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A hiperplasia hemimandibular é responsável por prejuízos estéticos, funcionais, motores e psicossociais. Com etiologia incerta, ocorre frente ao desequilíbrio de fatores regulatórios de crescimento presentes na camada cartilaginosa do côndilo. O relato objetiva descrever a tomada de decisões baseada em exames complementares específicos aliados à adequada intervenção cirúrgica da lesão. Paciente gênero feminino, 33 anos de idade, compareceu à clínica particular com queixa principal de "face assimétrica", foi requerido uma avaliação cintilográfica objetivando e confirmando a interrupção do crescimento condilar, descartando a hipótese de Osteocondroma e condilectomia. Após preparo ortodôntico prévio, os exames tomográficos foram utilizados na criação de um protótipo que foi impresso após a realização dos movimentos ósseos planejados. Mediante à reconstrução, foi concluído que a assimetria presente não seria totalmente corrigida somente através da intervenção ortognática, sendo necessária também uma osteotomia removendo parte da base do corpo e ângulo mandibular, através da confecção de um guia de corte, promovendo à reanatomização sem a necessidade de acesso extra oral submandibular, evitando uma cicatriz em face feminina. Paciente encontra-se em pós-operatório de 60 meses, sem queixas e satisfeita. Portanto, é evidenciado cada vez mais a influência positiva que o planejamento virtual pode trazer aos profissionais na otimização dos resultados cirúrgicos.

Hemimandibular hyperplasia is responsible for aesthetic, functional, motor, and psychosocial impairments. With an uncertain etiology, it occurs due to the imbalance of regulatory growth factors present in the cartilaginous layer of the condyle. The report aims to describe decision-making based on specific complementary exams combined with the appropriate surgical intervention for the condition. A 33-year-old female patient presented at a private clinic with the main complaint of "asymmetric face." A scintigraphic evaluation was requested to objectively confirm the interruption of condylar growth, ruling out the hypothesis of Osteochondroma and condylectomy. After prior orthodontic preparation, tomographic exams were used to create a prototype that was printed after planned bone movements. Through the reconstruction, it was concluded that the existing asymmetry would not be entirely corrected through orthognathic intervention alone, necessitating also an osteotomy to remove part of the base of the body and mandibular angle. This was done through the creation of a cutting guide, allowing for reanatomization without the need for submandibular extraoral access, thus avoiding a scar on the female face. The patient is 60 months postoperative, with no complaints and satisfied. Therefore, the increasingly positive influence of virtual planning on optimizing surgical outcomes for professionals is evident.

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Introducción: El quiste nasolaveolar, conocido también como nasolabial o de Klestadt, se considera un raro quiste del desarrollo, epitelial y no odontogénico. Aparece en la región del ala nasal, produce asimetría facial, afecta la estética y puede conducir a alteraciones psicológicas. Objetivo: Presentar un caso clínico de quiste nasoalveolar unilateral derecho. Caso clínico: Paciente masculino de 30 años de edad, de color de piel negra, procedencia rural y con antecedentes de salud. Acudió a consulta por presentar aumento de volumen en ala nasal derecha, que producía obstrucción nasal y dificultades al respirar. El examen físico y complementarios imagenológicos revelaron diagnóstico presuntivo de quiste nasoalveolar unilateral derecho. Se procedió a la exéresis quirúrgica de la lesión bajo anestesia local sin complicaciones, el examen histopatológico confirmó el presunto diagnóstico. Conclusiones: El quiste nasoalveolar es una entidad clínica poco frecuente en Cuba y el mundo, su tratamiento es quirúrgico y es baja su recurrencia(AU)

Introduction: The nasolaveolar cyst, also known as nasolabial or Klestadt, is considered a rare developmental, epithelial and non-odontogenic cyst. It appears in the region of the nasal wing, produces facial asymmetry, affects aesthetics and can lead to psychological disorders. Objective: To present a clinical case of a right unilateral nasoalveolar cyst. Clinical case: A 30-year-old male patient, black, rural origin and with a history of health. He came to the consultation due to presenting an increase in volume in the right nasal wing, which caused nasal obstruction and difficulties in breathing. The physical and complementary imaging examinations revealed a presumptive diagnosis of a right unilateral nasoalveolar cyst. The lesion was surgically removed under local anesthesia without complications and histopathological examination confirmed the presumed diagnosis. Conclusions: The nasoalveolar cyst is a rare clinical entity in Cuba and the world, its treatment is surgical and its recurrence is low(AU)

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The scientific need for standardized, high-quality facial stimuli has driven the creation of several face image databases in recent years. These stimuli are particularly important in facial asymmetry research. However, previous studies have reported facial anthropometric differences across a variety of ethnicities. This highlights the need to investigate whether these differences can also impact the use of face image databases, particularly in facial asymmetry research. In this study, we investigated facial asymmetry-based morphometric differences between the multi-ethnic Chicago Face Database (CFD) and the LACOP Face Database, which is composed of Brazilian subjects. We found reliable differences in facial asymmetry between the two databases, which were related to ethnic groups. Specifically, differences in eye and mouth asymmetry seem to drive these differences. The asymmetry-based morphometric differences among databases and ethnicities found in this study reinforce the necessity of creating multi-ethnic face databases.

