Facial Index Research Articles

Asymmetry-index and orthodontic facial analysis of children with foetal alcohol syndrome using 3D-facial scans.

The foetal alcohol spectrum disorder (FASD) is a complex and heterogenic disorder, caused by gestational exposure to alcohol. Patients with foetal alcohol syndrome (FAS-most severe form) show abnormal facial features. Our study aims at finding additional reliable and objective parameters for FAS diagnosis. Facial three-dimensional scans of 30 children with FAS and 30 controls were analysed. Orthodontic profile analysis (concerning position of upper and lower jaw) was performed. Vertical facial proportions were taken and facial asymmetry index (right to left side) was calculated. Profile type was significantly different for children with FAS (p = 0.001) with lower jaws more frequently in a retral position. Profile angle was significantly larger in the group with FAS (p = 0.009). Children with FAS had shorter middle thirds and longer lower thirds of the face (p < 0.001). Stomion (point between upper and lower lip) was located significantly more caudally in the FAS group (p < 0.001). Facial asymmetry index was not significantly different. Children with FAS differ significantly from controls in vertical and sagittal facial measurements. Profile analysis and measurement of vertical proportions are easy to apply standard procedures in everyday orthodontic practice and could be time-saving and objective means for additional verification of FAS.

Estimation of sex in Brazilian samples with cross-validation in populations of different regions

Sex estimation might be influenced by ancestry and Brazilian population is cross cultural. Skulls are often used for estimating sex dimorphism. The purpose of the present study was estimate sex based on five craniometric measurements from contemporary and identified samples from two different Brazilian regions with cross-validation. Ethnic group was estimated by Nasal Index and Prosopometric Facial Index. A population sample from South region of Brazil was used to estimate a model (train) and then its performance was tested in a population sample from the Southeast region (test). In a second moment, we performed analysis inverting the order or the populations. The two samples (Southeastern-Southern) were united in one group, in order to verify the influence of this union in the prediction of sex. Models with one, two, three independent variables were created using binomial logistic regression. The results revealed that sex estimation is best performed without the interference of the variable ancestry. Three craniometric measurements allowed a more predictive model for populations with high degree of cross cultural, as the Brazilian one. United samples, Southeastern-Southern, resulted in a good prediction (AUC=0.85), but an intermediate value between southern (AUC=0.89) and southeast (AUC=0.81). It is concluded that sex estimation is best performed without the interference of the variable ancestry. Three craniometric measurements allowed a good predictive model for the Brazilian Southern and Southeastern populations.

Rubeosis faciei diabeticorum is not associated with oxidative stress and skin autofluorescence

BackgroundRubeosis faciei diabeticorum is a persistent facial erythema in patients with diabetes mellitus. The actual pathogenesis has not been studied. However, it is speculated to be a cutaneous diabetic microangiopathy. ObjectiveExamine the correlation between the severity of facial erythema and the possible causes of microvascular diabetic complications, namely oxidative stress, hyperglycemia, and cutaneous accumulation of advanced glycation end-products . MethodsPatients diagnosed with Type 2 diabetes mellitus (n=32) were enrolled in the study. The facial erythema index was measured using the Mexameter MX18; cutaneous accumulation of advanced glycation end-products was estimated by measuring skin auto fluorescence with the AGE Reader (DiagnOptics Technologies B.V. – Groningen, Netherlands). Glycated haemoglobin, total antioxidant status, and malondialdehyde were measured in blood by TBARS assay. The correlation between the selected variables was assessed by Spearman's rank test; p≤0.05 was considered statistically significant. ResultsThere was a statistically significant correlation between total antioxidant status and the facial erythema index (ρ=0.398, p=0.024). Malondialdehyde, skin autofluorescence, glycated haemoglobin, body mass index, duration of diabetes, and age did not demonstrate statistically significant correlation with the facial erythema index. Study limitationsThis is an observational study. Elevation of total antioxidant status could have been caused by several factors that might have also influenced the development of rubeosis faciei, including hyperbilirubinemia and hyperuricemia. ConclusionsThe results contradicted expectations. Total antioxidant status correlated positively with facial erythema index; however, there was no correlation with oxidative stress and skin autofluorescence. Further investigations should be conducted to reveal the cause of total antioxidant status elevation in patients with rubeosis faciei.

Effects of Facial Threading on Female Skin Texture: A Prospective Trial with Physiological Parameters and Sense Assessment.

