Mandibular Asymmetry Research Articles

Intraoral Condylectomy with 3D-Printed Cutting Guide versus with Surgical Navigation: An Accuracy and Effectiveness Comparison.

This study compares the accuracy and effectiveness of our novel 3D-printed titanium cutting guides with intraoperative surgical navigation for performing intraoral condylectomy in patients with mandibular condylar osteochondroma (OC). A total of 21 patients with mandibular condylar OC underwent intraoral condylectomy with either 3D-printed cutting guides (cutting guide group) or with surgical navigation (navigation group). The condylectomy accuracy in the cutting guide group and navigation group was determined by analyzing the three-dimensional (3D) discrepancies between the postoperative computed tomography (CT) images and the preoperative virtual surgical plan (VSP). Moreover, the improvement of the mandibular symmetry in both groups was determined by evaluating the chin deviation, chin rotation and mandibular asymmetry index (AI). The superimposition of the condylar osteotomy area showed that the postoperative results were very close to the VSP in both groups. The mean 3D deviation and maximum 3D deviation between the planned condylectomy and the actual result were 1.20 ± 0.60 mm and 2.36 ± 0.51 mm in the cutting guide group, and 1.33 ± 0.76 mm and 4.27 ± 1.99 mm in the navigation group. Moreover, the facial symmetry was greatly improved in both groups, indicated by significantly decreased chin deviation, chin rotation and AI. In conclusion, our results show that both 3D-printed cutting-guide-assisted and surgical-navigation-assisted methods of intraoral condylectomy have high accuracy and efficiency, while using a cutting guide can generate a relatively higher surgical accuracy. Moreover, our cutting guides exhibit user-friendly features and simplicity, which represents a promising prospect in everyday clinical practice.

Himi-Lengthening Genioplasty: A Modified Technique for the Correction of Mandibular Asymmetry.

Mandibular asymmetry is among the most common facial anomalies. Traditionally, mandibular asymmetry with malocclusion has been treated with orthognathic surgery and genioplasty. However, routine genioplasty cannot achieve a satisfactory contour. Hence, this study presents a modified technique, himi-lengthening genioplasty, to resolve this matter. By combining this technique with orthognathic surgery, the authors successfully corrected mandibular asymmetry in 1-stage surgery, achieved ideal occlusion, and reconstructed the esthetic contour. No complications occurred during the 6-month follow-up period. Therefore, the authors recommend our modified surgical technique for its effectiveness, security, stability, and simplicity.

Modification of Sagittal Split Osteotomy in Class II Asymmetry: Optimizing Bone Contact between Proximal and Distal Segments.

Computer-assisted surgical simulation (CASS) allows more precise orthognathic surgery. However, few studies have evaluated associations between CASS-designed bilateral sagittal split osteotomy (SSO) and bone contact surface in class II mandibular asymmetry. This study aims to evaluate the effects of using computer-assisted simulation and design modification of SSO to improve bony contact in skeletal class II asymmetry. This retrospective analysis reviewed 28 patients with class II asymmetry who underwent orthognathic surgery, including 15 with modified SSO (group CS) and 13 with conventional SSO (group C). Modified SSO was designed under CASS. Operative characteristics, postoperative outcomes, and complications were collected and compared between the two groups. Bony contact was found at the distal end of the proximal segment in all group CS patients, while bone gap was noted in all group C patients ( P < 0.05). Moreover, bone graft was used in four group C patients but was not used in all cases in group CS patients ( P < 0.05). A trend toward lower operative time or perioperative bleeding was noted in group CS, but without statistical significance. After 1-year follow-up, inferior alveolar nerve disturbances were noted in two group CS patients and one group C patient. Palpable bone gap with uneven jaw line was noted in two group C patients 1 year after surgery and one patient received fat graft treatment. The simulation-based SSO modification provides appropriate contact surface and eliminates the bone gap between proximal and distal segments in class II asymmetry. Therapeutic, III.

