国际口腔医学杂志

国际口腔医学杂志 ›› 2026, Vol. 53 ›› Issue (6): 906-914.doi: 10.7518/gjkq.2026129

• 综述 • 上一篇    

偏颌畸形分类体系及颅颌面特征的研究进展

隋尚言1(),龚衍吉2,朱锦怡1,李昊霖1,刘洋1()   

  1. 1.口腔疾病防治全国重点实验室 国家口腔医学中心 口腔疾病国家临床医学研究中心 四川大学华西口腔医院颞下颌关节科 成都 610041
    2.口腔疾病防治全国重点实验室 国家口腔医学中心 口腔疾病国家临床医学研究中心 四川大学华西口腔医院锦江门诊部 成都 610041
  • 收稿日期:2025-09-19 修回日期:2026-03-18 出版日期:2026-11-01 发布日期:2026-10-29
  • 通讯作者: 刘洋
  • 作者简介:隋尚言，硕士，Email：suishangyan@163.com
  • 基金资助:
    国家重点研发计划(2023YFC3605600);四川省自然科学基金(2023NSFSC0568)

Research advances in the classification system and craniofacial features of facial asymmetry

Shangyan Sui1(),Yanji Gong2,Jinyi Zhu1,Haolin Li1,Yang Liu1()   

  1. 1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Jinjiang Out-patient, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2025-09-19 Revised:2026-03-18 Online:2026-11-01 Published:2026-10-29
  • Contact: Yang Liu
  • Supported by:
    National Key Research and Development Program of China(2023YFC3605600);Natural Science Foundation of Sichuan Province(2023NSFSC0568)

RichHTML

4

PDF (PC)

15

摘要：

偏颌畸形是口腔颌面部常见的畸形，主要表现为下颌偏斜，其分类体系与临床特征研究对精准诊疗至关重要。偏颌畸形的分类体系多样，可根据致畸因素作用时间、颌骨形态与移位方式、临床特征与病理机制进行分类探讨。偏颌畸形常伴有颅骨、上颌骨、下颌骨及颞下颌关节、咬合关系及功能、软组织形态、气道形态等颅颌面结构的特征性改变。本文介绍了偏颌畸形的分类体系以及颅颌面特征的相关研究，并探讨了现有偏颌畸形的颅颌面特征研究的局限性，旨在为偏颌畸形的临床诊断与治疗提供参考。

关键词: 偏颌畸形, 颞下颌关节, 颅颌面特征

Abstract:

Facial asymmetry is a common deformity of the oral and maxillofacial region. It is primarily characterized by mandibular deviation. Research on its classification system and clinical characteristics is crucial for its precise diagnosis and treatment. The classification system of facial asymmetry is diverse and can be systematically categorized on the basis of the duration of action of teratogenic factors, the morphology and displacement mode of the mandible, clinical characteristics, and pathological mechanisms. Patients with maxillary deformities frequently exhibit characteristic alterations in cranio-maxillofacial structures, including the skull, maxilla, mandible, and temporomandibular joints; occlusal relationships and functions; soft tissue morphology; and airway anatomy. This article provides an overview of the classification systems for facial asymmetry and reviews related to research on cranio-maxillofacial characteristics while also addressing the limitations of the current research in this field. It aims to offer valuable insights for clinical diagnosis and treatment, as well as to guide future scientific investigations into facial asymmetry.

Key words: facial asymmetry, temporomandibular joint, craniofacial feature

中图分类号: 

  • R782.2+3

图1

偏颌畸形下颌不同三维移动方式的示意图"

