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This is the third article in a three-part series considering skeletal discrepancies in the vertical and transverse dimensions. Significant discrepancies in the transverse dimension are relatively rare but present challenges for the orthodontist, in terms of treatment planning, management and relapse.
CPD/Clinical Relevance: This article aims to increase awareness of the assessment, aetiology and management of patients presenting with facial asymmetry.
Assessment of facial attractiveness is subjective and is influenced by social, personal and cultural factors. Facial symmetry is the equilibrium of contralateral facial landmarks in dimension and form around the mid-sagittal plane.1 Asymmetry occurs when there is a difference in the size and relationship of the two sides of the face and can include either the soft tissues alone, or a combination of the craniofacial skeletal complex and the soft tissues. No individual face is truly symmetrical, but imbalance beyond a threshold becomes clinically significant, although this threshold is subjective.2 There is an increasing gradient of asymmetry along the vertical axis, with mandibular disproportion observed more frequently than maxillary disproportion.3 This article provides an overview of the assessment of the transverse dimension and discusses the aetiology and management of patients presenting with transverse skeletal asymmetry.
The face can be divided into equal fifths, using intercanthal distance to define a fifth (Figure 1). This intercanthal distance represents the central fifth, while the width of an eye (inner to outer canthus) on each side are the medial fifths, and the lateral fifth on each side is the distance from the outer canthus of the eye to the ear. While the alar base width often approximates the central fifth, the distance between the mesial margins of the irises often correspond to the distance between the commissures of the lips.
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