Do patients with facial dsymorphology recognise themselves in profile?

Franks, Sarah Louise (2023). Do patients with facial dsymorphology recognise themselves in profile? University of Birmingham. M.Sc.

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Abstract

Aims:
The purpose of this investigation was to determine whether pre-operative Class III skeletal patients, who require orthognathic surgical correction, were able to accurately identify the site and extent of their dento-facial dysmorphology. As such determining whether 2D photo-cephalometric planning is a valid form of communication tool. In addition the study questioned patients whether they would prefer to see a three-dimensional reconstruction (rather than a 2D profile view) during orthognathic surgery treatment planning; and if patients would be willing to accept an increased radiation exposure to facilitate seeing themselves in 3D.

Design:
Single center, prospective cross-sectional study.

Materials and methods:
Twenty adults with a Class III dento-facial malocclusion, were recruited from the Birmingham Dental Hospital, United Kingdom. The participants used ‘Computer-Assisted Simulation System for Orthognathic Surgery’ (CASSOS) (SoftEnable Technology Ltd.) software package to manipulate a distorted digital construction of their soft tissue profile; to assess whether they have an accurate perception of their lateral profile. Patients were able to move their upper lip and lower lip/chin backwards and forwards. As well as the lower lip/chin up and down. Differences in linear horizontal distance between the patient-perceived position of the upper lip (Labrale superious) and chin (Pogonion) and the actual position of their upper lip and chin were measured. The subjects also completed a ‘Participant Questionnaire’.

Results:
Intra-patient reproducibility was found to be excellent (intra-class correlation coefficient score 0.93 to 0.98). The mean difference in upper lip position was -2.3 ± 3.0mm (95% CI -3.7mm to -0.9mm) (p=0.001). Mean differences in AP chin position and vertical chin position were 0.8 ± 3.7m (95% CI -0.9mm to 2.5mm) (p=0.334) and 4.7 ± 4.2mm (95% CI 2.7mm to 6.6mm) (p=0.001) respectively. All absolute mean differences were greater than 3.0mm, these differences would be deemed clinically significant.

Conclusions:
In this present study approximately half of patients could not correctly identify their current pre-surgical facial profile. Patients were able to determine their anterior-posterior chin position with greater accuracy than their upper lip position. There was a tendency to produce a retrusive upper lip position, exaggerating the extent of their Class III skeletal pattern. In the vertical direction there was a tendency to position the chin more inferiorly, producing a longer face. Patients were able to consistently reproduce their perception of their facial soft tissue profile on a second attempt. Given the lack of awareness of their own profile, this questions the validity of using profile planning as a tool for patient communication and informed consent.

Type of Work:

Thesis (Masters by Research > M.Sc.)

Award Type:

Masters by Research > M.Sc.

Supervisor(s):