Towards a standardization of new functional trait measurements by assessing intraspecific variation: the case of springtail mandibles

Novel quantitative functional traits, such as feeding traits, are increasingly described or applied to new soil invertebrate taxa, but their standardization remains deficient. A better systematic estimation of intraspecific trait variation (ITV) would not only bring conceptual advances (e.g. identifying population and community filters) but also allow for more robust protocols to compare trait data across studies. The aim of this study was to determine ITV of newly described mandibular traits of springtails (Collembola) to improve current measurement protocols and ultimately to demonstrate how such simple assessment can favour trait standardization both at a conceptual and methodological levels. To do so, three common cryptic springtail species (Isotomiella minor, Parisotoma notabilis and Protaphorura armata) were sampled at multiple forest sites in two distinct geographical zones given their potentially higher ITV than non-cryptic species. We assessed factors potentially influencing intraspecific variation of seven feeding traits (i.e. mandibular asymmetry, geographic zone, sex and life stage). Using linear mixed models, we determined the sample size needed to generate a representative mean trait value with bootstrap resampling analyses. Intraspecific trait variation was mostly related to body length differences among individuals of different sex, life stage and/or geographic zone. Our results allowed us to better standardize these springtail mandibular traits by (1) determining the adequate number of replicates needed for each trait, (2) proposing adjustments to the measurement protocol, (3) identifying a potential methodological error, (4) highlighting potential phenotypic plasticity and (5) validating the adequacy of using data derived from the literature and/or databases. Despite being an initial time investment, estimating ITV ultimately speeds up the standardization process. We encourage researchers to estimate ITV when describing new traits or measuring traits on new taxa in order to ensure reliable data and accelerate large-scale comparative efforts.

Transverse Malocclusions: Etiology, Development, Diagnosis and Treatment

Malocclusions that involve the transverse dimension are very common in the orthodontic office. They can be as simple as a crossbite of the posterior teeth or as severe as a Class III malocclusion with a mandibular asymmetry. Transverse malocclusions can vary from being a simple dento-alveolar problem to a more complex challenge as represented by a skeletal asymmetry that has developed after puberty and causing temporomandibular disorder (TMD) problems. In this review we shall address the most common types of transverse malocclusions and review their etiology and development. The most typical etiology of transverse anomalies will be discussed, and we will suggest diagnostic criteria to differentiate the individual malocclusions. We shall also introduce a frontal cephalometric analysis that relates to the anterior part of the face helping to differentiate between dento-alveolar and skeletal transverse malocclusions as well as determine the presence of dento-alveolar compensations. Furthermore, we shall suggest possible treatment approaches and the best timing of treatment for the most common types of transverse malocclusion. Finally, we shall present several cases with more unusual etiology including a case with mandibular asymmetry due to an anterior disc displacement of temporomandibular joint. A case with Class III malocclusion with mandibular overjet caused by maxillary stenosis will also be presented. Furthermore, we will show an example of a late developing mandibular asymmetry which is not an uncommon problem and document a case of excess mandibular growth with mandibular asymmetry and Class III malocclusion combined with posterior crossbite. This review will also address considerations that may affect the post treatment stability.

A Novel Method of Quantifying Mandibular Asymmetry

A Novel Method of Quantifying Mandibular Asymmetry

Comparison of Mandibular Volume and Linear Measurements in Patients with Mandibular Asymmetry

In patients with mandibular asymmetry, the volume of the mandible divided by the mandibular median plane is significantly larger on the non-deviated (N-Dev) side than on the deviated (Dev) side. However, it has been reported that there is no significant difference between the volumes of the N-Dev and Dev sides when the mandibular ramus and body are divided. The purpose of this study was to investigate which region is responsible for the volume difference between the N-Dev and Dev sides. Cone Beam Computed Tomography (CBCT) images of patients with mandibular asymmetry were analyzed by measuring the volume, and linear analysis of the mandibular body, ramus, and condyle on the N-Dev and Dev side was performed. In this study, CBCT images of 37 patients (8 Japanese, 16 Korean, and 13 Egyptian) aged ≥ 18 years with mandibular asymmetry (men: 20, women: 17) were used to evaluate mandibular asymmetry. In patients with mandibular asymmetry, the N-Dev side showed significantly larger values than the Dev side for both volume and linear condyle, ramus, and mandibular body measurements. These results do not differ according to sex or ethnicity. Therefore, it is suggested that the N-Dev side of mandibular asymmetry is large without any regional specificity in pathophysiology.