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RESUMEN Objetivo: Determinar la frecuencia de asimetrías mandibulares utilizando radiografías panorámicas digitales con presencia de piezas dentales completas. Material y métodos: Se diseñó un estudio de tipo descriptivo, observacional y de corte transversal retrospectivo, donde se revisaron los registros de todas las radiografías panorámicas digitales de pacientes de entre 18 y 59 años de edad del centro radiográfico Dental Image en el período 2016-2020. Se procedió a evaluar las radiografías panorámicas con el porcentaje de asimetría mandibular según el índice de Habets mediante el trazado radiográfico digital, considerando las siguientes variables: altura de la rama ascendente (C+R), altura de la rama mandibular (RH) y altura condilar (CH), comparando las radiografías simétricas y asimétricas. Resultados: Del total de radiografías analizadas de la muestra (1000), se obtuvo que el grupo etario predominante fue el de 34-41 años de edad, con un total de 301 radiografías (30,1 %); asimismo, en cuanto a la asimetría de acuerdo al sexo, predominó el masculino con 33 (6,6%) simétricos y 467 (93,4%) asimétricos. Conclusión: Existió prevalencia en la altura de la rama ascendente derecha, siendo mayor en el sexo masculino (64,8 mm); estos valores tuvieron significancia estadística entre edad y sexo.

ABSTRACT Objective: This study aims to determine the frequency of mandibular asymmetries using digital panoramic radiographs that display complete teeth. Material and methods: A descriptive, observational, and retrospective cross-sectional study was conducted. The records of all digital panoramic radiographs from patients aged 18 to 59 years, taken at the Dental Image radiographic center during the period 2016-2020, were reviewed. Panoramic radiographs were evaluated for the presence of mandibular asymmetry using the Habets index. Digital radiographic tracing was employed to assess variables including ascending ramus height (C+R), mandibular ramus height (RH), and condylar height (CH). Symmetrical and asymmetrical radiographs were compared. Results: Out of the total sample of 1000 radiographs analyzed, the predominant age group was 34-41 years, constituting 301 radiographs (30.1%). Additionally, in terms of asymmetry based on gender, males exhibited a predominance, with 33 (6.6%) symmetrical radiographs and 467 (93.4%) asymmetrical radiographs. Conclusions: The study revealed a prevalence of height asymmetry in the right ascending ramus, with greater height observed in males (64.8 mm). These values demonstrated statistical significance in relation to both age and gender.

RESUMO Objetivo: Determinar a frequência de assimetrias mandibulares utilizando radiografias panorâmicas digitais com todos os dentes presentes. Material e métodos: Foi elaborado um estudo descritivo, observacional, retrospectivo e transversal para analisar registros de todas as radiografias panorâmicas digitais de pacientes com idades entre 18 e 59 anos no centro radiográfico Dental Image, no período de 2016 a 2020. As radiografias panorâmicas foram avaliadas quanto à porcentagem de assimetria mandibular, utilizando o índice de Habets. Traçados radiográficos digitais foram empregados, considerando variáveis como a altura do ramo ascendente (C+R), altura do ramo mandibular (RH) e altura condilar (CH). Foram comparadas radiografias simétricas e assimétricas. Resultados: Das radiografias analisadas na amostra total (1.000), a faixa etária predominante foi de 34 a 41 años, totalizando 301 radiografias (30,1%). Em termos de assimetria por gênero, o sexo masculino apresentou predominância com 33 (6,6%) radiografias simétricas e 467 (93,4%) radiografias assimétricas. Conclusões: Observou-se prevalência na altura do ramo ascendente direito, com valores maiores no sexo masculino (64,8 mm). Esses valores demonstraram significância estatística em relação à idade e ao sexo.

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Facial asymmetry associated with unilateral condylar hyperplasia (UCH) is a rare disease. The aim of this study was to evaluate the clinical conditions of progressive facial asymmetry in young subjects treated with high condylectomy. A retrospective study was performed including nine subjects diagnosed with UCH type 1B and progressive facial asymmetry around 12 years old with an upper canine progressing towards dental occlusion. After an analysis and a decision of treatment, orthodontics began one to two weeks prior to the condylectomy (with a mean vertical reduction of 4.83 ± 0.44 mm). Facial and dental asymmetry, dental occlusion, TMJ status and an open/closing mouth were analyzed before surgery and in the final stage of treatment, almost 3 years after surgery. Statistical analyses were performed using the Shapiro-Wilk test and a Student's t-test considering a p value of <0.05. Comparing T1 (before surgery) and T2 (once orthodontic treatment was finalized), the operated condyle showed a similar height to that observed in stage 1 with a 0.12 mm difference in height (p = 0.8), whereas the non-operated condyle showed greater height increase with an average of 3.88 mm of vertical growth (p = 0.0001). This indicated that the non-operated condyle remained steady and that the operative condyle did not register significant growth. In terms of facial asymmetry in the preoperative stage, a chin deviation of 7.55 mm (±2.57 mm) was observed; in the final stage, there was a significant reduction in the chin deviation with an average of 1.55 mm (±1.26 mm) (p = 0.0001). Given the small number of patients in the sample, we can conclude that high condylectomy (approx. 5 mm), if performed early, especially in the mixed-dentition stage before full canine eruption, is beneficial for the early resolution of asymmetry and thus the avoidance of future orthognathic surgery. However, further follow-up until the end of facial growth is required.

