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Facial Asymmetry in Right- and Left-Handed Men and Women

Papatya KelesL a; Semíh Díyarbakirli a; Melíha Tan b; Üner Tan b
a
Department of Anatomy, Medical Faculty, Ataturk University, Erzurum, Turkey b Department of Physiology,
Medical Faculty, Ataturk University, Erzurum, Turkey

Online Publication Date: 01 October 1997

To cite this Article KelesL, Papatya, Díyarbakirli, Semíh, Tan, Melíha and Tan, Üner(1997)'Facial Asymmetry in Right- and Left-
Handed Men and Women',International Journal of Neuroscience,91:3,147 — 159
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FACIAL ASYMMETRY IN RIGHT- AND

LEFT-HANDED MEN AND WOMEN
PAPATYA KELES and SEMfH DfYARBAKIRLI

Department of Anatomy, Medical Faculty, Ataturk University, Erzurum, Turkey

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MELfHA TAN and UNER TAN

Department of Physiology, Medical Faculty, Ataturk University, Eriurum, Turkey

(Infinal form Iddugitst 1996)

A posteroanterior cephalometric radiographic study was performed on the right- and left-handed men
and women with normal occlusion. A posteroanterior cephalometric radiography was conducted in
these subjects. Method of triangulation was used to measure various face areas. The surface areas of
these triangles were compared with their equivalents on the contralateral side. Sex and its interactions
with handedness and side were significant factors influencing facial areas. Areas on the left were
found to be significantly larger than those on the right in right-handers. Left-handers were inconsistent
in facial asymmetry, but they tended to have larger facial areas on the right than the left. Sex was espe-
cially significant for left-handers. It was suggested that an asymmetric development in some brain
regions may be responsible for the development of asymmetric facial regions.

Keywords: Face; asymmetry; handedness; facial asymmetry; sex; human

INTRODUCTION

There is a left occipital and right frontal prominence in about 90-95% of human
skulls, which was established in healthy fetuses, infants, and adults (see Coffin,
1986). Trenouth (1984) reported that there is a left side expansion of the human
skull during fetal growth, which may be caused by unequal development of the
cerebral hemispheres, especially of the left temporal lobes. This suggests that

Address correspondence to Prof. Dr. Uner Tan, Director, Department of Physiology, Medical Faculty,
Atatiirk University, Erzurum, Turkey. Fax: +90 442 234 50 28. E-mail: unertan@superonline.com.
Prof. Dr. Uner Tan is the professional member of the Turkish Academy of Sciences.

147
 1-18 P. KELES et a1

asymmetry in human skull originates in prenatal period. Moreover, about two

thirds of humans possess a slightly larger left facial region (Burke, 1971;
Lundstrom, 1961; Vig & Hewitt. 1975). Burke (1971) and Mulick (1965) reported
that the maxillary regions were larger on the left side than the right side. However,
there are equivocal results in the literature concerning this issue. For instance,
some authors reported a right-biased facial asymmetry in normal human subjects
(Farkas & Cheung. 1981; Shah & Joshi, 1978). Sex and age did not significantly
influence the extent or prevalence of the facial asymmetries (Figalova, 1969;
Farkas & Cheung. 198 1 ).
Handedness and its interaction with sex were not considered in the above stud-
ies. As mentioned above, the asymmetries on the human-skull would depend on
cerebral lateralization. Accordingly. Trenouth ( 1984) suggested that asymmetry
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in human skull would be caused by unequal development of the cerebral hemi-

spheres. To assess the cerebral lateralization, hand preference can be taken as an
indirect index. Consequently, the facial asymmetry was re-studied in the present
work. considering the sex and hand preference of the subjects.

METHODS

The subjects were 40 women and 40 men, ranging in age between 21 and 35 years
with a mean of 24 years and 8 months. They all originated from the Eastern
Turkey and did not show any deviation of the mandible on opening and closing
(normal occlusion 1. Hand preference was assessed by Edinburgh Handedness
Inventory (Oldfield. 197 1 ). Subjects having Geschwind Scores (Tan, 1988)
greater than zero were considered as right-handed and those with Geschwind
Scores less than zero as left-handed. There were 20 right-handed men, 20 left-
handed men. 20 right-handed women, and 20 left-handed women.
To measure the surface areas of the facial regions, posteroanterior radiographic
cephalometric method was used (see Shah & Joshi. 1978). The head of the sub-
ject\ was fixed in the horizontal plane. The central ray of X-rays passed through
the center of the midsagittal plane. In doing so. the right and left sides of the face
had the same magnification.
To assess the asymmetry in the component areas of the facial complex, the right
and left sides of the face was divided into several triangles (triangulation). The fol-
lowing triangles were drawn on the cephalograms (see Fig. 1): Triangle A,
between the extreme superior extent of the head of the condyle. mesial extent of the
head of the condyle and sella (cranial base); Triangle B, between cella, mastoidale
and the root of zygoma (lateral maxillary region); Triangle C , joining sella, ante-
rior nasal spine and the root of the zygoma (upper maxillary region); Triangle D,
 FACIAL ASYMMETRY 149
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FIGURE 1 Triangulation of the human face. A: cranial base; B: lateral maxillary region; C:
upper maxillary region; D: middle maxillary region; E: lower maxillary region: F: dental region;
G: mandibular region.