[1] Blain R, Couly G, Shotar E, et al. A tridimensional atlas of the developing human head[J]. Cell, 2023, 186(26): 5910-5924.e17.
[2] Paradowska-Stolarz AM, Ziomek M, Sluzalec-Wieckiewicz K, et al. Most common congenital syndromes with facial asymmetry: a narrative review[J]. Dent Med Probl, 2024, 61(6): 925-932.
[3] de Lima Azeredo T, Freitas LRP, Soares RV, et al. Three-dimensional assessment of mandibular asymmetry in patients with unilateral cleft lip and palate at different growth stages: a cross-sectional study[J]. Dental Press J Orthod, 2024, 29(6): e242496.
[4] Hong M, Kim H, Yang IH, et al. Facial asymmetry phenotypes in adult patients with unilateral cleft lip and palate and skeletal class Ⅲ malocclusion using principal component analysis and cluster analysis[J]. J Craniofac Surg, 2023, 34(3): e314-e319.
[5] Salinero LK, Friedman L, Shulkin JM, et al. Orthognathic considerations of maxillary and mandibular asymmetry at skeletal maturity in patients with cleft lip and palate[J]. Plast Reconstr Surg, 2025, 155(6): 985-994.
[6] Romeo DJ, Oral KT, Ng JJ, et al. Mandibular condyle volumes are associated with facial asymmetry in patients with cleft lip and palate: a retrospective cohort study[J]. J Craniomaxillofac Surg, 2024, 52(4): 472-476.
[7] Harnádková K, Měšťák J, Dupej J, et al. The relationship between facial directional asymmetry, han-dedness, chewing side preference, and eyedness[J]. Sci Rep, 2024, 14(1): 23131.
[8] Liu ZY, Hou YL, Zhang PF, et al. Changes of the condylar cartilage and subchondral bone in the temporomandibular joints of rats under unilateral mastication and expression of Insulin-like Growth Factor-1[J]. J Stomatol Oral Maxillofac Surg, 2022, 123(4): 405-416.
[9] Stróżyk P, Bałchanowski J. Unilateral chewing of foods. Analysis of energy balance and peak power of the mandibular elevator muscles[J]. Front Bioeng Biotechnol, 2025, 13: 1559555.
[10] Miyazaki M, Yonemitsu I, Takei M, et al. The imba-lance of masticatory muscle activity affects the asymmetric growth of condylar cartilage and subchondral bone in rats[J]. Arch Oral Biol, 2016, 63: 22-31.
[11] Launonen AM, Vuollo V, Aarnivala H, et al. A longitudinal study of facial asymmetry in a normal birth cohort up to 6 years of age and the predisposing factors[J]. Eur J Orthod, 2023, 45(4): 396-407.
[12] Dattani A, Heggie A. Hemifacial hyperplasia: a case series and review of the literature[J]. Int J Oral Ma-xillofac Surg, 2021, 50(3): 341-348.
[13] Bernini JM, Kellenberger CJ, Eichenberger M, et al. Quantitative analysis of facial asymmetry based on three-dimensional photography: a valuable indicator for asymmetrical temporomandibular joint affection in juvenile idiopathic arthritis patients[J]. Pediatr Rheumatol Online J, 2020, 18(1): 10.
[14] Ajmera DH, Singh P, Leung YY, et al. Establishment of the mid-sagittal reference plane for three-dimensional assessment of facial asymmetry: a systematic review[J]. Clin Oral Investig, 2024, 28(4): 242.
[15] Alt S, Gajny L, Tilotta F, et al. Automated landmark-based mid-sagittal plane: reliability for 3-dimensio-nal mandibular asymmetry assessment on head CT scans[J]. Clin Oral Investig, 2025, 29(6): 311.
[16] Fan Y, He W, Chen G, et al. Facial asymmetry assessment in skeletal Class Ⅲ patients with spatially-dense geometric morphometrics[J]. Eur J Orthod, 2022, 44(2): 155-162.
[17] Zhu YJ, Wen AN, Xiao N, et al. Automatic extraction of facial median sagittal plane for patients with asymmetry based on the EDMA alignment algorithm[J]. Head Face Med, 2024, 20(1): 34.