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OBJECTIVE: To describe the position of the mandibular condyle, the size of the joint spaces and the condylar angulation in patients with facial asymmetry (FA), and to classify these results according to the type of FA and compare them with a reference group without FA. Materials and Methods/Patients: An observational, cross-sectional, descriptive study using computed tomography (CT) was conducted on a sample of 133 patients with a clinical diagnosis of FA derived from the following entities: hemimandibular elongation (HE) (n = 61), hemimandibular hyperplasia (HH) (n = 11), condylar hyperplasia in its hybrid form (HF) (n = 19), asymmetric mandibular prognathism (AMP) (n = 25), glenoid fossa asymmetry (GFA) (n = 9) and functional laterognathism (FL) (n = 8). Likewise, a group of 20 patients without clinical or tomographic characteristics of FA was taken and their complete cone beam tomography (CBCT) scans were analyzed. The quantified variables were joint spaces (anterior, middle and posterior), angle of the condylar axis and condylar position. All measurements were performed using the free, open-source Horos software. RESULTS: Most of the subjects without FA had a right middle condylar position (55%), while in the patients with FA the anterior condylar position predominated. On the left side, the most frequent condylar position was anterior, including the group without FA, except in the HH group. Considering the measurements of the anterior, middle and posterior joint space (mm) on the right side (anterior JS: 1.9 mm, middle JS: 2 mm and posterior JS: 2.8 mm) and on the left side (anterior JS: 2.7 mm, middle JS: 2.1 mm and posterior JS: 2.6 mm) of the subjects without FA, compared to those with FA, the latter presented smaller distances in all diagnoses and only for the right posterior JS (1.9 mm) in HH, was not significant. The condylar axis of the AF group showed significant differences with smaller angles for the left side in those diagnosed with HE (65.4°) and HH (56.5°) compared to those without AF (70.4°). CONCLUSIONS: The condylar position of patients with FA tends to be anterior, both on the right and left sides, while for cases without FA it is middle and anterior, respectively. Patients with FA have smaller joint spaces (mm) compared to patients without FA, with the exception of HH for the right posterior JS.

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Introducción: Un apoyo plantar incorrecto puede considerarse un factor etiológico de asimetrías faciales y cráneo-mandibulares pues modifica, de forma instantánea, la relación entre el maxilar y la mandíbula. Por tanto, resulta vital identificar la etiología de estas asimetrías para establecer diagnósticos y tratamientos certeros. Objetivo: Determinar la influencia del apoyo plantar en la postura corporal, la simetría facial y cráneo-mandibular en adolescentes. Métodos: Se realizó un estudio descriptivo y transversal de enero a septiembre de 2019 con 180 adolescentes que asistieron al servicio de Ortodoncia de la Clínica Docente de Especialidades «Victoria de Santa Clara», los cuales cumplían con criterios de selección de la investigación. Se analizaron variables faciales, posturales y cefalométricas. Se determinó: la simetría facial mediante el análisis de líneas faciales, el apoyo plantar al calcular el índice cavitario, la postura corporal, según la prueba de Di Rocca, y la simetría mandibular con el método modificado de Kurt y Uysal. Se siguieron las normas éticas y fueron aplicadas la prueba de Fisher, la de McNemar, y la técnica de conglomerado. Resultados: Predominaron los adolescentes con apoyo plantar asimétrico y los pies varo. Del total de casos con asimetría facial, 72,53 % presentó apoyo plantar asimétrico, y 39,44 % planos biilíaco y biclavicular desequilibrados y divergentes. La asimetría mandibular se observó en el 56,11%, la mayoría con apoyo plantar asimétrico. Conclusiones: Se pudo constatar la influencia del apoyo plantar en la postura corporal, la simetría facial y cráneo-mandibular, pues se observó un alto grado de relación entre las variables estudiadas.

Introduction: an incorrect plantar support can be considered an etiological factor of facial, mandibular and cranial asymmetries since it instantly modifies the relationship between the maxilla and mandible. Therefore, it is vital to identify the etiology of these asymmetries to establish accurate diagnoses and treatments. Objective: to determine the influence of plantar support on body posture and on facial, mandibular and cranial symmetries in adolescents. Methods: a descriptive and cross-sectional study was carried out from January to September 2019 with 180 adolescents who were seen in the Orthodontics service at "Victoria de Santa Clara" Specialty Teaching Dental Clinic, who met the research selection criteria. Facial, postural and cephalometric variables were analyzed. Facial symmetry was determined through the analysis of facial lines, plantar support by means of cavity index, body posture according to the Di Rocca test, and mandibular symmetry with the modified method of Kurt and Uysal. Ethical standards were followed and Fisher's and McNemar's tests as well as clustering technique were applied. Results: adolescents with asymmetric plantar support and varus feet predominated. The 72.53% had asymmetric plantar support from the total cases with facial asymmetry, and 39.44% had unbalanced and divergent biiliac and biclavicular planes. Mandibular asymmetry was observed in 56.11%, mostly with asymmetric plantar support. Conclusions: the influence of plantar support on body posture and on facial, mandibular and cranial symmetries was posible to verify since a high degree of relationship was observed among the variables studied.

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Unilateral condylar hyperplasia (UCH) is an uncommon disease involving progressive facial asymmetry. The aim of this research was to perform an analysis of the diagnosis and treatment of patients with UCH in a clinical series. An observational retrospective study was performed on subjects with progressive facial asymmetry in the lower third of the face; all the subjects were under treatment with condylectomy and orthodontics to improve occlusion and face balance. Variables such as age, sex, clinical type, SPECT (single photon emission computed tomography) intensity and a requirement for secondary surgery were included; the Shapiro Wilk test was performed to analyze the normality of the data and nonparametric analysis and the Kruskal-Wallis or Mann-Whitney tests were used to assess the association between the SPECT difference and the variables, where 2-tailed p values < 0.05 were considered to be statistically significant. Forty-nine patients between 10 and 45 y.o. (average age: 19.1 ± 7.4 y.o.) were included in the study. There were 41 female (83.6%) and 8 male (16.4%) subjects. The SPECT analysis comparing the right and left condyles with more than 10% in caption of the isotope was present in 46 subjects; the results obtained using SPECT were not statistically related to the age or sex of the sample (p = 0.277). The patients were classified into clinical types I, II and III, and no correlations could be confirmed between the clinical type and other variables. High condylectomy was conducted on all patients, among which 14 patients underwent a secondary surgery for orthognathic or cosmetic treatment, and was not related to the initial variables used in diagnosis (p = 0.98); interestingly, the second surgical treatment was more present in the clinical type I and in subjects under 16 years old with no statistical differences. Clinical analysis, medical records, 3D imaging and SPECT should be used as a complementary analysis in assessing the diagnosis of UCH and progressive facial asymmetry.

