Soft tissue facial angles in individuals with ectodermal dysplasia: A three-dimensional noninvasive study.

OBJECTIVE: To supply quantitative information about the facial soft tissues of patients with hypohidrotic ectodermal dysplasia. DESIGN: Prospective assessment. SETTING: National meetings of hypohidrotic ectodermal dysplasia patients and families. PATIENTS AND MAIN OUTCOME MEASURES: Facial and mandibular corpus convexities in the horizontal plane; facial convexity in the sagittal plane; interlabial, naso-labial, nasal convexity, and left and right soft tissue gonial angles were calculated from the three-dimensional coordinates of 11 soft tissue facial landmarks obtained in 18 male and 17 female hypohidrotic ectodermal dysplasia patients aged 3 to 41 years and in 504 reference healthy individuals. In addition, z-scores were computed and the patients were grouped by cluster analysis. RESULTS: Male and female z-scores did not differ. In the pooled group, facial convexities in the horizontal and sagittal planes were significantly (Student's t, p < .01) increased (flatter) in hypohidrotic ectodermal dysplasia patients, compared with normal controls. The naso-labial angle was significantly reduced (more acute). Upper and lower facial convexity and mandibular corpus convexity in the horizontal plane deviated less from the norm with increasing age. Facial convexity in the horizontal and sagittal planes, soft tissue gonial angles, and naso-labial and interlabial angles deviated less from the norm with increasing number of teeth present in the mouth. Cluster analysis identified three homogeneous groups, all characterized by a peculiar facial phenotype. Modifications in facial convexity and gonial and interlabial angles differentiated each cluster. CONCLUSIONS: Patients with hypohidrotic ectodermal dysplasia had flatter faces in the horizontal and sagittal planes than normal controls had. Cluster analysis revealed patterned differences in facial phenotype.     

三维摄影对蒙古族正常(牙合)成人面部软组织的侧貌分析

目的 应用三维测量的方法对面部软组织进行测量,研究正常(牙合)面部软组织的立体结果,建立正常(牙合)面部软组织的正常值,为错(牙合)畸形的诊断提供依据.方法 对144例受试者(蒙古族女性77例,男性70例)拍摄三维立体影像,并在软件上进行20个标志点的确定,23个角度、13个线距的测量,所得数据用SPSS 22.O统计...     

The effects of perennial allergic rhinitis on dental and skeletal development: a comparison of sibling pairs

This study analyzed the effect of perennial allergic rhinitis on dental and facial skeletal characteristics. Twenty-five allergic children who were apparent mouth breathers, their 25 siblings who did not have the disease and were apparent nose breathers, and 14 nasal breathing control subjects were examined medically, dentally, and cephalometrically. Compared with their siblings, the allergic subjects had more nasal mucosal edema, a higher proportion of eosinophils in their nasal secretions, and greater nasal power. The allergic subjects were characterized by deeper palatal height, retroclined mandibular incisors, increased total anterior facial height and lower facial height, a larger gonial angle, and greater SN, palatal, and occlusal planes to mandibular plane angles. All of these measures except gonial angle were also significantly different between the allergic children and the nonconsanguineous controls. Also, the allergic subjects compared with controls had smaller SNB and SN-pogonion angles and an increased overjet. Both allergic and nonallergic sibling groups showed larger mean adenoid size on radiographs than controls. For most variables the nonallergic siblings fell between the allergic children and the control subjects. Overall, the allergic children had longer, more retrusive faces than controls. This retrusive characteristic was present in nonallergic siblings and cannot be ascribed to the apparent breathing mode at the time of the study. These results confirm earlier reports that allergic rhinitis may be associated with altered facial growth. Controlled longitudinal studies to analyze a possible cause-and-effect relationship and the effects of medical and surgical treatments should be undertaken.     

