Treatment Of Facial Asymmetry Research Articles

Treatment outcome and long-term stability of orthognathic surgery for facial asymmetry: A systematic review and meta-analysis.

: This systematic review aimed to provide a comparative analysis of the treatment outcomes, including hard and soft tissues, postoperative stability, temporomandibular disorders (TMD), and quality of life (QoL), in patients with facial asymmetry who underwent orthognathic surgery. : The primary objective was to address the question, "How do different factors related to surgery affect the outcomes and stability of orthognathic surgery in the correction of facial asymmetry?" A meta-analysis was conducted on the outcome parameters, such as skeletal, dental, and soft tissue symmetry, TMD, QoL, and relapse, using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Subgroup analyses were conducted considering surgery-related factors such as surgical techniques (one-jaw vs. two-jaw), use of the surgery-first approach, utilization of computer simulation, and analytical methods employed to evaluate asymmetry (2D vs. 3D). : Forty-nine articles met the inclusion criteria. The meta-analysis demonstrated a significant improvement in the symmetry of hard and soft tissues. The subgroup analysis indicated that the treatment outcomes showed significant improvement, regardless of the factors related to surgery. Changes in TMD signs and symptoms varied according to the surgical technique used. Quality of life improved in the facial, oral, and social domains. Skeletal relapse was observed during the follow-up. : Our findings support the positive outcomes of orthognathic surgery in the treatment of facial asymmetry in terms of skeletal and soft tissue improvements, stability, relief of TMD symptoms, and enhancement of QoL. However, most of the included studies showed a low certainty of evidence and high heterogeneity.

Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach.

Facial asymmetry includes several etiologies, among them trauma to the condylar area during early childhood and congenital malformations such as hemifacial microsomia. This article describes the management of facial asymmetry in adolescents and young adults using a mandible first approach by distraction osteogenesis, followed by maxillary Le-Fort I as a second stage. Eighteen patients 14-25 years of age presented with unilateral hypoplasia of the jaws which manifested clinically by deviation of the chin and canting of the occlusal plane. Etiology included hemifacial microsomia and trauma injuries at early childhood.All patients underwent orthodontic treatment and two phases of surgical treatment. Surgical treatment included unilateral mandibular distraction followed by Le-Fort I osteotomy for alignment of the maxilla. Additional bone graft in the affected side and sliding genioplasty were done as required. Marked ramal elongation of 18.94 mm concomitant with mandibular forward traction of 12.5 mm was noted while achieving symmetry. In all cases, the maxilla was centered to the midline in proper occlusion. Post distraction, posteroanterior cephalometric radiographs demonstrated elongation of the affected ramus, improvement in facial symmetry, and correction of the occlusal canting. Relapse was minimal based on long-term follow-ups of 47.4 months. The two-stage surgical approach that includes elongation of the mandible as a first stage followed by adaptation of the maxilla is useful in correcting facial asymmetry. Using this protocol at the correct age (14-18) is very stable, as demonstrated by our results, yet one should always remember the transverse deficiency in the gonial angle requires additional bone grafting or patient specific implants.

Secondary Treatment of Facial Asymmetry in Hemifacial Microsomia

Hemifacial microsomia is most often diagnosed at birth and comprises varying degrees of malformations of one side of the face. Depending on the malformations involved, multiple procedures are required as primary treatment approaches, often embedded in an interdisciplinary concept from birth to adolescence. However, with regard to the symmetry of the face, soft tissue and bony discrepancies between the normal and the affected side often remain recognizable or even persist after surgery, resulting in lasting disturbed facial harmony. Such patients may have a high burden of disease. In our case report, we present the clinical course of a 39-year-old female with hemifacial microsomia, who was suffering persistent facial asymmetry after primary treatment comprising surgery on the mandible and soft tissue augmentation with the use of a free muscle flap. By means of virtual planning tools and patient-specific implants for genioplasty and bony augmentation in a first step followed by soft tissue augmentation with autologous fat cells in a second step, a very satisfactory result was achieved for both patient and medical staff. Hence, for secondary treatment of facial asymmetry in adulthood, a combined and step-by-step therapy addressing both soft and hard tissue seems to be the key to success.

The Treatment of Facial Asymmetry with Botulinum Toxin: Current Concepts, Guidelines, and Future Trends.

This article will describe facial asymmetry secondary to facial nerve paralysis (FNP), and review current concepts, guidelines, and future trends. Despite the increasing use of botulinum toxin (BoNTA) in treating FNP, ideal dosage, timing, and additional therapies are not unequivocally established. Facial asymmetry significantly impacts quality of life (QOL) by strongly affecting self-perception and social interactions; injectables may mediate great clinical improvement. This article provides practical guidelines for the use of BoNTA and provides schemes for accurate assessment and documentation. A systematic, stepwise approach is recommended with methodical assessment, meticulous placement, conservative dosage, and careful follow-up. Future trends include the potential use of newly developed toxins, muscle modification with fillers, improved imaging techniques, and targeted QOL studies. Hopefully, a growing number of aesthetic injectors may become technically proficient and join multidisciplinary teams for managing FNP.

