Correlation Between Volumetric Soft Tissue Asymmetry and Postero-Anterior Cephalometric Measurements in Patients with Skeletal Facial Asymmetry: A Cross-Sectional Pilot Study

<b>Background/Objectives:</b> While skeletal facial asymmetry is commonly assessed using posteroanterior (PA) cephalometric radiographs, the association between skeletal measurements and volumetric soft tissue asymmetry remains unclear. This study aimed to identify which skeletal parameters are most strongly correlated with soft tissue asymmetry measured using three-dimensional (3D) imaging. <b>Methods:</b> Thirty-three Japanese patients (8 males and 25 females; mean age: 26.85 ± 12.13 years) undergoing orthodontic-orthognathic treatment were included. Three-dimensional facial surface data were acquired using the VECTRA^® H1 imaging system. Soft tissue asymmetry was quantified by calculating the volumetric difference between the original and mirrored 3D facial images, divided into three regions: whole face, midface, and lower face. PA cephalometric radiographs were traced, and 28 skeletal variables were measured. Pearson correlation coefficients were calculated between skeletal variables and asymmetry volumes and squared to obtain R² values. <b>Results:</b> The strongest correlation with whole facial soft tissue asymmetry was found for menton deviation from the midline (R² = 0.630). Similar trends were observed for the lower face. In contrast, only one skeletal variable showed a moderate correlation with midfacial asymmetry (maximum R² = 0.186), and skeletal parameters related to maxillary occlusal cant did not show significant associations. <b>Conclusions:</b> Volumetric soft tissue asymmetry is strongly associated with mandibular skeletal deviation, particularly menton displacement, whereas midfacial skeletal morphology may have a limited impact. Further studies including more patients with pronounced midfacial soft tissue asymmetry are warranted.