Abstract
Background Symmetry, when applied to facial morphology, refers to the correspondence in size, shape, and location of facial landmarks on the opposite sides of the median sagittal plane.1 Mandibular asymmetry is associated with the condylar growth center and has a direct effect on facial appearance. The etiology is multifactorial—developmental, pathologic, functional, or traumatic—and affects the underlying skeletal structure or soft tissue drape.2 Three unique cases of mandibular asymmetry are presented below. Clinical and Radiologic Findings Case 1: Hemimandibular elongation (HME): Radiographic findings were conclusive of HME, a form of altered mandibular growth that can be differentiated from condylar hyperplasia because of the shift in dental midline to the opposite side and horizontal elongation of the ipsilateral half of mandible. Case #2: Hemimandibular hyperplasia (HH): Differential diagnosis (DDX): Osteochondroma/HH. Osteochondroma was ruled out by excisional biopsy. Case #3: Condylar myxoma: DDX: Condylar myxoma/central giant cell granuloma/hemangioma. Biopsy and histologic analysis confirmed condylar myxoma. Discussion and Conclusions Mandibular asymmetry is the fulcrum of many debates among orthodontists and maxillofacial surgeons and is correlated to the development of temporomandibular joint (TMJ) symptoms and temporomandibular disorders (TMDs). The importance of early diagnosis of progressive causative conditions is essential.
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