[18] Thiesen G, Gribel BF, Freitas MPM, et al. Mandibular asymmetries and associated factors in orthodontic and orthognathic surgery patients[J]. Angle Orthod, 2018, 88(5): 545-551.
[19] Li J, Liu Y, Ge XL, et al. A cross-sectional study on three-dimensional compensatory characteristics of maxillary teeth in patients with different types of skeletal Class Ⅲ malocclusion with mandibular asy-mmetry[J]. Clin Oral Investig, 2023, 27(9): 4973-4985.
[20] Kim KA, Lee JW, Park JH, et al. Targeted presurgical decompensation in patients with yaw-dependent facial asymmetry[J]. Korean J Orthod, 2017, 47(3): 195-206.
[21] Zhang LL, Cao C, Ma T, et al. Classification and characterization of facial asymmetry in adult patients with skeletal Class Ⅲ malocclusion using cluster analysis[J]. Am J Orthod Dentofacial Orthop, 2024, 166(3): 252-266.
[22] Ha SW, Kim SJ, Choi JY, et al. Characterization of facial asymmetry phenotypes in adult patients with skeletal Class Ⅲ malocclusion using three-dimensional computed tomography and cluster analysis[J]. Korean J Orthod, 2022, 52(2): 85-101.
[23] Osawa K, Nihara J, Nishiyama H, et al. A three-dimensional investigation of mandibular deviation in patients with mandibular prognathism[J]. Maxillofac Plast Reconstr Surg, 2023, 45(1): 4.
[24] Liu LC, Chen YG, Chen RF, et al. Type of mandibular asymmetry affects changes and outcomes of bimaxillary surgery for class Ⅲ asymmetry[J]. Clin Oral Investig, 2022, 26(1): 1077-1088.
[25] 沈刚. 偏颌与颜面不对称畸形的诊断、分类及临床意义[J]. 上海口腔医学, 2021, 30(1): 1-6.
Shen G. Classification for mandibular deviation and facial asymmetry and its clinical significance[J]. Shanghai J Stomatol, 2021, 30(1): 1-6.
[26] Feng B, Yu XW, Wang Y, et al. Using the anterior cranial base to provide a reliable reference plane for patients with or without facial asymmetry[J]. Am J Orthod Dentofacial Orthop, 2022, 162(5): e230-e245.
[27] Hayashi Y, Tachiki C, Morikawa T, et al. Three-dimensional analysis of the cranial base structure in patients with facial asymmetry[J]. Diagnostics, 2024, 14(1): 24.
[28] Guo Y, Wu D, Xu QJ, et al. Inhibition of smoo-thened receptor by vismodegib leads to micrognathia during embryogenesis[J]. Differentiation, 2022, 125: 27-34.
[29] Kim SJ, Lee KJ, Lee SH, et al. Morphologic relationship between the cranial base and the mandible in patients with facial asymmetry and mandibular prognathism[J]. Am J Orthod Dentofacial Orthop, 2013, 144(3): 330-340.
[30] Tibesar RJ, Scott AR. Syndromic craniofacial disorders[J]. Facial Plast Surg Clin North Am, 2024, 32(1): 141-156.
[31] Sun W, Tang YX, Zhao TY, et al. The relationship between eye canting and vertical craniofacial skeletal asymmetry in adult patients with dento-maxillofacial deformities[J]. J Stomatol Oral Maxillofac Surg, 2024, 125(6): 101803.
[32] Ortún-Terrazas J, Fagan MJ, Cegoñino J, et al. Towards an early 3D-diagnosis of craniofacial asymmetry by computing the accurate midplane: a PCA-based method[J]. Comput Methods Programs Bio-med, 2020, 191: 105397.
[33] Ortún-Terrazas J, Fagan MJ, Cegoñino J, et al. Biomechanical evaluation of the unilateral crossbite on the asymmetrical development of the craniofacial complex. A mechano-morphological approach[J]. Com-put Methods Programs Biomed, 2022, 217: 106703.