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New possibilities such as Surgery-first and Minimal Presurgical Orthodontics have become extra alternatives for patients, orthodontists, and oral and maxillofacial surgeons, with immediate facial improvements, reduced preparation time, and shorter treatment time. The purpose of this case report was to demonstrate the retreatment of a female patient, dissatisfied with the instability of the compensatory orthodontic treatment, chin deviation, and forward inclination of the maxillary incisors, which was successfully treated with Minimal Presurgical Orthodontic approach associated with customized lingual brackets and virtual planning on the open-source Blender 3D software, where the post-surgical maxillary lingual brackets were also designed. Orthodontic preparation was performed in 5 months. After surgery, orthodontic treatment was finished with the aid of mini-implants and miniplates. The total treatment time was 18 months. Great facial and occlusal results were obtained and the patient was satisfied. Overall, all treatment steps were performed following a digital workflow and open-source software. It is possible to conclude that Minimal Presurgical Orthodontic Preparation was an excellent alternative for the retreatment of this patient with mandibular asymmetry and increased treatment expectations. Additionally, the surgical planning and design of lingual braces with open-source software can be considered useful and low-cost alternatives for orthodontists.

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Resumo Este relato de caso clínico apresenta o tratamento não cirúrgico de uma paciente de 17 anos e 4 meses de idade, com má oclusão de Classe III, subdivisão direita, assimetria facial, desvio do mento para a direita, perfil reto, mordida anterior de topo, com prognatismo mandibular e mordida cruzada posterior unilateral. Foi realizado um tratamento compensatório com arcos multiloop para nivelamento lateral e sagital do plano oclusal, uma vez que o tratamento ortodôntico-cirúrgico não foi aceito pela paciente devido aos custos e riscos envolvidos. Adequados trespasses vertical e horizontal foram alcançados, além da relação de Classe I, com uma melhora aceitável da assimetria facial que permaneceu estável após 10 anos do tratamento ortodôntico (AU)

Abstract This clinical case report presents the non-surgical treatment of a 17 years and 4 months old female patient, with right subdivision, Class III malocclusion, facial asymmetry, chin deviation to the right, straight profile, top anterior bite, with mandibular prognathism, and unilateral posterior crossbite. A compensatory treatment was performed with multiloop archwires for lateral and sagittal leveling of the occlusal plane, since the orthodontic-surgical treatment was not accepted by the patient due to the cost and risks involved. Adequate overjet and overjet were achieved, in addition to a Class I relationship, with an acceptable improvement in facial asymmetry that remained stable after 10 years of orthodontic treatment. (AU)

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A esclerodermia localizada (morfeia linear) é uma doença rara que causa distrofia e assimetria faciais em mulheres jovens. É relatado o caso de uma paciente de 20 anos que foi tratada com enxertos compostos de gordura. Após a coleta do lipoaspirado de gordura subcutânea profunda, a microgordura e a nanogordura não filtrada foram processadas separadamente para formar enxertos compostos de gordura. Estes foram meticulosamente transplantados em camadas, para reconstruir o subcutaneo da face da paciente. Após um ano, observou-se boa pega de gordura com correção bem-sucedida da assimetria e restabelecimento do equilíbrio facial.

Localized scleroderma (linear morphea) is a rare disease that causes facial dystrophy and asymmetry in young women. We report the case of a 20-year-old female patient who was treated with novel composite fat grafts. After extracting lipoaspirate from deep subcutaneous fat, the microfat and the unfiltered nanofat were processed separately, and amalgamated, obtaining composite fat grafts. These were meticulously transplanted layer by layer to rebuild the subcutaneous tissue of the patient's face. After one year, a good volume of fat retention was observed with successful correction of asymmetry and restoration of facial balance.

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Introducción: la asimetría facial es una condición notoria en el tercio inferior de la facie del sujeto y entre los tercios medio y superior, en este último será menos evidente esta condición, de tal manera que podría considerarse como una de las molestias de mayor incidencia en pacientes con necesidades o no de terapia or- todóncica. Objetivo: evaluar mediante una revisión de la literatura los tratamientos ortodóncico-quirúrgicos de pacientes con asimetría facial. Material y métodos: la literatura se seleccionó mediante una búsqueda en las bases de datos electrónicas: PubMed, Scopus, Web of Science. Las palabras clave utilizadas fueron: facial asymmetry, asymmetry, surgical treatment, surgical orthodontic treatment. La búsqueda se restringió a artículos en inglés publicados del año 2011 al 2021. Resultados: después de aplicar los criterios de inclusión y exclusión en total se obtuvieron y revisaron 27 artículos. Se realizó la revisión de literatura del tratamiento ortodóncico-quirúrgico en pacientes con asimetría facial. Conclusión: es preciso el abordaje ortodóntico quirúrgico para la corrección de la asimetría facial, del protocolo dependerá la situación clínica y la elección de tratamiento ortodóntico quirúrgico, lo que brindará mejoras significativas en la simetría facial (AU)

