Source: AJO-DO on CD-ROM (Copyright Š 1998 AJO-DO), Volume 1984 Mar (224 - 237): Diagnosis and treatment planning of skeletal asymmetry with submental-vertical radiograph - Forsberg, Burstone, and Hanley -------------------------------Diagnosis and treatment planning of skeletal asymmetry with the submental-vertical radiograph Clifton T. Forsberg, B.S., D.D.S., Charles J. Burstone, D.D.S., M.S., and Kevin J. Hanley, D.D.S. Farmington, Conn. The purpose of this study was to assess the reproducibility of landmarks visible in the submental-vertical radiographic projection. Ten subjects with at least a 2 mm apical base discrepancy as diagnosed by means of a posteroanterior headfilm were selected. Mean tracing and measurement error was found to be less than 1 mm for all landmarks. A system of patient orientation and radiographic technique is presented. The radiographs were made at 90 kVp, 15 mA, 1 second exposure, using Kodak Lanex X-D film with a speed of 600. A system of cephalometric analysis is presented for the assessment of skeletal asymmetry in the horizontal plane. This system of analysis uses landmarks within the cranial base, maxilla, and mandible to construct reference lines with which to assess asymmetry. These reference systems allow the assessment of asymmetry within each component part of the craniofacial complex as well as the relative relationship of these parts to one another. Examples are presented to demonstrate the use of this system in assessing skeletal asymmetry. These examples show how this system of analysis can be incorporated into the data base for a particular patient and how it can be useful in making treatment decisions for patients with skeletal asymmetries. This method lends itself to future incorporation into a three-dimensional computerized cephalometric analysis. With the advent of orthognathic surgery, the orthodontist's role in diagnosis and treatment planning of cases involving skeletal disharmony has expanded greatly. since contemporary surgical procedures can alter the bones of the craniofacial complex, it is important that the orthodontist accurately assess the degree to which skeletal disharmony contributes to a given malocclusion before he or she formulates treatment objectives. Lateral headfilms are routinely used to assess anteroposterior and vertical relationships within the craniofacial complex, but these films are of little use in the assessment of facial symmetry. Several methods of assessing asymmetry by means of posteroanterior (P-A) headfilms have been suggested in the past.1-9 Problems associated with the use of the P-A cephalometric view, especially the selection of valid midsagittal reference points, have led to the use of alternate cephalometric projections in the assessment of asymmetry. Berger10 was the first to suggest using the submental-vertical (S-V) projection in cephalometrics to assess asymmetry. He used a best-fit line through crista galli, crista frontalis, vomer, tubercle of atlas, odontoid process, and crista occipitalis interior as a midsagittal reference line, but he did not test this reference line for reproducibility or validity.