[Orthopedic approach to asymmetry]

Asymmetry being a clinical manifestation of various pathologies, the orthopedic attitude greatly varies from one practitioner to another. Thanks to a better knowledge of the etiopathogenesis, the orthopedic approach in some particular cases reveals very effective, either alone or together with other therapeutics. In mandibular laterodeviations most often consecutive to a maxillary contraction, the best treatment is to expand maxilla which will allow a mandibular centric repositioning. This therapy is often achieved early to limit the asymmetric expression of growth and normalize the dental eruption. In unilateral condylar hypoplasias of variable extension, from a simple defect in condylar growth to a hemifacial microsomia, the therapeutic attitude has mostly evolved. A surgical orthodontic protocol can integrate an increasingly significant orthopedic phase in the course of time. Some authors show that a surgical case may be treated originally only with the help of orthopedics. The devices used are of activator or hyperpropulsor type. In unilateral condylar hyperplasias, orthopedic therapy must be considered with reservations.