Facial symmetry is an important factor in physical attractiveness and is influenced by traits like averageness and youthfulness. The document discusses methods for evaluating normal facial symmetry, including determining facial height and width by dividing the face into vertical fifths with the eye width as a measurement point. Common causes of facial asymmetry are also outlined, such as congenital defects, trauma, infections, and tumors. Treatment options depend on the severity and include growth modification, orthodontic camouflage, and orthognathic surgery to correct skeletal asymmetries.

1. By: Dr.Adeel Butt
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2. Facial symmetry, is one element of bodily
symmetry, including fluctuating asymmetry.
Along with traits such as averageness and
youthfulness it influences judgements of
aesthetic traits of physical attractiveness and
beauty, and is associated with fitness-linked
traits including health,[1] It is also hypothesized
as a factor in both interpersonal attraction and
interpersonal chemistry.
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3.  Evaluation of normal symmetry of face include
determination of facial height and width.
 Facial vertical height:
facial vertical height can be evaluated in both
frontal view as well as lateral view of face.
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6.  The easiest way to evaluate the relative width of facial
structures is to divide the face into vertical fifths with each
fifth being equal to one. The face can be divided into fifths
using the width of the eye from corner to corner as a point of
measurement. Starting from the very outside edge of one ear
to the other -- the face ideally would be 5 eye widths
apart. Of course, since we are human and not designed by
computers, it is perfectly fine if you are not exactly 5 eye
widths a part. The width of the base of the nose, at the
nostrils (or ala), should be 1/5 of the face, or one eye
widtheye width.
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8.  Other parameters to be evaluated:
Lips - Other considerations include the width of the lips, the
interlabial gap and the degree of incisor show with smiling. The oral
commissures should be located along vertical lines drawn from the
medial limbus of the iris. Also, the lower lip should be slightly fuller
than the upper lip. When relaxed and with teeth in occlusion, the lips
should approximate one another with an interlabial gap of 3 mm
being the upper limit of acceptable. When smiling, there should be
no gingival show and no more than two thirds of the maxillary
incisors exposed
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The length of upper lip is about twice that of lower lip and
chin.
The position of upper lip in smile is that it should not be
ideally covering more than 1/4th of teeth.
The teeth may be touching the lower lip or there may be a
slight gap.

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10.  The width of nose at its base should be
approximately the distance between the eyes
(medial canthus).
 The angle at the bridge of nose should be
near the eyelashes.
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11.  Any deviation from the
normal symmetry of face
leading to the problems
associated with aesthetics
,occlusion etc.
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12. 1)Congenital defect:
•Facial hemi-trophy or hypertrophy of superfacial tissue ,
muscle & bone.
•Mandibular Condylar hypoplasia due to intrauterine or birth
trauma.
•TMJ Ankylosis, the mandible moves to the affected side.
•Mandibular body or ramus hyperplasia, the mandible moves
to the unaffected side.
2)Traumatic:
Zygomatic process fracture & followed infra orbital depression.
3)Inflammatory:
Abscess - cellulitis - cyst
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13. 4)Muscular:
a- Atrophy of facial musculature following Bell's palsy.
b- Hyperplasia of masseter muscle in clenching habit.
c- Patients using only one side in chewing
5)Salivary Glands:
Inflammatory as mumps or neoplastic.
6)Neoplastic:
Ameloblatoma - lipoma - osteoma
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14.  Congenital, Developmental Disorders
 Shprintzen-Goldberg craniosynostosis syndrome (15q21.1)
 defects in the palate, mild differences in facial features, Cleft
palate.
 Also named as DiGeorge syndrome (DGS), DiGeorge anomaly,[2][3]
velo-cardio-facial syndrome, Shprintzen syndrome, conotruncal
anomaly face syndrome.
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 Goldenhar syndrome:
 Chief markers of Goldenhar syndrome are
incomplete development of the ear, nose, soft
palate, lip, and mandible on usually one side of
the body. It is associated with anomalous
development of the first branchial arch and
second branchial arch.
 Silver-Russell syndrome:
 Russell-Silver syndrome (RSS) is a growth
disorder affecting growth of jaws leading to
asymmetric growth of mandible.