Cephalometric soft tissue profile analysis between two different ethnic groups: a comparative study

The aim of this investigation was to study and compare the cephalometric soft tissue profile analysis between Saudis and Caucasian Americans. The study was carried out using standardized cephalometric radiographs of 56 Saudi subjects (30 males and 26 females) with pleasant and balanced facial profiles, competent lips, normal overjet and overbite, and showing no craniofacial deformities. Subject ages ranged from 22 to 23 years. One skeletal and thirteen soft tissue variables were investigated. F-test, two samples t-test, Mann-Whitney, and Wilcoxon tests were used for data analysis. The results showed no statistical significant differences between the Saudi males and females except for the angle of total facial convexity, soft tissue facial plane angle, lower lip length, sagittal nasal tip to the most protrusive lip distance, and also sagittal chin to the most protrusive lip distance. The Saudi females had a greater angle of total facial convexity and soft tissue facial plane angle than the males. In addition, the females had a shorter lower lip. They also had a short distance between the nasal tip and chin to the most protrusive lip. These results reveal significant differences in most of the soft tissue variables when comparing Saudis with Caucasian Americans as well as in other ethnic groups. Most of these variables are essential for the diagnosis and treatment planning of cases requiring orthodontics and orthognathic surgery.     

Evaluating the relationship between dimensions of the upper airway and facial profile according to initial lateral cephalometric radiography in orthodontic patients in the north of Iran

PurposeDecreased upper airway dimensions due to adenoid enlargement may have unfavorable aesthetic and/or functional effects on the soft or hard tissue profile development. The aim of this study was to investigate the associations between adenoid sizes to upper airway size ratio (airway ratio) in the midsagittal plane and various types of soft and hard tissue facial profile convexity.Materials and methods251 lateral cephalometric images of pre-orthodontic healthy subjects with age group of 6?12, 13?18, 19?25 and 26?29 years, were collected. They were classified into four subgroups based on the airway ratio (grade 1: <1/4 í 100), (grade 2: 1/4?1/2 í 100), (grade 3:1/2?3/4 í 100) and (grade 4: >3/4 í 100). The radiographs were characterized as convex, normal and concave soft tissue facial profile according to the facial convexity angle. Cephalometric analyses were done using Dolphin imaging computer software 11.95. Kruskal Wallis test was used to evaluate differences between airway ratio and facial morphologies; the mandibular plane angle was compared between airway ratio subgroups by Chi square.ResultsAirway ratio was not significantly different (P = 0.241) between soft tissue facial convexity subgroups and within age subgroups. Mandibular plane angle was in a significant relation within airway ratio (p = 0.028).ConclusionThere was not any significant relation between decreased upper airway ratios and types of the soft or hard tissue facial profile convexity, however there was a significant relation between upper airway ratios and age subgroups. A significant revers correlation was seen between the mandibular plane angle and nasopharyngeal dimensions.     

Frontal soft tissue analysis using a 3 dimensional camera following two-jaw rotational orthognathic surgery in skeletal class III patients

Although two dimensional cephalometry is the standard method for analyzing the results of orthognathic surgery, it has potential limits in frontal soft tissue analysis. We have utilized a 3 dimensional camera to examine changes in soft tissue landmarks in patients with skeletal class III dentofacial deformity who underwent two-jaw rotational setback surgery.We assessed 25 consecutive Asian patients (mean age, 22 years; range, 17–32 years) with skeletal class III dentofacial deformities who underwent two-jaw rotational surgery without maxillary advancement. Using a 3D camera, we analyzed changes in facial proportions, including vertical and horizontal dimensions, facial surface areas, nose profile, lip contour, and soft tissue cheek convexity, as well as landmarks related to facial symmetry.The average mandibular setback was 10.7 mm (range: 5–17 mm). The average SNA changed from 77.4° to 77.8°, the average SNB from 89.2° to 81.1°, and the average occlusal plane from 8.7° to 11.4°. The mid third vertical dimension changed from 58.8 mm to 57.8 mm (p = 0.059), and the lower third vertical dimension changed from 70.4 mm to 68.2 mm (p = 0.0006). The average bigonial width decreased from 113.5 mm to 109.2 mm (p = 0.0028), the alar width increased from 34.7 mm to 36.1 mm (p-value = 0.0002), and lip length was unchanged. Mean mid and lower facial surface areas decreased significantly, from 171.8 cm² to 166.2 cm² (p = 0.026) and from 71.23 cm² to 61.9 cm² (p < 0.0001), respectively. Cheek convexity increased significantly, from 171.8° to 155.9° (p = 0.0007).The 3D camera was effective in frontal soft tissue analysis for orthognathic surgery, and enabled quantitative analysis of changes in frontal soft tissue landmarks and facial proportions that were not possible with conventional 2D cephalometric analysis.     

