Habilidade de ortodontistas e leigos na percepção de assimetrias da mandíbula Orthodontists' and laypersons' perception of mandibular asymmetries

OBJETIVO: analisar a habilidade de ortodontistas e leigos para perceber as assimetrias faciais causadas por desvios mandibulares. MÉTODOS: foram obtidas fotografias frontais da face de dois indivíduos, sendo um do sexo masculino e outro do sexo feminino. As fotografias foram tiradas em Posição Natural de Cabeça (PNC) com desvios mandibulares progressivos - em 2, 4 e 6mm -, partindo-se da posição de Máxima Intercuspidação Habitual (MIH). Para testar a reprodutibilidade do método, utilizaram-se os Coeficientes de Correlação Intraclasse (ICC) e o teste de Kappa ponderado.As diferenças entre os examinadores leigos e ortodontistas foram investigadas através do teste de Mann-Whitney, enquanto a análise de Friedman foi utilizada para investigar as diferenças nos escores para os progressivos avanços mandibulares. Todas as estatísticas foram executadas com nível de confiabilidade de 95%. RESULTADOS: os ortodontistas foram hábeis em perceber os desvios somente a partir de 4mm, quando comparados à posição de MIH (p&#8804;0,05), enquanto os leigos tiveram o mesmo padrão para o indivíduo do sexo feminino. Porém, ao examinar o sujeito do sexo masculino, os leigos não observaram nenhuma alteração executada a partir de MIH (p>0,05). De modo geral, apesar de as medianas atribuídas pelos ortodontistas terem sido menores que as dos leigos, essa diferença foi significativa apenas para o desvio de 6mm, em ambos os pacientes. CONCLUSÕES: ortodontistas e leigos avaliaram a assimetria mandibular de modo diferente, visto que ortodontistas tendem a ser mais críticos quando as assimetrias são mais severas. Conclui-se, ainda, que existe variação na avaliação das assimetrias faciais dependendo do paciente examinado, principalmente entre os examinadores leigos.<br>OBJECTIVE: To analyze orthodontists' and laypersons' perceptions of facial asymmetries caused by mandibular changes. METHODS: The faces of two patients, a man and a woman, were photographed in natural head position, and additional photos were produced with progressive mandibular shifts of 2, 4 and 6 mm from maximum intercuspation (MI). Intraclass correlation coefficients (ICC) and weighted kappa coefficients were used to test method reproducibility. The differences in scores for mandibular positions between orthodontists and lay examiners were examined using Friedman analysis. All statistical analyses were performed at 95% confidence interval. RESULTS: Orthodontists only perceived shifts greater than 4 mm from MI position (p<0.05), and laypersons had similar results when analyzing the woman's photos. However, when examining the man's photos, laypersons did not perceive any change in relation to MI (p>0.05). Although median scores assigned by orthodontists were, in general, lower than those of laypersons, this difference was only significant for the 6-mm shift in both patients. CONCLUSIONS: Orthodontists and laypersons evaluated mandibular asymmetries differently. Orthodontists tended to be more critical when asymmetries were more severe. The evaluation of facial asymmetries also varied according to what patient was being examined, particularly among lay examiners

Chin Microgenia: A Clinical Comparative Study

Background: The aesthetic relevance of the chin and its relatively simple correction through different approaches make genioplasty one of the most performed aesthetic procedures of the face. Sliding genioplasty is extremely rewarding, particularly when performed as an adjunction to rhinoplasty, rhytidectomy, or jaw surgery. In the scientific literature, many different surgical techniques are described, but the biological implications and the economical impact can shape the surgeon’s decision on which can be the best treatment: surgical correction with osteotomy, chin implants, or with fillers. Objective: The authors propose a decision making protocol for correcting chin microgenia based on a revision of 345 treated cases. Methods: A retrospective review of 345 cases of chin microgenia was undertaken to understand the proper preoperative assessment and therapeutic planning. A total of 135 patients were treated with surgical sliding genioplasty (group A): 60 patients (group B) have been grafted with alloplastic implants and the remaining 150 patients (group C) with hyaluronic acid. We recorded clinical indications, complications, and long-term aesthetic results at 3-year follow-up. Results: The analysis of the results based on the entity of the chin’s sagittal defect, the chin soft-tissue thickness, the patient’s age, and self-judgment allows for simplified treatment planning for sagittal chin deformities showing a greater predictability and a more stable long-term aesthetic result regarding sliding genioplasty compared to alloplastic implant placement and fillers. Conclusions: Our proposal for a simple and versatile protocol of chin microgenia aims to simplify the therapeutic indications for a predictable and a stable long-term aesthetic result. Level of Evidence IIThis journal requires that authorsassign a level of evidence to each article. For a fulldescription of these Evidence-Based Medicine ratings,please refer to Table of Contents or the online Instruction