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 Curry-Jones Syndrome:
 Curry Jones syndrome is the association of
cranio-facial anomalies. Unilateral
craniosynostosis and shortness of the base of
the skull caused striking asymmetry of the
face. Hypertelorism and narrow palpebral
fissures are observed as well.
 Klipple-Feil syndrome:
 cleft palate, associated with abnormalities of
the head and face.

17. Ameloblastoma
Hemifacial atrophy hemifacial hypertrophy
tmj ankylosis emerg_facialswelling
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18.  Different methods are used to detect the
facial asymmetries.
1)frontal analysis (PA ceph)
2)ceph smile.(computerized method)
3)symmeter and symface.
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20. Landmarks on PA view
For frontal ceph:
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21. This include;
1)dental frontal problem.
2) maxillomandibular relationship.
3) dentoskeletal relationship.
4) craniofacial relationship.
5) inner structural.
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22.  Molar relation:
distance b/w buccal surface of upper and lower molar at
occlusal plane level.
normal value is 1.5mm upper molar buccaly.
 lower or –ve value means lingual cross-bite.
 higher value means buccal cross-bite.
 Intermolar width:
distance b/w buccal surface of mand.1st molar at occlusal plane
level.
Normal value 55mm for boys and 54mm for girls.
It measures arch width.
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23.  Intercuspid width:
Distance b/w cusps of both mand.cuspids at o.p.
normal value 22.7mm at age 7 and adult is 27.5mm.
determine spcae problem in lower arch.
 Denture midline:
space between maxillary and mandibular midlines.
determine co-incidence of midlines.
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24.  Left and right maxillomandibular width:
distance b/w pt.j and frontal facial plane(zr-ga)
normal value is 10mm for average student.
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25.  Maxillomandibular midline:
angle b/w midsgital plane and
ANS-Me.
determine mandibular
midline deviation and it represent
functional or skeletal asymmetry.
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26.  Molar to both jaws:
distance b/w buccal surface of mand.1st
molar and frontal maxillomandibular plane.
normal value is 6.3mm.
an increased value indicate buccal mandibular
expansion.
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27.  Postural
symmetry:
difference b/w ZL-
AG-ZA and ZR-GA-AZ
normal value is 0
degree.
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28. 5) inner structural.
 Nasal width: max. width of nasal cavity and
help to assess mouth breathing if reduces
value than normal value 0f 25mm
 Nasal height: distance b/w ANS and ZL-ZR
plane.
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29.  Maxillary width: distance b/w J points.it
indicate max.growth.
 Mandibular width: distance b/w AG and GA.
 Facial width: distance b/w ZA and AZ.
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31.  Symmeter is a web-based system that provides a simple way
to measure the symmetry of any person, place or thing that
can be rendered through a digital image.
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32.  Treatment options for facial asymmetries
include :
1)growth modification.
2)camouflage.
3)orthognathic surgery.
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33.  Growth modification:
mainly achieved in children when growing age is still
present by the use of orthopaedica and myofunctional appliances.
 Orthodontic camouflage:
when skeletal deformity is very mild and any
further change is not expected,camouflage should be
considered.
Camouflage should not be done at the expense of
undesirable facial esthetics though there may be some
compensation of the same.
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34. Conditions with severe skeletal asymmetries are not able
to be corrected by orthodontic camouflage and growth
modification so surgical procedures are used to
correct the deformities or asymmetries.
 Before opting orthognathic surgery, pre-surgical
orthodontics have to be done i.e,
• Position the teeth over respective basal bone.
• Allign and level teeth.
• Adjust slight discrepencies.
• Adjust rotations.
• Achieve root parallelling .
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35.  Treatment options include:
 mandibular hyperplasia:
1)sagital split osteotmy.
2)sub-sigmoid osteotomy.
 Mandibular hypoplasia:
1)sagital aplit osteotomy with mandibular
advancement.
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36.  Maxillary hypoplasia:
1)Le-forte 1 osteotomy
withmax.advancement.
 Maxillary hyperplasia:
maxillary segmental setback.
 Maxillary vertical excess:
leforte-1 osteotomy with maxillary impaction.
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37.  Cosmetic surgeries are also used for the
correction of facial asymmetries like,
1)rhinoplasty.
2)genioplasty.
3)cheiloraphy.
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38. The end
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