drawn between the root of zygoma, upper molar points and the anterior nasal spine
(middle maxillary regions); Triangle E, joining anterior nasal spine, upper molar
points and the point of intersection of a line drawn between the bilateral upper molar
points and the arbitrary anatomical axis (lower maxillary regions); Triangle F,
drawn between upper molar points, upper incisal point and the point of intersec-
tion of a line joining the upper molar points and the anatomical axis (dental
regions); Triangle G, drawn between the condylar points, gonion, and menton
(mandibular component of the face).
The statistical analyses were performed using a software (Systat 5.01 for win-
dows). ANOVA was performed to assess the influence of various factors on facial
areas. The significance of the mean differences was then evaluated using Fisher’s
Least-Significant-Difference Test (pairwise mean differences). Odds Ratios were
computed to compare the proportions.
 150 P. KELES et al.

RESULTS

Total Facial Area (A+B+C+D+E+F+G+)

According to the results of ANOVA. the following factors and interactions were
significant for the total face surface: sex (F = 506.8, p < .001), sex*handedness
~ .05),handedness*side (F = 1 8 . 1 , ~< .001),
(F = 7.0.p < .Ol), sex*side (F = 4 . 7 , <
sex*handedness*side (F= 4.7, p < .05). Side alone was not significant for the total
face area (F = 2.6, p > .05). Table I shows the results of ANOVA.
The mean total areas were found to be 3243.2 mm2 (SD = 263.9) and 4133 mm2
(SD = 385.7) for women and men, respectively. The mean facial area in the right-
handed men was significantly greater than that in the left-handed men ( p = .004).
There was no significant difference between the total facial areas of the right- and
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left-handed women ( p = .39).

Table I1 shows the mean facial areas in the right- and left-handed men and
women. In right-handers. the mean facial area on the left was significantly
greater than that on the right ( p = .000). In left-handers, the mean facial area on
the right was found to be greater than that on the left, but the difference was only
marginally significant ( p = .064).

TABLE I Results of A N O V A for Various Face Areas

Areus Fucror-s F Cr-aiiial P

Area A (Cranial base) Sex 41.5 0.000
Handedness*sex 4.6 0.034
Handedness*side 3.8 0.000
Area B (Lateral Maxillary) Sex 246.0 0.000
Side * handedness 34.2 0.000
C (Upper Maxillary) Sex 130.3 0.000
Handedness 24.1 0.000
Sex*Handedness 8.0 0.005
Handedness*Side 12.3 0.001
D (Middle Maxillary) Sex 70.5 0.000
Handedness 7.3 0.008
Sea*Handedness 14.3 0.000
E (Lower Maxillary) Sex 94.0 0.000
Handedness 6.3 0.013
Side*Sex 4.2 0.043
F (Dental Region) Sex 116.9 0.000
Side 4.2 0.042
Handedness 36.2 0.000
Side*Handedness 5.8 0.017
G (Mandibular) Sex 229.3 0.000
Sex 4.2 0.042
Side*sex 13.6 0.000
Sex*Handedness 5.8 0.018
Side*Sex*Handed 5.6 0.019
 FACIAL ASYMMETRY 151

TABLE I1 Mean ares (mm2) of different facial regions in the right- and left-handed men and women