Introduction: facial asymmetry, is a notorious condition in the lower third of the subject's facie and between the middle and upper thirds, in the latter this condition will be less evident; in such a way, it could be considered as one of the discomforts of greater incidence in patients with needs or not of orthodontic therapy. Objective: to evaluate by means of a literature review the orthodontic-surgical treatment of patients with facial asymmetry. Material and methods: the literature was selected through a search in the following electronic databases: PubMed, Scopus, Web of Science. The keywords used were: facial asymmetry, asymmetry, surgical treatment, surgical orthodontic treatment. The search was restricted to articles in English published from 2011 to 2021. Results: after applying the inclusion and exclusion criteria, a total of 27 articles were obtained and reviewed. The literature review of orthodontic-surgical treatment in patients with facial asymmetry was performed. Conclusion: surgical orthodontic approach is necessary for the correction of facial asymmetry, the protocol will depend on the clinical situation, the choice of surgical orthodontic treatment, which will give significant improvements in facial symmetry (AU)

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Introdução: A paralisia facial necessita de um tratamento multidisciplinar e as opções cirúrgicas são individualizadas para cada paciente e conforme a experiência da equipe médica. O Retalho Ortodrômico Temporal (ROT) é uma forma de correção bem documentada na literatura, com resultados satisfatórios. Um dos passos de sua realização é a coleta da fáscia lata para ponte entre o tendão temporal e os lábios. O objetivo é propor uma padronização da quantidade necessária de fáscia lata e técnica de coleta simplificada. Métodos: Descrição cirúrgica da medida de fáscia necessária para o procedimento e sua coleta. Resultados: Procedimento replicável e seguro conforme experiência do autor sênior. Conclusão: A tática de coleta proposta pode facilitar a realização deste procedimento e torná-lo mais seguro para os pacientes em diferentes serviços de saúde.

Introduction: Facial paralysis requires a multidisciplinary treatment, and surgical options are individualized for each patient according to the medical team's experience. The Temporal Orthodromic Flap (TOF) is a well-documented form of correction in the literature, with satisfactory results. One of the steps of its accomplishment is the collection of the fascia lata to bridge between the temporal tendon and the lips. The objective is to propose a standardization of the required amount of fascia lata and a simplified collection technique. Methods: Surgical description of the fascia measure necessary for the procedure and collection. Results: Replicable and safe procedure according to the senior author's experience. Conclusion: The proposed collection tactic can facilitate the performance of this procedure and make it safer for patients in different health services.

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Introducción: Estudios previos han demostrado diferencias en la percepción de asimetrías dentales y faciales entre profesionales de la odontología y personas no expertas. Sin embargo, la literatura sobre las diferencias en la percepción de las asimetrías del mentón es limitada. Objetivo: Comparar la percepción estética de las asimetrías del mentón entre ortodoncistas, odontólogos especialistas, estudiantes y pacientes de la Facultad de Odontología de la Universidad Central del Ecuador. Métodos: Estudio observacional, analítico y transversal. El universo estuvo conformado por 36 ortodoncistas, 77 odontólogos especialistas, 96 estudiantes y 2580 pacientes de esta Facultad. El tamaño de la muestra fue de 30 participantes para cada grupo. Se modificó digitalmente la posición transversal del mentón de 0° a 6° en las fotografías de dos sujetos (hombre-mujer) ecuatorianos. La evaluación se realizó por medio de una escala visual análoga. Resultados: Las fotografías de asimetrías del mentón con 0° de desviación fueron calificadas como muy estéticas y las asimetrías con 6° fueron poco estéticas para los cuatro grupos. Los ortodoncistas, odontólogos especialistas y estudiantes consideraron como límite estético los 2° de desviación del mentón para la fotografía del sujeto femenino y masculino. Los límites estéticos fueron los 2° de desviación para el sujeto femenino y 3° para el sujeto masculino. Se encontraron diferencias significativas entre los grupos de evaluadores y las fotografías (p < 0,05). Conclusiones: Los ortodoncistas percibieron la estética facial cercana a la norma de la asimetría del mentón, que tiene un papel importante en la percepción de la estética facial(AU)

Introduction: Previous studies have shown differences in the perception of dental and facial asymmetries between dental professionals and non-experts. However, the literature on differences in the perception of chin asymmetries is limited. Objective: Compare the aesthetic perception of chin asymmetries among orthodontists, specialist dentists, students and patients of the Faculty of Dentistry of the Central University of Ecuador. Methods: Observational, analytical and cross-sectional study. The universe was made up of 36 orthodontists, 77 specialist dentists, 96 students and 2580 patients from this Faculty. The sample size was 30 participants for each group. The transverse position of the chin was digitally modified from 0° to 6° in the photographs of two Ecuadorian subjects (male-female). The evaluation was carried out by means of an analogous visual scale. Results: The photographs of asymmetries of the chin with 0° of deviation were qualified as very aesthetic and the asymmetries with 6° were unsightly for the four groups. Orthodontists, specialist dentists and students considered as an aesthetic limit the 2nd deviation of the chin for the photography of the female and male subject. The aesthetic limits were 2° of deviation for the female subject and 3° for the male subject. Significant differences were found between the groups of evaluators and the photographs (p < 0.05). Conclusions: Orthodontists perceived facial aesthetics close to the norm of chin asymmetry, which has an important role in the perception of facial aesthetics(AU)

