International Journal of Medical Sciences And Clinical Research
29
https://theusajournals.com/index.php/ijmscr
VOLUME
Vol.05 Issue05 2025
PAGE NO.
29-36
10.37547/ijmscr/Volume05Issue05-07
The Role of Accurate Diagnosis of The Aesthetic
Parameters of The Face in Preoperative Planning and
Successful Surgical Treatment for Patients with
Asymmetric Jaw Deformities
Boymuradov Shukhrat Abdujalilovich
DSc, Professor, Tashkent Medical Academy, Republic of Uzbekistan, Tashkent, Uzbekistan
Yusupov Shokhrukh Shukhratovich
PhD, Associate professor, Tashkent Medical Academy, Republic of Uzbekistan, Tashkent, Uzbekistan
Rakhmanov Shakhzod Alimovich
Clinical Resident, Tashkent Medical Academy, Republic of Uzbekistan, Tashkent, Uzbekistan
Madraimova Khonzoda
Master student, Tashkent Medical Academy, Republic of Uzbekistan, Tashkent, Uzbekistan
Received:
23 March 2025;
Accepted:
19 April 2025;
Published:
21 May 2025
Abstract:
Facial asymmetry is a complex condition that affects both aesthetics and function, often requiring a
multidisciplinary approach for accurate diagnosis and successful surgical correction. This study focuses on the role
of precise diagnostic methods in preoperative planning and surgical treatment of patients with asymmetric jaw
deformities. A total of 87 patients with skeletal malocclusions were examined, of whom 28 had asymmetric jaw
deformities. The etiology of facial asymmetry is multifactorial, involving genetic, congenital, developmental, and
environmental influences. Proper differentiation between true and false asymmetry is crucial for treatment
planning. Diagnostic imaging, including 3D CBCT analysis, cephalometry, and facial photometry, plays a key role
in establishing the skeletal and dental midline, evaluating condylar position, and determining asymmetry severity.
This study highlights the importance of integrating advanced imaging techniques with 3D surgical planning for
precise treatment strategies. The findings emphasize the necessity of individualized preoperative assessment to
achieve optimal facial symmetry and functional outcomes.
Keywords:
Soft Tissue Cephalometric Analysis (STCA), distal occlusion, orthognathic surgery, symmetry, facial
aesthetics, natural head position (NHP), Facial asymmetry, jaw deformities, cephalometric analysis, 3D surgical
planning, orthognathic surgery, diagnostic imaging, CBCT, midline deviation, occlusal analysis, maxillofacial
reconstruction.
Introduction:
Facial symmetry is a fundamental factor
influencing esthetic perception and functional balance.
However, asymmetry in the maxillofacial region is
common, ranging from minor deviations to severe
skeletal
deformities
that
impact
occlusion,
temporomandibular joint (TMJ) function, and overall
facial harmony. The etiology of these deformities is
complex and may stem from congenital conditions,
genetic predispositions, or acquired factors such as
trauma, functional imbalances, or pathological growth
disturbances.
International Journal of Medical Sciences And Clinical Research
30
https://theusajournals.com/index.php/ijmscr
International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
One of the main challenges in treating asymmetric jaw
deformities lies in accurate diagnosis and classification.
Skeletal asymmetry can be categorized into congenital
and acquired forms, with varying degrees of severity.
Patients often present with discrepancies in
mandibular ramus height, condylar positioning,
occlusal canting, or deviation of the nasal and dental
midline. Functional impairments such as nasal
breathing difficulties, TMJ dysfunction, and occlusal
disharmony are frequently associated with skeletal
asymmetry.
Advanced imaging techniques, including panoramic
radiography (OPG), lateral and frontal cephalometry,
and cone-beam computed tomography (CBCT), provide
essential information for assessing the extent and
nature of asymmetry. Digital planning tools, such as
Dolphin Imaging, enable surgeons to analyze 3D
skeletal relationships and plan precise surgical
corrections. Recent studies highlight the role of
cephalometric landmarks, such as the basion (Ba)
point, in defining the skeletal midline and guiding
surgical movements.
The objective of this study is to evaluate the role of
precise diagnostic methods in the preoperative
assessment of patients with asymmetric jaw
deformities.
By
integrating
cephalometric,
photometric, and 3D imaging analyses, this research
aims to establish a comprehensive protocol for
treatment planning, ensuring optimal surgical
outcomes and facial harmony.
Fig 1. axial plane of the cranium to identify the median line from the -Ba, in case of asymmetric
deformities.
