Modalities of facial asymmetry correction
Facial asymmetry correction surgery needs an eye for esthetics on the part of the surgeon. It can be achieved solely through surgery or in conjunction with orthodontic treatment when malocclusion of the teeth is also a component of the facial asymmetry. No human face is perfectly asymmetric. Everyone has a slightly asymmetric face. The facial contours are slightly different on the right and left sides of the face. This however is for the large part imperceptible.
When the patient has crooked teeth, particularly the front teeth, orthodontic appliances are used to correct this before proceeding with surgery. The patient needs to have healthy teeth before proceeding with orthodontic treatment. Carious teeth have to be restored and gum health has to be optimal before beginning orthodontic therapy. It is only at the completion of preliminary orthodontic therapy that surgery is performed.
Orthodontic appliances can either be fixed or removable. Removable appliances are used when minor tooth movements like tipping of anterior teeth is the only orthodontic correction required. Fixed orthodontic treatment is required for more complex corrections. Lingual braces are used for patients who are particular about their braces not being visible to others.
Martial artist with gradual development of facial asymmetry
The patient is a 35-year-old male martial artist from Srinagar in Kashmir, India who has been competing in tournaments for over 20 years now. He had started developing problems with his jaws when he was around 20 years old. His lower jaw developed an extreme crossbite due to jaw deviation and he started to experience difficulty with speech and eating. It reached the point where normal function became impossible.
He then approached a local oral and maxillofacial surgeon for management of his problem. Upon examining the patient, the surgeon realized that the degree of deformity was extreme and that very few surgeons in India performed these surgeries. He then referred the patient to Balaji Dental and Craniofacial Hospital in Chennai for surgical management of his problems. Our hospital is renowned for facial asymmetry surgery and corrective jaw surgery in India. He fixed up an appointment with the hospital manager and flew down to Chennai.
Incidence of facial asymmetry in the general population
Facial symmetry is a fallacy as it does not exist. Even Hollywood stars have the smallest degree of facial asymmetry though it cannot be easily perceived. Among the general population, facial asymmetry can at times be noted at the clinical or subclinical level. It is only when it is obvious or interferes with function that people seek treatment. Facial asymmetry can either be congenital or acquired. Treatment plan for facial asymmetry is formulated depending upon factors such as age, severity and cause.
Patient undergoes initial evaluation at our hospital
Dr SM Balaji, facial asymmetry correction surgeon, examined the patient and obtained a detailed oral history. The patient related that he holds a black belt in Karate and has won many tournaments over the years. He said that he has been kicked innumerable times in the jaws over the course of his career as a martial artist though he related that he does not recall any particular injury that could have triggered the development of his facial asymmetry.
The patient stated that he started noticing the jaw deviation around 15 years ago, but had ignored it at that time. This has slowly gotten worse over time and he decided to seek medical help once it began to make normal functioning impossible.
Clinical and radiological evaluation revealed that the patient had a crossbite with class III malocclusion and high arched narrow palate.
Treatment planning for correction of the facial asymmetry
It was recommended to the patient that he undergo lower jaw surgery for correction of his facial asymmetry as well as orthodontic treatment for management of his malocclusion.
Patient undergoes surgical correction of his asymmetry
Under general anesthesia, eyelets were first placed in both the jaws and interarch wiring was performed thus orienting the mandible into desired occlusion. Incisions were then made in the mandibular retromolar regions bilaterally and a flap was elevated. Following this, bone cuts were performed and bilateral sagittal split osteotomy done. Adequate care was taken to protect the inferior alveolar in from the proximal segment of the mandible to protect it from injury during surgery. The mandible was then pushed backward following which occlusion was checked and the jaw fixed using titanium plates and screws. The incisions were then closed using resorbable sutures.
Full correction of facial asymmetry
The patient expressed his complete satisfaction at the outcome of the surgery. His occlusion had become completely normal and his asymmetry had been corrected. He expressed his relief at this correction and was given instructions to return for orthodontic treatment to correct his malaligned teeth.