[34] Ronsivalle V, Isola G, Lo Re G, et al. Analysis of maxillary asymmetry before and after treatment of functional posterior cross-bite: a retrospective study using 3D imaging system and deviation analysis[J]. Prog Orthod, 2023, 24(1): 41.
[35] Li JL, Wu SJ, Mei L, et al. Facial asymmetry of the hard and soft tissues in skeletal Class Ⅰ, Ⅱ, and Ⅲ patients[J]. Sci Rep, 2024, 14: 4966.
[36] Evangelista K, Teodoro AB, Bianchi J, et al. Prevalence of mandibular asymmetry in different skele-tal sagittal patterns[J]. Angle Orthod, 2022, 92(1): 118-126.
[37] Lemes CR, Tozzi CF, Gribel S, et al. Mandibular ramus height and condyle distance asymmetries in individuals with different facial growth patterns: a cone-beam computed tomography study[J]. Surg Radiol Anat, 2021, 43(2): 267-274.
[38] Leung MY, Leung YY. Three-dimensional evaluation of mandibular asymmetry: a new classification and three-dimensional cephalometric analysis[J]. Int J Oral Maxillofac Surg, 2018, 47(8): 1043-1051.
[39] Beltran J, Zaror C, Moya MP, et al. Diagnosis and treatment in unilateral condylar hyperplasia[J]. J Clin Med, 2023, 12(3): 1017.
[40] Sun R, Sun LS, Sun ZP, et al. A three-dimensional study of hemimandibular hyperplasia, hemimandi-bular elongation, solitary condylar hyperplasia, simple mandibular asymmetry and condylar osteoma or osteochondroma[J]. J Craniomaxillofac Surg, 2019, 47(11): 1665-1675.
[41] Chou ST, Tsai PL, Chen SC, et al. Condylar and ramus volume in asymmetric and symmetric skeletal class Ⅲ malocclusion: a cone-beam computed tomography study[J]. J Dent Sci, 2023, 18(1): 175-183.
[42] Chou ST, Wang JL, Chen SC, et al. Correlation between facial asymmetry of skeletal class Ⅲ jaw relationship and morphology of the temporomandibular joint: a cone beam computed tomography study[J]. J Dent Sci, 2023, 18(3): 1031-1041.
[43] Ahmed MMS, Shi DL, Ali Al-Somairi MA, et al. Three dimensional evaluation of the skeletal and temporomandibular joint changes following stabilization splint therapy in patients with temporomandibular joint disorders and mandibular deviation: a retrospective study[J]. BMC Oral Health, 2023, 23(1): 18.
[44] Musa M, Awad R, Izeldin S, et al. Quantitative and qualitative condylar changes following stabilization splint therapy in patients with temporomandibular joint disorders with and without skeletal lateral mandibular asymmetry: a cone beam computed tomographic study[J]. BMC Oral Health, 2024, 24(1): 363.
[45] Zhu JY, Gong YJ, Zheng FJ, et al. Relationships between functional temporomandibular joint space and disc morphology, position, and condylar os-seous condition in patients with temporomandibular disorder[J]. Clin Oral Investig, 2024, 28(3): 193.
[46] Wang G, Feng Y, Tang JQ, et al. Measurement and analysis of condylar morphology and thickness of the roof of the glenoid fossa in patients with unila-teral second molar scissor bite[J]. Sci Rep, 2024, 14(1): 24747.
[47] 殷晓丽, 刘洋, 王军. 伴发于偏颌畸形的颞下颌关节内部结构变化[J]. 国际口腔医学杂志, 2020, 47(5): 567-573.
Yin XL, Liu Y, Wang J. Internal structural changes of the temporomandibular joint associated with mandibular lateral displacement[J]. Int J Stomatol, 2020, 47(5): 567-573.
[48] Oh MH, Cho JH. The three-dimensional morphology of mandible and glenoid fossa as contributing factors to menton deviation in facial asymmetry-re-trospective study[J]. Prog Orthod, 2020, 21(1): 33.
[49] Li CX, Xie X, Li MJ, et al. A pilot investigation of condylar position and asymmetry in patients with unilateral posterior scissors-bite malocclusion based on three-dimensional reconstructive imaging technique[J]. BMC Musculoskelet Disord, 2023, 24(1): 253.