ReZion M(RH) SD MILH) SD W(RH) SD WfLH) SD

A
(Cranial base)
Right side 222.5 34.7 249.5 50.8 153.2 58.9 195.1 39.9
Left side 249.5 36.0 212.8 47.1 195.1 48.1 192.7 44.2
Right-left -26.9 18.0 30.1 30.2 41.8 37.8 8.3 27.2
B Lateral maxillary
Right side 617.6 95.3 688.7 37.6 415.0 32.3 483.4 88.6
Left side 658.2 102.2 583.0 86.1 475.8 62.6 403.4 83.8
Right-left 40.6 20.7 105.6 71.0 -60.8 75.4 80.0 77.3
C Upper maxillary
Right side 618.3 49.8 683.3 31.1 554.4 53.4 604.0 36.8
Left side 640.3 45.6 680.6 30.7 587.1 56.2 566.0 31.7
Right-left -22.0 33.1 2.7 22.9 -32.7 34.9 38.0 22.8
D Middle maxillary
Right side 364.5 77.8 313.4 41.9 264.4 28.5 287.1 49.9
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Left side 394.3 81.7 329.5 67.4 276.5 30.5 273.2 48.2
Right-left -29.8 14.5 -16.0 49.5 -12.2 27.7 13.9 11.3
E Lower maxillary
Right side 347.4 60.6 320.6 31.2 263.4 28.4 276.1 31.3
Left side 350.8 64.5 317.9 36.5 281.1 31.3 262.1 28.6
Right-left -3.4 9.8 2.8 25.9 -17.7 9.5 14.1 4.2
F Dental region
Right side 168.4 28.0 144.3 28.9 106.6 22.0 98.1 31.9
Left side 175.7 29.1 145.1 29.8 139.5 26.5 94.1 31.1
Right-left -7.3 8.0 -0.8 19.0 -32.9 19.9 4.0 1.2
G Mandibular
Right side 1759.8 118.3 1626.3 142.7 1346.1 137.0 1455.5 192.0
Left side 1860.0 164.0 1817.4 128.6 1380.2 184.1 1338.2 155.5
Right-left -101.4 147.6 -191.1 86.3 -34.1 72.0 117.3 55.4
Total surface area
Right side 4098.4 284.7 4019.4 204.5 3102.4 211.7 3405.1 292.7
Left side 4329.9 329.5 4086.1 223.8 3335.2 175.5 3129.6 239.8
Right-left -23 1.5 146.8 -66.7 99.2 -232.3 74.6 275.5 111.9
Total maxillary area
Right side 1947.7 29.6 2006.0 29.6 1497.1 29.6 1650.6 29.6
Left side 2043.5 29.6 1910.9 29.6 1620.5 29.6 1504.7 29.6
Right-left -95.8 18.7 95.1 18.7 -123.4 18.7 146.0 18.7
~ ~~~~

M: men; W: women: RH: right-handed; LH: left-handed

In right-handed men, the mean facial area on the left was significantly greater
than that on the right ( p = .004). In left-handed men, there was no significant dif-
ference between the mean facial areas from the right and left sides ( p = .40). In
right-handed women, the mean facial area from left was significantly greater than
that from right ( p = .004); vice versa in left-handed women ( p = .001).

Total Maxillary Area (Triangles B+C+D+E)

Only the sex and its interaction with handedness were significant factors influenc-
ing the total maxillary area (sex: F = 381.2, p < .001; sex*handedness: F = 30.2,
 151 P. KELES et a1

p < .OO 1 ). The total maxillary area was significantly larger in men than women
(11 < .001). In right-handers, the left maxillary area was significantly larger than
the right maxillary area ( p c .001). In left-handers, the right maxillary area was
significantly larger than the left maxillary area ( p < .001). Side, handedness,
side*sex, sex*handedness, and side*sex*handedness were not significant factors
influencing the total maxillary area.

Area A (Cranial Base)

The mean Area A was significantly larger in men than in women ( p < ,001). This
area u a s significantly larger in left-handed women than in right-handed women
( p = .028). There was no significant difference between Area As in the right- and
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left-handed men ( p > .05).In right-handers, the area A from left was significantly
larger than that from right ( p = ,001).In left-handers, the Area A from right was
significantly larger than that from left, but the difference was only marginally sig-
nificant ( p = .061). Handedness, side, sex*side, and handedness*sex*side were
not significant factors influencing Area A.

Area B (Lateral Maxillary)

The mean area B was significantly larger in men that in women ( p < ,001). In
right-handers, this area on the right was significantly larger than that on the left
( p = ,004).The mean area B from right was significantly larger than that from left
in left-handers ( p = .OOO). Side, handedness. sex*side, sex*handedness, and
sex*side*handedness were not significant factors.

Area C (Upper maxillary)

The mean facial area C was significantly larger in males than that in females
( P < ,001). It was significantly larger in left-handed men than in right-handed men
( p = ,000).There was no significant difference between the mean Area Cs in the
right- and left-handed men ( p > .OS). In right-handers, the left Area was signifi-
cantly larger than the right Area C ( p = ,005).In left-handers, the mean area C on
the right was significantly larger than that on the left ( p = ,036). Side, sex*side,
and sex*handedness*side were not significant.

Area D (Middle Maxillary)

The mean area D was significantly larger in males than that in females ( p < .001).
It was significantly larger in right-handers than that in left-handers ( p = .008).
 FACIAL ASYMMETRY 153

Moreover, the mean area D was significantly larger in right-handed men than that
in left-handed men ( p = .OOO). There was no significant difference between the
mean Area Ds of the right- and left-handed women ( p > .05).
Side, hand*side, sex*side, and handedness*sex*side were not significant.