The evaluation of horizontal reference planes of adult Chinese in natural head position.

A group of 112 adult females (average age 25.66) and 104 adult males (average age 25.62) were subjected to cephalometric evaluation in their natural head position. No significant differences were found in the nasionsella (SN) plane, Frankfort horizontal (FH) plane or palatal planes between male and female subjects. The SN plane was found to be located at 7.26 degrees above the true horizontal on the average, and the FH plane differed on the average 1.92 degrees from the true horizontal with the line diverging forward and upward. The palatal plane was found to be located in a downward and forward direction at 1.17 degrees from the true horizontal plane on the average. The orbitale (Or) was found to be located at 2.34 mm on the average above the true horizontal plane depicted from the porion (Po) in this study, which implies that the racial characteristic of a high zygomatic bone in Chinese may have some influence upon the position of Or, and this should be taken into consideration when the FH plane is used as the true horizontal during face bow transfer. The mandibular plane (MP) angle, occlusal plane (OP) angle and the gonial angle (GA) of males were found to be smaller than those of females, with a significant difference at the level of P less than 0.001, P less than 0.01 and P less than 0.01, respectively. The upper facial divergent angles of males and females were quite similar, as reflected by the similarity in the SN-FH angles and SN-PP angles between the sexes A significant difference was found to exist in the lower facial divergent angles between males and females. The SN-MP angle, PP-OP angle and PP-MP angle were all significantly smaller in males, with a P less than 0.001. The OP-MP angle was also smaller in males with P less than 0.05.     

中国正常牙合人群面部软组织侧貌性别差异的Meta分析

目的    系统性分析国内外公开发表的中国正常牙合人群面部软组织侧貌的研究结果，探讨软组织侧貌测量指标的性别间差异。方法    计算机检索中英文数据库，包括PubMed、Embase、Cochrane Library、中国知网（CNKI）、万方数据库，检索时间从1990-01-01至2018-05-01。由2名评价员独立完成文献筛选、质量评价、数据提取和交叉核对后，运用RevMan5.3软件进行Meta分析。结果    共纳入17篇相关文献，其中男性836名，女性923名。Meta分析结果显示：男性的鼻唇角、颏唇角、全面突角、鼻尖角均小于女性，组间差异均有统计学意义（均P < 0.05）；男性的面突角、H角、鼻底部唇厚度、颏部厚度均大于女性，组间差异均有统计学意义（均P < 0.05）；而男性与女性的上唇-E线距、下唇-E线距差异均无统计学意义（均P > 0.05）。结论    中国正常牙合人群中，男性鼻部较女性更挺拔，软组织厚度较女性厚，唇部及面中部较女性更前突。     

Craniofacial growth in untreated skeletal Class I subjects with low, average, and high MP-SN angles: A longitudinal study

Sixty-eight (36 male and 32 female) untreated skeletal Class I subjects with low (< or = 27 degrees ), average (>27 degrees - <37 degrees ), and high (> or = 37 degrees ) mandibular plane (MP-SN) angles were selected from the Bolton-Brush and Burlington Growth Studies. Cephalograms of each subject at ages 9 and 18 were traced, and 28 parameters were measured. The difference in each parameter from ages 9 to 18 was calculated, and comparisons were made between the groups with low, average, and high angles. Results showed that, for boys and girls at age 9, the low-angle groups exhibited significantly larger SNA angle, SNB angle, facial taper, PFH, PFH:AFH, and ramus height, and the high-angle groups showed significantly larger ANS-Me and gonial angle. From ages 9 to 18, all the male and female low-, average-, and high-angle groups showed an increase in SNA and SNB angles, and PFH:AFH, and a decrease in ANB angle, convexity (more flattened face), MP-SN angle, and gonial angle (mandibular forward rotation). The dental measurements showed few changes with growth in all groups. In terms of skeletal measurements from ages 9 to 18, similar growth changes were found between the sexes in most angular measurements, but males had larger values in linear measurements than females.     

