Dentofacial Deformities

What are Dentofacial Deformities? 

Almost all normal faces are asymmetrical. You may see the asymmetry if you divide a photograph of any person in half and match each side with its mirrored version.

Dentofacial deformity is a condition where the lower and upper jaw deviates from normal proportions and the relations between each tooth series deteriorate. It can occur in congenital syndromes or due to genetic predisposition in individuals with a family history of jaw growth disorders. Other factors that may cause dentofacial deformity include childhood jaw trauma resulting in cessation of bone growth and undesirable fusion of undiagnosable joint fractures to the skull base. The acceptable limits of deviation from normal are still a subject of debate.

How are dentofacial deformities diagnosed and what are the symptoms?

Dentofacial deformities are diagnosed by evaluating symptoms related to head and neck functions such as breathing, swallowing, speaking, chewing, and lip position/closure. Symptoms of dentofacial deformities may include skeletal problems such as forward or backward position of the lower and/or upper jaw, dental problems such as misaligned lower and upper jaw teeth or gums showing during laughter, soft tissue problems such as lips not closing, and temporomandibular joint problems such as pain and joint sounds. Tooth and gum issues may also be present. Face disproportion may have a negative impact on the individual’s psychosocial health in the community.

What are the treatment methods for Dentofacial Deformities?

Treatments such as orthodontic treatment (braces), speech therapy, and rehabilitation of teeth with prostheses are generally insufficient to treat haw growth disorder alone.

Repositioning the jaws surgically to their normal positions, known as orthognathic surgery, is often recommended for resolving jaw growth disorders, and requires a complex treatment plan that involves multiple disciplines working together.

Facial disproportions that appear in childhood may sometimes resolve spontaneously. For example, lower jaw deficiencies can return to normal limits with puberty growth spurts. In some cases, orthodontic appliances can encourage the development of the lower and upper jaw to some extent, but these techniques may not be effective when the deviation from normal is significant.

Another form of treatment is dental compensation (camouflage) treatment for skeletal disorders. This treatment aims to hide the main problem by aligning the teeth on incorrectly positioned jaws. This treatment can only be applied to a small number of patients, and over time it usually ends with the teeth losing their alignment achieved with this treatment. Furthermore, this treatment may overcomplicate future surgical treatments that may be required or desired.

Approximately 19% of patients who require orthodontic treatment cannot be treated with it alone and will also require orthognathic surgery.

Here is what you can expect from the orthognathic surgery process:

First, the doctors will conduct a clinical exam and ask about your complaints. They are likely to request radiographic exams, such as panoramic radiography and computed tomography, to help assess the situation. Correcting chin growth disorders usually requires collaboration between these two branches. Once your teeth have been aligned with orthodontics, the surgical process can begin. They will measure your jaws and produce plates to use during surgery. Additionally, they may request a final computed tomography exam before surgery.

Orthodontics and oral and maxillofacial surgery

During the operation, they will make all incisions inside your mouth. They will mobilize your jaws and, with the help of the produced plates, reposition them to the desired forward or backward position. Once in the desired position, the doctors will fix the jaw with titanium plates and screws.

After the procedure, they will typically hospitalize you for 2-3 days for post-operative follow-up. You can expect to return to your normal life within 2-3 weeks after discharge. You will continue to have control appointments with your orthodontist during this time.

After the healing process, not only do changes occur in bone tissues, but also in adjacent soft tissues. This can lead to improvements in facial aesthetics. With ideal osseous and dental closure, speech and chewing functions can also be improved. In cases where the lower/upper jaw is positioned behind and taken forward, respiratory distress decreases due to airway widening. These benefits can also have positive effects on your psychosocial health.

If you suspect that you have a disorder or asymmetry in your jaws, it is important to consult with an orthodontist and a maxillofacial surgeon. They can help you determine if orthognathic surgery is the right option for you.