Objective:To review the application and research progress of mandibular distraction osteogenesis (MDO) in the treatment of craniofacial microsomia (CFM). Methods:Recent domestic and international literature on MDO for CFM was extensively reviewed, with systematic summarization of its indications, device development, key technical points of MDO, complication management, digital surgical applications, biological enhancement strategies, and controversies regarding early intervention. Results:MDO stimulates new bone formation through the "tension-stress" principle, serving as an effective method to elongate the mandible in CFM patients and early improve airway and occlusal functions. Digital technology has enhanced its precision, while biological strategies show potential for optimizing osteogenesis. However, challenges such as postoperative relapse and the long-term efficacy of early intervention remain. Conclusion:MDO is a core component of the sequential treatment for CFM. Future efforts should focus on intelligent technologies and high-quality clinical studies to optimize individualized treatment plans and improve long-term stability.

OBJECTIVE:To compare the validity and reliability of 3 mandibular condylar segmentation planes-conventional Frankfort-parallel (C), adjusted global (F), and condylar long-axis-based (P) planes-in patients with unilateral craniofacial microsomia (CFM). METHODS:This retrospective methodological study included 47 patients with unilateral type IIA CFM. Condyles were segmented from 3-dimensional CT scans using the 3 planes. Validity was assessed using a custom 4-grade integrity score (grades 1-2 were considered valid). Reliability was evaluated using intraclass correlation coefficients (ICCs) for intra- and interoperator volume measurements. Statistical analyses included the Friedman test, the Cochrane Q test, and the Bonferroni correction. RESULTS:Plane P demonstrated the highest valid segmentation rate (97.9%), significantly greater than plane C (40.4%, adjusted P<0.001) but not significantly different from plane F (78.7%, adjusted P=0.069). All planes showed good to excellent reliability (ICCs: 0.939-0.998). Condylar volumes and asymmetry ratios differed significantly among planes (P<0.001). CONCLUSIONS:The choice of segmentation plane significantly affects condylar volumetric measurement validity in CFM. Plane P provides the most valid segmentation, but requires enhanced standardized training. Plane F is a viable alternative. The conventional plane C frequently results in incomplete segmentation, limiting its validity in this population.

BACKGROUND:Craniofacial microsomia (CFM) is the second most common congenital craniofacial anomaly. As patients increasingly seek health information online, large language models (LLMs) like ChatGPT and DeepSeek have emerged as potential sources of medical information. This study evaluates the performance of ChatGPT-5 and DeepSeek-V3.2 in providing bilingual responses to CFM-related questions. METHODS:Twenty-two questions covering CFM definition, etiology, diagnosis, treatment, and prognosis were developed. Each question was submitted in English and Chinese to both LLMs using a zero-prompt approach. Responses were evaluated for accuracy using a predefined 4-point scale, with readability assessed using the Flesch Reading Ease score for English and the Chinese Readability Platform for Chinese. Safety statement frequency was also recorded. RESULTS:DeepSeek demonstrated significantly higher accuracy than ChatGPT in both English (score 1: 86.4% versus 45.5%, P =0.004) and Chinese (77.3% versus 40.9%, P =0.014). However, only DeepSeek produced responses with inaccurate or misleading content (score 3). For English readability, DeepSeek scored significantly higher (39.4±5.5 versus 35.1±8.4, P =0.031), while Chinese readability was comparable. DeepSeek also included safety statements more frequently (54.5%-72.7% versus 4.5%-18.2%). CONCLUSIONS:Both LLMs show potential for CFM patient education, with DeepSeek offering superior accuracy and readability in English, though it occasionally produced misleading information. ChatGPT provided safer but less detailed responses. These findings highlight the need for model-specific optimization and clinician oversight when integrating LLMs into patient education for complex craniofacial conditions.