Malocclusion and facial morphology is there a relationship? An epidemiologic study

The purpose of this study is to examine associations between facial morphology and malocclusion, and to test for sexual dimorphism in such relationships. The sample of 500 subjects is studied by roentgenographic cephalometry, using the Facial Height Ratio (FHR) of Jarabak as the mensurational approach to describe craniofacial morphology. Significant findings are: Neutral pattern is dominant in Class I and Class II1 malocclusions. Hypodivergent pattern is dominant in Class II2 and Class III malocclusions. The majority of females demonstrate a neutral pattern, whereas the majority of males demonstrate a hypodivergent pattern. Sexual dimorphism in pattern is greatest in Class II1 and Class III. Males show a greater tendency toward prognathism, while females tend toward orthognathism and retrognathism. Mean values of all linear measurements in males are larger than in females. Relatively strong correlations are found between facial height ratio and ramus height, gonial angle, lower gonial angle, mandibular plane angle, occlusal/mandibular plane angle, palatal/mandibular plane angle, Frankfurt/mandibular plane angle, S-N-B, Y-axis angle, and the sum of the saddle + articular + gonial angles.     

Dental and craniofacial features of Aarskog syndrome: report of a case and review of literature

Aarskog syndrome is a rare syndrome with a typical triad of facial, digital and genital characteristics. The characteristic cephalometric finding in this patient was the unusually large upward slant of SN plane and a steep Ba-N plane. Though the patient presented with a class I skeletal pattern, both the maxilla and mandible were hypoplastic and retruded with respect to the cranial base. Other characteristic features regarding the mandibular morphology were a large FMA (37 degrees) and Sn-GoGn (44 degrees) angles, a large gonial angle (138 degrees), an increase in total anterior facial and lower anterior facial height.     

Soft tissue profile changes after maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: a 1-year follow-up.

PURPOSE: This study was conducted to evaluate the soft tissue profile changes after maxillary advancement with distraction osteogenesis (DO). PATIENTS AND METHODS: Sixteen subjects underwent maxillary advancement with rigid external distraction after a high Le Fort I osteotomy. There were 11 male and 5 female patients, ages 5.2 to 25.7 years. The subjects included 9 with unilateral cleft lip and palate (UCLP), 4 with bilateral CLP, 2 with facial clefts and bilateral CLP, and 1 with cleft palate. Pretreatment and posttreatment lateral cephalograms were compared to evaluate the changes in soft tissue profile. A line 7 degrees below the SN plane was used as the horizontal coordinate, and a perpendicular line through Sella was used as the vertical coordinate in an XY coordinate system. RESULTS: The preoperative facial concavity (N'SnPg') was reduced by 15.59 degrees, and the nasal tip moved 3.75 mm forward and 2.05 mm upward. These changes were positively correlated with the change of ANS position. The soft-tissue-to-hard-tissue ratio was 0.53:1 for nasal tip and ANS. The ratio was negatively correlated with the age of the patient. The ratio of soft tissue A point to skeletal A point was 0.96:1 and for the incisal edge to vermilion border of the upper lip it was 0.8:1. The soft tissue B point and Pg did not change significantly with maxillary distraction. However, the nasolabial angle increased by 4.96 degrees, the upper lip curvature flattened by 0.65 mm, and the lower lip curvature was accentuated by 0.89 mm after distraction. The amount of upper incisal exposure increased from 1.1 to 5.01 mm in the rest position. CONCLUSION: Maxillary DO improved the soft tissue profile by increasing nasal projection, normalizing the nasolabial angle, and making the upper lip more prominent. More upper anterior tooth show in the rest position was obtained, but the upper lip length did not change. The concave facial profile became convex, with improved facial balance and aesthetics.     

