Clinical Oral Investigations

, Volume 23, Issue 2, pp 623–632 | Cite as

Treatment outcome of bimaxillary surgery for asymmetric skeletal class II deformity

  • Yun-Fang Chen
  • Yu-Fang LiaoEmail author
  • Yin-An Chen
  • Yu-Ray Chen
Original Article



Facial asymmetry is one of the main concerns in patients with a dentofacial deformity. The aims of the study were to (1) evaluate the changes in facial asymmetry after bimaxillary surgery for asymmetric skeletal class II deformity and (2) compare preoperative and postoperative facial asymmetry of class II patients with normal controls.

Materials and methods

The facial asymmetry was assessed for 30 adults (21 women and 9 men, mean age: 29.3 years) who consecutively underwent bimaxillary surgery for asymmetric skeletal class II deformity using cone-beam computed tomography before and at least 6 months after surgery. Thirty soft tissue and two dental landmarks were identified on each three-dimensional facial image, and the asymmetry index of each landmark was calculated. Results were compared with those of 30 normal control subjects (21 women and 9 men, mean age: 26.2 years) with skeletal class I structure.


Six months after surgery, the asymmetric index of the lower face and total face decreased significantly (17.8 ± 29.4 and 16.6 ± 29.5 mm, respectively, both p < 0.01), whereas the asymmetric index of the middle face increased significantly (1.2 ± 2.2 mm, p < 0.01). Postoperatively, 53% of the class II patients had residual chin asymmetry. The postoperative total face asymmetric index was positively correlated with the preoperative asymmetric index (r = 0.37, p < 0.05).


Bimaxillary surgery for patients with asymmetric class II deformity resulted in a significant improvement in lower face asymmetry. However, approximately 50% of the patients still had residual chin asymmetry. The total face postoperative asymmetry was moderately related to the initial severity of asymmetry.

Clinical relevance

These findings could help clinicians better understand orthognathic outcomes on different facial regions for patients with asymmetric class II deformity.


Orthognathic surgery Facial asymmetry Class II malocclusion Asymmetry index 



The work was supported by the Chang Gung Memorial Hospital, Taiwan.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Ethics Committee for Human Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Informed consent

Informed consent was not needed due to the retrospective design of the study.


