FACIAL ASYMMETRY

• Dr V.RAMKUMAR

• CONSULTANT DENTAL &FACIOMAXILLARY SURGEON

• REG NO: 4118 –TAMILNADU- INDIA(ASIA)

Abnormal skeletal anatomy may be

described simply in forms of maxillary and

mandibular morphology, which may or may not

be further complicated by associated

abnormalities in other parts of the skull.

Facial Asymmetry can occur in three planes

Sagittal or Anteroposterior

Vertical

Transverse

ETIOLOGY

Genetic (Piere robinsyndrome)

Trauma (Ankylosis)

Congenital and developmental (Condylar agenesis)

Acquired (Stills disease)

LEVELS OF THE FACE

Cranial (upperthird)

Maxillary (Middlethird)

Mandibular (Lowerthird)

CLASSIFICATION OF FACIAL ASYMMETRY

Symmetrical disproportion of jaws

Asymmetrical disproportion of jaws

Mandibular lower facial enlargement

Mandibular lower facial deficiency

Maxillary enlargement

Maxillary deficiency

Cleft lip and palate syndrome

Craniofacial asymmetry

MAXILLARY DEFICIENCY

Naso maxillary hypoplasia

Total midface hypoplasia

MAXILLARY ENLARGEMENT

Dentoalveolar Enlargement

Class II Div.I

Premaxillary enlargement (Pagets disease)

Vertical maxillary excess (Long face syndrome)

MANDIBULAR LOWER FACIAL ENLARGEMENT

Progeria

Vertical mandibular excess

Sagittal mandibular excess

Bilateral massetric hypertrophy

MANDIBULAR LOWER FACIAL DEFICIENCY

Microgenia and Retrogenia

Low angle (AP growth and transverse growth are affected)

High angle (The growth is more vertical than horizontal)

NASO MAXILLARY HYPOPLASIA

Group 1. Involving dento alveolar segment (Short columella)

Group 2. Excluding dento alveolar segment (Binders syndrome, short cranial base)

Group 3. Cleft palate syndrome (Short nose)

Group 4. Panfacial problems

TOTAL MIDFACE HYPOPLASIA

It affects the whole midface including orbital walls zygomatic region without cranial mal formation.

Crouzon syndrome

Aperts syndrome

INVESTIGATION

WELL ORIENTED PHOTOGRAPHS

Radiographs

Posterior and lateral cephalograms

Model analysis

Arch alignment

Occlusion

Model surgery

Photocephalometry

Sterio lithography

TREATMENT OPTIONS Maxilla

Anterior maxillary osteotomy

Posterior maxillary osteotomy

Lefort I osteotomy and its modification

Lefort II osteotomy and its modification

Lefort III osteotomy and its modification

Quadrangular osteotomy

ANTERIOR MAXILLARY OSTEOTOMY

LEFORT I OSTEOTOMY

LEFORT II OSTEOTOMY

LEFORT III OSTEOTOMY

TREATMENT OPTIONS MANDIBLE

Subapical osteotomy

Genioplasty and its variations

Sagittal spilit osteotomy

Subsigmoid osteotomy

C osteotomy

GENIOPLASTY

SAGITTAL SPLIT OSTEOTOMY

Thank U