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Orthognathic classification - Facial asymmetries

Facial symmetry influences judgements of aesthetic traits, of physical attractiveness and beauty. When facial asymmetry becomes obvious and disturbing, this is due to abnormal growth development of the lower jaw. The mandible as a bony organ is indeed sensible to asymmetric outgrow. This can be due to:
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery 1. Abnormal overgrowth of half the mandible, or mandibular head or collum. One side becomes too big with obvious asymmetry. The middle of the chin shifts towards the unaffected side. Characteristics of condylar hyperplasia may also include: posterior open bite on the affected side when developed in (late) adolescence or canting of the occlusal plane of the upper jaw when developed at a younger age.

2. Abnormal undergrowth of mandibuar head. The growth centre of the lower jaw, located in the condylar head is affected by trauma or infection. Juvenile idiopathic arthritits (JIA) and condylar fractures are also a common cause of growth disorder of the lower jaw. The growth centre of the lower jaw within the condyle is destroyed by trauma or inflammatory disease. Both result on the affected side in underdevelopment and impaired growth with asymmetry. The affected side of the face is the underdeveloped with the chin shifting towards the affected side. There is a severe asymmetrical retrognatic occlusion (class II). If there is juvenile arthritis, both sides are affected, and chances are that an open bite with class II develops with severe retrognathia. Treatment is waiting till the disease is completely burned out, and then orthognathic surgery. Asymmetric underdevelopment is what follows. One side becomes too small with obvious asymmetry.
Malocclusion, cross bites and facial asymmetry. This condition creates a variable cosmetic affecting the occlusion, jaws and face. In the affected condyle the abnormal growth during childhood can be persistent and continuous or this growth can be in different waves.

Treatment of the hemi-mandibular hyperplasia during youth (growth) requires more elaborate treatment planning since it includes condylar head surgery.

The abnormal growth stops totally (burns out) once growth is finished. Treatment then becomes more simple and more predictable with upper lower jaw (and often upper jaw) repositioning. Surgery on the condylar head is then no longer necessary.