Area E (Lower Maxillary)

The mean area E was significantly larger in men than that in women ( p = .OOO). It
was significantly larger in right-handers than that in left-handers ( p = .013). It was
significantly larger in the male right-handers than that in the male left-handers
( p < .002). There was no significant difference between the mean Area Es in the
female right- and left-handers ( p > .05). Side, handedness*side, sex*side, and
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handedness*sex*side were not significant.

Area F (Dental Region)

The mean area F was significantly larger in males than females (P = .OOO). It was
also significantly larger in right-handers than that in left-handers ( p = .OOO). In
right-handers, the mean Area F from the left side was significantly larger than that
from the right side ( p = .002). There was no significant difference between the
right and left Area Fs in left-handers ( p > .05). Side, handedness*sex, sex*side,
and handedness*sex*side were not significant.

Area G (Mandibular)
The mean area G was significantly larger in males than that in females ( P = .OOO).
There was no significant difference between the Area Gs of the right- and left-
handed women. The mean Area G was significantly larger in right-handed men
than in left-handed men ( p = .015). In the right-handed women, there was no sig-
nificant difference between the right and left Area Gs ( p > .05). In the right-
handed men, the left Area G was larger than the right Area G, but it was only
marginally significant ( p = .049). In the left-handed women, the mean Area G on
the right was significantly greater than the mean Area G on the left ( p = .023). In
the left-handed men, the left Area G was found to be significantly greater than the
right Area G ( p = ,000). Handedness and handedness*side were not significant.

Proportions of Subjects with R > L, R c L, and R = L Facial Areas

Table I11 shows the proportions of the right- and left-handed subjects with
R > L, R < L, and R = L facial areas. The numbers of the subjects with L > R
 I51 P. KELES et a1

(Mean = 96.6%) facial areas including the total facial, total maxillary, and single
areas significantly exceeded those with R > L areas in the right-handed subjects.
The results with the left-handers were not consistent, however (see Table 111). For
instance, the number of the left-handed men with L > R total facial areas signifi-
cantly exceeded that with R > L areas for the total facial area and Area G, as in
the right-handers. In some left-handers. there was no significant difference
between the right and left halves of the facial areas (total facial area: left-handers,
Area C: left-handed men and women, Area D: left-handers. Area E: left-handers
and left-handed men, and Area F: left-handed men). The mean proportions of the
left-handed subjects with R > L, R < L. and R = L facial areas were 68.2%,
76.5%. and 5.3%. respectively.
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TABLE 111 Frequenc) of R > L. R < L. and R = L Facial Regions in the Right- and Left-Handed
Subject5

Facial (Total)
Right-Handers 40 2 (5.0%) 38 (95.0%) 0 (0.0%) 61.3 ,000
Left-Handrrs 40 24 (60.0%1 16 1400%) 0 (0.0%) 2.5 .I20 (NS)
Women ( R H ) 20 0 (0.0%) 20 (100.0%) 0 (0.0%) 36.1 -000
Women ( L H ) 20 20 ( 100.0%) 0 (0.0%) 0 (0.09) 36.1 ,000
hlen ( R H ) 20 2 ( 10.0%) 18 (90.0%) 0 (0.0%) 22.5 ,000
Men (LH) 70 4 (20.0%) 16 (80.0%) 0 ( 0 . 0 9 ) 12.1 ,001
Maxillary (Totali
Right-Handers 30 1 (2.5%) 37 192.5%) 2 (5.0%) 68.5 ,000
Left-Handers 40 35 (87.5%) 4 (19.0%) 1 (2.5%) 48.1 ,000
Women (RH 1 20 1 (5.0%) 19 195.0%) 0 (0.0%) 28.9 ,000
Women (LH 1 20 20 (100.09) 0 (0.0%) 0 (0.0%) 36.1 ,000
Men (RH) 20 0 (0.0'7r) 18 (90.07r) 2 (10.0%) 22.5 ,000
Men ( L H ) 20 I5 (75.0%) 4 (20.0%) 1 (5.0%) 8.1 ,004
Cranial Base ( A i
Right-Handers 40 0 (0.0%) 35 (87.5%) 5 (12.5%) 42.1 -000
Left-wanders 40 31 (77.5%) 5 (12.5%) 4 ( 1 0 . 0 9 ) 22.1 -000
Women (RH) 20 0 (0.0%) 18 (90.6) 2 (10.0%) 22.5 .000
Women ( L H ) 20 14 (70.0%) 4 (20%) 2 (10.0%) 4.9 ,030
Men (RH) 20 0 (0.0%) 17 (85.05) 3 (15.0%) 16.9 ,000
Men (LH) 20 17 (85.0%) 1 ( 5 . 0 0 ) 2 (10.0%) 16.9 ,000
Lat.Maxillary (B)
Right-Handers 40 3 (7.5%) 37 (92.5'il) 0 (0.0%) 54.5 ,000
Left-Handerb 30 20 (70.0%) 10 (25.0%) 2 (5.04,) 11.3 .001
Women (RH I 20 2 ( 10.0%) 18 (90.0%) 0 (0.0%) 22.5 ,000
Women ( L H ) 20 I4 (70.04) 6 (30.0%) 0 (0.0%) 4.9 ,030
Men (RH) 20 I (5.0%) 19 (95.0%) 0 (0.0%) 28.9 ,000
Men (LH) 20 16 (80.0%) 2 (10.0%) 2 (10.0%) 12.1 ,001
Lipper Maxillary ( C )
Right-Handers 40 3 (7.55%) 34 (85.09) 3 (7.5%) 36.5 .OOO
Left-Handera 40 31 (77.5%) 7 (17.50%) 2 (5.070) 22.1 ,000
Woinen (RH j 20 I (5.0%) 18 (90.0%) 1 (5.0%) 22.5 .OOO
Women (LH 1 20 20 ( 100.0%) 0 (0.0%) 0 (0.0%) 0.05 ,820 (NS)
.Men ( R H ) 20 2 (10.0%) 17 (85.04) 1 (5.0%) 16.9 ,000
Men (LH I 20 11 (55 0 % ) 7 (35.0%) 2 (10.0%) 0.10 -750 (NS)
 FACIAL ASYMMETRY 155