OBJECTIVE:This study aimed to characterize the three-dimensional (3D) upper airway morphology in children with bilateral craniofacial microsomia (BCFM) and to evaluate its association with obstructive sleep apnea (OSA). METHODS:A retrospective cross-sectional study was conducted involving 9 BCFM children and 10 age- and gender-matched controls. All participants underwent craniofacial CT imaging and polysomnography. The upper airway was segmented into four anatomical regions (nasopharynx, velopharynx, glossopharynx, and laryngopharynx) using a standardized 3D coordinate system. Morphometric parameters including volume, vertical height, minimum cross-sectional area (CSA), and maximum diameters were measured. Statistical analyses were performed to compare groups and assess correlations with obstructive apnea-hypopnea index (OAHI) and oxygen saturation (SpO₂). RESULTS:Significant reductions in nearly all airway dimensions were observed in the BCFM group compared to controls (P < 0.05), with large effect sizes (Cohen's d > 0.8 or |r| > 0.5). Total airway volume was markedly smaller in BCFM patients (median 10,569.86 mm³ vs. 22,957.68 mm³, P < 0.001). The velopharynx and glossopharynx showed the most pronounced decreases. Strong negative correlations were identified between OAHI and both velopharyngeal volume (r = -0.717, P = 0.030) and total airway volume (r = -0.800, P = 0.014). SpO₂ was positively correlated with laryngopharyngeal volume (r = 0.778, P = 0.017). CONCLUSIONS:Children with BCFM exhibit significant 3D morphological alterations in the upper airway, characterized by reduced volumes and restricted dimensions. This preliminary study suggests a strong association between airway morphological alterations and OSA severity in children with BCFM and provides a foundation for tailored therapeutic interventions.

OBJECTIVE:The lingula and antilingula are important anatomic references in oral and maxillofacial procedures. This study aims to characterize morphologic variations of the lingula and antilingula in unilateral craniofacial microsomia (CFM) and evaluate their associations. METHODS:Cranial CT scans of 98 unilateral CFM patients (Pruzansky-Kaban types I, IIA, and IIB) were retrospectively analyzed. Lingula morphology was classified as nodular, triangular, truncated, or assimilated (absent); antilingula was recorded as present/absent. Statistical analyses included χ2 tests, Cochran-Armitage trend tests, and Cohen κ for concordance. RESULTS:Among 196 mandibular sides, lingula absence occurred in 19.4%, with higher prevalence on affected sides (35.7% versus 3.1%, P<0.001). Antilingula absence increased significantly with Pruzansky-Kaban severity on affected sides (type IIB: 62.1% versus type I: 9.1%, P=0.003). Lingula-antilingula concordance was weak (κ=0.157, P=0.020). CONCLUSIONS:CFM patients exhibit high variability in lingula and antilingula anatomy, particularly on the affected side. Preoperative 3‑dimensional CT evaluation is therefore crucial for safe osteotomy planning.

BACKGROUND:Hemifacial microsomia (HFM) is a genetically complex craniofacial disorder. While GWAS and family studies have identified multiple candidate genes, functional validation rates remain low (<10%). METHODS:The authors established a high-throughput zebrafish CRISPR-Cas9 platform to functionally validate 16 prioritized genes (12 literature-derived, 4 bioinformatically predicted). Tg(col2a1a:EGFP) embryos underwent F0 knockout with ≥70% editing efficiency. Mandibular development was quantitatively analyzed using 6 morphometric parameters at 5 dpf. RESULTS:The authors identified distinct phenotypic profiles among candidate genes: ednrb knockout caused panmandibular hypoplasia (Meckel cartilage ↓21%, P<0.0001); fgf3 deficiency led to selective arch defects (ceratohyal length ↓28%, P<0.0001); epas1 ablation resulted in unilateral dysgenesis (cranial length ↓24%, P<0.0001). In addition, gbx2 and pax1 knockouts showed significant craniofacial anomalies. CONCLUSION:This study utilizes functional genomics to prioritize EDNRB, FGF3, and EPAS1 as high-confidence candidate genes for hemifacial microsomia. Our findings suggest a functional landscape where distinct genetic pathways converge to produce HFM-like phenotypes and validate TP53 and ESR2 as potential environmental susceptibility factors. These findings enable gene-targeted therapeutic strategies and prenatal risk assessment.

Craniofacial microsomia (CFM), a congenital anomaly stemming from first and second branchial arch dysplasia, poses challenges due to its diverse clinical manifestations, necessitating a comprehensive understanding of its complex etiology. We explored gene-environment interactions in CFM, focusing on genetic factors, and environmental influences, aiming to enhance insights into its multifactorial origins and guide future research. Genetic studies suggest HOXA2, PAX3, and TBX1 as potential susceptibility genes, while epidemiological research links maternal smoking, diabetes, and alcohol use to increased risk. Gene-environment interactions may impact craniofacial development via epigenetic mechanisms, though the exact pathways remain unclear. Future studies should expand CFM cohorts for better G×E risk assessment and apply multiomics approaches to clarify mechanisms. Functional validation via animal models and stem cells will verify genetic and environmental impacts. Advancing personalized medicine with early screening, precise diagnostics, and prevention remains crucial for high-risk cases.