Soft tissue facial morphometry in subjects with Moebius syndrome

Moebius syndrome is a congenital facial palsy associated with the impairment of ocular abduction. The three‐dimensional characteristics of the facial soft tissues of 12 male and 14 female subjects [3–52 yr of age (mean age + standard deviation: 17 + 14 yr)] were measured using a non‐invasive, computerized system; facial volumes, areas, angles, and distances were computed and compared with those obtained in reference subjects of the same age and gender. When compared with reference subjects, patients with Moebius syndrome had a more prominent and hyperdivergent face in the sagittal plane, a smaller and more prominent upper facial third; a smaller middle facial width; a smaller nose; smaller mandibular volume, depth, corpus length, and ramus height; and a more posterior positioned mandible, with a less prominent chin. In conclusion, patients with Moebius syndrome had a tendency towards a skeletal Class II pattern. These morphological variations may be the combined effect of a general alteration of the motor and sensitive facial nerves, including the trigeminal nerve, and of a maldevelopment of the brainstem.     

Morphometry of the ear in Down's syndrome subjects. A three-dimensional computerized assessment

The three-dimensional coordinates of 13 soft-tissue landmarks on the ears were obtained by a computerized digitizer in 28 subjects with Down's syndrome aged 12-45 years, and in 449 sex, age and ethnic group matched controls. From the landmarks, left and right linear distances (ear width and length), ratios (ear width-to-ear length), areas (ear area), angles (angle of the auricle versus the facial midplane) and the three-dimensional symmetry index were calculated. For both males and females, all linear dimensions and areas were significantly (Analysis of Variance, P < 0.001) larger in the reference subjects than in the subjects with Down's syndrome. All values significantly increased as a function of age (P < 0.05); the increment was larger in the reference subjects than in the subjects with Down's syndrome. On both sides of the face, the subjects with Down's syndrome had larger ear width-to-ear length ratios, and larger angles of the auricle versus the facial midplane than the reference subjects. The three-dimensional symmetry index was significantly larger in the reference subjects and in the older persons. In conclusion, ear dimensions, position and shape significantly differed in subjects with Down's syndrome when compared to sex, age and ethnic group matched controls. Some of the differences were sex and age related.     

Dentoskeletal determinants of soft tissue morphology

The position of the lips and the soft tissues overlying points A and B seem to be substantially related to the horizontal positions of the upper and lower incisors and to the angulation of the upper incisor. The angulation of the lower incisor is much less important than its spatial position. The A-N-B angle is strongly related to the overlying soft tissue outline. Point A convexity is a very important factor in soft tissue form. The Ricketts E line, the Steiner S line and the soft tissue facial plane all seem to be equally acceptable bases for assessment of the soft tissues of the profile.     

The facial soft tissue profile of the southern Chinese: prosthodontic considerations.

A simple photographic setup was established to produce standardized life-sized black and white prints of Southern Chinese adults. Facial soft tissue profile analysis was performed on 28 men and 31 women aged 19 to 30, dentate Chinese, having class I occlusion and originating from Guangdong province. The facial profile values studied included the profile convexity, the interlabial contour, the nasolabial contour, the columella and upper lip inclination angles to the true horizontal, and the relative positions of upper and lower lips from the Esthetic plane. Data obtained were compared with those from previous Caucasian studies and other accepted empirical values. The lower third of the face presented the greatest ethnic difference: the interlabial contour was more convex and the upper and lower lips were more protrusive among the Southern Chinese. The widely-used standard of a right-angled nasolabial contour proved to be applicable among the Southern Chinese adult males. However, a more obtuse nasolabial angle, almost 100 degrees, occurred among the women.     

不同矢状骨面型成人鼻部形态的X线头影测量研究

目的探讨不同矢状骨面型成人的鼻部形态差异。方法选取150例山东地区成人错畸形患者作为研究对象,患者均为中等面角,按ANB角分为Ⅰ、Ⅱ、Ⅲ类3种不同矢状骨面型,每种面型患者各50例。对12项鼻部形态测量指标进行X线头影测量分析及统计学分析。结果Ⅰ类、Ⅱ类、Ⅲ类骨面型患者,在鼻唇角（NLA）、鼻颏角（NMA）、面型角（SFC）、鼻骨长（NboneL）4项鼻部形态测量指标上差异有统计学意义（P〈0.05）。其中,鼻唇角（NLA）、面型角（SFC）为Ⅲ类、Ⅰ类、Ⅱ类依次增大;鼻颏角（NMA）为Ⅲ类、Ⅰ类、Ⅱ类依次减小;鼻骨长（NboneL）为Ⅰ类、Ⅱ类、Ⅲ类依次增大。结论Ⅰ、Ⅱ、Ⅲ类骨面型成人鼻部形态存在差异。     