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An important parameter in diagnostic analysis and treatment planning of different biological areas is facial symmetry, and several etiological factors have been attributed to skeletal facial asymmetry. Although causality cannot be determined, previous studies have reported a relationship between the anatomical deviation of the nasal septum and facial development. Diagnosis is critical for patients in growth stages due to the association between nasal septum deviation (NSD) and abnormal growth of the nasomaxillary complex. To understand this relationship, this study aimed to investigate the influence of nasal septum deviation on fluctuating asymmetries (FA) of the nasomaxillary complex at different stages of skeletal maturation. Another goal was to determine whether an association exists between the degrees of septal deviation severity and asymmetry of the nasomaxillary complex. This was a retrospective, cross-sectional observational study comprising 60 selected cone-beam computed tomography (CBCT) scans that were divided into four groups (n = 15) according to the degree of septal deviation and skeletal maturation: mild deviation (MD; <10°), moderate to severe deviation (MSD; ≥10°), early group (EG), and late group (LG). The angle and area of deviation were measured for the greatest NSD, and a geometric morphometric approach was used to evaluate the nasal septum (NS) shape. The morphology of the nasomaxillary complex and the presence of fluctuating asymmetries were evaluated using 23 two-dimensional landmarks on the nasomaxillary complex (nasal, lateral, and palatal regions) with Procrustes ANOVA and Mann-Whitney test. Additionally, Spearman's correlation and multivariate regression were used to correlate the NSD with asymmetries in these regions. No significant differences were observed in the Procrustes FA scores of the nasomaxillary complex between the MD-EG × MSD-EG and MD-LG × MSD-LG (p > 0.05). However, the results of the multivariate regression revealed more specific aspects of asymmetry (asymmetry component), there was a positive correlation between the NSD angle and the palatal regions (p = 0.035 and p = 0.047, middle and posterior, respectively), and the nasal septum shape and anterior palatal regions (p = 0.039). The nasal and lateral regions did not correlate with the NSD angle in the multivariate regression analysis (p > 0.05). The results of this study indicate that there were no significant differences in the fluctuating asymmetry of the nasomaxillary complex between the mild and moderate to severe nasal septum deviation groups, in both early and late skeletal maturation stages. However, a positive correlation was observed in the degree of nasal septum deviation angle and asymmetry components of the middle and posterior palatal regions, likewise between the nasal septum shape and asymmetry components of the anterior palatal region. The diagnosis of nasal septum deviation by both physicians and dentists is important, as a relationship was observed with fluctuating asymmetry component of the palatal region. This information can guide the decision of the treatment planning for these individuals, and should be considered, especially in cases of severe septum deviation, due to the great anatomical proximity of these structures.

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INTRODUÇÃO A simulação computadorizada 3D foi uma quebra de paradigma no tratamento das deformidades dentofaciais, porém, a melhor maneira de alcançar a Posição Neutra da Cabeça (PNC) ainda é controversa. Há uma carência de estudos comparativos entre os protocolos disponíveis, para avaliação do grau de precisão dos métodos. Este trabalho objetiva avaliar o grau de discrepância entre métodos de PNC em ambiente virtual. MÉTODOS Dez pacientes selecionados de forma consecutiva com deformidades dentofaciais foram incluídos na análise. Cada paciente foi submetido a todos os seguintes protocolos de aquisição da posição neutra da cabeça: (A) O Método do Protocolo CASS; (B) O Método do Protocolo Charlotte; (C) O Método do Protocolo Universal. Tomografias computadorizadas cone-beam (TCCB) com registro de mordida em RC foram solicitadas e moldagens de ambas as arcadas dentárias foram realizadas para o escaneamento 3D. Em seguida, para o preparo e posicionamento dos crânioscompostos na PNC foi utilizado o software Anatomic Aligner (Houston Methodist Research Institute), gerando um total de 30 crânios-compostos, uma vez que cada paciente virtual foi submetido a 3 protocolos de transferência de PNC. As discrepâncias foram avaliadas pela sobreposição dos modelos 3D craniofaciais pela análise cefalométrica Gateno-Xia, seguida de mensurações das diferenças lineares e angulares RESULTADOS Nos casos analisados nesse estudo, quando comparando os métodos de aquisição de PNC entre si os valores lineares e angulares obtidos encontram-se dentro dos limites preconizados na literatura como sendo excelentes (diferenças angulares inferiores a 4°, e lineares inferiores a 2mm, e para a linha média da maxila inferiores igual ou inferiores a 1mm), sendo o maior desvio linear de 1,1mm, e de orientação de 2,3°, e um máximo de desvio de linha média da maxila de 1mm, considerando todos os crânio-compostos orientados. Ainda, análises comparativas pareadas entre os métodos de PNC foram realizadas, seguindo as seguintes confrontações: Grupo A contra Grupo B; Grupo A contra Grupo C; e Grupo B contra Grupo C. Os autores não observaram desvios dos valores preconizados na literatura em todas as duplas comparativas. Por fim, análise estatística de ANOVA não evidenciou nenhuma diferença estatisticamente significante. DISCUSSÃO Os autores confirmam a hipótese de que todos os métodos de orientação da cabeça avaliados neste estudo não apresentam diferenças estatisticamente significantes (P>0,05) e consideram que quando realizado o preparo e orientação do crânio-composto em ambiente controlado e por profissionais especializados e capacitados na área cirúrgica, todas as técnicas para orientação da cabeça poderão ser úteis, precisas e válidas para o resultado desejado. Isso devido ao fato da checagem da PNC ser sempre baseado na análise facial e dados clínicos coletados pelo cirurgião. CONCLUSÃO Esse estudo evidenciou que não houve diferença estatística em questão de precisão entre todos os protocolos elencados para comparação, e mostrou-se de suma importância para a proporcionar aos cirurgiões uma reflexão sobre qual técnica seria mais adequada para o tratamento dos pacientes com deformidades dento faciais em seu centro, considerando sempre os principais aspectos que facilitam o dia a dia clínico do cirurgião, a saber: Simplicidade de execução; menor gasto de tempo; e familiaridade com a técnica (AU).

