Patient with facial asymmetry facing difficulties with speech and eating
The patient is a 22-year-old female patient from Gwalior in Madhya Pradesh, India who has always had the complaint of facial asymmetry. She had an anterior crossbite with jaw deviation to the left upon mouth opening. She said that she had always felt very self conscious of her facial asymmetry and had always kept to herself. This had also led to her not being able to chew her food thoroughly and to have difficulty with speech. The patient stated that she cannot ever recall being injured or recall any incident that could have led to the development of her facial asymmetry.
Her parents took her to a local oral surgeon in her hometown. The surgeon had examined the patient and explained to them that the patient needed jaw surgery. He had further stated that this was a complex surgery that could be successfully undertaken only in specialty oral and maxillofacial surgery hospitals in India. The oral surgeon had thus referred them to our hospital for definitive surgical management of her condition. Our hospital is a premier centre for facial asymmetry surgery in India. We are also very well known for jaw correction surgery in India.
Occurrence of facial asymmetry
Facial asymmetry is the norm as facial symmetry is a myth. Every single one of us has a mild degree of facial asymmetry that is imperceptible to the naked eye. This does not detract from the attractiveness of the face and in fact adds a charm to every face. A completely symmetrical face can be seen only in science fiction.
There are however instances when the amount of facial asymmetry exceeds a certain level. It then becomes discernible to the naked eye and turns into a social handicap for the person. It decreases the attractiveness of the face and can in fact attract unwelcome stares when present above a certain level. It is this level of facial asymmetry that has to be surgically corrected.
Facial asymmetry can occur when there is asymmetry of the ascending ramus of the mandible. This leads to a skewed occlusal cant. Cleft lip and facial trauma also lead to facial asymmetry. Unilateral partial edentulousness can also lead to facial asymmetry. This can be corrected by placement of dental implants.
Maxillofacial surgeons perform reconstructive surgery of the facial structures.
Initial presentation and treatment planning at our hospital
Dr SM Balaji, facial asymmetry surgeon, examined the patient thoroughly and ordered radiological studies. It was noted that the mandible was deviated to the left side with a crossbite in relation to the left side. This is a condition that will lead to a lot of functional difficulties as it would be very hard to occlude the teeth properly during eating. It was advised that the patient undergo lower jaw correction through a bilateral sagittal split osteotomy surgery. This was to be followed by fixed orthodontic treatment for management of her dental malocclusion.
Surgical correction of the patient’s facial asymmetry through mandibular surgery
Under general anesthesia, eyelets were placed. This was followed by incisions placed in the mandibular retromolar regions bilaterally. Flaps were then elevated followed by bone cuts for the bilateral sagittal split osteotomy. Special care was taken to ensure that there was no damage caused to the inferior alveolar nerve. The mandible was then rotated to the right side, pushed backward, checked for occlusion and fixed using titanium plates and screws. One final check of the occlusion was made following which the incisions were closed using resorbable sutures.
Successful correction of the patient’s facial asymmetry
The change in esthetics of the face following surgery was immediate. The patient now had a symmetrical face as well as a normal occlusion. She was very happy with the surgical outcome. Next step of the treatment will be fixed orthodontic treatment for correction of her malaligned teeth.