Background Facial threading is a common tradition in Taiwan, Southeast Asia (called “Bande Abru”), Middle East (called “Khite”), and Egypt (called “Fatlah”). In addition to the ability to remove facial vellus hairs, facial threading can make the skin fairer and shinier. However, there has been a lack of hard evidence regarding the effects of facial threading on the skin. Objective To examine the effects of facial threading on skin physiology as well as visual and touch senses by using scientific instruments. Methods A total of 80 participants were allocated to receive facial threading, application of powder only, exfoliation, and shaving. Prior to and following the assigned treatment, a noninvasive skin condition detection device was used to measure skin coarseness, hydration, melanin, and erythema index. Sense assessment and image analysis were also performed. Results This study showed that facial threading was found to improve the facial skin roughness indices with significant decreases by 30.4%, 35.9%, and 16.7%, respectively, for the participants' forehead, cheek, and mouth corner skin. No significant adverse changes in moisture levels and skin pigment indices were detected. In addition, there was improvement in subjects' touch sense of their skin and feelings about skin color. Conclusions Traditional facial threading can remove facial vellus hairs and lower skin roughness levels, thereby improving the skin texture. However, pricking sensation appeared during the facial threading process, which might cause concerns about irritation.

Morphometric study of cephalo-facial indices among Bini children in southern Nigeria

Cephalometry is an important branch of anthropometry which involves the morphological study of structures present in the human head or scientific measurement of the dimensions of the head. Some of the most important cephalometric parameters include the length/height and breadth/width of the head, the face and the nose as well as their respective indices. These cephalometric parameters are vital in the description of variation which is a common phenomenon that characterizes human physiognomy. They are also useful in the description of human inter-racial and intra-racial similarities both within and across gender. This study involved 450 Bini children (235 males and 215 females) between ages 5-12 years. The length and width of the head and face of each subject was measured between the appropriate anatomical landmarks using spreading and sliding calipers. The measurements were used to calculate the cephalic and facial indices for each subject. The result showed sexual variation in both cephalic and facial indices among the Bini children with the males having higher values than the females. Also, the result of this study showed that prevalence of brachycephalic head type among both male (51.1%) and female (49.8%) Bini children. The mesoproscopic face type was the most prevalent face type among both male (62.6%) and female (47.4%) Bini children. The cephalo-facial indices are vital in demonstrating similarity and variation in physical morphologies of individuals or group of people of different ethnicity, races, gender and geographical locations. Keywords: Cephalometry, Cephalic index, facial index, Bini children, Nigeria

Study of Facial Index in Andhra Pradesh Population

130 patients (65 males and 65 females) facial Index of adults aged between 18 to 25 Andhra Pradeshpopulations were studied. The maximum facial height divided with maximum Breath of zygomatic archand multiplied with 100.The instruments used for measurement were spreading caliper and sliding caliper.The mean value of facial index in adult males was 91.5cm (SD ±05) and in females 88cm (SD ±0.3) + testvalue was 8.2 and statistically highly significant (P&lt;0.01) The Obtained Facial Index was classificationsleptoproscopic (In males 88 to 92.9 and in females 85 to 89.9.) This study of facial Index is quite useful tooral and maxillo facial surgeon to differentiate from congenital, under developed or post traumatized facialindex, moreover this facial index has anthropological and medico –legal importance.

Morphometric analysis of the skulls of domestic cattle (Bostaurus L.) and water buffalo (Bubalusbubalis L.) in Turkey

A total of 20 domestic cattle (Bos taurus L.) and 15 water buffalo (Bubalis bubalis L.) skulls were analyzed in this study. All of the specimens belonged to female individuals. Using a total of 27 craniometric measurements from each of the skulls, 9 indices were calculated. Although there were statistically significant differences between the linear measurements of the skulls of both species, while calculating the indices with their ratios, the values of the measurements of the facial area were determinative in the craniology. Among these indices, the facial index 1 value was statistically significant (P < 0.01) in the comparison of these two species. On the other hand, while considering the orbit and foramen magnum measurements, in contrast with the transversal measurement, the height was more determinant for their index and form.

