Soft tissue compensation of skeletal facial asymmetry and its perception in the general population and among orthodontists

This study assesses soft tissue compensations on the left and right sides of the face in individuals with apparent facial asymmetry and compares perception differences between the general population and orthodontists. This prospective study was conducted on 20 patients (aged 18-30 years) with apparent facial asymmetry. Skeletal asymmetry was evaluated using posteroanterior cephalograms, measuring deviations of the zygomatic suture, zygomatic arch, nasal cavity, antegonion (Ag), and menton (Me) from the midsagittal reference line. Corresponding soft tissue deviations were clinically measured. Perception of facial asymmetry was assessed using a visual analog scale (VAS) based on frontal photographs rated by 20 orthodontists and 20 members of the general population. Patients were categorized into four groups based on chin asymmetry (1-2 mm, 3-4 mm, 5-7 mm, > 7 mm). The findings showed that the skeletal asymmetry was greater than soft tissue asymmetry, indicating soft tissue compensation, particularly at Ag and Me. Orthodontists rated facial asymmetry more critically, but for chin shifts > 5 mm, both groups had similar perceptions. It was concluded that soft tissue compensations, especially in the lower face, help to mask skeletal asymmetry. Orthodontists detect subtle facial asymmetries better than laypersons, though larger asymmetries (> 5 mm) are universally noticeable.