Characteristics of Midface Asymmetry in Skeletal Class III Malocclusion Using Three-Dimensional Analysis

Background: The midface plays an important role in the judgment of symmetry. However, studies on three-dimensional analyses of midface asymmetry are limited. This study investigated the characteristics of midface asymmetry in skeletal Class III malocclusion patients through three-dimensional analysis. Methods: Sixty-eight adult subjects with skeletal Class III malocclusion were included and divided into mandible symmetry and asymmetry groups. The prevalence of recognizable malar asymmetry and the deviation of anterior nasal spine (ANS) were examined. The relation between midface and mandible asymmetry were investigated with Spearman correlation. The difference in distance of landmarks to reference planes were compared between the two groups using Mann-Whitney U test (p < 0.05). Results: The overall prevalence of malar asymmetry was 7.35% and of ANS deviation was 38.24%. In subjects with chin deviated to the right, there was a moderate negative correlation between chin deviation and difference of zygion and zygomatic process to mid-sagittal plane. The absolute value of difference in the glenoid fossa was significantly greater in female asymmetry subjects. Conclusions: The prevalence of midface asymmetry is not low. The more severely the chin is shifted, the greater asymmetrical position of the zygoma and glenoid fossa was found. Therefore, pre-surgical case-by-case evaluation of the midface region is essential for understanding the midface skeletal characteristics of Class III patients with chin deviation, thereby providing patients with realistic expectations and optimizing surgical outcomes and patient satisfaction.