Prevalence of Leptoprosopic type of Face among Dental Students

Facial index is useful for anatomists, forensic scientists and plastic surgeons during treatment of congenital and traumatic deformities, identification of individuals in medico-legal cases and identifying craniofacial deformities and they help us in distinguishing one person from another. Very few researchers from Nepal have worked on these facial features with respect to population and environment. The study aims to find the prevalence of leptoprosopic type of face among dental students of Kantipur Dental College, Kathmandu, Nepal. The descriptive cross-sectional study was conducted among 173 dental students of age group 17-25 years in the Department of Anatomy, Kantipur Dental College Teaching Hospital and Research Center, Basundhara, Kathmandu from September to December 2018. Ethical clearance was obtained from Institutional Review Committee of the institution and convenience sampling was done. The facial parameters include facial height, facial width which was measured using Digital Vernier Caliper and Sliding Caliper respectively. The face was classified into three different types based on the value of facial index, according to Bannister Classification. Data was analyzed using SPSS 20. Prevalence of leptoprosopic type of face was 70 (40.46%) [40.39-40.53 at 95%CI]. Among these, 37 (21.39%) were males and 33 (19.07%) were females. Leptoprosopic was most common which was followed by hyperleptoprosopic in 64 (36.99%), mesoprosopic in 26 (15.03%), euryprosopic in 12 (6.94%) and hypereuryprosopic facial types in 1 (0.58%). All three facial parameters including facial height, facial width and facial index were greater in male than in female. This study concludes that the leptoprosopic face was most common followed by hyperleptoprosopic, mesoprosopic, europrosopic and hypereuroprosopic type of face.

Customized Three-Dimensional Printing Spacers for Bone Positioning in Orthognathic Surgery for Correction and Prevention of Facial Asymmetry.

Orthognathic surgery is a powerful tool for correction of facial asymmetry and malocclusion. The goal is to achieve good dental function and facial aesthetics. Three-dimensional simulation is used for surgical planning, and bone gaps could be created to achieve facial balance. In this study, customized "spacers" were made using computer-aided design and three-dimensional printing for guides for use during surgery. With the final three-dimensional plan, the skull images were exported to 3-Matic software, where spacers were designed according to the bone gaps. Three-dimensionally-printed spacers were made and used to facilitate positioning and fixation. Consecutive patients with facial asymmetry were recruited in this prospective study. The postoperative outcome was assessed using a visual analogue scale and the three-dimensional facial surface area discrepancy index for subjective and objective evaluation. There were 12 patients and a total of 19 spacers for the Le Fort I and mandibular ramus segments. The spacers worked nicely during the bone fixation process. Mean preoperative and postoperative visual analogue scale scores were 4.83 and 7.14, with a statistically significant improvement for facial symmetry (p = 0.018). Mean preoperative and postoperative facial surface area discrepancy index was 0.95 and 0.98, and the correction of asymmetry was significant (p = 0.009). There were no related surgical complications. All patients were satisfied with the correction of facial asymmetry and malocclusion. The custom-made, three-dimensionally-printed spacers help to achieve surgical precision to correct and prevent facial asymmetry in orthognathic surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.

Retracted: Morphometric study of cephalo-facial indices among Bini children in southern Nigeria

This article has been retracted by the Editor.Cephalometry is an important branch of anthropometry which involves the morphological study of structures present in the human head or scientific measurement of the dimensions of the head. Some of the most important cephalometric parameters include the length/height and breadth/width of the head, the face and the nose as well as their respective indices. These cephalometric parameters are vital in the description of variation which is a common phenomenon that characterizes human physiognomy. They are also useful in the description of human inter-racial and intra-racial similarities both within and across gender. This study involved 450 Bini children (235 males and 215 females) between ages 5-12 years. The length and width of the head and face of each subject was measured between the appropriate anatomical landmarks using spreading and sliding calipers. The measurements were used to calculate the cephalic and facial indices for each subject. The result showed sexual variation in both cephalic and facial indices among the Bini children with the males having higher values than the females. Also, the result of this study showed that prevalence of brachycephalic head type among both male (51.1%) and female (49.8%) Bini children. The mesoproscopic face type was the most prevalent face type among both male (62.6%) and female (47.4%) Bini children. The cephalo-facial indices are vital in demonstrating similarity and variation in physical morphologies of individuals or group of people of different ethnicity, races, gender and geographical locations.Keywords: Cephalometry, Cephalic index, facial index, Bini children, Nigeria

