Mandibular Asymmetry Research Articles

Mandibular asymmetry. Hemimandibular hyperplasia vs. hemimandiubular elongation

Introduction. Hemimandibular hyperplasia and elongation create a developmental asymmetry characterized by volumetric changes of the hemimandible. Both entities cause progressive aesthetic and functional problems causing depression with poor quality of life. The treatment of these anomalies is combined, orthodontic and surgical Material and methods. The study was based on the analysis of bibliographic sources as well as the rehabilitation of two patients diagnosed with hemimandibular hyperplasia and hemimandibular elongation. Results. The specialized literature proposes a variety of surgical techniques for osteotomy of the mandible to correct mandibular asymmetries. The surgical planning of the interventions was carried out using the digital protocol, with the manufacture of intermediate and final splints. Conclusions. Contemporary digital medical imaging in combination with virtual surgical planning allows a patient specific treatment protocol, a fact that significantly contributes to optimizing not only the treatment plan but also the surgery itself.

Chromatin assembly factor subunit CHAF1A as a monogenic cause for oculo-auriculo-vertebral spectrum.

Oculo-auriculo-vertebral spectrum (OAVS) is characterized by abnormal development of the 1st and 2nd branchial arches. Despite arguments against a monogenic condition, a few genes have been involved in a minority of cases. We now report heterozygous, presumably loss-of function variants in the CHAF1A gene in 8 individuals, including 3 members of the same family. Four cases fulfill stringent diagnostic criteria for OAVS, including asymmetric ear dysplasia, preauricular tags, mandibular asymmetry +/- vertebral malformations. Two patients also presented with kidney malformations. CHAF1A encodes a subunit of CAF-1 (chromatin assembly factor-1), a heterotrimeric protein complex responsible for the deposition of newly synthesized histones H3-H4 onto the newly synthetized DNA strand during replication. The identification of loss-of-unction variants in CHAF1A is consistent with the hypothesis of early developmental genes dysregulation driving OAVS and other associations recently lumped under the acronym Recurrent Constellations of Embryonic Malformations (RCEM).

Photogrammetry protocol in babies with congenital torticollis: part 1 – inter-arch intraoral assessment

Torticollis is defined as an imbalance of the sternocleidomastoid muscle (SCM), with less extension of the neck, resulting in a preference to turn the head more from one side to the other. The characteristics frequently found are: ear contralateral to the torticollis displaced forward, facial asymmetry, and contralateral occipital flattening, as well as a smaller ipsilateral eye, causing misalignment of the eyes. This condition can also cause mandibular inclination (MI), in the frontal plane, with a difference in opening between the maxilla and mandible from one side or the other. The diagnosis and treatment of torticollis are routinely carried out by the physiotherapist and the diagnosis of this mandibular inclination is traditionally through visual examination. This assessment of mandibular inclination, carried out by the dentist, in an objective manner, can contribute to the diagnosis and also to the monitoring of proposed treatments that should reduce mandibular asymmetries. The objective of this study was to create a protocol for objective measurement of the distance between the maxilla and mandible, on the right and left sides, using photogrammetry, to detect whether mandibular inclination can be observed by the shorter inter-arch distance on the side corresponding to the torticollis. Case reports of two babies (1 baby aged 9 months and another aged 1 year and 1 month), diagnosed with congenital torticollis. Photogrammetry was carried out: the babies were positioned on a dental stretcher and photographed in maximum opening, intermediate, and closing positions. Using the photos and the IMAGE J program, measurements between the maxilla and mandible were taken (see photogrammetry description). Results: The measurement protocol used in both babies confirmed the greater mandibular inclination by approaching the hemi-arch corresponding to the side of the torticollis, compared to the opposite side. Objective measurement of mandibular inclination can be part of the timely diagnosis for congenital torticollis. Studies with an adequate sample size and methodology are necessary to confirm this diagnostic tool.

Does mandible ramus height asymmetry affect postoperative skeletal stability in orthognathic surgery patients?