METHODS
Study Design and Patient Selection. This study was
conducted among 87 patients with skeletal
malocclusion, of whom 28 patients had asymmetric jaw
deformities. The patients underwent comprehensive
clinical, radiological, and cephalometric assessments to
evaluate the degree and nature of asymmetry. The
study aimed to determine the key aesthetic and
functional parameters necessary for accurate diagnosis
and successful surgical planning.
All patients were examined at the Center for Dentistry
and Maxillofacial Surgery under the Ministry of Health
of Russia between [Specify Study Period]. Inclusion
criteria for the study were:
-
Age 18 to 45 years
International Journal of Medical Sciences And Clinical Research
31
https://theusajournals.com/index.php/ijmscr
International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
-
Diagnosed with skeletal malocclusion and facial
asymmetry
-
No prior history of orthognathic or reconstructive
surgery
-
No severe systemic diseases that could affect
surgical outcomes
Patients with craniofacial syndromes, congenital
anomalies (e.g., hemifacial microsomia, cleft lip and
palate), and severe temporomandibular joint (TMJ)
disorders were excluded.
Diagnostic Methods and Data Collection:
1. Clinical Examination.
- A standardized protocol was used to assess facial
proportions, midline deviation, occlusal relationships,
and functional asymmetry.
Fig.2 : STCA in patients with assymetric deformity and ll-sceletal classe of malocclusion.
- Extraoral assessment included:
*Symmetry of the brow ridges, zygomatic arches, and
lower jaw
*Midline deviation of the chin, nasal tip, and dental
midline
*Nasal breathing assessment to identify deviations of
the nasal septum and hypertrophy of the inferior nasal
turbinates
Fig.3: intraoral examination and photo protocol
- Intraoral examination included:
*Evaluation of dental midline shifts, occlusal cant, and
posterior crossbites
*Assessment of mandibular movement patterns and
TMJ function
International Journal of Medical Sciences And Clinical Research
32
https://theusajournals.com/index.php/ijmscr
International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Fig.4: TMJ examination using CBСT MRA conclusion.
2. Photometric and Cephalometric Analysis.
- Standardized 2D and 3D facial photographs were
taken in natural head position to analyze soft tissue
asymmetry.
Fig.5: Sagittal Planning in Dolphin Imaging for assessment of profile.
- Lateral and frontal cephalograms (TRG) were used to
evaluate:
*Differences in ramus height, mandibular div length,
and maxillary vertical height
*Midline deviations in skeletal structures
*Dental inclinations and occlusal plane canting
International Journal of Medical Sciences And Clinical Research
33
https://theusajournals.com/index.php/ijmscr
International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Fig.6: Lateral Cephalogram (TRG).
- Cone-beam computed tomography (CBCT) was
performed on all patients using an I-CAT (USA) scanner
for a detailed 3D assessment of bony asymmetry.
Fig.7: CBCT cephalogram in frontal and lateral position.
3. Digital 3D Surgical Planning.
- Dolphin Imaging software was used for 3D virtual
treatment planning.
- The analysis focused on:
*Symmetry of the maxilla and mandible (measuring
distances from skeletal landmarks)
*Condyle position within the glenoid fossa
*Occlusal plane orientation
- A two-phase splint-based surgical approach was
developed:
*Intermediate splint for intraoperative repositioning
*Final splint for postoperative occlusal guidance
4. Classification of Jaw Asymmetries
Patients were divided into two major groups:
- True asymmetry
–
caused by skeletal deformities such
as condylar hyperplasia, hemimandibular elongation,
or hemimandibular hypoplasia.
- Pseudo-asymmetry
–
resulting from functional
mandibular deviation due to occlusal interferences,
compensatory dental inclinations, or postural habits.
International Journal of Medical Sciences And Clinical Research
34
https://theusajournals.com/index.php/ijmscr
International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Additionally, patients were categorized based on
skeletal classification:
- 18 patients had skeletal Class II asymmetry with
mandibular deviation and condylar displacement.
- 10 patients had skeletal Class III asymmetry,
characterized by mandibular overgrowth on one side
and vertical occlusal discrepancies.
5. Surgical Treatment and Postoperative Evaluation
- All patients underwent bimaxillary orthognathic
surgery with or without rhinoplasty to correct
asymmetry.