Mandibular asymmetry in patients with skeletal class I and skeletal class II Malocclusions: A cone-beam computed tomography study

ObjectiveTo study the difference in mandibular asymmetry between patients with skeletal Class I and skeletal Class II malocclusions and analyze the correlation between mandibular asymmetry and different facial skeletal sagittal patterns based on CBCT measurements. MethodsOne hundred and twenty patients were selected according to the inclusion and exclusion criteria. Patients were divided into two groups (60 in the skeletal Class I group and 60 in the skeletal Class II group) based on ANB angles and Wits values. Patients’ CBCT data were collected. Dolphin Imaging 11.0 was used to determine the mandibular anatomic landmarks and calculate the linear distance in patients in the two groups. ResultsIntragroup comparison: in skeletal Class I group, measurements of the most posterior point of the condyle (Cdpost), the outer lateral point of the condyle (Cdlat), sigmoid notch point (Sn)), coronoid process point (Cop), gonion point (GO) and antimony notch point (Ag), right>left (P<0.05); in skeletal Class II group, measurements of Cdpost and Cop, right>left (P<0.05). Intergroup comparison: for measurements of GO and Ag, skeletal Class I group>skeletal Class II group (P<0.05). The asymmetry of the Ag and GO points was negatively correlated with the ANB angle (p<0.05). ConclusionMandibular asymmetry was significantly different between patients with skeletal Class I and skeletal Class II malocclusions. The asymmetry of the mandible angle region in the former group was greater than that in the latter group, and the asymmetry of the mandibular angle was negatively correlated with the ANB angle.

Effects of the Mandibular Functional Units and Soft Tissue on Facial Asymmetry.

Mandibular asymmetry has a variety of patterns because they are affected the position and the shape of mandible in addition to the overlying soft tissue. This study aimed to assess the factor in mandibular asymmetry, focusing on each mandibular functional units and the soft tissue thickness in the mandibular angle area. Forty patients who were diagnosed with facial asymmetry and undergone the orthognathic surgery without genioplasty were enrolled in this study. The skeletal patterns of the patients were analyzed by using cone-beam computed tomography data and 3D virtual images divided into 2 categories; the mandibular functional unit length and the soft tissue depth. All difference in bilateral mandibular functional unit lengths had a statistically significant with chin top deviation ( P <0.05). The greatest correlation was the condylar unit length compared with other functional units. The soft tissue thickness in the mandibular angle area was not statistically related to chin top deviation ( P >0.05), and the soft tissue did not change remarkably after orthognathic surgery ( P >0.05). This study suggests that the considerations of a surgical plan for treatment based on the mandibular asymmetry.

Long-Term Outcomes After External Maxillary Distraction Surgery in Patients With Down Syndrome

Patients with Down syndrome have severe facial deformities that can precipitate functional consequences and social stigmatization. Craniofacial surgical intervention can play a role in improving these symptoms and patient quality of life. The objective of this study was to investigate the long-term outcomes of distraction osteogenesis and orthognathic surgical intervention in patients with Down syndrome. Charts of 3 patients with Down syndrome who were treated with external maxillary distraction osteogenesis were retrospectively reviewed. The patients' caregivers were prospectively interviewed between 10 and 15 years after surgery to determine surgical stability, long-term function, and quality of life status. All patients and their caregivers reported excellent results with improvements in function and quality of life. Facial skeletal changes have been stable over time. The cephalometric analysis demonstrated significant maxillary advancement in all 3 patients and mandibular changes to correct mandibular prognathism and asymmetry in the patient who underwent finishing orthognathic surgery. External maxillary distraction osteogenesis and orthognathic surgery may be considered in select patients with Down syndrome as part of their multidisciplinary health care. These interventions can result in long-term improvements in patient function and quality of life.

Normal variation of mandibular asymmetry in children.

To explore the normal variation of asymmetry in mandibles of children in the age group of 1 to 12 years. The study group consisted of 92 cadaveric mandibles of children with a dental age of 1 to 12 years old in possession of ACTA (Academic Centre for Dentistry Amsterdam), Faculty of Dentistry, the Netherlands. 3D models of the mandibles were obtained from CT-scans and hemimandibular volumes of all mandibles were calculated. The condylar height, ramus height, mandibular body length and the gonial angle were bilaterally determined using a novel landmark-based method, and the degree of asymmetry was calculated. No relationship was found between dental age and asymmetry of the studied parameters (P < .05). The highest degree of asymmetry was found in the ramus height, whereas the gonial angle presented the lowest degree of asymmetry. A positive correlation was found between the asymmetry of the hemimandibular volume vs the height of the ramus (P < .05) and the length of the mandibular body (P < .05). An inverse correlation was found between the asymmetry of the ramus height vs the condylar height (P < .05), mandibular body length (P < .05) and gonial angle (P < .05). Mandibular asymmetries in children did occur (9.8% of the included mandibles presented with a relevant overall asymmetry of ≥3%) and were unrelated to age. The different segments of the mandible seem to compensate for each other, in order to maintain a functional equilibrium.