BackgroundRelapses following orthognathic surgery have been reported to exceed 2% to 50%, depending on multiple factors. This study aimed to analyze the stability after orthognathic surgery in patients with mandibular ramus height asymmetry through 3D reconstruction using Cone-beam CT.MethodsThis retrospective cohort study investigated patients who underwent mandibular setback surgery using bilateral sagittal split ramus osteotomy. Three-dimensional CT scans were taken at three different time points. Evaluation of the postoperative stability involved measuring changes in the x, y, and z axes as well as roll and yaw rotations of the mandible at specific landmarks (B point, mental foramen) on 3D CT scans obtained immediately after surgery and 6–12 months postoperatively. They were categorized into four groups based on bilateral mandibular height asymmetry through Asymmetry index (AI). The one-way ANOVA was implemented to compare the intergroup differences and Tukey's post hoc test was employed. Additionally, the Pearson correlation coefficient was also calculated.ResultsA total of 24 patients were included in this study. The corresponding AI, representing the degree of asymmetry in both mandibles, were calculated as Group 1 was 1.25 ± 0.64%, Group 2 was 2.89 ± 0.47%, Group 3 was 5.03 ± 0.51%, and Group 4 was 9.40 ± 1.99%. The x-axis change in Group 4 was significantly larger at 1.71 mm compared to Group 1 at 0.64 mm. The mandibular roll, Group 4 showed a statistically significant increase at 1.33° compared to Group 1 at 0.35°. And there was a significant positive correlation observed between x-axis change and AI (p = 0.019), as well as between mandibular roll and AI (p = 0.025).ConclusionAfter orthognathic surgery, stability was influenced by numerous factors, with the findings of this study suggesting that the degree of ramus height asymmetry in the mandible can be considered one contributing factor.

Triad of temporomandibular joint ankylosis, micrognathia, and obstructive sleep apnoea: a systematic review of surgical management

Complex functional issues arising from temporomandibular joint (TMJ) ankylosis are associated with abnormal mandibular growth secondary to the condylar-glenoid fossa and its surrounding structures. These include severe limited mouth opening, micrognathia, mandibular asymmetry, and obstructive sleep apnoea (OSA), which necessitate effective treatment to allow optimum functional rehabilitation. This article aims to present a comprehensive systematic review of the surgical strategy for patients who present with a triad of TMJ ankylosis, micrognathia and OSA via a literature search of PubMed, Google Scholar, and Scopus following PRISMA guidelines. The outcomes of interest were difference in maximum mouth opening, incidence of reankylosis, amount of mandibular advancement, posterior airway space, preoperative and postoperative apnoea/hypopnoea index, and arterial oxygen saturation, as well as changes in other cephalometric or polysomnographic variables. Thirty four studies involving 360 patients were included. Surgical interventions included distraction osteogenesis (DO), release of TMJ ankylosis and mandibular advancement, simultaneous arthroplasty and DO, pre-athroplasty DO, and post-arthroplasty DO. Most studies reported functional post-intervention mouth opening, with reankylosis reported in four. Mandibular advancement was between 6 mm and 34 mm. All studies reported improvement in the various polysomnographic variables measured. In conclusion, the systematic review was conducted based on a low level of literature evidence. Even though various surgical strategies were reported, effective case-specific management of TMJ ankylosis with micrognathia and OSA requires comprehensive assessment and careful consideration of surgical options that promote mandibular advancement and airway improvement.

Morphological Profiling of Unilateral Condylar Hyperplasia: Implications for Surgical Decision-Making.