Mandibular distraction osteogenesis (MDO) is recommended for children with craniofacial microsomia (CFM) and obstructive sleep apnea (OSA). However, its efficacy remains limited, with success rates of 36.4–60

Background: Hemifacial Microsomia (HFM) is a genetically complex craniofacial disorder. While GWAS and family studies have identified multiple candidate genes, functional validation rates remain low (<10%). Methods: We established a high-throughput zebrafish CRISPR-Cas9 platform to functionally validate 16 prioritized genes (12 literature-derived, 4 bioinformatically predicted). Tg(col2a1a:EGFP) embryos underwent F0 knockout with ≥70% editing efficiency. Mandibular development was quantitatively analyzed using six morphometric parameters at 5 dpf. Results: We identified three high-confidence pathogenic genes: EDNRB knockout caused pan-mandibular hypoplasia (Meckel's cartilage ↓21%, p<0.0001); FGF3 deficiency led to selective arch defects (ceratohyal length ↓28%, p<0.0001); EPAS1 ablation resulted in unilateral dysgenesis (cranial length ↓24%, p<0.0001). PAX1 knockout induced lethal pan-craniofacial defects. Conclusion: This study establishes EDNRB-FGF3-EPAS1 as a core pathogenic axis and validates environmental susceptibility genes (TP53/ESR2). These findings enable: 1) OMENS+ molecular subtyping, 2) gene-targeted therapeutic strategies, and 3) prenatal risk assessment for environmental exposures.

OBJECTIVE:While the Pruzansky-Kaban classification categorizes mandibular deformity in craniofacial microsomia (CFM), significant morphologic variability exists within each subtype. This study aimed to characterize mandibular morphology in type IIA CFM using functional unit analysis. METHODS:This retrospective case-control study included 55 unilateral type IIA CFM patients (6-17 years) and 55 matched controls. Three-dimensional CT scans were used to measure ramus height, body length, and 5 mandibular functional units (condylar, coronoid, angular, body, and chin). Asymmetry index (AI) and absolute asymmetry index (AAI) were calculated, and nonparametric tests assessed group differences and correlations. RESULTS:Mandibular asymmetry was pronounced in CFM patients versus controls, particularly in the condylar unit (median AI: 13.9%-17.5%, P <0.001), followed by the coronoid and angular units. While angular unit AI showed no intergroup differences in adolescents, its AAI was significantly elevated ( P <0.001), indicating age-related interindividual variability. In children (6-11 years), ramus height and body length asymmetry strongly correlated with condylar unit AI ( P =0.007 and 0.003, respectively), whereas adolescents (12-17 years) showed a shift to angular unit dominance ( P <0.001 and P =0.001, respectively). CONCLUSIONS:Type IIA CFM primarily involves the condylar unit, with the angular unit demonstrating significant growth variability. The developmental transition in asymmetry correlations from condylar to angular units suggests distinct growth patterns in CFM. These findings enhanced our understanding of mandibular morphology in CFM and suggested potential directions for future therapeutic research.

OBJECTIVE:To compare the symmetry of bilateral buccal fat pad(BFP) volumes in patients with prominent zygomatic bones before surgery. METHODS:Fifty cosmetic female patients were selected and scanned using computed tomography. Based on the symmetry of the patients' zygomatic bones prior to surgery, they were divided into the Sym group and the Asym group. The buccal extension of buccal fat pads on both sides were delineated and reconstructed layer by layer using the draw function of MIMICS 26.0, and their volumes were calculated. The Volume Asymmetry Index (VAI) was compared between the Sym group and the Asym group using a t-test. For patients in the Asym group, a paired t-test was used to compare the volumes of the buccal fat pads on the larger (L) and the contralateral side (S). RESULTS:The VAI in the Sym group was smaller than that in the Asym group (15.3 % ± 4.8 % vs 21.7 % ± 6.1, p = 0.02). For the Asym group, the volume of the buccal extension of buccal fat pad on the S side was smaller than that on the L side (S) (1.31 ml vs 1.66 ml p = 0.01). CONCLUSION:For patients undergoing zygomatic reduction surgery, the symmetry of the buccal fat pads prior to surgery should be emphasized, and measures should be taken to adjust the volume symmetry of the buccal fat pads in patients with asymmetric prominent zygomatic bones.

