Quantification of facial asymmetry by 2D analysis - A comparison of recent approaches

Introduction: Symmetry has been found to play a crucial role in attractiveness assessment and so its restoration is an essential problem in oral maxillofacial surgery. This paper presents an overview of recent 2D asymmetry analysis techniques. These are techniques which are based on the evaluation of two-dimensional data, like photos. The aim of this paper is to find the most precise and practical techniques to investigate facial asymmetry. Materials and methods: For this purpose studies addressing symmetry investigations are collected and categorized by the type of data they extract from the photos. The reference points on the facial surface, which are frequently used in these studies, are presented and calculation methods are described. Results: Three kinds of techniques using vertical or horizontal reference lines or centres of bilateral points appear to be most appropriate. Recommendations are made, which aspects should be taken into account when calculating symmetry/asymmetry indices from photos. Advantages and disadvantages of the three selected methods are summarized in a table. Conclusions: Using one of the three recommended approaches denoted by FA, AI and z-score allows calculating meaningful asymmetry values. The proper selection and identification of reference points is crucial. For highest accuracy, a sufficient number of evenly distributed and reproducible reference points should be used. (C) 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.