Unilateral condylar hyperplasia (UCH) presents challenges with functional and esthetic concerns, including facial and chin asymmetry, prognathism, class III malocclusion, and temporomandibular joint symptoms. This study aims to precisely locate condylar and mandibular asymmetry in patients with UCH, aiding targeted surgical correction and addressing persistent skeletal changes. This retrospective study analyzed data from patients with UCH and controls, utilizing high-quality cone beam computed tomography scans with 1mm or fewer slices. Morphometric points were placed using Planmeca software, measuring linear distances on both affected and unaffected sides. In a cohort of 40 patients (29 UCH, 11 controls), significant differences in condylar head and neck lengths were observed between the affected and unaffected sides in patients with UCH ( P = 0.0019). However, ramus length showed no significant variation ( P = 0.65). When comparing differences in condylar head and neck length between controls and patients with UCH, a substantial contrast was evident ( P = 1.98e-07), while ramus length differences were not significant ( P = 1.00). The median condylar head and neck lengths were 20.3mm for controls, 19.78mm for the unaffected side in patients with UCH, and 23.48mm for the affected side. Facial asymmetry in UCH primarily results from differences in condylar head and neck length, not ramus length. This emphasizes the importance of high condylectomy in addition to bilateral sagittal split osteotomy to achieve improved symmetry and reduced temporomandibular joint dysfunction. Understanding these regional skeletal changes is critical for effective UCH treatment.

A three-dimensional quantitative assessment on bony growth and symmetrical recovery of mandible after decompression for unicystic ameloblastoma

Unicystic ameloblastoma (UAM) of the jaw can be effectively reduced in volume through decompression, which promotes bone regeneration and restores jaw symmetry. This study quantitatively evaluated changes in mandible volume and symmetry following decompression of mandibular UAM. This study included 17 patients who underwent surgical decompression followed by second-stage curettage for mandibular UAM. Preoperative and postoperative three-dimensional computed tomography (CT) images were collected. Bone volume and the area of cortical perforation were measured to assess bone growth during decompression. Mandibular volumetric symmetry was analyzed by calculating the volumetric ratio of the two sides of the mandible. Twelve pairs of landmarks were identified on the surface of the lesion regions, and their coordinates were used to calculate the mean asymmetry index (AI) of the mandible. Paired t-tests and the Mann–Whitney U test were used for statistical analysis, with p < 0.05 considered indicative of statistical significance. The mean duration of decompression was 9.41 ± 3.28 months. The mean bone volume increased by 8.07 ± 2.41%, and cortical perforation recovery was 71.97 ± 14.99%. The volumetric symmetry of the mandible improved significantly (p < 0.05), and a statistically significant decrease in AI was observed (p < 0.05). In conclusion, UAM decompression enhances bone growth and symmetry recovery of the mandible. The present evaluation technique is clinically useful for quantitatively assessing mandibular asymmetry.

Difference in discrepancies of mandibular incisor compensation relative to Menton deviation between Class III roll- and yaw-dominant asymmetries.

To compare mandibular incisor compensation relative to Menton (Me) deviation between skeletal Class III patients with roll- and yaw-dominant mandibular asymmetries. Sixty skeletal Class III patients (21.62 ± 2.69 years) with facial asymmetry were divided into roll- or yaw-dominant asymmetry groups. Mandibular skeletal and incisor measurements were carried out using cone-beam computed tomography data, and values were compared between the two asymmetry groups or between moderate and severe asymmetry subgroups using independent t-test or Mann-Whitney U-test. The relationship between skeletal and dental measurements was assessed using Pearson correlation coefficient. Relative to the mandibular midsagittal plane, the yaw-dominant group presented significantly greater mandibular dental midline deviation in distance (LI-mid deviation, 2.15 mm) and angulation (4.20°) toward the nondeviated side than the roll-dominant group (P < .001). The ratio of amount of LI-mid deviation to Me deviation was significantly greater in the yaw-dominant group (26.44%) than in the roll-dominant group (1.76%; P < .001). In the yaw-dominant group, the LI-mid deviation was significantly greater in the severe asymmetry subgroup than in the moderate asymmetry subgroup, and the amount of mandibular incisor compensation was positively correlated with Me deviation and mandibular yaw. Mandibular incisor compensation differed significantly between the roll- and yaw-dominant asymmetry groups. The yaw-dominant group demonstrated significant mandibular dental midline deviation, and dental compensation of the anterior teeth was positively correlated with Me deviation and mandibular yaw.