Application of computer-assisted navigation in mandibular angle osteotomy

ObjectiveTo compare the effectiveness, accuracy, and surgical safety of a navigation technique with those of a traditional technique for intraoperative mandibular angle osteotomy.MethodsForty-three postsurgical patients with mandibular angle hypertrophy who were admitted to our Department from June 2014 to June 2017 were retrospectively reviewed. Of these patients, 23 underwent mandibular angle osteotomy using computer-assisted navigation (navigation group), and 20 underwent osteotomy using a traditional technique (traditional group). Postoperative computed tomography images were analyzed by three-dimensional software. Each patient’s facial proportion indices were measured using Mimics 19.0 software, and statistical comparisons and analyses were performed preoperatively and postoperatively.ResultsThe postoperative facial contour morphology and facial proportion were improved in both groups; the navigation group showed greater improvement. The difference between the predicted and postoperative values was smaller in the navigation group than traditional group. The postoperative shape of the mandibular angle sample was similar to the preoperative predicted shape in the navigation group. No complications occurred in the navigation group, but paresthesia occurred in 17% of patients in the traditional group.ConclusionsMandibular angle osteotomy aided with computer-assisted navigation is more effective, accurate, and safe than the traditional technique and represents a promising clinical approach.

Cephalic and Facial Indices among Adult Females of Kurseong

The present cross-sectional study in Kurseong of Darjeeling district, West Bengal, India was conducted among adult Nepali speaking Hindu females, aged 18 to 46 years. The aim of the study was to find out the cephalic and facial index of adult Nepali females. All measurements were taken by using standard techniques. The mean age was 35.56 (SD 8.56) years. It was observed that Mesocephal form was the dominant head type and Mesoprosop was the dominant face type among the studied population.

Effect of acupuncture at "reflection points" of the affected side on the peripheral facial paralysis in acute phase

To explore the effect of acupuncture at the "reflection points" of affected side on the peripheral facial paralysis in acute phase. Ninety patients with peripheral facial paralysis in acute phase were randomly divided into a reflection group (group A), a conventional acupuncture group (group B) and a physiotherapy group (group C), 30 cases in each group. The same basic medication were given in all three groups. In the group A, acupuncture at "reflection points" of the affected side and local acupoints in acute phase, such as Dicang (ST 4), Jiache (ST 6), Quanliao (SI 18), Xiaguan (ST 7), Yangbai (GB 14), Taiyang (EX-HN 5), etc. were applied. The electroacupuncture was added in the stationary phase, and Zusanli (ST 36) was added in the recovery phase. In the group B, acupuncture at Yifeng (TE 17) of the affected side in acute phase and local acupoints, such as Dicang (ST 4), Jiache (ST 6), Quanliao (SI 18), Xiaguan (ST 7), Yangbai (GB 14), Taiyang (EX-HN 5), etc. were applied. The electroacupuncture was added in the stationary phase, and Zusanli (ST 36) was added in the recovery phase. In the group C, ultrashort wave on Yifeng (TE 17) of the affected side in acute phase was applied, and the treatment in the stationary phase and the recovery phase was the same as the group B. The treatment was given once every day, 5 times as one course for 4 courses. The House-Brackmann (H-B) grading scale, facial disability index scale, the symptom and physical score integral scale were used to score before and after treatment, and the clinical effects of the three groups were compared. After treatment, the functional grade of H-B facial nerve was better than that before treatment in the three groups (P<0.01). There was no significant difference among the three groups after treatment (P>0.05). After treatment, the course of treatment required to reflect the healing in the group A was shorter than that in the group B and the group C (P<0.01); the body function scores and social function scores in the three groups were better than those before treatment (P<0.01), there was no significant difference among the three groups after treatment (P>0.05). The scores of symptoms and signs in the three groups were lower than those before treatment (P<0.01), there was no significant difference among the three groups after treatment (P>0.05). H-B facial nerve function grading scale and facial disability index (FDI) scale were used as the evaluation criteria, the curative rate was 66.7% (20/30) in the group A, 50.0% (15/30) in the group B and 46.7% (14/30) in the group C, the curative rate in the group A was better than the other two groups (P<0.05). The curative and markedly effective rate in the group A was 83.3% (25/30), 70.0% (21/30) in the group B and 63.3% (19/30) in the group C, the curative and markedly effective rate in the group A was better than the other two groups (P<0.05). The scores of symptoms and signs were used as the evaluation criteria, the curative rate was 66.7% (20/30) in the group A, 50.0% (15/30) in the group B, and 46.7% (14/30) in the group C. The curative rate in the group A was better than the other two groups (P<0.05). Compared with general acupuncture and physiotherapy, acupuncture at the "reflection points" of the affected side on the peripheral facial paralysis in acute phase could shorten the course of treatment and improve the curative effect.