PURPOSE:Craniofacial microsomia (CFM), the second most common congenital craniofacial anomaly, is poorly characterized in bilateral cases because conventional cephalometry cannot accurately assess facial asymmetry. This study aims to characterize craniofacial morphology in children with bilateral CFM using three-dimensional (3D) cephalometric analysis. MATERIALS AND METHODS:A retrospective 3D cephalometric analysis was conducted on 8 bilateral CFM patients and 10 age-/sex-matched normal patients as controls. A coordinate system was established with three reference planes: the Frankfurt Horizontal Plane (FHP), the Midsagittal Plane (MSP) and the Nasion Perpendicular Plane (CP). Fifteen linear and angular measurements assessed maxillary, mandibular, chin, and occlusal parameters. Subgroups were stratified by bilateral mandibular deficiency severity according to Pruzansky-Kaban classification (Group A: similar; Group B: different). Statistical comparisons utilized independent t-tests (CFM vs. controls) and Mann-Whitney U tests (subgroups), with Pearson's correlation analysis exploring variable relationships. RESULTS:Bilateral CFM patients exhibited significant reductions in ramal height (Co-Go: p < 0.001) and mandibular body length (Go-Me: p < 0.001), a posteriorly inclined occlusal plane (OP-FHP: 27.63° ± 5.50° vs. 8.13° ± 3.33°, p < 0.001), and pronounced chin retrusion (Me-NP: 46.08 ± 6.66 mm vs. 8.28 ± 7.71 mm, p < 0.001) and lateral deviation (Me-MSP: 5.84 ± 4.64 mm vs. 1.73 ± 0.93 mm, p < 0.05). Me-NP and Me-MSP differed significantly in subgroup analyses. Pearson correlation analysis revealed strong associations between Me-NP and Me-MSP and OP-MSP, posterior maxillary height (U6-FHP) and Co-Go. CONCLUSION:Bilateral CFM is mainly characterized by posteriorly inclined occlusal plane and pronounced mandibular retrognathia. The occlusal plane and chin will consistently deviate toward the more severely affected side. When bilateral mandibular involvement is similar in extent, chin deviation tends to be mild, resulting in less severe facial asymmetry.

BACKGROUND:As an inflammatory skin condition, acne usually presents with a complex pathogenesis. Recent studies suggest that BMI may relate to the incidence of acne. Mendelian randomization is a statistical method that is used to evaluate the causal effects of exposure factors on outcome variables. METHODS:We applied the inverse-variance weighted (IVW) method to evaluate the causal effect as the primary analysis between BMI and acne in our two-sample Mendelian randomization study. We included 58 SNPs accounting for 2.5% (R2) of the BMI variation as instrumental variables (IVs) for BMI-acne causal estimations. RESULT:The F-statistic obtained from the first stage of the MR regression model was 61. Importantly, the results from all three methods consistently indicated that an increase in BMI did not elevate the risk of acne, with each result reaching statistical significance. Cochran's Q test revealed no evidence of heterogeneity among the IV estimates for individual variants. Our I2 values suggested low heterogeneity, thereby reinforcing the reliability of the MR estimates. Additionally, the "leave-one-out" analysis confirmed that no single SNP disproportionately affected the IVW point estimate. CONCLUSION:Our findings suggested that there is no causal relationship between BMI and acne.

Objective:Pre-bent titanium plates are widely used for internal fixation in L-shaped zygomatic reduction. The aim is to evaluate the effect of pre-bent Z-shaped titanium plate on the narrowing of the zygomatic arch in L-shaped reduction malarplasty.Methods:Thirty cosmetic female patients were selected and scanned using computed tomography (CT). The CT images of pre-operation (T1) and post-operation(T2) were re-established through MIMICS26.0 (Materialise). After the 2 images were registered based on the skull base, the narrowing distance (ZRN) at the posterior end of the free zygomatic arch, as well as the preoperative and postoperative cross-sectional dimensions of the zygomatic arch, were measured. The ZRN and the altitude of the pre-bent titanium plate (TA) were compared using an independent t test, and their correlation was also analyzed using the Pearson coefficient. The preoperative and postoperative longest diameter (L1) and shortest diameter (L2) of the posterior zygomatic arch were compared using a paired t test.Results:The TA was 3.80 +/- 0.82 mm and the ZRN was 3.21 +/- 0.82 mm. The difference value was 0.59 +/- 0.41 mm, which was statistically significant. TA showed a strong correlation with ZRN (r=0.916, P=0.002). The L1 and L2 of the zygomatic arch root were slightly reduced postoperatively.Conclusion:The pre-bent Z-shaped titanium plate does not completely correspond to the zygomatic arch narrowing distance in the actual application of L-shaped reduction malarplasty. However, it can control the narrowing distance of the zygomatic arch predictably, and achieve satisfactory surgical outcomes.