Changes in the pharyngeal airway space and hyoid bone position after sagittal split ramus osteotomy in mandibular asymmetry: A retrospective cephalometric study

ObjectiveThe purpose of the present study was to compare changes in the stability of the pharyngeal airway space (PAS) and the hyoid bone position between patients with and without mandibular asymmetry. MethodsWe included 104 patients who underwent sagittal split ramus osteotomy. Patients whose menton was deviated by ≥ 4 mm from the facial median line were categorized as the asymmetry group. The patients were divided into the symmetry group (72 patients) and the asymmetry group (32 patients). The patients treated were evaluated using lateral cephalometric radiography 1 and 6 months postoperatively. ResultsFollowing orthognathic surgery, the airway space in the oropharynx and the hypopharynx significantly decreased in both the both groups (p < 0.05). The diameters of the oropharynx and hypopharynx in the asymmetry group gradually decreased after sagittal split ramus osteotomy compared with those in the symmetry group (p < 0.05). The hyoid bone was moved in an inferoposterior direction postoperatively in both groups. In the symmetry group, the hyoid bone that was moved inferiorly tended to move back toward the original position over a period of 6 months postoperatively(p < 0.05). In the asymmetry group, the hyoid bone that was moved inferiorly remained in the same position 6 months postoperatively. ConclusionThese results showed that the time required before pharyngeal airway morphology and the hyoid bone were stabilized was relatively longer in the asymmetry group.

Unilateral Condylar Hyperplasia in Surgeons’ Perspective—A Narrative Review

The following paper focuses on the topic of mandibular unilateral condyle hyperplasia (UCH). This form of mandibular asymmetry (MA) is one of the less common but still known pathologies that requires detailed surgical and orthodontic planning and treatment. Since this pathology is mostly related to a high number of individual dental, bone, and overgrowth factors, until now the treatment methods were individually driven. It seems that the scope of surgical intervention is greatly dependent on the degree of bone overgrowth and the occurrence of asymmetry. Many treatment modalities and possible surgical perspectives are known, yet, so far, no adequate detailed guidelines are known. This detailed review of this type of mandibular asymmetry will focus on diagnostics and treatment plans and outcomes. The following paper underlines the authors’ own clinical experiences in MA and UCH treatment, which are compared with the literature review. The authors intend to investigate what has changed in the treatment and diagnostics of one-sided mandibular condyle and bone overgrowth.

Vertical asymmetry of the condyle and mandibular ramus measured by cone beam computed tomography (CBCT)

Mandibular asymmetries can be defined as morphological variations that indicate disproportion in its size, shape or position between the right and left side. In Ecuador there are no investigative contributions on the vertical symmetry of the condyle and mandibular ramus despite its importance and its affordable diagnosis through panoramic radiography. For this reason, the importance of this study is evident, for which Cone Beam Computed Tomography (CBCT) was used from adult patients from the Faculty of Dentistry of the University of Cuenca of the seventh cycle of the dental career, in which a higher prevalence of mandibular asymmetries is evidenced in the female gender and in Class II skeletal type patients. Through the Habets method, it was possible to determine the index of vertical asymmetries, concluding that there is a higher index of vertical asymmetries in the condyle, followed by asymmetry in the ramus, and finally, with a lower percentage, the total asymmetry of the condyle and ramus.

Use of a novel body mandibular plane (mental foramen-protuberance menti) in analyzing mandibular asymmetry compared with conventional border mandibular plane.