The treatment of facial asymmetry: Review.

Some degree of congenital or acquired asymmetry is normal and universal. Significant facial asymmetry, however, causes both aesthetic, as well as functional problems. The comprehensive management of facial symmetry is scarcely addressed.1-5 Differing etiologies, heterogeneous material, and different ages of patients tend to produce fragmentary reports, the more so as evidence-based evaluation of outcomes is almost impossible. Therefore, a presentation of the general rules of treatment, illustrated by our own material collected from the Hospital and Clinic of Plastic Surgery in Polanica-Zdrój and from private surgical and orthodontic practice, could be regarded as useful and justified. Special attention has been given to both functional and cosmetic problems encountered in severe congenital and acquired asymmetries. The management of selected craniofacial malformations in so-called rare clefts, cleft lip and palate, and craniofacial microsomia (CFM), as well as large hemangiomas and neurofibromas, have been discussed. Additionally, the treatment of extensive and asymmetrical post-traumatic deformities and defects is discussed with particular attention given to problems related to ankylosis of the temporomandibular joints. Numerous examples of one-stage procedures, as well as combined, multidisciplinary treatments are presented.

Virtual surgical planning in the treatment of facial asymmetry

Virtual surgical planning in the treatment of facial asymmetry

Alternatives for Treatment of Facial Asymmetry by Condylar Hyperplasia: A Review

The purpose of the present review was to describe the numerous alternatives for the treatment of facial asymmetry caused by condylar hyperplasia and compare the results obtained in both aesthetic and functional aspects. A search for articles published from 2002 to 2017 in the PubMed and Lilacs databases was realized. A total of 42 articles were selected according to the inclusion criteria, of which 32 were used for the study. The selection of the most appropriate treatment for condylar hyperplasia depends on factors such as the age of the patient, degree of deformity, osteoblastic activity of the condyle, etiology and functional limitations. The procedure of first choice when confirming active growth of the condyle will be condylectomy in combination with orthognathic surgery. Condylectomy is essential in the presence of joint problems and tumors. The treatment with condylectomy as well as orthodontic camouflage through the use of mini-implants can be considered in cases of mild asymmetry.

Les asymétries faciales à composante squelettique

The diagnosis and treatment of facial asymmetries is one of the most difficult challenges in orthognathic surgery. In some cases, the involvement of soft tissue defects or, in other cases, an associated basi-cranial asymmetry can complicate the management. The influence of various components of the cephalic end in the development of the face requires a thorough clinical and radiographic examination including the overall posture of the patient. The causes are multiple: congenital, constitutional, acquired with an important esthetic, functional, and psychological and social impact. The classification of these asymmetries can only be incomplete and purely didactic because of the multiplicity of clinical forms. Two elements are mandatory for the diagnosis and surgical treatment: first, the anterior clinical and radiological "craniofacial cross" established from the midline or midplane of the face; second, the clinical and radiological orientation of the maxillary and mandibular occlusal transverse and sagittal planes. The surgical techniques are the same as in conventional orthognathic surgery except for those used for the correction of the vertical posterior dimension of the face: condylectomy, lengthening osteotomy of the mandibular ramus, costochondral graft, and free flap. The contribution of 3D vision of the facial skeleton and its possibilities of measurement have improved the assessment of skeletal structure displacement during surgery. However, traditional radiographic examinations are still useful for pre and postoperative comparison and also to assess results. Computer simulation and computer-assisted surgery should allow achieving better and more stable results because of their reliability and easy access.

Treatment of Facial Asymmetry and Temporomandibular Joint Ankylosis by Distraction Osteogenesis: A Case Report

Facial asymmetry and functional problems due to dentofacial discrepancy and soft tissue disparities are commonly managed by orthognathic surgery and augmentation procedures. Distraction osteogenesis is a relatively new technique of bone generation and reconstruction. A patient reported with the chief complaint of asymmetry of face and deviated chin; had temporomandibular joint ankylosis. Distraction device was applied with simultaneous release of ankylosis by gap arthroplasty. For management of mandibular deformity and discrepancy of the dentition, orthodontic therapy was done using MBT 0.022” prescription. Distraction was stopped when the midline of upper central incisor coincided with the midline of lower central incisor followed by stabilization period of ten weeks. The functional and esthetic results achieved were acceptable.

