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Mandibular asymmetry and the fourth dimension.

Leonard B Kaban1

  • 1Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts, USA. LKaban@Partners.org

The Journal of Craniofacial Surgery
|February 3, 2009
PubMed
Summary

Hemifacial microsomia (HFM) involves progressive facial asymmetry due to abnormal mandibular growth. Early surgical intervention, particularly mandibular lengthening in children, can prevent severe, long-term deformities.

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Area of Science:

  • Craniofacial surgery
  • Pediatric plastic surgery
  • Orthognathic surgery

Background:

  • Hemifacial microsomia (HFM) is often characterized by progressive facial asymmetry.
  • Traditionally, HFM was viewed as unilateral, but bilateral involvement occurs in 20-30% of cases.
  • Previous skeletal correction focused primarily on lengthening the affected side.

Purpose of the Study:

  • To understand the temporal growth patterns in hemifacial microsomia (HFM).
  • To develop rational treatment protocols for jaw asymmetry in children and adults.
  • To elucidate the role of mandibular growth in progressive facial distortion.

Main Methods:

  • Longitudinal clinical observations of unoperated patients with HFM.
  • Analysis of progressive deformity over time in mandibular asymmetry.
  • Review of conditions involving mandibular undergrowth and overgrowth.

Main Results:

  • Abnormal mandibular growth is hypothesized as the earliest skeletal manifestation in HFM.
  • Restricted mandibular growth significantly contributes to progressive ipsilateral and contralateral facial distortion.
  • Progressive distortion is observed in other mandibular asymmetry conditions like tumor resection, radiation, and condylar hyperplasia.

Conclusions:

  • Understanding the progression of mandibular asymmetry is critical for effective treatment.
  • Early mandibular lengthening in children with HFM can prevent end-stage deformity.
  • Rational treatment protocols for HFM and other mandibular asymmetries require consideration of growth dynamics.