1. FACIAL ASYMMETRY
• Dr V.RAMKUMAR
• CONSULTANT
DENTAL
&FACIOMAXILLAR
Y SURGEON
• REG NO: 4118 –
TAMILNADU-INDIA(
ASIA)

2. Abnormal skeletal anatomy may be
described simply in forms of maxillary and
mandibular morphology, which may or may not
be further complicated by associated
abnormalities in other parts of the skull.

3. Facial Asymmetry can occur in three planes
Sagittal or Anteroposterior
Vertical
Transverse

5. ETIOLOGY
 Genetic (Piere robinsyndrome)
 Trauma (Ankylosis)
 Congenital and developmental (Condylar
agenesis)
 Acquired (Stills disease)

6. LEVELS OF THE FACE
Cranial (upperthird)
Maxillary (Middlethird)
Mandibular (Lowerthird)

8. CLASSIFICATION OF FACIAL
ASYMMETRY
 Symmetrical disproportion of jaws
 Asymmetrical disproportion of jaws
 Mandibular lower facial enlargement
 Mandibular lower facial deficiency

9. Maxillary enlargement
Maxillary deficiency
Cleft lip and palate syndrome
Craniofacial asymmetry

10. MAXILLARY DEFICIENCY
Naso maxillary hypoplasia
Total midface hypoplasia

11. MAXILLARY ENLARGEMENT
Dentoalveolar Enlargement
Class II Div.I
Premaxillary enlargement (Pagets disease)
Vertical maxillary excess (Long face syndrome)

12. MANDIBULAR LOWER FACIAL
ENLARGEMENT
Progeria
Vertical mandibular excess
Sagittal mandibular excess
Bilateral massetric hypertrophy

13. MANDIBULAR LOWER FACIAL
DEFICIENCY
 Microgenia and Retrogenia
 Low angle (AP growth and transverse
growth are affected)
 High angle (The growth is more vertical
than horizontal)

14. NASO MAXILLARY
HYPOPLASIA
Group 1. Involving dento alveolar segment
(Short columella)
Group 2. Excluding dento alveolar segment
(Binders syndrome, short cranial base)
Group 3. Cleft palate syndrome (Short nose)
Group 4. Panfacial problems

15. TOTAL MIDFACE HYPOPLASIA
It affects the whole midface including
orbital walls zygomatic region without cranial
mal formation.
Crouzon syndrome
Aperts syndrome

16. INVESTIGATION
WELL ORIENTED PHOTOGRAPHS
Radiographs
Posterior and lateral cephalograms
Model analysis
Arch alignment
Occlusion
Model surgery
Photocephalometry
Sterio lithography

20. TREATMENT OPTIONS
Maxilla
Anterior maxillary osteotomy
Posterior maxillary osteotomy
Lefort I osteotomy and its modification
Lefort II osteotomy and its modification
Lefort III osteotomy and its modification
Quadrangular osteotomy

21. ANTERIOR MAXILLARY
OSTEOTOMY

22. LEFORT I OSTEOTOMY

23. LEFORT II OSTEOTOMY

24. LEFORT III OSTEOTOMY

25. TREATMENT OPTIONS
MANDIBLE
Subapical osteotomy
Genioplasty and its variations
Sagittal spilit osteotomy
Subsigmoid osteotomy
C osteotomy

26. GENIOPLASTY

27. SAGITTAL SPLIT
OSTEOTOMY

29. Thank U