It checks for the alignment of the soft tissue nasion, the middle part of the upper lip at the vermillion border, and the chin point. If present, it is necessary to distinguish between a false and true asymmetry. A false asymmetry arises due to occlusal interferences, which results in a lateral displacement of the mandible, producing a cross-bite in the anterior/buccal region. Elimination of the displacement will return the mandible to a centric position. On the other hand, a true asymmetry indicates unequal facial growth on the left or right side of the jaws. Elimination of any occlusal cross-bites is not only difficult, but unlikely to improve the facial asymmetry. The assessment of the transverse components of the facial width is best described by the "rule of fifths", which sagittally divides the face into five equal parts:
Each transverse fifth should be an eye distance in width. The middle fifth is marked by the inner canthus of both eyes. The medial three-fifths of the face is marked from the outer canthus of the eye frames
The outer two-fifths of the face is measured from the lateral canthus to lateral helix of the ear, which represents the width of the ears. Tests
It is insufficient to derive at a diagnosis of jaw deformity solely based on the clinical examination. Hence, additional information is gathered from diagnostic tests, which may include dental model analyses and radiographic imaging studies. Dental Model Analyses - Study models for analysis can be made by taking dental impressions, or by 3D intra-oral scanning.
These findings include a "corkscrew" appearance of arteries that result from vascular damage, particularly the arteries in the region of the wrists and ankles. Collateral circulation gives "tree root" or "spider leg" appearance. Angiograms may also show occlusions (blockages) or stenosis (narrowings) in multiple areas of both the arms and legs. Distal plethysmography also yields useful information about circulatory status in digits. To rule out other forms of vasculitis (by excluding involvement of vascular regions atypical for Buergers), it is sometimes necessary to perform angiograms of other body regions (e.g., a mesenteric angiogram).Skin biopsies of affected extremities are rarely performed because of the frequent concern that a biopsy site near an area poorly perfused with blood will not heal well. Prevention
The cause of the disease is thought to be autoimmune in nature and heavily linked to tobacco use in patients with Buergers as primary disease. Treatment
Smoking cessation has been shown to slow the progression of the disease and decrease the severity of amputation in most patients, but does not halt the progression. In acute cases, drugs and procedures which cause vasodilation are effective in reducing pain experienced by patient. For example, prostaglandins like Limaprost are vasodilators and give relief of pain, but do not help in changing the course of disease. Epidural anesthesia and hyperbaric oxygen therapy also have vasodilator effect. There is moderate certainty evidence that intravenous iloprost (prostacyclin analogue) is more effective than aspirin for relieving rest pain and healing ischemic ulcers.