INDIANA UNIVERSITY

Introduction

- Should be based on qualitative and quantitative diagnosis

- List of esthetic treatment objectives should be determined
preoperatively
- Usually involves orthodontic treatment and orthognathic
surgery
Treatment Considerations
- Functional mandibular shifts (laterocclusions)
- Amendable to correction with occlusal adjustments and
orthodontic appliance only
- Unilateral open bite (laterognathism)
- Surgical correction deemed necessary
- Diagnostic Splints
Treatment Considerations
- Asymmetry related to muscle hypetrophy
- Botox injections
- Muscle relaxants
- Biofeedback therapy
- Muscle resection and bone recontouring
Treatment Considerations
- Complex facial asymmetry
- Prognostic challenges and predicting hard/soft tissue
improvements
Facial Asymmetry and TMJ Involvement
- TMD symptoms more likely in class III skeletal
discrepancy
- Surgical management of TMJ pathology in facial
asymmetries is mandatory
- Stable and unchanging facial asymmetry with no
evidence of TMJ pathology; surgery not required
Hemifacial (Craniofacial) Microsomia
- Provision of early treatment is aimed at optimizing facial
growth
- Minimize secondary asymmetric development of maxilla
and canting of occlusal plane.
- Different early treatment modalities:
- DO, costochondral rib graft to reconstruct condyle
Goal-Oriented Therapy
- Model surgery and cephalometric prediction tracing two
valuable tools that help providers manifest the results of
indicated surgery
Single Jaw Surgery
- Isolated OGS indicated in uncomplicated asymmetries
affecting mandible only (i.e. deviant prognathism)
- SSRO usually employed for correction of asymmetry up
to 7-8mm
- IVRO usually preferred for correction of larger
asymmetries
Bimaxillary (Double Jaw) Surgery
- Indicated to correct asymmetric deformities in more than
two planes
- Dental and skeletal midlines should be ideally aligned to
the facial midline
- Intercommisural plane parallel to intercanthal plane
- Accurate prediction of soft tissue and lip position very
difficult
Genioplasty
- Correction of transverse asymmetry of the chin
- Sliding genioplasty
- May also alter A-P direction and vertical height as well
- Autogenous or alloplastic onlays may be used for
augmentations in esthetic reconstructive sxs
Adjunctive Soft-Tissue Manipulation
- Usually performed as secondary procedures
- Buccal fat pad or masseter muscle reduction, free fat or
dermal fat transfer, alloplastic implants, etc
Surgery First Approach (SFA)
- Gaining popularity
- Reduction in treatment time
- Addressal of C.C., ensuring better patient compliance
Distraction Osteogenesis
- Facilitates the three-dimensional correction of asymmetric
hypoplastic dentofacial deformities
The End