  1. 1.
    Fink B, Neave N, Manning JT, Grammer K (2006) Facial symmetry and judgements of attractiveness, health and personality. Personal Individ Differ 41:491–499CrossRefGoogle Scholar
  2. 2.
    Ostwald J, Berssenbrugge P, Dirksen D, Runte C, Wermker K, Kleinheinz J, Jung S (2015) Measured symmetry of facial 3D shape and perceived facial symmetry and attractiveness before and after orthognathic surgery. J Craniomaxillofac Surg 43:521–527CrossRefGoogle Scholar
  3. 3.
    Peck S, Peck L, Kataja M (1991) Skeletal asymmetry in esthetically pleasing faces. Angle Orthod 61:43–48Google Scholar
  4. 4.
    Zaidel DW, Deblieck C (2007) Attractiveness of natural faces compared to computer constructed perfectly symmetrical faces. Int J Neurosci 117:423–431CrossRefGoogle Scholar
  5. 5.
    Bishara SE, Burkey PS, Kharouf JG (1994) Dental and facial asymmetries: a review. Angle Orthod 64:89–98Google Scholar
  6. 6.
    Cheong YW, Lo LJ (2011) Facial asymmetry: etiology, evaluation, and management. Chang Gung Med J 34:341–351Google Scholar
  7. 7.
    Ferrario VF, Sforza C, Schmitz JH, Santoro F (1999) Three-dimensional facial morphometric assessment of soft tissue changes after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:549–556CrossRefGoogle Scholar
  8. 8.
    Hajeer MY, Ayoub AF, Millett DT (2004) Three-dimensional assessment of facial soft-tissue asymmetry before and after orthognathic surgery. Br J Oral Maxillofac Surg 42:396–404CrossRefGoogle Scholar
  9. 9.
    Yu CC, Bergeron L, Lin CH, Chu YM, Chen YR (2009) Single-splint technique in orthognathic surgery: intraoperative checkpoints to control facial symmetry. Plast Reconstr Surg 124:879–886CrossRefGoogle Scholar
  10. 10.
    Ko EW, Huang CS, Chen YR (2009) Characteristics and corrective outcome of face asymmetry by orthognathic surgery. J Oral Maxillofac Surg 67:2201–2209CrossRefGoogle Scholar
  11. 11.
    Wermker K, Kleinheinz J, Jung S, Dirksen D (2014) Soft tissue response and facial symmetry after orthognathic surgery. J Craniomaxillofac Surg 42:e339–e345CrossRefGoogle Scholar
  12. 12.
    Lee GC, Yoo JK, Kim SH, Moon CH (2016) Lip line changes in class III facial asymmetry patients after orthodontic camouflage treatment, one-jaw surgery, and two-jaw surgery: a preliminary study. Angle Orthod 87:239–245CrossRefGoogle Scholar
  13. 13.
    Kim BR, Oh KM, Cevidanes LH, Park JE, Sim HS, Seo SK, Reyes M, Kim YJ, Park YH (2013) Analysis of 3D soft tissue changes after 1- and 2-jaw orthognathic surgery in mandibular prognathism patients. J Oral Maxillofac Surg 71:151–161CrossRefGoogle Scholar
  14. 14.
    Hunsuck EE (1968) A modified intra- oral sagittal splitting technique for correction of mandibular prognathism, vol 26Google Scholar
  15. 15.
    Honda T, Lin CH, Yu CC, Heller F, Chen YR (2005) The medial surface of the mandible as an alternative source of bone grafts in orthognathic surgery. J Craniofac Surg 16:123–128CrossRefGoogle Scholar
  16. 16.
    Chen YA, Ng LS, Ko EW, Chen YR (2017) Mandibular contouring during orthognathic surgery using the modified hunsuck technique. J Craniofac Surg 28:239–240CrossRefGoogle Scholar
  17. 17.
    Bell WH (1992) Modern practice in orthognathic and reconstructive surgery. Saunders, PhiladelphiaGoogle Scholar
  18. 18.
    Swennen GRJ, Schutyser FAC, Hausamen JE (2005) Three-dimensional cephalometry: a color atlas and manual. SpringerGoogle Scholar
  19. 19.
    Ras F, Habets LL, van Ginkel FC, Prahl-Andersen B (1995) Method for quantifying facial asymmetry in three dimensions using stereophotogrammetry. Angle Orthod 65:233–239Google Scholar
  20. 20.
    Farkas LG (1994) Anthropometry of the head and face. Raven PressGoogle Scholar
  21. 21.
    Kowner R (1997) The perception and attribution of facial asymmetry in normal adults. Psychol Rec 47:371–384CrossRefGoogle Scholar
  22. 22.
    Ferrario VF, Sforza C, Miani A Jr, Serrao G (1995) A three-dimensional evaluation of human facial asymmetry. J Anat 186(Pt 1):103–110Google Scholar
  23. 23.
    Ferrario VF, Sforza C, Ciusa V, Dellavia C, Tartaglia GM (2001) The effect of sex and age on facial asymmetry in healthy subjects: a cross-sectional study from adolescence to mid-adulthood. J Oral Maxillofac Surg 59:382–388CrossRefGoogle Scholar
  24. 24.
    Hwang HS, Yuan D, Jeong KH, Uhm GS, Cho JH, Yoon SJ (2012) Three-dimensional soft tissue analysis for the evaluation of facial asymmetry in normal occlusion individuals. Korean J Orthod 42:56–63CrossRefGoogle Scholar
  25. 25.
    Verze L, Bianchi FA, Schellino E, Ramieri G (2012) Soft tissue changes after orthodontic surgical correction of jaws asymmetry evaluated by three-dimensional surface laser scanner. J Craniofac Surg 23:1448–1452CrossRefGoogle Scholar
  26. 26.
    Ho CT, Lin HH, Liou EJ, Lo LJ (2017) Three-dimensional surgical simulation improves the planning for correction of facial prognathism and asymmetry: a qualitative and quantitative study. Sci Rep 7:40423CrossRefGoogle Scholar
  27. 27.
    Shin YM, Lee ST, Kwon TG (2016) Surgical correction of septal deviation after Le Fort I osteotomy. Maxillofac Plast Reconstr Surg 38:21CrossRefGoogle Scholar
  28. 28.
    Kokich VO Jr, Kiyak HA, Shapiro PA (1999) Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Dent 11:311–324CrossRefGoogle Scholar
  29. 29.
    Williams RP, Rinchuse DJ, Zullo TG (2014) Perceptions of midline deviations among different facial types. Am J Orthod Dentofac Orthop 145:249–255CrossRefGoogle Scholar
  30. 30.
    Blockhaus M, Kochel J, Hartmann J, Stellzig-Eisenhauer A, Meyer-Marcotty P (2014) Three-dimensional investigation of facial surface asymmetries in skeletal malocclusion patients before and after orthodontic treatment combined with orthognathic surgery. J Orofac Orthop 75:85–95CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yun-Fang Chen
    • 1
    • 2
    • 3
    • 4
  • Yu-Fang Liao
    • 2
    • 3
    • 4
    • 5
    Email author
  • Yin-An Chen
    • 2
    • 3
    • 6
  • Yu-Ray Chen
    • 2
    • 3
    • 4
    • 6
  1. 1.Department of Craniofacial OrthodonticsChang Gung Memorial HospitalTaipeiTaiwan
  2. 2.Craniofacial CenterChang Gung Memorial HospitalTaoyuanTaiwan
  3. 3.Craniofacial Research CenterChang Gung Memorial HospitalLinkouTaiwan
  4. 4.College of MedicineChang Gung UniversityTaoyuanTaiwan
  5. 5.Department of Craniofacial OrthodonticsChang Gung Memorial HospitalTaoyuanTaiwan
  6. 6.Department of Plastic and Reconstructive SurgeryChang Gung Memorial HospitalLinkouTaiwan

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