I read with interest the article by Ha et al, particularly their discussion of the terminology related to “long face deformity” and “long face syndrome.” At the expense of being pedantic, one has to ask whether the term “long” is accurate or even the correct use of English in such instances.

The Oxford English Dictionary defines “long” as “great in measurement from end to end,” citing examples such as the length of a swimming pool, the distance between the nose and tail of a horse, and the distance between the bow and stern of a ship. These are all examples in the horizontal plane, which is not a coincidence. Craniometry and craniofacial anthropometry define cranioskeletal “length” and craniofacial “length,” respectively, as the horizontal length from glabella to opisthocranion (a point situated in the occipital region, most distant from glabella). The cranial index (craniometry) and cephalic index (anthropometry) are numeric expressions of the ratio between head width and horizontal length; eg, “dolichocephalic” means a head type that is horizontally long and transversely relatively narrow.

The Oxford English Dictionary defines “height” as “the distance or measurement from the base to the top,…the stature of a person,…and the elevation of an object above the ground.” Again, it is no surprise that athletics has the horizontal “long jump” and the vertical “high jump.” We refer to a person of increased standing height as “tall,” not “long,” just as with a tall building. We refer to vertical facial “heights,” both clinically and cephalometrically. We refer to the horizontal distance from anterior to posterior nasal spines as maxillary “length,” but midfacial height from glabella or nasion to subnasale as a vertical measurement. Yet the term “long face” continues. Rhinoplasty surgeons refer to nasal height in the vertical plane (nasion to subnasale) but refer to nasal length in relation to nasal prominence. Therefore, at the expense of being pedantic, one must question the use of “long face” when referring to an increase in face height, which is more correctly termed a tall face, or simply described in terms of facial height.

This leads inevitably to the term “long face syndrome,” from which the previous term reached the profession. The etiology of the “syndrome” may be related to vertical maxillary excess (total or just posterior) and/or vertical chin height excess—already potentially different parameters. Additionally, a “long face syndrome,” even as defined by the American Association of Orthodontists Glossary, may be associated with a Class I, Class II, or Class III sagittal skeletal pattern or malocclusion, and/or an asymmetry—which raises the question about how it can be described logically as a “syndrome.”

Misnomers are common in clinical practice. Clinicians, and even peer-reviewed articles, often refer to maxillary incisor “angulation” when they clearly mean “inclination.” For a specialty that prides itself on working to accuracies of 0.5 mm and 0.5°, perhaps we should be somewhat more accurate with our use of English—even at the expense of being pedantic.