TABLE 111 (Continued )

Areas and Subjects N R>L R<L R=L x2 P

Middle Maxillary (D)
Right-Handers 40 3 (7.5%) 36 (90.0%) 1 (2.5%) 48.1 ,000
Left-Handers 40 24 (60.0%) 13 (32.5%) 3 (7.5%) 2.5 .120(NS)
Women (RH) 20 2 (15.0%) 16 (80.0%) 1 (5.0%) 12.1 ,001
Women (LH) 20 19 (95.0%) 1 (5.0%) 0 (0.0%) 28.9 ,000
Men (RH) 20 0 (0.0%) 19 (95.0%) 1 (5.0%) 28.9 .OO
Men (LH) 20 5 (25.0%) 12 (60.0%) 3 (15.0%) 8.1 .oo
Lowere Maxillary (E)
Right-Handers 40 2 (5.0%) 35 (87.5%) 3 (7.5%) 42.1 ,000
Left-Handers 40 24 (60.0%) 12 (30.0%) 4 (10.0%) 4.5 .120(NS)
Women (RH) 20 0 (0.0%) 19 (95.0%) 1 (5.0%) 28.9 ,000
Women (LH) 20 19 (95.0%) 0 (0.0%) 1 (5.0%) 28.9 ,000
Men (RH) 20 5 (10.0%) 16 (80.0%) 2 (10.0%) 12.1 .001
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Men (LH) 20 5 (25.0%) 12 (60.0%) 3 (15.0%) 0.90 .340(NS)

Dental Regions (F)
Right-Handers 40 1 (2.5%) 36 (90.0%) 3 (7.5%) 48.1 ,000
Left-Handers 40 27 (67.5%) 9 (22.58) 1 (2.5%) 6.1 ,014
Women (RH) 20 0 (0.0%) 19 (95.0%) 1 (5.0%) 28.9 ,000
Women (LH) 20 20 (100.0%) 0 (0.0%) 0 (0.0%) 36.1 ,000
Men (RH) 20 1 (5.0%) 17 (85.0%) 4 (20.0%) 16.9 ,000
Men (LH) 20 7 (35.0%) 9 (45.0%) 4 (20.0%) 2.5 .lIO(NS)
Mandibular (G)
Right-Handers 40 5 (12.5%) 34 (85.0%) 1 (2.5%) 36.5 ,000
Left-Handers 40 20 (50.0%) 20 (50.0%) 0 (0.0%) 36.1 ,000
Women (RH) 20 3 (15.0%) 16 (80.0%) 1 (5.0%) 12.1 ,001
Women (LH) 20 20 (100.0%) 0 (0.0%) 0 (0.0%) 36.1 ,000
Men (RH) 20 2 (10.0%) 18 (90.0%) 0 (0.0%) 22.5 .OOO
Men (LH) 20 0 (0.0%) 20 (100.0%) 0 (0.0%) 36.1 ,000
RH: right-handed; LH: left-handed

DISCUSSION

As mentioned above, the previous attempts to elucidate the facial asymmetries in

humans yielded controversial results. These studies did not consider the hand pref-
erence of subjects. This would be the reason of controversial results. The results of
the present work supported this proposition. Accordingly, sex, handedness, and
their interactions were found to be significant factors influencing facial asymme-
tries. According to sex and hand preference of the subjects, a right-dominance, left-
dominance, or ambilaterality were established in facial laterality. So, the results of
the present work were not in accord with those from previous studies.

