Structural Patterns of the Mandibular Condyle in Facial Asymmetry and Dentofacial Deformities

Facial asymmetry is defined as a clinical discrepancy between the 2 sides of the face and is considered multifactorial in origin. It may affect any facial region, although it is most frequently observed in the lower third of the face. In this context, the mandibular condyle represents a primary growth center whose variations in behavior may lead to changes in volume and morphology. The aim of this study was to analyze the morphologic characteristics of the mandibular condyle in subjects with facial asymmetry associated with sagittal class II deformity (AF-CII) and in subjects with facial asymmetry associated with sagittal class III deformity (AF-CIII). A cross-sectional study was conducted including candidates for orthognathic surgery. Cone-beam computed tomography (CBCT) was used for dentofacial assessment. Condylar width and condylar height were measured, and both condyles were evaluated in each scan to identify the larger and smaller condyle relative to the contralateral side. Condylar morphology was classified as convex (normal) or irregular/flattened based on the characteristics of the superior articular surface. A total of 119 subjects with facial asymmetry and sagittal skeletal deformity were analyzed and divided into AF-CII and AF-CIII groups. In the AF-CIII group, only 4 subjects (3.27%) presented unilateral condylar morphologic alterations. In contrast, the AF-CII group demonstrated greater morphologic variability, with condylar alterations observed in 67.24% of cases, including both unilateral and bilateral changes. Statistically significant differences in condylar dimensions were identified between AF-CII and AF-CIII subjects (P=0.0001). Conclusions: Facial asymmetry in patients with sagittal dentofacial deformity is associated with differences in mandibular condylar size. AF-CII is related to condylar morphologic alterations, whereas AF-CIII does not demonstrate relevant morphologic changes. Facial deviation predominantly occurs toward the side of the smaller condyle.