Evaluation of commonly used occlusal indices in determining orthodontic treatment need.

The main objective of this study was to validate commonly used occlusal indices in measuring treatment need, irrespective of their original objective: Index of Orthodontic Treatment Need (IOTN) that includes a dental health component (DHC) and an aesthetic component (AC), Peer Assessment Rating (PAR) index, Index of Complexity, Outcome, and Need (ICON), Discrepancy Index (DI), and Facial Aesthetic Index (FAI). The dental casts, x-rays, and photographs of 101 participants were randomly selected among patients whose orthodontic treatment was completed. The indices were validated against the panel assessments of four experts using the receiver operating characteristic curve analysis. The area under the curve (AUC) helped to determine their optimal cut-off points. The raters exhibited an excellent level of inter-rater reliability in assessing need scores [intra-class correlation coefficients (ICC) = 0.85]. The DHC, AC, ICON, and PAR demonstrated 'good' diagnostic properties (AUC = 0.85, 0.84, 0.83, and 0.82, respectively). Adding the AC and the DHC into a combined index score [our proposed Combined Index of Orthodontic Treatment Need (CIOTN)] yielded the strongest correlation with need (r = 0.79) and the highest AUC value of 88 per cent with 91 per cent sensitivity and 71 per cent specificity. The DI had poor discriminating abilities (AUC = 0.69), however, its dental component was substantially better (AUC = 0.81). The supplemental FAI did not enhance the correlation of indices with need. The DHC, AC, ICON, PAR, and only the dental component of the DI reliably captured treatment need. The newly combined CIOTN had superior diagnostic properties than its components and all other indices, probably because of the cumulative values of its components. The FAI could not be validated as a supplemental measure of treatment need.

Facial Nerve Translocation for Low Tension Neurorrhaphy to Masseteric Nerve.

The techniques of facial reanimation are continually evolving in search of the ideal method for rehabilitating the paralyzed face. In the past, alternative cranial nerve motor nuclei have been used to power facial musculature. The trigeminal nerve is gaining popularity as a promising nerve to drive facial motion, particularly in the lower face. This article describes a low-tension technique of using the transposed facial nerve to the trigeminal nerve (masseteric branch) for facial reanimation. Six patients over 2.5 years were treated with facial nerve translocation with division at the geniculate and direct neurorrhaphy to the motor branch of the masseter. Patients were evaluated by physical examination, measurement of oral commissure excursion using MEEI FACE-gram software, video assessment, Sunnybrook Facial Grading System, Facial Disability Index, and Facial Clinimetric Evaluation Scale (FaCE). Patients demonstrated early motion within 4 months postoperatively and were placed into facial physical therapy. All demonstrated improvements in oral competence, strong oral commissure excursion with good symmetry, speech improvements, and variable results in facial tone. Synkinesis to the smile antagonists in the lower face was noted and treated with chemodenervation in three of six. No upper division synkinesis was noted. The motor branch of the trigeminal nerve is an effective option for facial reanimation via facial nerve translocation and end-to-end neurorrhaphy. Variable results in facial tone were noted with excellent oral commissure excursion. This procedure is safe in the reoperated mastoid.

Evaluation of facial esthetics in long-faced white Brazilian middle school students.

This study aimed to determine orthodontists' and layperson's perceptions about facial esthetics in a long face pattern sample. The sample consisted of 64 frontal photographs of white Brazilian middle school students (9-15years old), diagnosed as long faced through morphologic evaluation and confirmed by the facial index. A Likert-type scale was used to determine orthodontists' (22) and laypeople's (22) perceptions about facial esthetics. Chi-square and proportions tests were used for comparison between the examiners regarding the classification in each degree of esthetics, adopting a significance level of 5%. For orthodontists and laypeople, most of the subjects were considered to have acceptable appearance: 36.4% and 40.3%, respectively. Subjects whose appearance was classified as unpleasant constituted one-third of the sample: for orthodontists, 7.8% very unpleasant and 22.9% unpleasant, and 6.7% and 22.2%, respectively, for laypeople. The facial structures most cited as responsible for unpleasantness were the lack of lip sealing followed by incisor exposition. The increase of the lower third of the face for orthodontists and eyes for laypeople were the third most cited unpleasant characteristics. For the evaluators, two-thirds of the long face sample were considered to have an acceptable, pleasant, or very pleasant appearance. Laypeople's opinions aligned with the orthodontists', that one-third of long-face patients were considered to have an unpleasant appearance.