Right-Handers
The left side was significantly larger than the right side in the right-handed sub-
jects. This was true for the total facial area, total maxillary area, Area A, B, and C.
 156 P. KELES et al

Area D and E did not exert significant asymmetries. However, the number of the
right-handed men and women with L > R Area D and E significantly exceeded
those with R > L Area D and E. In Area G, the facial asymmetry depended on sex.
Namely. this area was symmetrical in women, but asymmetrical in men (L > R).
However, the proportion of women with L > R Area Gs significantly exceeded
that with R > L. These results imply a left dominance in facial asymmetry in the
right-handed men and women.
The left-shifted facial asymmetry in right-handers may be accounted for by the
asymmetrical development of the brain (Woo. 1931; Brash & McKeag, 1956). In
accord. Trenouth ( 1984) reported a left side expansion of the human skull during
fetal growth. which would be caused by unequal development of the cerebral
hemispheres, especially of the temporal lobes. Trenouth ( 1983) also argued that
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the development of the temporal lobes might be responsible for flattening out of
the cranial base and anterior displacement of the nasomaxillary segment; the
greater development of the temporal lobes on the left would cause a greater dis-
placement of the nasomaxillary segment on the left.
The above mentioned considerations suggest that the morphological asymme-
tries in the brain would be responsible for a left shift in facial asymmetries in
right-handers. Accordingly. a left dominance in various cerebral asymmetries is
obvious in right-handers. For instance. the sylvian fissure is generally longer on
the left side in humans (Rubens. 1977) and even in cats (Tan, 1992b; Tan &
Kutlu. 1992. 1993). The left planum temporale, especially the superior portion of
the superior temporal gyms (Chi et al. 1977), and the left parietal operculum
(LeMay & Culebras, 1972) are larger than the right in a majority of cases.
Moreover, the left hemisphere's anteroparietal and posterooccipital regions are
larger than their counterparts (Chui & Damasio, 1980). Broca's area is also larger
on the left than the right side (Falzi et al. 1982). These results were valid for, espe-
cially. right-handers.
In 96.6% of right-handers. the left facial areas were larger than the right. The
dependence of this facial asymmetry on the left hemisphere dominance for speech
in right-handers is also supported by the fact that almost all right-handers were
left-hemisphere dominant for speech (Milner, 1974; Rasmussen & Milner, 1977).

Left-Handers
The facial asymmetries in left-handers were not quite opposite to right-handers.
In general. the right facial areas tended to be larger than the left facial areas in
these subjects. However. the differences were either marginally significant or
insignificant. The asymmetry in Area G of men even resembled to that seen in
right-handers. i.e.. the mean Area G on the left was significantly greater than that
 FACIAL ASYMMETRY 157

on the right. In general, the facial areas on the right were larger than those on the
left in 68.2% of left-handers, vice versa in 26.5%, and no difference in the remain-
ing 5.3% of left-handers.
The inconsistency in facial lateralization of left-handers is, in fact, a general
feature of left-handers in cerebral lateralization. The right shift theory (Annett,
1985) suggests that an inconsistent cerebral lateralization may be observed in
some of the left-handers, if there is no right-shift gene to produce language on the
left brain. The inconsistency of cerebral laterality in left-handers was also
reported for dichotic listening and visual field asymmetries (see Iaccino, 1993).
These relations between facial and other asymmetries in left-handers support the
hypothesis that cerebral lateralization may be essential for facial asymmetry.
These peculiar characteristics of left-handers were best described by Galaburda
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et al. (1978). These authors stated that “(i) brains without a particular asymmetry
are more common in the left-handed; (ii) the left-handed are more likely than the
right-handed to show the reverse asymmetry, but the extent of the asymmetry is
less striking; and (iii) in some cases the asymmetry is in the same direction in the
left-handed asdn the right-handed, but again it is less striking in magnitude.”

