University of Oulu

Anniina M Launonen, Ville Vuollo, Henri Aarnivala, Tuomo Heikkinen, Pertti Pirttiniemi, A Marita Valkama, Virpi Harila, A longitudinal study of facial asymmetry in a normal birth cohort up to 6 years of age and the predisposing factors, European Journal of Orthodontics, Volume 45, Issue 4, August 2023, Pages 396–407,

A longitudinal study of facial asymmetry in a normal birth cohort up to 6 years of age and the predisposing factors

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Author: Launonen, Anniina M.1,2,3; Vuollo, Ville1,2,3; Aarnivala, Henri4,5;
Organizations: 1Department of Oral Development and Orthodontics, Oulu University Hospital, Oulu, Finland
2Department of Oral Development and Orthodontics, Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
3Medical Research Center Oulu, Oulu, Finland
4Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
5PEDEGO Research Group, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
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Language: English
Published: Oxford University Press, 2023
Publish Date: 2023-09-20


Objectives: This prospective, population-based cohort study aimed to investigate the development of facial asymmetry up to 6 years of age using a three-dimensional (3D) soft tissue imaging method in a normal population. In addition, the study sought to identify potential predisposing factors to facial asymmetry.

Methods: A total of 102 newborns were enrolled in the study at birth. 3D stereophotogrammetric images of the head and face were analysed at the ages of 12 months (T1), 3 years (T2), and 6 years (T3). The surface-based analysis involved the calculation of the average distance (mm) and the symmetry percentage (%) between the original and mirrored surfaces. For landmark-based analysis, the distance of facial landmarks to the facial midline was examined.

Results: The final analysis included 70 (68.6%) subjects. Surface-based analysis showed a significant improvement of facial symmetry from T1 to T3 in all facial areas. Landmark-based analysis showed that upper facial landmarks were located, on average, slightly on the left and lower facial landmarks slightly on the right in relation to the facial midline (P < 0.001).

Limitations: The size of the study population was limited. Facial posture may affect the reliability of the results, especially in younger children.

Conclusions: Facial asymmetry is detectable in early childhood and tends to reduce with age in young children. The lower face deviates slightly to the right, and the upper face to the left in relation to the facial midline. Possible predisposing factors for facial asymmetry at the age of 6 years include deformational plagiocephaly, sleeping position, and previous facial asymmetry.

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Series: European journal of orthodontics
ISSN: 0141-5387
ISSN-E: 1460-2210
ISSN-L: 0141-5387
Volume: 45
Issue: 4
Pages: 396 - 407
DOI: 10.1093/ejo/cjad012
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: This research was supported by the Emil Aaltonen Foundation, The Finnish Dental Society Apollonia and the Finnish Dental Foundation.
Copyright information: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.