Impact of lower motor neurone facial palsy on oro-motor function and its remediation

Lower motor neurone facial paralysis (LMNFP) is often viewed by the general public and wider non-facial palsy fraternity as a cosmetic issue rather than a functional one. In this article, we sought to determine the severity and frequency of oro-motor dysfunction in LMNFP and assess the benefits of physical therapy and rehabilitation in this cohort. A prospective study at our institute was conducted for a one-year period (2015-2016), involving adult patients with LMNFP with significant oro-motor dysfunction. The exclusion criteria were (i) pre-existing oro-motor dysfunction, (ii) within six months of facial palsy onset. The assessment tools used were (i) The Facial Disability Index (FDI), (ii) IPREDD or Inventory of Patient-Reported Eating and Drinking Dysfunction for mastication and (iii) a bespoked Visual Analogue Scale (VAS) based on focus group discussions. Of the 183 new clinic referrals, FDI identified that 14% of patients with LMNFP had significant oro-motor dysfunction. IPREDD analysis showed that 74% of this cohort had masticatory problems, while the VAS indicated significant oro-motor dysfunction as well in those with LMNFP. Following speech and facial therapy, IPREDD-focused symptoms were reduced from 74% to 43% (shown to be significant), while VAS similarly showed a significant reduction in symptoms (two-tailed, paired Student's t-test p<0.01). Oro-motor function is a significant sequel of facial paralysis. Facial rehabilitation, both physical and psychological, can help reduce patients' distress and improve oro-motor function, without the need for surgical intervention in the first instance.

Translation, cultural adaptation and validation of the facial disability index into Brazilian Portuguese

IntroductionFacial paralysis may occur due to a variety of causes. It is associated to the impairment of some basic daily activities such as eating, drinking, speaking and social communication, which affects the quality of life of these patients. The facial disability index is a short form auto reported outcome questionnaire used to assess patient with facial paralysis. It has been validated and proved to be superior to other general health related quality of life questionnaires. ObjectiveWe aim to do the cultural adaptation and validate the facial disability index into Brazilian Portuguese. MethodsTranslation and cultural-adaptation following the stages recommended by the International Society of Pharmacoeconomics Outcomes Research task force. The questionnaire was administered to 100 patients for evaluation of reliability and validation. ResultsThe reliability of the Portuguese version of the facial disability index was found to be adequate, with a Cronbach’s alfa coefficient of 0.73 for the complete scale. Intra-class correlation was 0.79 (95% CI: 0.71–0.85) and 0.85 (95% CI: 0.78–0.89) for the physical and social well-being subscales. There was a significant correlation between the social well-being subscale of the Portuguese version of the facial disability index and the social function and mental health components of the SF-36. There was also a correlation between the facial disability index and the degree of facial dysfunction according to the House–Brackmann global scale. ConclusionThis adapted version of the facial disability index provides a valid and reliable instrument to assess the physical and psychosocial impact of facial nerve dysfunction in Brazilian-speaking patients.

A Comparative Study to Assess the Inter-Relationship of Lip Prints with Facial Index and Cephalic Index

A Comparative Study to Assess the Inter-Relationship of Lip Prints with Facial Index and Cephalic Index

Facial flatness indices: application in orthodontics.

Facial flatness indices have been used in anthropology to discern differences among populations. They were evaluated on skulls from around the world.Aims(1) to evaluate the use of facial flatness indices in orthodontics and (2) to assess their variation among malocclusions, age and sex.Materials and MethodsA total of 322 cone beam computed tomography radiographs were digitized and three facial indices (frontal, simotic and zygomaxillary) along with three transverse distances (fmo1–fmo2, zma1–zma2 and n1–n2) were assessed and compared between different groups.ResultsThe zygomaxillary index was increased in Class II (32.6 ± 0.42; p < 0.001) and decreased in Class III malocclusions (29.4 ± 0.66; p < 0.001) compared to Class I (31.18 ± 0.3; p < 0.001). The frontal and nasal flatness are not characteristic features of any of the sagittal malocclusions. Facial flatness indices did not differ between males and females and between growing and non-growing patients.ConclusionThe position of subspinale point (A point) forward or backward relative to the zygomaxillary width is a factor of assessment of facial flatness. The zygomaxillary index could be helpful in weighting proportionally the width of the maxilla (expansion) relative to its sagittal position in Class II and Class III malocclusions.