Sex-Related Differences
Sex was always a significant factor influencing all of the facial areas. Namely,
the mean facial areas were significantly larger in men than in women. This can
be due to larger skulls in men relative to women. Accordingly, it is well known
that hemispheric weight is significantly smaller in females than males (see
McGlone, 1980).
For most of the facial areas (total facial area, total maxillary area, Area A, C, D,
E, and G), the interactions of sex with handedness and side were found to be sig-
nificant. The sex differences were more apparent for left-handers. Namely, a lack
of facial asymmetry was encountered more frequently in left-handed men than in
left-handed women. In accord, Tan (1988j reported that women are more right- or
left-handed than men in hand preference. Gur et al. (1982) suggested that females
may be more asymmetrical than males in the cerebral representation of functions.
Moreover, Borod et al. (1984) reported that females had larger dominance rations
than males for preference measures, indicating that females were more lateralized
than males. These results did not support the others stating no sex-related differ-
ences in facial asymmetries (see above). The interactions of sex with handedness
and side suggest that sex hormones may play a role in early and/or late develop-
ment of cerebral lateralization and consequently in the emergence of the facial
asymmetries. It was frequently reported that sex hormones are indeed related to
cerebral lateralization (Diamond, 1984; Geschwind & Galaburda, 1987; Rosen
 158 P. KELES et al

et al., 1983: Tan. 1990a, b: Tan, 1991; Tan, 1992a, b; Tan, 1993; Tan, 1994; Tan
& Kutlu. 1992; Tan & Kutlu, 1993: Tan & Zor, 1993).
The results of the present work were not in accord with supporters of a right or
left shift in facial asymmetry. Instead, the present results indicated that asymme-
tries in different facial regions may be in different directions depending upon sex
and handedness of the subjects. As expected from laterality research, the right-
handers exerted a consistent facial asymmetry, the left side being larger than the
right side. In contrast. the left-handers were inconsistent in facial asymmetry. The
results suggested that facial asymmetries may depend upon an asymmetric devel-
opment of the brain areas under the genetic and hormonal control.
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References
Annett. M. i 1985).Lrft. ria&, h a d mid broi!i; the right sh$ theor?.. London: Erlbaum. Borod, J. C.,
Caron. H. S.. & Koff. E. ( 1984). "Left-handers and right-handers on performance and preference
measure5 of lateral dominance". Brirish Joitnial qfPs?.cholog!.. 75. 177-186.
Burke. P. H. ( 1971 ), "Stereophotogrammetric measurement of normal facial asymmetry in children",
H ~ m Biology.
m 4. 536-548.
Chi. J . G.. Dooling, E. C. & Gilles. F. H. i 1977). "Left-right asymmetries of the temporal speech areas
of the human fetus". A r d ~ i i v sofiliritrolog~.34. 346348.
Chui, H. C. & Damasio. A. R . (1980)."Human cerebral asymmetries evaluated by computed tomog-
raphy". Joirnzd of Neiirolog?. Neitnmrger?, arid Ps?.c/iia?n.43, 873-878.
Coffin. G. S. ( 1986). "Asymmetry of the human head: clinical observations", Clinical Pediatrics, 25,
230-23.2.
Diamond. M. C. (1981). Age. ses. and environmental influences on anatomical asymmetry in rat fore-
brain. In N. Geschwind & A. M. Galaburda (Eds.). Cerebral Donihiance: The biologicnlfounda-
tioris. Cambridge. MA: Harvard University Press.
Falzi, G.. Perrone. P. & Vignolo. L. A. (1982). '.Right-left asymmetry in anterior speech region".
Archives ofhieirrology. 39, 239-210.
Farkas. L. G. & Cheung. G. ( 1981). "Facial asymmetry in healthy North American Caucasians",Ang[e
Orrhodontist. 51. 70-77.
Figalova. P. ( 1969). "Asymmetry of the face". Antropologin. 7. 31-34.
Galaburda, A. M.. LeMay. M.. Kemper. T. L. & Geschwind. N. (1978). "Right-left asymmetries in the
brain". Sciencc. 199. 852-856.
Geschwind. N. & Galaburda. A. M. i 1987). Ccrrbrd 1atercili:utiori; Biological mechanisms. associa-
riotis arid /iatholoy. Cambridge. MA: MIT Press.
Gur. R. C., Gur. R. E.. Obrist. W. D.. Hungerbuhler. J. P.. Younkin. D.. Rosen. A. D., Skolnick, B. E.
& Reivich, M. ( 1982). "Sen and handedness differences in cerebral blood flow during rest and
cognitive activity". Sciencc. 217. 659-661.
Iaccino. J. F. ( 1993). Lefr Brain-RiSht Brain Difere/ice.s. Lawrence Erlbaum Ass., Publishers:
Hillsdale. New Jersey.
LeMay. M. & Culebras. A. (1972)."Human brain morphologic differences in the hemispheres demon-
strated by carotid angiography". New Englczrid Joitrnnl ofhfedicitie. 287, 168-170.
Lundstroni. A. (1961). "Some asymmetries of the dental arches. jaws and skull and their etiological
significance", Amrricnri Jorrnid of Orthodonric.7, 47. 8 1-106.
hlcGlone. J. ( 1980). "Sex differences in human brain asymmetry: A critical survey", Behavior arid
Bmzii Sciences. 3. 2 15-263.
Milner. B. ( 1971). Hemispheric speciali:utiori: Scope and h i t s . In F. 0. Schmitt & F. G. Warden
(Ed\.). The neurosciences: Third study program. Cambridge, MA: MIT Press.
Mulick. J. F. (1965). "An investigation of cranio-facial asymmetry using the serial twin study
method'. Aniericari Joirnicil ofOnhodor1ric.s. 41. 658-678.
 FACIAL ASYMMETRY 159

