Facial asymmetry and dental occlusal cant have been detected in two-dimensional cephalometry using different horizontal reference lines, but equivalent 3-dimensional (3D) reference planes have not been thoroughly investigated. In this study, 3D cone-beam computed tomography scans of 83 consecutive patients were evaluated using a standardized 3D frame and three horizontal reference planes, Supraorbitale (Sor), Frontozygomatic (Z), and Frankfurt horizontal (FH) for cant detection. Canting was defined as a vertical difference between left and right sides of 2 mm or more, and in at least two investigated planes. Concordance for negative canting was found in 38 patients, and for positive canting in 22 patients. Discordance in cant detection was found in 23 patients (28%). 29 patients were found to have canting in at least 2 planes. The FH plane was discordant to the other two planes in 4 patients, the Sor plane in 7 patients and the Z plane in 12 patients. Youden’s index showed the highest performance for FH (0.878), followed by Sor (0.823) and Z plane (0.762). This study revealed that the FH plane was the best method for cant detection in 3D imaging. The FH plane and Sor plane can be combined if orbital asymmetry is suspected.

Background: Synkinesis of the facial musculature is a detrimental sequalae in post-paralytic facial palsy (PPFP) patients. Detailed knowledge on the technical requirements and device properties in a high-resolution ultrasound (HRUS) examination is mandatory for a reliable facial muscle assessment in PPFP patients. We therefore aimed to outline the key steps in a HRUS examination and extract an optimized workflow schema. Methods: From December 2020 to April 2021, 20 patients with unilateral synkinesis underwent HRUS. All HRUS examinations were performed by the first author using US devices with linear multifrequency transducers of 4–18 MHz, including a LOGIQ E9 and a LOGIQ S7 XDclear (GE Healthcare; Milwaukee, WI, USA), as well as Philips Affinity 50G (Philips Health Systems; Eindhoven, the Netherlands). Results: Higher-frequency and multifrequency linear probes ≥15 MHz provided superior imaging qualities. The selection of the preset program Small Parts, Breast or Thyroid was linked with a more detailed contrast of the imaging morphology of facial tissue layers. Frequency (Frq) = 15 MHz, Gain (Gn) = 25–35 db, Depth (D) = 1–1.5 cm, and Focus (F) = 0.5 cm enhanced the image quality and assessability. Conclusions: An optimized HRUS examination protocol for quantitative and qualitative facial muscle assessments was proposed.

Background: This study explored how Taiwanese schoolchildren perceive the appearance of their peers with and without cleft lip and palate (CLP) and whether this perception affects social interactions. We specifically focused on early adolescents with surgically repaired CLP to assess the impact of residual craniofacial deformities. Methods: A cross-sectional design was used, analyzing three-dimensional (3D) surface images of twenty patients with repaired CLP and five without. A total of 91 schoolchildren (40 with CLP, 51 without) served as raters. Participants used a Likert scale to rate images on facial appearance and perceived social acceptance. The study also measured the reliability of its questionnaires using Cronbach’s alpha. Results: All participants successfully differentiated between images of children with and without CLP, though non-cleft participants had significantly better distinguishing abilities. Non-cleft raters consistently gave more positive appearance ratings to non-cleft images, a pattern less evident among cleft raters. While differences in awareness and acceptance between the two groups were not statistically significant, over half of all responses regarding social interaction were neutral. The questionnaires demonstrated high reliability, with Cronbach’s alpha values greater than 0.85. Conclusions: Despite the ability to perceive residual craniofacial differences, appearance alone did not significantly affect social interactions for early adolescent children with surgically repaired CLP in Taiwan. This suggests that other factors may play a larger role in social dynamics within this population.

BACKGROUND Augmentation rhinoplasty with autologous fat grafting is a useful procedure to meet the demand for facial harmonization in the Asian population. We used this procedure during orthognathic surgery to address inadequate dorsum projection. OBJECTIVE This prospective study was conducted to determine the fat retention rate in patients with simultaneous autologous fat injection augmentation rhinoplasty and orthognathic surgery. METHODS Nineteen patients were treated with simultaneous bimaxillary orthognathic surgery and autologous fat grafting of the nasal dorsum and tip. The paired- t -test was used to compare the nasal volumes before and at least 6 months after surgery measured by 3D CT scans. All measurements were performed twice by the same evaluator at least 2 weeks apart for intra-rater consistency. RESULTS Seventeen patients completed the study. The volume means before and after surgery were 22.3 +/- 4.6 cm3 and 23.3 +/-4.7 cm3 respectively with a mean difference of 1.0 +/- 0.3 cm3 (p<0.001). The mean retention rate was calculated to be 50.5 +/- 7.0% (range 40.5% to 64.7%). Intra-rater consistency was high with a Cronbach α of 0.97 (P<0.001) and 0.98 (P<0.001) respectively. CONCLUSIONS To the best of our knowledge, this is the first prospective study that provides objective graft retention measurements based on computer tomography scans for orthognathic surgery combined with fat injection. All patients were satisfied with the results and no complications or additional morbidity was noted in the postoperative course. We consider this procedure to be a safe, reliable and powerful adjunct to improve the aesthetic results of orthognathic surgery.