Appraising Asymmetric Temporal Deformity: A Three-Dimensional Imaging-Based Panel and Morphometric Outcome Study

Asymmetric temporal deformity is a common yet often underrecognized complication following craniofacial and neurosurgical procedures. The optimal method for its accurate characterization remains debated, with no universally accepted standard. This study aimed to assess subjective perceptions of temporal asymmetry among professionals and laypersons, objectively evaluate temporal asymmetry using morphometric techniques, and examine whether subjective and objective evaluations correlate.

This cross-sectional study included magnetic resonance imaging-derived 3-dimensional craniofacial images from 64 adults who underwent a pretemporal approach for the surgical treatment of drug-resistant temporal lobe epilepsy at a tertiary-level multidisciplinary epilepsy center. Temporal asymmetry was evaluated using a 4-point Likert scale by professionals (n = 36) and laypersons (n = 40), based on preoperative and 12-month postoperative frontal images. Subjective ratings were correlated with objective morphometric parameters commonly used to quantify temporal asymmetry-specifically, automatically computed differences in volume (cm³) and contour area (cm²) between the left and right temporal regions. Higher subjective scores and objective values indicated greater asymmetry.

Postoperative temporal asymmetry significantly increased (all P <0.001) in volume (from 27.73±8.87 to 55.30±30.13 cm³), contour (from 6.63±2.27 to 13.95±8.23 cm²), and subjective scores (from 1.30±0.22 to 2.20±0.70). Professional and lay scores did not differ significantly (all P >0.05), and both panels showed moderate-to-strong positive correlations ( rho = 0.43-0.83; all P <0.001) with volume and contour measures, regardless of surgical status.

Professional and lay raters demonstrated comparable perceptions of temporal asymmetry, which showed varying correlation with objective measures.