Oldfield, R. C. (1971). “The assessment and analysis of handedness: The Edinburgh Inventory”,
Neuropsycologia, 9,97-114.
Rasmussen, T. & Milner, B. (1977). “The role of early left-brain injury in determining lateralization
of cerebral speech functions”, Annals of the New York Academy of Sciences, 299, 353-369.
Rosen, G. D., Benebi, A. S. & Yutzey, D. A. (1983). “Prenatal testosterone causes shift of asymme-
try in neonatal tail posture of the rat”, Developmental Brain Research, 9, 99-101,
Rubens, A. B. (1977). Anatomical asymmetries of human cerebral cortex. In S. Hamad, R. W. Dory,
L. Goldstein, J. Jaynes, & G. Krauthamer (Eds.), Lateralizatiori in the nervous svstem
(pp. 503-516). New York: Academic Press.
Shah, S. M. & Joshi, M. R. (1978). “An assessment of asymmetry in the normal craniofacial com-
plex”, Angle Orthodontist,48, 141-148.
Tan. U. (1988). “The distribution of hand preference in normal men and women”, Interiiational
Journal of Neuroscience, 41,35-55.
Tan, U. (1990a). “Relation of testosterone and hand preference in right-handed joung adults to sex and
familial sinistrality”, International Journal of Neuroscience, 53. 157-1 65.
Tan, U. (1990b). “Testosterone and hand skill in right-handed men and women”, International
Journal of Neuroscience, 53, 179-189.
Downloaded By: [TÜBTAK EKUAL] At: 13:11 7 August 2009

Tan, U. (1991). “Serum testosterone levels in male and female subjects with standard and anomalous
dominance”, International Journal of Neuroscience, 58.2 1 1-2 14.
Tan, U. (1992a). “Testosterone and estradiol in right-handed men but only estradiol in right-handed
women is inversely correlated with the degree of right-hand preference”, Intematiorzal Journal of
Neuroscience. 66,25-34.
Tan, U. (1992b). “Similarities between sylvian fissure asymmetries in cat brain and planum temporale
asymmetries in human brain”, International Journal of Neuroscience. 66. 163-175.
Tan, U. (1993). “Association of serum-free-testosterone level with hand preference in right-handed
young females”, hiternational J0141ml of Neuroscience, 68. 157-163.
Tan, U. (1994). “The grasp reflex from the right and left hand in human neonates indicates that the
development of both cerebral hemispheres in males, but only the right hemisphere in females, is
favoured by testosterone”, International Journal oj’Psychophysiology, 1 6 , 3 9 4 7 .
Tan, U. & Kutlu. N. (1992). “Asymmetrical relationships between the right and left heights of the syl-
vian end points in right- and left-pawed male and female cats: similarities with planum temporale
asymmetries in human brain”, International Journal of Neuroscience, 61, 8 1-91.
Tan, U. & Kutlu. N. (1993). “The end point of the sylvian fissure is higher on the right than the left in
cat brain as in human brain”, International Journal of Neuroscience, 68, 11-17.
Tan, U. & Zor, N. (1993). “Sex-dependent relations of grasp-reflex srengths from right and left hands to
serum gonadotropine (FSH and LH) levels in human neonates with regard to cerebral lateraliza-
tion”, International Jounial of Neuroscience, 13, 221-226.
Trenouth, M. J. (1984). “Asymmetry of the human skull during fetal growth, The Anatomical Record,
211,205-212.
Trenouth, M. J. (1993). The measurement of fetal craniofacial growth by computer graphic centroid
morphoanalysis. Ph.D. Thesis, University of Manchester, England.
Vig, P. S., Hewitt, A. B. (1975 b). “Asymmetry of the human facial skeleton”, Angle Orthodontics. 45,
125-1 29.
Woo, T. L. (193 1). “On the asymmetry of the human skull’’, Biometrica, 22, 324-341.