INTRODUCTION The 3D computer simulation was a paradigm shift in treating dentofacial deformities. However, the best way to achieve the Neutral Head Position (NHP) is still controversial. There there are need to perform comparative studies between the available protocols to assess the degree of accuracy of the methods. This work aims to evaluate the degree of discrepancy between PNC methods in a virtual environment. METHODS Ten consecutively selected patients with dentofacial deformities were included in the analysis. Each patient underwent all the following neutral head position acquisition protocols: (A) The CASS Protocol Method; (B) The Charlotte Protocol Method; (C) The Universal Protocol Method. Cone-beam computed tomography (CBCT) with CR bite registration was requested, and impressions of both dental arches were taken for 3D scanning. Then, for preparing and positioning the composite skulls in the PNC, the Anatomic Aligner software (Houston Methodist Research Institute) was used, generating a total of 30 composite skulls since each virtual patient was submitted to 3 transfer protocols of PNC. The discrepancies were evaluated by superimposing the 3D craniofacial models using the Gateno-Xia cephalometric analysis, followed by linear and angular differences measurements. If within limits recommended in the literature as being excellent (angular differences less than 4°, and linear differences less than 2mm, and for the midline of the maxilla less than or equal to 1mm), the most significant linear deviation being 1.1mm, and orientation of 2.3°, and a maximum maxillary midline deviation of 1mm, considering all oriented cranial composites. Also, paired comparative analyzes between the PNC methods were carried out, following the following comparisons: Group A against Group B, Group A against Group C, and Group B against Group C. The authors did not observe deviations from the values recommended in the literature in all comparative pairs. Finally, ANOVA statistical analysis did not show any statistically significant difference. DISCUSSION The authors confirm the hypothesis that all the head orientation methods evaluated in this study do not present statistically significant differences (P>0.05) and consider that when the preparation and orientation of the skull-composite are carried out in a controlled environment and by specialized professionals and trained in the surgical area, all head orientation techniques can be helpful, accurate and valid for the desired result. This is because the PNC check is always based on facial analysis and clinical data collected by the surgeon. CONCLUSION This study showed no statistical difference in accuracy between all the protocols listed for comparison, and it proved to be of paramount importance to provide surgeons with a reflection on which technique would be most appropriate for the treatment of patients with dentofacial deformities. At its center, always consider the main aspects that facilitate the surgeon's day-to-day clinical: Simplicity of execution, less time spent, and familiarity with the technique (AU).

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Introdução: A paralisia facial é um quadro que pode gerar algumas sequelas, e às vezes apenas as estéticas podem ser melhoradas. Com base nisso, objetivou-se relatar um caso em que foi utilizada uma tela de polipropileno e poliglecaprone com finalidade de elevar as estruturas da hemiface direita. Relato de Caso: A paciente apresentava paralisia em hemiface direita, com selamento palpebral incompetente, desvio de comissura labial e sem movimento da musculatura temporal. Foi realizada uma incisão abaixo da costeleta, pré e retroauricular, com descolamento do retalho cutâneo em toda a hemiface direita. Após levantar o sistema musculoaponeurótico superficial e fixá-lo com fios de mononylon, foi colocada a tela de polipropileno e poliglecaprone na região do terço médio e fixada com monocryl. Foi realizada cantotomia e cantopexia lateral da pálpebra direita. No pós-operatório imediato a paciente evoluiu sem edemas, retrações ou abaulamentos, e após um ano e sete meses apresenta total integração da tela, sem retração, fibrose ou recidiva. Discussão: A escolha do tratamento estético de paralisia facial depende da causa e duração da lesão, mas existem diversas formas de fazê-lo. Entre as ideias mais novas, estão o uso de células tronco e materiais aloplásticos e, seguindo essa segunda linha, a tela de polipropileno e poliglecaprone pode ser pensada como uma técnica viável, como foi neste caso relatado.

Introduction: Facial paralysis is a condition that can cause some sequelae, and sometimes only aesthetics can be improved. Based on this, the objective was to report a case in which a polypropylene and poliglecaprone mesh was used in order to raise the structures of the right hemiface. Case Report: The patient had paralysis in the right hemiface, with incompetent eyelid sealing, deviation of the labial commissure and no movement of the temporal musculature. An incision was made below the cutlet, pre and retroauricular, with detachment of the skin flap across the right hemiface. After lifting the superficial musculoaponeurotic system and fixing it with mononylon threads, the polypropylene and poliglecaprone mesh was placed in the middle third region and fixed with monocryl. Canthotomy and lateral canthopexy of the right eyelid were performed. In the immediate postoperative period, the patient evolved without edema, retraction or bulging, and after one year and seven months, she had complete integration of the mesh, with no retraction, fibrosis or recurrence. Discussion: The choice of aesthetic treatment for facial paralysis depends on the cause and duration of the injury, but there are several ways to do it. Among the newer ideas are the use of stem cells and alloplastic materials, and following this second line, the polypropylene and poliglecaprone canvas can be thought of as a viable technique, as was reported in this case.