Orthodontic and orthognathic management of a complex mandibular asymmetry

The application of a combined surgical-orthodontic procedure for the treatment of major facial deformities (eg, asymmetries) and associated malocclusions has become an increasingly prevalent treatment modality over the past few decades. Development of sound conjoint treatment principles made possible the correction of skeletal and dental dysplasias that were unyielding to either surgical or orthodontic treatment alone. The presence and severity of dentofacial asymmetries has been the subject of many commentaries and investigations. Treatment of facial asymmetry has always been a challenge with respect to the cause and the rationale behind the corrective procedures adopted. This case report describes a 23-year-old male patient whose chief complaint was attributed solely to the clinically discernible facial asymmetry. A combined orthodontic and surgical approach was done to correct both the dental and skeletal asymmetry. The reasons for selecting this treatment protocol and the 5-year postretention stability of the final results obtained are highlighted in this report.

Orthognathic surgery associated with joint prosthesis in the treatment of facial asymmetry: case report

The asymmetric growth of the face may be triggered by skeletal congenital, genetic or traumatic as a result of injuries and fractures that impair mandibular growth. The correction of mandibular asymmetry aims to achieve, simultaneously, improve aesthetics and prevent jaw function, too, the recurrence of such a deformity. The cases of facial asymmetry are not easy to fix and do not always involve only the mobilization of a segment. However, an important part of orthognathic surgery. This study reports a case of mandibular asymmetry, exposing the possible causes for this deformity and the type of surgical treatment offered to order corrective surgery concomitantly.

Assessing soft-tissue characteristics of facial asymmetry with photographs

Precise diagnosis and treatment of facial asymmetry are important in orthodontics. The aims of this study were to determine the soft-tissue characteristics of patients perceived to have severe asymmetry requiring treatment and the soft-tissue factors affecting the subjective assessment of facial asymmetry. In the first part of this study, 5 observers examined 1000 photographs of patients receiving orthodontic treatment and selected 100 for further assessment. These photographs showed 50 patients who were considered to have little or moderate asymmetry and 50 who were considered to have severe asymmetry. A pilot study was performed to select the reference photographs representing the most symmetric (score of 0) and the most asymmetric (score of 100). A panel of 9 orthodontists then rated the facial asymmetry of the 100 patients on a 100-mm visual analog scale. The scale was divided into 3 equal regions. Region 1 included patients with the least facial asymmetry; according to the orthodontists, these patients did not require treatment. Region 2 included patients with moderate facial asymmetry who did not require treatment. Region 3 included patients with the most facial asymmetry who did require treatment. One-way analysis of variance showed that lip canting, chin deviation, body inclination difference, and gonial angle difference had significant differences between the groups. Chin deviation and gonial angle difference were significant factors affecting the assessment of facial asymmetry, according to stepwise linear regression analysis. These results will help in the diagnosis and treatment planning for patients with asymmetry.

Surgical Treatment of Facial Asymmetries

Surgical Treatment of Facial Asymmetries

Treatment of Facial Asymmetry with Poly-L-Lactic Acid: A Case Study

Poly-L-lactic acid (PLLA) (Sculptra, Dermik Laboratories, Bridgewater, NJ, a business of sanofi-aventis US, LLC) is a novel biocompatible and biodegradable injectable device currently under review by the Food and Drug Administration for a cosmetic indication. When implanted into soft tissues, PLLA is thought to elicit a foreign body reaction, resulting in fibroplasia and subsequent collagen formation. This process leads to a gradual thickening of the dermis and long-lasting augmentation of facial contours. In the reported case, PLLA was used to treat a 69-year-old African-American woman who had undergone numerous unsuccessful procedures for correction of prominent facial asymmetry. One vial of PLLA (5-ml dilution) was injected into the dermal-subcutaneous plane using a lattice distribution in the right upper cheek and malar regions, followed by massage. The procedure was repeated 6 weeks later. Several months after the two separate PLLA treatment sessions, the contours of the right upper cheek and malar regions were visibly and cumulatively enhanced, and facial symmetry was gradually restored, to the patient's full satisfaction. The treatment was well tolerated on both occasions, and the benefits of treatment have been sustained 18 months after the last procedure. The author concludes that injectable PLLA is a safe and effective minimally invasive treatment for facial contour defects.

Discriminative thresholds of cephalometric indexes in the subjective evaluation of facial asymmetry

The purpose of this study was to determine the means and the ranges of the thresholds of cephalometric indexes by which orthodontists subjectively differentiate patients needing treatment for facial asymmetry from those who do not. The study was performed at the Departments of Orthodontics and Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry in Nagoya, Japan, in 2004. Ten orthodontists subjectively evaluated the frontal photographs of 100 subjects and classified them into 2 groups. The subjects in group A showed good or clinically acceptable levels of asymmetry and did not require treatment. Those in group B showed marked asymmetry, and treatment was recommended. The frontal cephalographs were also analyzed with 5 indexes related to the mandible. For each orthodontist, the threshold was determined by means of the discriminant analysis. As the number of subjects who were judged to require treatment increased, the threshold of cephalometric indexes became smaller, and the discriminant accuracy was reduced. Among the 5 indexes evaluated, the distance of menton (mean, 4.28 mm), maxillomandibular midline angle (mean, 4.31 degrees ), and the distance of L1 (mean, 2.78 mm) showed relatively high accuracy in all observers. The distance of menton, the maxillomandibular midline angle, and the distance of L1 appeared to be relevant indexes for the subjective evaluation of facial asymmetry. The thresholds determined in this study could contribute to the planning and evaluation of orthodontic treatments.