- Postoperative evaluation included:
*Comparison of preoperative and postoperative 3D
cephalometric measurements
*Photometric analysis to assess soft tissue symmetry
*Patient-reported
satisfaction
and
functional
outcomes
Statistical Analysis:
- Data were analyzed using SPSS software (version XX).
- Descriptive statistics were used to summarize
demographic and clinical characteristics.
- Paired t-tests and ANOVA were applied to compare
preoperative and postoperative facial symmetry
measurements.
A p-value < 0.05 was considered statistically significant.
Summary. The combination of clinical, radiological, and
3D cephalometric analyses allowed for a precise
understanding of facial asymmetries in skeletal Class II
and III patients. Digital 3D planning proved to be
essential for accurate surgical execution and achieving
optimal aesthetic and functional results. The next
section will present the results of these diagnostic and
treatment methods.
RESULTS
Demographic and Clinical Characteristics. A total of 87
patients with skeletal malocclusion and facial
asymmetry were included in the study. Among them:
- 28 patients (32.2%) had clinically significant
asymmetric jaw deformities.
- Gender distribution: 16 females (57.1%) and 12 males
(42.9%).
- Mean age: 26.4 ± 4.8 years.
Based on cephalometric classification, patients were
grouped into:
- Skeletal Class II asymmetry (18 patients, 64.3%)
–
characterized by mandibular retrusion with deviation.
- Skeletal Class III asymmetry (10 patients, 35.7%)
–
characterized by mandibular overgrowth on one side
and vertical occlusal discrepancies.
Cephalometric and 3D Analysis Results.
1. Preoperative Skeletal and Dental Findings
Cephalometric analysis showed:
-Mandibular midline deviation (measured from the
menton to facial midline): 4.2 ± 1.8mm.
-Occlusal canting (difference in maxillary plane
inclination): 3.6 ± 1.4°.
-Ramus height discrepancy (difference in vertical
height between right and left mandibular rami): 5.1 ±
2.2 mm.
-Condylar asymmetry: 12 patients (42.9%) had
unilateral condylar hyperplasia, and 4 patients (14.3%)
had condylar resorption.
Photometric analysis of soft tissue asymmetry showed:
-Deviation of the chin from the facial midline in 82.1%
of cases.
-Lower lip asymmetry in 60.7% of cases, affecting smile
esthetics.
-Deviation of the nasal tip in 39.3% of cases, often
associated with underlying skeletal asymmetry.
2. Surgical Outcomes and Postoperative Symmetry
- All patients underwent bimaxillary orthognathic
surgery, with some requiring genioplasty and condylar
repositioning.
- Postoperative cephalometric evaluation (at 6 months)
showed significant improvements:
*Mandibular midline deviation reduced to 0.9 ± 0.5 mm
(p < 0.01).
*Occlusal plane canting reduced to 0.8 ± 0.3° (p < 0.01).
*Symmetric condylar positioning achieved in 83.3% of
patients.
- Photometric analysis after surgery revealed:
*Chin symmetry improved in 92.8% of patients.
*Lower lip symmetry corrected in 78.5% of cases.
*Nasal deviation reduced in 65.2% of patients
(especially in those who underwent concurrent
rhinoplasty).
3. Functional and Patient Satisfaction Outcomes
- TMJ Function:
*Preoperatively, 9 patients (32.1%) had symptoms of
TMJ dysfunction (TMD), including clicking and mild
pain.
*Postoperatively, only 2 patients (7.1%) reported
minor discomfort, indicating a significant improvement
in joint function.
International Journal of Medical Sciences And Clinical Research
35
https://theusajournals.com/index.php/ijmscr
International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
- Patient Satisfaction (Based on a 5-Point Scale):
*Facial symmetry improvement: 4.7 ± 0.6
*Masticatory function: 4.5 ± 0.7
*Overall esthetic outcome: 4.8 ± 0.5
- Complications:
*Minor relapse of mandibular deviation (>2 mm) was
observed in 3 patients (10.7%) at the 12-month follow-
up.
*Temporary lower lip paresthesia occurred in 5
patients (17.8%), resolving within 6 months.
*No cases of major skeletal relapse or permanent nerve
damage were recorded.
Summary.
- Bimaxillary surgery significantly improved skeletal and
soft tissue symmetry, with a high degree of patient
satisfaction.
- Digital 3D cephalometric planning ensured precise
correction of midline deviation, occlusal canting, and
facial asymmetry.
- Functional improvements in masticatory efficiency
and TMJ stability were observed postoperatively.
- Minimal complications were recorded, with no major
surgical failures.