Craniofacial microsomia (CFM) involves complex skeletal asymmetries, including mandibular and zygomatic arch deficiencies, leading to facial deformities and occlusal cant. Current animal models inadequately replicate these features, hindering the development of customized temporomandibular joint prostheses for CFM. This study aimed to develop a miniature pig model that mimics the proportional craniofacial skeletal defects observed in severe CFM, serving as a platform for future TMJ reconstruction studies. Three miniature pigs underwent preoperative CT imaging and digital surgical planning. Proportional mandibular ramus and zygomatic arch defects were created on the surgical side to reflect measurements from clinical CFM patients. Craniofacial morphology, masticatory efficiency, and maximum mouth opening (MMO) were assessed preoperatively and postoperatively at 3 and 13 weeks. At 13 weeks, craniofacial asymmetry closely resembled CFM. The ramus height and zygomatic arch surgical side to nonsurgical side ratios were reduced by 30% ( P = 0.003) and 52% ( P = 0.003), respectively, compared with preoperative values. Despite significant occlusal plane cant ( P = 0.011), maxillary height and chin deviation showed nonsignificant changes. Functional outcomes, including MMO and masticatory efficiency, were preserved. This model successfully replicates craniofacial skeletal defects characteristic of severe CFM. It offers a quantitative framework for testing TMJ prostheses, advancing reconstructive approaches for craniofacial deformities.

The primary aim of our study was to investigate the genetic correlations, colocalized genes, and causal relationships between craniofacial microsomia (CFM) and 33 diseases (including tumours and respiratory, heart, and kidney diseases). On the basis of extensive summary-level data from genome-wide association studies (GWASs), we evaluated the genetic linkage between CFM and a spectrum of 33 medical conditions using linkage disequilibrium score regression (LDSC). We employed PLACO to identify pleiotropic loci and genes associated with CFM and other diseases. These genes were subsequently subjected to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Finally, the causal effect of CFM on the 33 diseases was assessed through Mendelian randomization (MR). We observed a genetic association between CFM and malignant lymphoma, thyroid cancer, and chronic obstructive pulmonary disease. The PLACO analysis identified 172 potential multi-effect loci (P < 5 × 10- 8). Furthermore, the MAGMA analysis of colocalized single nucleotide polymorphisms (SNPs) revealed that 1,760 SNPs shared genes (P < 0.05/18,345 = 2.726e-6). KEGG analysis revealed enrichment of these genes in the calcium signalling pathway. Finally, Mendelian randomization (MR) analysis suggested that CFM may reduce the risk of developing urolithiasis (IVW: OR = 0.989, 95% CI = 0.979-0.999, p = 0.034). Our study reveals for the first time the genetic associations of CFM with three diseases (malignant lymphoma, thyroid cancer and chronic obstructive pulmonary disease) in an Asian population. In addition, we found a common calcium signalling pathway between these three diseases and CFM. These results provide new insights into the pathogenesis and research potential of CFM.

Craniofacial microsomia (CFM) is the second most common congenital craniofacial deformity, presenting diverse clinical manifestations and treatments that may influence oral bacteria dysbiosis (OBD). However, research linking CFM to OBD is limited. Saliva samples were collected from 20 patients with CFM and 24 controls. We compared oral microflora and gene function using 16 S ribosomal RNA sequencing and metagenomics. We also evaluated the correlation between CFM clinical phenotypes and microbiota community structure. Patients with CFM demonstrated greater richness and evenness in their oral microflora. The dominant genera included several pathogenic species, such as Actinomyces, Fusobacterium, and Prevotella. Notably, the severity of CFM correlated positively with the abundance of Neisseria and Porphyromonas. Upregulated pathways were primarily linked to biotin and amino acid metabolism, such as Tryptophan metabolism and Lysine degradation, and further underscored the need for focused oral health interventions in this population. This study is the first to indicate that CFM patients exhibit unique oral bacterial dysbiosis, marked by a higher presence of opportunistic pathogens and increased pathways related to oral and systemic health. These findings highlight the importance of monitoring oral health in patients with CFM.

