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Abnormal dental and facial growth affects many adults and childrens and involves the two most common conditions seen at craniofacial centers, cleft lip/palate and craniofacial microsomia. Although not life threatening, many of these conditions can severely affect psychosocial function and limit proper development. Whether the facial deformity is congenital or acquired by trauma or tumor surgery, the impact to the patient and their family’s life is significant.
Decreased maxillary growth in both the AP plane or in the sagittal plane represents the most common finding in the cleft lip and palate clinic affecting up to twenty five percent of our patients. Increased maxillary growth although less common is frequently seen and is recognizable by a “gummy” smile and prominent overjet. Decreased mandibular growth is seen in children with Pierre Robin Sequence and in older children and adults. Increased mandibular growth is often identified by the proud chin and underjet.
Orthognathic surgery is a process in which dentofacial deformities and malocclusions are corrected. Orthodontics and surgical operations of the facial skeleton accompanied by soft tissue procedures can significantly correct many of these disordes. The term orthog nathic originates from the Greek words orthos meaning to straighten and gnathos meaning jaw. It is possible to correct deformities separately in the maxilla or the mandible with many types of surgical techniques or to concurrently perform surgery on both jaws (bimaxillary operations). This type of treatment changes the bony relations of the face but also improves the soft tissues and can significantly improve the patient’s appearance.
Typically performed in the teenage years after facial growth is completed, jaw surgery can also be safely performed at younger ages including the neonatal period for more serious deformities that affect the airway or ocular exposure. The technique of distraction osteogenesis has greatly improved safety and long-term results by first cutting and then gradually moving the bones into their new position over a few weeks rather than a few hours. These techniques have decreased the need for secondary bone grafting procedures, decreased potential tooth bud damage, and significantly decreased blood loss during surgery. With increasing experience both external and internal distraction devices have been used successfully while minimizing stress on the patient and family. With the use of modern fetal ultrasound, infants with dentofacial abnormalities are increasingly being identified before birth and the process of education and support can be started for a new mother before delivery.
ASMS surgeons use a comprehensive method of correction of dentofacial skeletal abnormalities in our craniofacial center and offer treatment for the entire spectrum of abnormalities including orbital and transcranial approaches to facial skeletal surgery. Wide eyes or hypertelerism and uneven or dystopic eyes are more common that appreciated and can be safely corrected with modern craniofacial surgery techniques. ASMS member surgeons use a multidisciplinary approach, which includes evaluation by speech experts, genetic counseling and testing, dental and orthodontic evaluation, neurosurgical consultation when indicated, plastic surgery and oral surgery consultations, and social support services for patients and their families. All dentofacial abnormalities are evaluated thoroughly from the most challenging to the seemingly simple case.