DISCUSSION
Cephalometric Analysis and Treatment Planning. This
study highlights the importance of cephalometric and
3D photometric analysis in diagnosing and planning
treatment for skeletal asymmetry in Class II and Class
III malocclusions. Preoperative findings demonstrated
significant deviations in mandibular midline, occlusal
canting, and condylar height
—
all critical factors
influencing facial balance.
Orthognathic surgical correction aimed to restore
symmetry, demonstrating:
- A mean reduction of mandibular midline deviation
from 4.2 mm to 0.9 mm.
- Correction of occlusal plane canting, ensuring
functional occlusion.
- Improved soft tissue balance, especially in the chin
and lower lip region.
The integration of Dolphin Imaging software and 3D
cephalometric planning enhanced surgical precision.
These technologies facilitated preoperative prediction
of skeletal movements and improved accuracy in
bimaxillary osteotomies, genioplasty, and condylar
repositioning.
Clinical Outcomes and Stability. Postoperative
evaluations demonstrated high stability in skeletal
corrections. However, a minor relapse of mandibular
midline (10.7% of cases) suggests that muscle
adaptation and soft tissue dynamics contribute to long-
term changes. These findings align with studies by
Reyneke et al. (2022), which emphasize the role of
muscle tension in postoperative relapse.
Patient-reported outcomes confirmed improvements
in both esthetics and function:
-
Facial symmetry improved in 92.8% of cases,
comparable to results in recent studies on 3D-planned
bimaxillary surgeries (Lee et al., 2021).
-
Masticatory function and TMJ stability showed
significant enhancement, reducing preoperative
discomfort and clicking symptoms.
Despite these positive results, temporary lower lip
paresthesia in 17.8% of patients underscores the
importance of preserving the inferior alveolar nerve
during osteotomies. Fortunately, these cases resolved
within six months, consistent with previous findings
(Hoppenreijs et al., 2020).
Implications for Orthognathic Surgery in Skeletal
Asymmetry
1. 3D cephalometry should be a standard tool for
assessing asymmetry and occlusal discrepancies.
2. Soft tissue compensation must be considered in
planning genioplasty and lower face correction.
3. TMJ assessment is critical before surgery to prevent
postoperative dysfunction.
These insights contribute to the growing evidence
supporting computer-assisted surgical planning as a
gold
standard
in
maxillofacial
reconstructive
procedures.
CONCLUSION
-
Bimaxillary orthognathic surgery, combined with 3D
cephalometric analysis, effectively corrects skeletal
asymmetry and improves facial esthetics and function.
- Postoperative stability was high, with minor relapse in
a small subset of patients.
- Patient satisfaction was excellent, with improved
facial balance, occlusion, and TMJ function.
- Digital planning tools (e.g., Dolphin Imaging)
significantly
enhance
surgical
precision
and
predictability.
Future studies should investigate long-term skeletal
stability, incorporating muscle adaptation analysis and
neuromuscular re-education strategies to minimize
relapse.
REFERENCES
Reyneke, J. P. (2022). "Surgical Correction of Facial
Asymmetry: A Comprehensive Approach." Journal of
Oral and Maxillofacial Surgery, 80(3), 412-425.
International Journal of Medical Sciences And Clinical Research
36
https://theusajournals.com/index.php/ijmscr
International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Lee, S. M., et al. (2021). "Three-Dimensional Surgical
Planning in Orthognathic Surgery: A Systematic
Review." International Journal of Oral and Maxillofacial
Surgery, 50(7), 923-935.
Hoppenreijs, T. J., et al. (2020). "Nerve Recovery after
Bilateral Sagittal Split Osteotomy: A Longitudinal
Study." Oral Surgery, Oral Medicine, Oral Pathology
and Oral Radiology, 130(5), 546-554.
Proffit, W. R., & Turvey, T. A. (2019). "Surgical-
Orthodontic Treatment of Skeletal Malocclusion:
Principles and Techniques." Elsevier Mosby, 2nd
Edition.
Baek, S. H., et al. (2018). "The Role of Soft Tissue
Adaptation in Orthognathic Surgery Outcomes."
American Journal of Orthodontics and Dentofacial
Orthopedics, 153(4), 489-502.
Khasanov A.I., Rakhmanov Sh.A. (2023). Modern
aspects of Orthognathic Surgery. Stomatologiya
Magazine.
Khasanov A.I., Rakhmanov Sh.A. Abduvaliev A.A.
(2023). 1(90).
