameters of the corresponding areas on the left and right sides of the cranium (mm).
Maximum (mm)Minimum (mm)Mean (mm)
Symmetry
|a–e|4.501.8
|b–d|4.801.4
Asymmetry
|a–e|6.001.4
|b–d|12.13.97.0
Table
Table 3. Measurements of the area of the corresponding region on the left and right sides of the cranium (mm2).
Table 3. Measurements of the area of the corresponding region on the left and right sides of the cranium (mm2).
Maximum (mm2)Minimum (mm2)Mean (mm2)
Symmetry
|1–6|186.00144.7
|2–5|396.124.1126.6
|3–4|373.01.1107.3
Asymmetry
|1–6|362.05.3111.9
|2–5|705.28.1298.7
|3–4|645.035.2329.9
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MDPI and ACS Style

Ono, S.; Tachiki, C.; Morikawa, T.; Aihara, Y.; Matsunaga, S.; Sugahara, K.; Watanabe, A.; Kawamata, T.; Nishii, Y. Morphological Evaluation of Cranium Facial Asymmetry in Class III Malocclusion Patients. Appl. Sci. 2023, 13, 6533. https://doi.org/10.3390/app13116533

AMA Style

Ono S, Tachiki C, Morikawa T, Aihara Y, Matsunaga S, Sugahara K, Watanabe A, Kawamata T, Nishii Y. Morphological Evaluation of Cranium Facial Asymmetry in Class III Malocclusion Patients. Applied Sciences. 2023; 13(11):6533. https://doi.org/10.3390/app13116533

Chicago/Turabian Style

Ono, Sayumi, Chie Tachiki, Taiki Morikawa, Yasuo Aihara, Satoru Matsunaga, Keisuke Sugahara, Akira Watanabe, Takakazu Kawamata, and Yasushi Nishii. 2023. "Morphological Evaluation of Cranium Facial Asymmetry in Class III Malocclusion Patients" Applied Sciences 13, no. 11: 6533. https://doi.org/10.3390/app13116533

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