Hanna's Modified Sagittal Split Osteotomy (HSSO): An Alternative to Inverted L Osteotomy-Merging Function and Aesthetics for Enhanced Stability, Attractiveness, and Nerve Protection.

Background: The current high standards in orthognathic surgery demand surgical solutions that are both ⁠ functionally ⁠ effective and aesthetically pleasing. Our approach offers one for enhanced stability, attractiveness, and nerve protection ⁠ with improved accessibility ⁠ in the majority of orthognathic scenarios ⁠ compared to an inverted L osteotomy. Methods: A case series is presented to illustrate the application and outcomes of HSSO, an optimised approach that combines the advantages of a transoral inverted L osteotomy with specific enhancements and increased versatility, ⁠ with accessibility and exposure similar to a BSSO. Results: HSSO as a completely transoral technique, demonstrate the ability to perform significant counterclockwise rotations of the mandible, eliminating the need for trocars or skin incisions. We experinced high postoperative stability when HSSO was performed in conjunction with a three-piece LeFort 1 osteotomy on a dynamic opposing arch. In comparison to an inverted L approach, we postulated that HSSO offers advantages in stability, due to the increased segmental overlap of the proximal and distal segments of the mandible. This approach is designed to enhance the safety of the inferior alveolar nerve compared to traditional sagittal split methods. Furthermore, HSSO represents an alternative to total joint replacement in select cases of idiopathic condylar resorption and is effective for correcting mandibular asymmetries while maintaining jawline aesthetics. This is achieved through the manipulation of the mandibular angle, ramus height, and inferior border without creating a step deformity in the soft tissue. Conclusions: The outcomes of HSSO highlight its capacity to deliver predictable, functional, and aesthetically pleasing results, offering a viable alternative to more traditional orthognathic techniques.

Comparison of Surgical Techniques for Correction of Mandibular Asymmetry in TMJ Ankylosis Patients.

Temporomandibular joint (TMJ) ankylosis frequently results in mandibular asymmetry, which impairs an affected person's ability to function and look good. Because of the intricacy of TMJ ankylosis and the variety of surgical procedures available, correcting mandibular asymmetry surgically can be difficult. Patients with mandibular asymmetry and TMJ ankylosis who had surgery at a tertiary care facility between certain periods were the subject of a retrospective investigation. Medical records were used to gather information on patient demographics, pre-operative imaging, surgical methods, and post-operative results. Surgical methods included condylectomy with or without reconstruction, joint reconstruction with or without orthognathic surgery, and unilateral or bilateral mandibular distraction osteogenesis (MDO). Occlusion, patient-reported results, and facial symmetry made up the evaluation criteria. The study had a total of 50 patients, with different surgical method distributions. Comparing unilateral and bilateral MDO to condylectomy and joint reconstruction, notable gains in face symmetry and occlusion were seen. The largest complication rate was seen with condylectomy, mostly from recurrence and device-related issues, albeit the rates of other procedures varied as well. In conclusion, customized treatment planning is necessary for the correction of mandibular asymmetry in individuals with TMJ ankylosis. Although mandibular distraction osteogenesis produces better results for occlusion and facial symmetry, it is crucial to carefully weigh the risks involved. While still feasible treatments, condylectomy and joint reconstruction require strict monitoring for any consequences. In order to enhance patient care in this difficult patient group, future research should concentrate on improving treatment procedures and long-term results.

Prevalence of mandibular asymmetries in the pediatric population of Jazan: A radiographic analytical study