Congenital meningoencephalocele is a rare condition where brain tissue and meninges protrude through a skull defect, often requiring complex surgical management. The authors report the case of a 14-year-old female with a frontoethmoidal meningoencephalocele, presenting with a progressively enlarging nasal mass since birth. Preoperative imaging revealed significant cranial base defects and brain herniation. A multidisciplinary team, including plastic surgery, neurosurgery, and otolaryngology, decided on a combined intracranial and extracranial approach. The surgery involved resection of the encephalocele, dura repair, and reconstruction of the cranial base using autologous bone grafts. Endoscopic techniques were used to create a drainage channel to manage the large bony cavity. Prophylactic cerebrospinal fluid (CSF) drainage was used to prevent CSF leakage. Postoperative recovery was uneventful, with no signs of infection or CSF leakage. Follow-up imaging showed proper cranial repair, and the patient had excellent functional and aesthetic outcomes. This case highlights the value of a multidisciplinary approach and advanced surgical techniques in managing rare and complex craniofacial anomalies.

Objective:Parry-Romberg syndrome (PRS) is an acquired disease characterized by progressive unilateral atrophy of the facial skin, subcutaneous tissue, muscle, and bone. There are various hypotheses to try to explain the occurrence of the disease, but the specific etiology and pathogenesis remain unclear. This study aimed to explore the potential molecular pathogenesis of the disease by using next-generation RNA-sequencing technology.Methods:The authors collected oral mucosal tissue from the affected side and the healthy side from 3 patients with PRS. Tissue samples were subjected to RNA extraction, whole transcriptome sequencing, and bioinformatics analysis. Differentially expressed genes were obtained from both groups of samples and then analyzed for functional enrichment.Results:A total of 186 differentially expressed genes were screened from the 2 groups of samples. Compared with the healthy side, several immune-related genes, including immunoglobulin kappa variable (IGKV)2D-28, IGKV1D-33, IGKV1-33, and NLRP10, were significantly upregulated in the affected tissue. In addition, the differential genes were significantly enriched in metabolic pathways including pancreatic secretion, protein and fat digestion, and absorption.Conclusions:The authors described the gene expression differences between the affected and healthy tissues of patients with PRS for the first time. Immune responses may play a role in the pathogenesis of PRS.

ObjectiveTo characterize mandibular morphology in patients with Parry-Romberg syndrome (PRS).DesignRetrospective study.SettingA craniofacial center.PatientsThirty-three patients with PRS affecting mandible.InterventionsPreoperative computed tomography data were analyzed using Mimics 26.0 (Materialise Inc.). Distances between landmarks-condyle process (Con), coronoid process (Cor), mandibular foramen (IAF), gonion (Go), and mental foramen-were measured to represent the sizes of skeletal units. Positional asymmetry was reflected by angles between lines connecting bilateral landmarks and the occlusal plane.Main outcome measure(s)Bilateral differences in unit sizes were compared. Absolute difference (Δ) > 5 mm and relative size (RS) < 80% were set to evaluate the severity of hypoplasia. Angular measurements were compared to 0° using one-sample t tests. Pearson correlation analysis was conducted to examine the relationship between onset ages and both RS and angular measurements.ResultsThe affected side's skeletal units were smaller. Severe hypoplasia was more common in the angular unit. Angles between Con-Con', Cor-Cor', IAF-IAF', and the occlusal plane were less than 0°, whereas the angle with Go-Go' was greater than 0°. Age of onset was positively correlated with the condylar unit size and the Con-Con' to occlusal plane angle.ConclusionsPatients with PRS affecting mandible exhibit smaller skeletal units on the affected side, particularly in the angular unit. Most landmarks on affected side tend to cluster toward the occlusal plane. Earlier onset of PRS correlates with more pronounced condylar asymmetry. Evaluating the severity of functional units involvement and implementing appropriate treatment should be considered.