Orthopedic treatment of facial asymmetry in first and second branchial arch syndrome

目的 探讨第一、二鳃弓综合征面部不对称畸形的整形外科矫治方法.方法 根据第一、二鳃弓综合征患者临床及X线所示面部双侧不对称情况,采用健侧下颌骨外板去除、颧骨截骨降低;患侧下颌体、颧骨应用健侧下颌骨外板贴附植骨或高密度多孔聚乙烯(Medpor)假体置入等术式,配合颏部水平截骨颏成形术,以缩小面部双侧宽度的差异,矫治颜面不对称畸形.结果 共矫治23例,经6个月至3年的术后随访观察,双侧面部宽度差异明显缩小,正面观面部不对称明显改善.结论 第一、二鳃弓综合征面部骨骼发育畸形是三维方向的,双侧面骨宽度的差异,是造成正面观面部不对称的重要因素,根据受术者的具体情况,采用以上术式的组合,扩充患侧或同时缩窄健侧骨骼,进行面部骨性支架重建,可以取得良好的矫治效果。

Botulinum Toxin: A Treatment for Facial Asymmetry Caused by Facial Nerve Paralysis

Sacramento, Calif. Received for publication May 27, 2004; revised June 9, 2004. Follow-up to Clark, R. P., and Berris, C. E. Botulinum toxin: A treatment for facial asymmetry caused by facial nerve paralysis. Plast. Reconstr. Surg. 84: 353, 1989. Richard P. Clark, M.D., Plastic and Reconstructive Surgery, 83 Scripps Drive, Suite 180, Sacramento, Calif. 95825, [email protected]

Occlusal cant in the frontal plane as a reflection of facial asymmetry

The authors present a well-done investigation that composes conventional radiographs with photographs, aiming at a better three-dimensional treatment of orthognathic and maxillofacial patients. Indeed, the problems involved in the detection and treatment of facial asymmetry, with all its functional and esthetic implications, are of great interest for orthodontists, oral and maxillofacial surgeons, and dentists. Nevertheless, the study has some shortcomings. I have some perplexities about the necessity of using PA radiographs to measure the occlusal plane. I believe that the same quantitative assessment could be performed on standardized frontal photographs, thus avoiding all the postural problems of posteroanterior (PA) radiographs, and limiting the radiation exposure. For example, in the protocol used by Ferrario et al,’ the subjects were photographed while clenching on a Fox plane between their posterior teeth. The interpupillary plane was taken as the intrinsic horizontal reference. This plane has an advantage, being almost horizontal in all individuals’ (ie, it could be used as an approximation of the true horizontal plane). Moreover, lingual and buccal molar cusps are not located on the same horizontal plane (in the frontal plane they describe Wilson’s curve’); the authors did not specify on which cusps the plane was established. Figure 5 is not discussed in detail in the text. It seems that the percentage of correctly detected occlusal cants rises almost linearly up to 6”, and then it goes down at 7”. A further increment corresponds to go. The behavior of this variable is strange, and a detailed discussion, together with some possible interpretations would allow a better assessment of the value of the proposed method. The authors discuss the cultural background of their panel, but the addition of lay people (ie, outside the medical and dental professions) could have enhanced the significance of the investigation. Indeed, facial asymmetry also has esthetic implications, and recognition of the “ordinary people” threshold for occlusal canting would be additional useful data in the treatment planning of borderline patients.3*4 Finally, a further development of the study could be the detection of the functional threshold of muscular asymmetry,’ as well as the functional correlates of the different degrees of morphologic asymmetry.

Treatment of facial asymmetries by one-stage maxillary and mandibular bilateral osteotomies

Very often facial asymmetry is confused with laterognathia, but a careful study of facial asymmetries shows that the malformation does not involve the lower part of the face only but rather the middle part as well. Many surgeons correct the mandibular abnormality first and the affected maxilla at a later operation. This preliminary report of four cases shows that both procedures can be accomplished in a single operation. The surgical procedure was a bilateral osteotomy of the mandible together with supraalveolar osteotomy to allow a tilting and rotating movement of the bone fragments, accomplished by balancing the resection for shortening the bone against the bone grafting for lengthening. Good occlusal adjustment is obtained and the facial outlines are restored esthetically.