Analysis of soft tissue facial profile in white males

Three of the integumental variables, namely, the total facial convexity, upper lip to esthetic plane, and lower lip length, showed significant measurement errors in the preadolescent boys. Large standard deviations were also found for several variables in both age groups. This suggests that a range of values, rather than means, should be used in clinical cephalometric evaluations. A table of means, standard deviations, and ranges for the variables evaluated is provided. The nasolabial and the mentolabial angles did not differ significantly between the younger and the older age groups. The total soft tissue facial convexity was noted to have a marginally significant difference between the adults and children. Other variables were significantly different between the two age groups, and indicated that the adults had a relatively straighter facial profile than the children. In addition, the upper and lower lips were more retrusive relative to the esthetic plane in adults. Sagittal proportions relating nasal depth/nose to most protrusive lip/chin to most protrusive lip were found to have a ratio of 2.1:1.0:1.2 in children and 1.8:1.0:0.3 in adults.     

Combined skeletal and soft tissue reconstruction for severe Parry-Romberg syndrome

Parry-Romberg syndrome is an acquired facial deformity that manifests as progressive hemifacial atrophy that has unknown cause. Many surgical techniques to address it have been reported, such as fat transplantation and use of free flaps. Undoubtedly, the results of such techniques can be satisfactory for mild hemifacial atrophy after soft tissue restoration. But in severe cases, except for large-scale soft tissue atrophy, the osseous framework is involved, rendering their management difficult, and the results are often inadequate. On the basis of the severity of facial soft tissue atrophy and the extent of involvement of the osseous framework, we classified the deformities into 3 groups: (1) Mild: the facial atrophic area is confined to a small region and is located in the lateral face, the nasal ala and upper lip are normal, and there is no deviation of the oral commissure, and the occlusal plane is horizontal. (2) Moderate: there are large areas of soft tissue atrophy, and the nasal ala and upper lip are also affected; the oral commissure is deviated; the bony framework is nearly normal; and the occlusal plane is nearly horizontal or slightly deviated. (3) Severe: moderate form of soft tissue atrophy and serious bone framework atrophy, involving the zygoma, maxilla, and mandible; the chin and occlusal plane have deviated extensively to the affected side.In this article, we report our experience in successfully treating 23 patients with severe Parry-Romberg syndrome, according to our classification; mild and moderate cases were not included in this series. Microsurgical flap transplantation, lipoinjection, liposuction revision, dermis grafting, and cross-lip flap were used to correct soft tissue deformities, and bone augmentation using the MEDPOR implant, orthognathic surgery, bone grafting, and mandibular distraction were performed to reconstruct the bone framework.     

不同垂直骨面型安氏Ⅱ1类错(牙合)的软组织侧貌特征

目的：探讨安氏Ⅱ^1错（牙合）不同垂直骨面型患者软组织的侧貌特征。方法：随机选取安氏Ⅱ^1类错（牙合）低角型、均角型、高角型女性成年患者各28例,共84例,年龄18～23岁,平均20-3岁。选取矫治前X线头颅侧位片,进行头影测量,采用SPSS12．0统计软件包进行单因素方差分析和独立样本t检验。结果：一系列指标随着面高的增加呈现出有规律的变化趋势。侧貌突度及上、下唇突度依次明显增大,而面下部深度逐渐由过深变浅,同时上下唇弧的弧度由大变小、弧形由深变浅、由过于弯曲趋于过直立,尤其是低角组颏唇沟过凹陷而高角组过平坦。结论：垂直骨面型对安氏Ⅱ^1类错（牙合）的软组织侧貌特征尤其是唇颏部形态有着显著影响。