To compare a novel body mandibular horizontal plane (mental foramen-protuberance menti; Body-MHP) with the conventional border mandibular horizontal plane (gonion-menton [Me]; Border-MHP) to assess mandibular body inclination and dental compensation of skeletal Class III patients with and without facial asymmetry. Retrospective data obtained from diagnostic cone-beam computed tomography of 90 skeletal Class III patients (mean age, 21.67 ± 2.93 years; range, 15.0-30.6 years) were divided into symmetry (n = 30) and asymmetry groups (n = 60). The asymmetry group was subdivided into roll (n = 30) and non-roll types (n = 30). The differences in body inclination and dental measurements (distance and angle) according to two mandibular planes (Body-MHP and Border-MHP) were assessed in the groups and subgroups. Mandibular body inclinations relative to the Body-MHP were not different in the roll-type asymmetric mandible between the sides, while those relative to the Border-MHP were different (P < .001). For the mandibular first molar positions relative to the Border-MHP, the differences in vertical distance between the sides were undermeasured and the inclination differences were overmeasured when compared relative to the Body-MHP. The Body-MHP demonstrated better bilateral similarity in body inclination compared with the Border-MHP in patients with roll-type facial asymmetry. The novel body mandibular plane ensures an accurate diagnosis for tooth movement and jaw surgery, particularly in the roll-type asymmetric mandible.

Evaluation of treatment with unilateral mandibular sagittal split ramus osteotomy and maxillary osteotomy in patients with condylar osteochondroma and mandibular asymmetry: A retrospective case series

The aim of the study was to describe an approach where condylar resection with condylar neck preservation was combined with Le Fort I osteotomy and unilateral mandibular sagittal split ramus osteotomy (SSRO).Patients with a unilateral condylar osteochondroma combined with dentofacial deformity and facial asymmetry who underwent surgery between January 2020 and December 2020 were enrolled. The operation included condylar resection, Le Fort I osteotomy and contralateral mandibular sagittal split ramus osteotomy (SSRO). Simplant Pro 11.04 software was used to reconstruct and measure the preoperative and postoperative craniomaxillofacial CT images. The deviation and rotation of the mandible, change in the occlusal plane, position of the “new condyle” and facial symmetry were compared and evaluated during follow-up. Three patients were included in the present study. The patients were followed up for 9.6 months on average (range, 8–12). Immediate postoperative CT images showed that the mandible deviation and rotation and occlusion plane canting decreased significantly postoperatively; facial symmetry was improved but still compromised. During the follow-up, the mandible gradually rotated to the affected side, the position of the “new condyle” moved further inside toward the fossa, and both the mandible rotation and facial symmetry were more significantly improved.Within the limitations of the study it seems that for some patients a combination of condylectomy with condylar neck preservation and unilateral mandibular SSRO can be effective in achieving facial symmetry.

Occlusal function and electromyographic activity of masticatory muscles in skeletal Class III patients with different patterns of mandibular asymmetry.

Although jaw asymmetry is commonly seen in skeletal Class III patients, its correlation with occlusal function and masticatory muscle activity has not been fully elucidated. The purpose of this study was to investigate the occlusal function and masticatory muscle activity in skeletal Class III patients with various patterns of mandibular asymmetry. Forty-two patients and 10 normal participants were examined. The patients were categorised into three groups. Groups 1 and 2 exhibited menton and ramus deviation to the same side. Menton deviation was larger than ramus deviation in Group 1, whereas Group 2 showed the inverse relation. Group 3 patients showed menton and ramus deviation in opposite directions. Occlusal contact area (OCA), relative bite force (RBF), and temporalis anterior (TA) and masseter muscle (MM) activity at maximum clenching were measured using T-Scan Novus system and Bio-EMG-III. Statistical analysis was performed using the t-test, one-way analysis of variance with Bonferroni correction and Spearman correlation (α=.05). Compared with normal participants, the patients had smaller OCA and greater asymmetry in the distribution of masticatory muscle activity. Greater ramus deviation was associated with smaller OCA in Group 1 but with larger OCA in Group 3. In Group 1, greater menton deviation was related to stronger TA activity on the non-deviation side. In Group 2, greater ramus deviation was related to stronger MM activity on the deviation side. Deviation of the menton and ramus was individually related to OCA and masticatory muscle activity, and this relationship varied according to the pattern of mandibular asymmetry.