[50] López DF, Rios Borrás V, Cárdenas-Perilla R. Positional features of the mandibular condyle in patients with facial asymmetry[J]. Diagnostics, 2023, 13(6): 1034.
[51] Afroz S, Naritani M, Hosoki H, et al. Prevalence of posterior disc displacement of the temporomandibular joint in patients with temporomandibular disorders: systematic review and meta-analyses[J]. J Oral Facial Pain Headache, 2018, 32(3): 277-286.
[52] Silva MAG, Pantoja LLQ, Dutra-Horstmann KL, et al. Prevalence of degenerative disease in temporomandibular disorder patients with disc displacement: a systematic review and meta-analysis[J]. J Craniomaxillofac Surg, 2020, 48(10): 942-955.
[53] Zhao JM, Xu YF, Wang JX, et al. 3-dimensional analysis of hard- and soft-tissue symmetry in a Chinese population[J]. BMC Oral Health, 2023, 23(1): 432.
[54] Setvaji NR, Muthuswamy Pandian S. Evaluation of soft tissue compensations in subjects with facial asymmetry using cone beam computed tomography (CBCT): a retrospective study[J]. Cureus, 2024, 16(1): e52601.
[55] Chen YJ, Yao CC, Chang ZC, et al. Occlusal function and electromyographic activity of masticatory muscles in skeletal Class Ⅲ patients with different patterns of mandibular asymmetry[J]. J Oral Rehabil, 2023, 50(4): 276-285.
[56] Hikosaka Y, Koizumi S, Kim YI, et al. Comparison of mandibular volume and linear measurements in patients with mandibular asymmetry[J]. Diagnostics, 2023, 13(7): 1331.
[57] Tam TKM, Guo RZ, Liu H, et al. Hard and soft tissue asymmetry in patients with skeletal class Ⅲ malocclusion: a cone-beam computed tomography study[J]. Diagnostics, 2023, 13(5): 869.
[58] Yu JF, Hu Y, Huang MN, et al. A three-dimensional analysis of skeletal and dental characteristics in ske-letal class Ⅲ patients with facial asymmetry[J]. J Xray Sci Technol, 2018, 26(3): 449-462.
[59] Teng CT, Liu C, Yu Q, et al. Cone-beam computed tomography-based three-dimensional cephalometric analysis of mandible symmetry and the occlusal plane of adult patients with high-angle skeletal class Ⅲ malocclusion and jaw deformity[J]. Arch Oral Biol, 2021, 127: 105157.
[1] 郝旭蕾,赵强. 激光协同针灸治疗颞下颌关节紊乱病的临床效果观察[J]. 国际口腔医学杂志, 2026, 53(6): 859-865.
[2] 韩林艺,张丽媛. 咬合平面特征与颞下颌关节关系的研究进展[J]. 国际口腔医学杂志, 2026, 53(5): 753-760.
[3] 李晶晶,邵琳琳,俞青. 颞下颌关节盘可复性前移位患者关节振动特征研究[J]. 国际口腔医学杂志, 2026, 53(4): 537-544.
[4] 王美青. 青少年特发性髁突吸收或系发育期异常咬合所致软骨退变相关的病理性改建[J]. 国际口腔医学杂志, 2026, 53(2): 145-154.
[5] 李榕,赵青. 基于颞下颌关节思考成人安氏Ⅱ2分类错 畸形的治疗[J]. 国际口腔医学杂志, 2024, 51(6): 687-698.
[6] 张桃李,龚衍吉,刘方,张秦兰蕙,刘洋. 颞下颌关节退行性改变与颅面形态及颞下颌关节形态结构的关联[J]. 国际口腔医学杂志, 2024, 51(5): 642-652.
[7] 韩婧文,王蕾,任诗琦,王红宇,黄颖怡,李佳敏,郑艳. 青少年颞下颌关节形态特征与下颌骨三维方向生长的相关性研究[J]. 国际口腔医学杂志, 2024, 51(4): 456-466.
[8] 张静,钟亦思,郑耘昊,张莉,熊鑫. 不同类型颞下颌关节紊乱病患者焦虑抑郁情绪的差异[J]. 国际口腔医学杂志, 2024, 51(3): 296-302.
[9] 薛晴,齐慧川,胡敏. 机械应力下初级纤毛在骨和颞下颌关节软骨改建中力学感知作用的研究进展[J]. 国际口腔医学杂志, 2024, 51(2): 201-207.
[10] 韩婧文,任诗琦,刘星宇,郎鑫,储梦诗,Waseem Saleh Abdo Kaid Algumaei,郑艳. 成人不同垂直及矢状骨面型髁突特征的研究[J]. 国际口腔医学杂志, 2022, 49(2): 153-162.
[11] 张哲,刘进,王卫红,陈志强,杨春,刘丽. 焦磷酸钙沉积症继发颞下颌关节脱位1例[J]. 国际口腔医学杂志, 2021, 48(6): 664-667.
[12] 殷晓丽,刘洋,王军. 伴发于偏颌畸形的颞下颌关节内部结构变化[J]. 国际口腔医学杂志, 2020, 47(5): 567-573.
[13] 林阳阳,侯敏. 双侧下颌支矢状骨劈开术对下颌近心骨段位移变化的影响[J]. 国际口腔医学杂志, 2019, 46(6): 718-723.
[14] 郭骏,费伟,李庆华. 创伤性颞下颌关节强直转归机制的动物研究[J]. 国际口腔医学杂志, 2019, 46(1): 12-19.
[15] 黎静, 刘星辰, 李佳园, 李小兵. 稳定咬合板治疗慢性颞下颌关节盘不可复性移位的临床随机对照试验的系统评价[J]. 国际口腔医学杂志, 2017, 44(4): 405-410.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!