BackgroundFacial asymmetry results from variation in mandibular linear and angular dimensions on the right and left sides of the face. Mandibular asymmetry is of great significance to oral surgeons and orthodontists as it directly impacts the facial profile of an individual. AimThe present study aimed to measure the prevalence of mandibular asymmetry and its fluctuations during the mixed dentition growth phase in healthy children aged 6–8 years in the Jazan region of Saudi Arabia. MethodThis retrospective observational study was conducted by measuring linear asymmetrical measurements of mandible on orthopantomograms of 390 healthy children (182 boys and 208 girls, aged 6–8 years) with mixed dentition. Linear measurements from orthopantomograms were obtained using a standardized digitizer. Two sets of mandibular measurements were recorded, alongside subjective assessments of mandibular first molar development. An independent t-test was employed to assess the significance between measurements on both sides, while one-way ANOVA was used to demonstrate facial asymmetry significance among different age groups. ResultThe result of this study revealed a significant statistical difference (p-value≤ 0.05) for both sides of the mandible across two dimensions: condylar and ramus height (p value = 0.03) and mandibular length (p value = 0.04). The asymmetry index resulted in no asymmetry among most of the included subjects. However, compared to the other three linear measurements, many seven-year-old participants possess mandibular asymmetry on condylar height (54.5 %). ConclusionWithin the limitation it could be concluded that children in growing age have a significant mandibular asymmetry (mainly 7 years), which, however, is only seldom clinically significant. Hence, treatment plan should be cautiously planned.

Mandibular asymmetries in brazilian adolescents: prevalence and associated factors

Objectives : Estimate the prevalence of mandibular asymmetries in Brazilian adolescents and investigate the demographic and skeletal factors associated to the asymmetries. Methods : Cone beam computed tomography (CBCT) images from 376 individuals aged from 10 to 19 were analysed to investigate mandibular asymmetry categorized as relative mandibular symmetry, moderate asymmetry, and severe asymmetry. Exposure variables included sex, age, side of mandibular deviation, sagittal and vertical skeletal pattern of the individuals, and cranial base angulation. The chi-square test was used to evaluate the association among asymmetry and the exposure variables. Gross prevalence rations were estimated and adjusted by Poisson regression with robust variance. Significance level was established at 5%.

Late Outcomes of Undiagnosed Unilateral Condylar Hyperplasia and Reoccurrence of Mandibular Asymmetry.

Unilateral condylar hyperplasia (UCH) is a rare cause of asymmetrical mandibular overgrowth because of the presence of an atypical growth in the affected condyle. SPECT (single-photon emission computed tomography) can easily establish the presence of an atypical, prolonged growth exceeding far beyond normal condylar growth and activity. A CT, CBCT, or LDCT (computed tomography, cone-beam computed tomography, or low-dose computed tomography) can confirm the diagnosis by evaluating the scope of bone overgrowth, mandibular basis/ramus asymmetry, tendency to condylar head enlargement, changes in bone density, and occurrence of differences in condylar head shapes, size, and bone structure. In most cases, a condylectomy is the procedure of choice in growing cases of UCH to remove the pathological condyle and reduce asymmetry levels. Sometimes, the growth is very slow and progressive over time, causing slowly growing asymmetry with similar symptoms to any other mandibular asymmetry, and this causes some troublesome procedures in UCH diagnostics, resulting in patients being underdiagnosed; it can even lead to some relapses in mandibular asymmetry and skeletal malocclusion after previously performed orthodontic and surgical treatment of such discrepancies. When the source of asymmetry is not identified in time, possible inadequate treatment protocols can be used. If any relapse of facial and mandibular asymmetry re-occur, SPECT and CT evaluation are necessary to evaluate if condylar hyperplasia is present and to establish what kind of surgical intervention should be used in each case.

Growth disturbances of the temporomandibular joint: causes, diagnosis and treatment

Growth disturbances of the temporomandibular Joint are characterized by mandibular asymmetry, sometimes with secondary maxillar disturbances. Although the clinical symptoms are sometimes quite severe, patients usually have no pain. There are several growth disturbances, but in this article we discuss three particular causes of facial asymmetry, namely hemimandibular growth defects; overdevelopment, underdevelopment and neoplasms of the mandibular joint. Hemimandibular overdevelopment (hyperplasia) is a growth disorder characterized by progressive asymmetry of the mandibula. Hemimandibular hypoplasia, on the other hand, is a growth disorder involving underdevelopment of the condyle mandibulae due to impingement of the growth center and ankylosing. A pronounced asymmetrical face can cause aesthetic problems and always requires diagnostics, because in addition to the hyperplasia and hypoplasia mentioned above, other causes can explain the asymmetry such as, for example, an osteoarthritis or even a tumor emanating from the base of the skull, mandibula or soft tissues.