Three-dimensional evaluation of orofacial movements during articulation in patients with skeletal Class III malocclusion with mandibular asymmetry

ABSTRACT Purpose This study aimed to compare the perioral soft tissue movements in patients with skeletal Class III malocclusion with and without mandibular asymmetry during sound articulation. Materials and Methods Patients with skeletal Class III facial deformity with mandibular asymmetry (asymmetric facial deformity; AFD, n = 21), without mandibular asymmetry (symmetric facial deformity; SFD, n = 27), and control skeletal Class I healthy individuals (n = 24) participated in this study. Perioral soft tissue movements were recorded during the articulation of /apa/, /ipi/, /upu/, /epe/, and /opo/ using a three-dimensional motion capture system. The asymmetry index (AI) of the range of movements of the commissure points on both sides was compared among the three groups by Kruskal–Wallis test and Dunn–Bonferroni test. Additionally, the correlation between the AI and the range of menton (Me) deviation was examined among patients in the SFD or AFD group by Spearman’s correlation test. Results AI on the vertical and sagittal dimensions during the /ipi/ sound articulation in the AFD group was significantly lower than in the other two groups (p < 0.05). In the AFD and SFD groups, AI on the vertical dimension was significantly correlated with Me deviation during /ipi/ sound articulation, as well as on the sagittal dimension during /apa/, /ipi/, /upu/, and /epe/ sound articulation (p < 0.05). Conclusion AFD patients displayed more asymmetric perioral soft tissue movements than SFD patients during bilabial sound production.

Observational study investigating the relationship between maxillomandibular characteristics and temporomandibular disc conditions in female patients with a skeletal class III pattern.

The objective of this study was to analyze the relationship between maxillomandibular characteristics and the severity of temporomandibular disc displacement in female patients with a skeletal class III (SKIII) pattern. Fifty-seven samples were included in the study. The evaluation of articular disc conditions was conducted using magnetic resonance imaging, while 25 cephalometric variables from lateral and postero-anterior (P-A) cephalograms were measured to determine their maxillomandibular characteristics. The samples were categorized into three groups based on the articular disc conditions: (1) normal disc position (NDP), (2) disc displacement with reduction (DDwR), and (3) disc displacement without reduction (DDwoR). The relationship between the maxillomandibular characteristics and disc conditions was examined through both basic statistical analysis and multivariate analysis using principal component analysis (PCA). The Kruskal-Wallis and Dunn-Bonferroni tests revealed a significant difference between the groups in terms of the deviation of mandibular characteristics observed on the P-A cephalogram. The DDwoR group exhibited significantly larger menton deviation, ramal height asymmetry index, and total mandibular length asymmetry index compared to the NDP and DDwR groups. Moreover, the PCA successfully extracted all cephalometric variables into eight principal components. Among them, only the principal component related to mandibular asymmetry was able to differentiate the SKIII samples with DDwoR from the other groups. The findings of this study highlight a significant relationship between mandibular asymmetry and the severity of disc displacement, particularly DDwoR, in female patients with a SKIII pattern.

Assessment of mandibular asymmetry in different skeletal malocclusions and vertical patterns in adult individuals: A cone-beam computed tomography study

The study aims to measure the mandibular condylar height (CH), ramus height (RH), total height (CH+RH), asymmetry index, and condylar volume (Cvol) in individuals with different anteroposterior and vertical skeletal discrepancies.The study sample consisted of 131 subjects (60 females and 71 males) with a mean age of 35.06 ± 12.79 years. Pre-existing CBCT images were divided into groups according to the anteroposterior and vertical skeletal discrepancies. The investigator analyzed the data using t-tests to assess the mandibular bilateral sides of the individuals and gender differences. The mean difference between groups was determined using a one-way analysis of variance (ANOVA). The Chi-square test was used to study the association between the asymmetry index and groups.Each individual's bilateral sides exhibited statistically significant differences in CH, RH, and Cvol (P = 0.033, P = 0.039, P = 0.005, respectively), but not in CH+RH (P = 0.458). There were, however, statistically significant gender differences in CH+RH (P < 0.001). Skeletal Class III and hypodivergent groups revealed the highest linear and volumetric values compared to other groups. The asymmetry index was increased in CH (P = 0.006) and Cvol (P = 0.002) in skeletal Class II subjects.Significant differences in CH, RH, and Cvol were found on the right and left sides of the same individual. This study found increased linear and volumetric values in males, skeletal Class III, and hypodivergent subjects. Class II individuals had an increased CH and Cvol asymmetry index. This study highlights in-depth knowledge of mandibular asymmetry, which is extremely important to achieve an accurate diagnosis and provide the best treatment outcome.