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RESUMEN Se presentó un paciente masculino de 8 años de edad, de la raza negra, a la consulta del servicio de Cirugía Maxilofacial del Hospital Américo Boavida de Luanda, en la República de Angola, en el mes de marzo de 2018. Los familiares refirieron una gran deformidad facial de crecimiento lento y progresivo, que se acompañaba de dificultad para respirar por las fosas nasales. Se le realizó un diagnóstico presuntivo de displasia fibrosa facial monostótica del maxilar derecho. Fue intervenido quirúrgicamente bajo anestesia endotraqueal, previa realización de las pruebas para la valoración de la apertura de la boca, donde se tomaron los incisivos superiores e inferiores como referencia: obtuvo una clasificación en clase II (2,6-3 cm) y la escala de Mallampati en grado IV. Se logró superar las dificultades para la intubación. Se le realizó exéresis tridimensional con abordaje de Weber-Ferguson y reconstrucción estética facial.

ABSTRACT An eight-years-old black male patient was attended in the Maxillofacial Surgery Service consultation at the Americo Boavida Hospital in Luanda, Angola, in march 2018. Relatives reported a huge facial deformity with characteristic variable (slow growth) and evolve with time. Also they referred presence of difficulty in breathing through the nostrils, associated with this anomaly. A presumptive diagnosis of monostotic facial fibrous dysplasia of the right maxillary segment was made. He underwent surgery under endotracheal anesthesia, after undergoing tests for the evaluation of the range of mouth opening, where the upper and lower incisors were taken as references: classification obtained in test was Class II (2.6-3 cm) and the Mallampati scale was Grade IV. The intubation procedures difficulties were overcome. Three-dimensional excision with Weber-Ferguson approach and reconstructive plastic surgery was performed.

RESUMO Paciente do sexo masculino, 8 anos, de raça negra, apresentou-se ao serviço de Cirurgia Buco Maxilo Facial do Hospital Américo Boavida, em Luanda, na República de Angola, em março de 2018. Os familiares relataram grande deformidade facial lenta e progressiva, que foi acompanhada de dificuldade em respirar pelas narinas. Foi feito diagnóstico presuntivo de displasia fibrosa facial monostótica da maxila direita. Foi operado sob anestesia endotraqueal, após a realização dos testes de avaliação da abertura da boca, onde foram tomados como referência os incisivos superiores e inferiores: obteve a classificação de classe II (2,6-3 cm) e a escala de Mallampati no grau IV. As dificuldades na intubação foram superadas. A exérese tridimensional foi realizada com a abordagem de Weber-Ferguson e cirurgia plástica reconstrutiva.

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OBJECTIVE: To systematically review literature on therapeutic options for treating hemifacial microsomia (HFM), in young patients with growth potential, classifying and comparing the different dentofacial treatment methods. STUDY DESIGN: An independent review of databases (Scopus, Embase, Ovid, Cochrane Library and PubMed) following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), conducted by four evaluators. The protocol of this study was registered in International prospective register of systematic reviews (PROSPERO), under the number CRD42021293076. RESULTS: Between 1970-2021, a total number of 1137 articles were published of which 27 were included in this study according to the selection criteria: one randomized multicentric trial, two case-control studies, three case series and 21 case reports. CONCLUSIONS: The most common orthopedic treatments provide vertical stimulation of the maxillary process in the affected side. Orthodontic approaches are mainly applied for vertical correction and stabilization of the occlusal plane. Other treatment options include orthognathic surgery, osteogenic distraction, temporomandibular reconstruction and grafting. It is recommended that prospective clinical randomized controlled studies be conducted using homogeneous pediatric groups with long-term follow-up, to establish recommended evidence-based methods for treating each set of hemifacial microsomia symptoms.

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Resumo A Expansão Rápida da Maxila (ERM) vem sendo uma alternativa eficaz para correção das deformidades faciais com uso de aparelhos disjuntores. Na literatura atual são muitos os artigos relacionados à expansão maxilar apoiada em miniparafusos (MARPE) e a utilização desse sistema ajudando muito nas correções transversais superiores, principalmente, em indivíduos adultos sem a necessidade de cirurgias assistidas. Com a evolução da técnica, alguns autores sugeriram as corticoperfurações sobre a rafe palatina no intuito de fragilizar essa estrutura, favorecendo uma separação das hemimaxilas. Ainda mais recente foi complementada com perfurações também na região de crista infrazigomática, facilitando ainda mais o ganho transversal e em alguns casos, corrigindo a assimetria facial com uma expansão unilateral. Quando realizadas as perfurações unilaterais em uma das cristas infrazigomáticas, pode se observar o deslocamento lateral da maxila em maior quantidade no lado em que a crista foi fragilizada. A comprovação em radiografias e tomografias desse maior ganho unilateral abre um novo horizonte para as correções assimétricas da face. O objetivo deste trabalho é comprovar esse tipo de correção e o maior deslocamento unilateral da maxila após a utilização desse sistema. (AU)

Abstract Rapid Maxillary Expansion (RME) has been an effective alternative for correcting facial deformities with the use of circuit breakers. In the current literature there are many articles related to maxillary expansion supported by miniscrews (MARPE) and the use of this system helping in many upper transverse corrections, especially in adult individuals without the need for assisted surgery. With the evolution of the technique, some authors have suggested corticoperforations over the palatine raphe in order to weaken this structure, favoring hemimaxillas separation. More recently, it was complemented with perforations also in the infrazygomatic crest region, facilitating even more the transversal gain and in some cases correcting the facial asymmetry with a unilateral expansion. When performing unilateral perforations in one of the infrazygomatic ridges, we can observe a greater amount of lateral displacement of the maxilla on the side where the ridge was weakened. The confirmation in radiographs and tomographies of this greater unilateral gain opens a new horizon for face asymmetric corrections. The objective of this work is to substantiate this type of correction and the greater unilateral displacement of the maxilla after using this system. (AU)

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