Evaluation of aesthetic outcomes of mandibular reconstruction using artificial intelligence.

Although vascularized bone graft (VBG) transfer is the current standard for mandibular reconstruction, reconstruction with a mandibular reconstruction plate (MRP) and with a soft-tissue flap (STF) alone remain crucial options for patients with poor general conditions. However, objective aesthetic outcome evaluations for these methods are limited. In a retrospective analysis of 65 patients (VBG, 33; MRP, 19; and STF, 13), mandibular asymmetry value was calculated for each patient's photograph using facial recognition AI, with a higher value indicating worse asymmetry. The MRP group had a value comparable to the VBG group regardless of mandibular defect types. The STF group had a significantly higher value than the VBG group. Regarding cosmesis, STF was inferior to VBG, whereas MRP was comparable to VBG, even for anterior defects for which rigid reconstruction is mandatory. However, MRP's risks of plate-related complications limit its use to cases where VBG is contraindicated or with poor prognosis.

D152. Computed Tomography Analysis of Mandibular Asymmetry Progression in Patients with Unilateral Craniofacial Microsomia

D152. Computed Tomography Analysis of Mandibular Asymmetry Progression in Patients with Unilateral Craniofacial Microsomia

Retrospective Evaluation of Condyle and Ramus Asymmetry with Ortopantomography in Dentate and Total Edentulous Patients

Objectives: A symmetrical facial appearance affects people's social relationships. Mandibular asymmetry directly effects the facial appearance and may have many morphological and functional causes. Clinically healthy individuals may experience complete edentulousness in advancing ages, which may lead to asymmetry in the condyles and facial appearance. Our aim in this study is to evaluate whether fully-toothed and total edentulous conditions cause changes in the vertical height of the condyle and ramus and also asymmetry. Material and Methods: A total of 200 patients (104 female, 96 male) with 100 fully-toothed and 100 edentulous were included in the study. Right and left condylar ramus were measured and recorded according to the asymmetry measurement index of Habets et al., with using tracing paper under the reflector light on the patients' orthopantomographic images. Statistical analysis was done using SPSS:22 package program. T-tests, Mann-Whitney U and chi-square tests were used for comparisons. P &amp;lt;0.05 were considered significant. Results: In previous studies, the difference between the genders was found to be statistically insignificant, therefore we evaluated men and women together. In our research, the mean of the condyle and ramus height asymmetry index in edentulous patients was 4.76 mm and 2.12 mm respectively, and the mean of the condyle and ramus height asymmetry index in fully-toothed patients was 4.88 mm and 2.34 mm, respectively. According to the t-test, the mean of the condyle height and ramus height asymmetry index was found to be higher in fully-toothed patients but this difference was not statistically significant (p&amp;gt;0.05). Conclusion: Although condylar asymmetry was more common than ramus asymmetry in this study, this difference was not statistically significant when total edentulous and fully-toothed patients were compared. Keywords: Habets technique; condylar asymmetry; ramus asymmetry

Orthognathic Considerations of Maxillary and Mandibular Asymmetry at Skeletal Maturity in Patients with Cleft Lip and Palate.

