Diagnosis and Patient Evaluation

Facial features are more symmetric in certain people compared with others, yet facial asymmetry of different degrees is present in every individual. While one person’s asymmetry may be noticeable only to their eye, others have asymmetry which greatly affects their daily lives. Regardless of the perceived severity of one’s asymmetry, each person will form their own opinion about the relevance of their unique facial features. Functional, psychological, and social barriers are just a few of the ramifications that can result from an individual’s perception of their facial symmetry, or lack thereof. In addition to history and physical with thorough history of the present illness, facial asymmetry workup requires a detailed clinical assessment of the patient. This assessment should include extraoral and intraoral examination, with particular attention being given to the orbits, chin, skull base, position of the glenoid fossae, and ramus condyle unit. Adjunctive craniofacial imaging, dental study models, and computer-aided surgical simulation (CASS) may be used to aid in diagnosis and treatment planning. Facial asymmetry may be absolute in nature or involve a number of known sources of pseudo-asymmetry. Furthermore, age considerations related to growth and development of craniofacial structures should play a role in evaluation of any pediatric patient.