Improving occlusion and aesthetics is the primary objective of orthognathic surgery for patients with cleft lip and palate (CLP). However, these patients often suffer from horizontal, vertical, and rotational asymmetry in addition to maxillary retrusion. This study aims to describe maxillary and mandibular asymmetry in patients with CLP undergoing orthognathic surgery and analyze its anatomic basis. Patients with isolated CLP undergoing CT imaging prior to orthognathic surgery were retrospectively reviewed. Maxillary and mandibular positioning and dimensional symmetry were evaluated. Incidence of clinically significant asymmetry, correlations between areas of asymmetry, and associations with clinical history were analyzed. Fifty-eight patients, with mean age 17 years were analyzed, including 32 patients with unilateral CLP and 26 with bilateral CLP. Twenty (34%) patients demonstrated chin deviation ≥4mm and 21 (36%) had a ≥5% discrepancy in mandibular ramus lengths. Horizontal occlusal plane cant of ≥2° was seen in 20 (34%) maxillae and 28 (48%) mandibles, with dental arch yaw ≥2° noted in 32 (55%) of both maxillae and mandibles. Chin deviation correlated with maxillary cant, discrepancy in ramus length, discrepancy in mandibular body length, and discrepancy in condylar volume (p<0.05). Bilateral and unilateral CLP did not show significantly different asymmetry on any measure (p>0.05). Both maxillary and mandibular asymmetry is common in skeletally mature patients with CLP and frequently results in notable chin deviation. Preoperative three-dimensional imaging and virtual surgical planning of orthognathic surgery aid in recognition of facial asymmetries and reveal opportunities to optimize results in this population.

The Evaluation of Condylar Position Change in the Asymmetric Mandible Following Sagittal Split Osteotomy.

The change of condyle position following orthognathic surgery affects the stability of treatments. This study aims to assess the correlation between the amount of condyles' position change and the severity of mandibular asymmetry following BSSO. This is a cross-sectional study. Subjects with asymmetric mandibular prognathism following BSSO were studied. Subjects were classified into 2 groups: group 1, subjects had mandibular asymmetry without occlusal cant and underwent BSSO. Group 2, subjects had mandibular asymmetry with occlusal cant and underwent BSSO+ Lefort I osteotomy. The condyle position was evaluated using cone-beam computer tomography (CBCT). Pearson's correlation test was used to assess any correlation between the condyle changes and the change in the mandible in sagittal and anterior-posterior directions. A total of 44 subjects were studied. In group 1, the condyle tilted outward in the deviated condyle and inward in the non-deviated condyle immediately after osteotomy. After 12 months, both condyles showed a rotation relative to the original position. In group 2, the condyles of the deviated sides and non-deviated sides moved inferiorly after surgery (condylar sagging), which was more significant in the non-deviated sides. The condyle rotation was similar to group 1. The severity of asymmetry and occlusal cant correlate with the condylar position change in the two groups. The severity of mandibular asymmetry correlates with the amount of condyles' position change immediately after BSSO. However, the condyles tend to return to their original position 12 months later.

Evaluation of Malocclusion Types in Adult Patients with Nasal Septal Defects – An Observational Cross-Sectional Analysis

ABSTRACT Introduction: The nasal septum is crucial in the development of the craniofacial structures. Deviated nasal septum is one of the anatomical causes of mouth breathing which in turn lead to malocclusion. Aims and Objectives: To evaluate the dentofacial and cephalometric characteristics in individuals with nasal breathing obstruction brought on by nasal septal deviation, as well as the relationship between these defects and various malocclusions and the degree of facial asymmetry. Materials and Methods: A two-point evaluation was adopted for the selected patients, one at the ENT department using clinical examination and CT–PNS and the severity classified according to the Mladina classification and another at the dental department, using clinical examinations, PA cephalograms, lateral cephalograms, and facial photographs. Results and Discussion: The association between malocclusion and various grades of septal deviation was statistically significant with a P value of 0.006. Results showed that 13 patients are with Class I skeletal pattern, 20 patients with Class II, and 7 patients with Class III skeletal pattern. None of the grade 7 nasal septal deviation patients had class I malocclusion and none of the grade 2 nasal septal deviation patients had class III malocclusion. Class II division I malocclusion was the most common type noted in patients with nasal septal deviation. Grade 7 nasal septal deviation was associated with the maximum amount of ANS and mentioned deviation indicating significant facial asymmetry. Conclusion: Class-II Division-1 malocclusion was the most common type noted and Class III malocclusion was more common in higher grades of nasal septal deviation. Maxillary and mandibular asymmetry worsens significantly with an increase in the grade of nasal septal deviation and is one of the significant factors in causing facial asymmetry.