jaw deformities

JAW DEFORMITIES

Contents

• Definition

• History

• Classification

• Treatment consideration

• Assessment

• Treatment planning

• Complications

Definition

A true resultant deformity of the jaw bone/bones due to congenital anomalies or acquired during the growth and development of an individual (trauma, habbits, familial, pathology or post cancer surgery).

Adverse Effects

Function - Chewing

Swallowing

Speech

Airway related

Malnourishment

Esthetics

Social acceptance

History

• The first known correction of jaw deformity was carried out without anaesthesia in the mid 19th century by an American, General Surgeon Simon Hullihen.

• He was referred a patient with gross facial deformities as the result of scarring from burns early in childhood, with a history of multiple previous operations.

• He undertook initially an osteotomy of the mandible, repositioning the anterior segment to correct an anterior open bite and subsequently he carried out soft tissue surgery to improve the overall appearance and functionality of the soft tissues of the lips, chin and neck to return them to their normal position thus achieving lip closure and a relatively normal facial profile. That was in 1848 .

History • Maxillary surgery for tumour removal had been carried out in the

19th century by von Langenbeck in Germany and by Cheever in the US.

• It was not until the 1920’s that midface surgery as previously described in the 19th century was specifically used to correct maxillary deformity where there was severe maxillary retrusion often in association with cleft palate problems.

• Martin Wassmund and Georg Axhausen were the first in Germany to develop the procedure for midface deformity .

• Le Fort I osteotomy became widely accepted for the correction of low midface deformity often in conjunction with mandibular surgery.

Classification

1. Congenital

2. Acquired

3. Pseudo/ Other Causes…

(Related to soft tissues)

BASED ON

ETIOLOGY

1. Trauma during forceps delivery

2. Trauma causing soft tissue damage

3. Trauma causing jaw fracture

4. Trauma causing jaw dislocation

5. Trauma causing dental damage

6. Trauma from dental procedures

7. During Wisdom tooth removal

TRAUMA

Trauma during forceps delivery

Trauma causing soft tissue damageTrauma causing jaw fracture &

Malunion of fractured segments

Trauma causing dental damage &

Disfigurement

Trauma from dental procedures

& Trauma causing jaw dislocation

During Wisdom tooth removal

1. Dental caries

2. Dental abscess

3. Wisdom teeth

4. Infection of jaw bone (osteomyelitis)

5. Dental cyst

6. Poor dental hygiene

Dental Causes

Dental caries

Dental abscess

Poor oral hygiene

Dental CystOdontogenic keratocyst

Osteomyelitis

Mandibular deficiency• Treacher-Collins

syndrome• Pierre Robin's syndrome• Hemifacial microstomia

(Goldenhar syndrome)

Mandibular excess• Gorlin goltz syndrome• Hemihypertrophy• Worth syndrome 

SYNDROME ASSOCIATED

Midfacial deficiency• Achondroplasia• Apert syndrome• Cleidocranial dysosteosis

(Yunis Varon syndrome )• Crouzon• Hemifacial microstomia

Facial deficiency• Hemihypertrophy• Hemifacial microstomia

Orabital & cranio-orbital deformities

• Apert syndrome

• Crouzon

• Gorlin goltz syndrome

• Orofacial digital (type I)

• Treacher-Collins syndrome

OthersFirst arch syndrome Cortical hyperostosis-syndactyly - asymmetric lower jaw bone McCune-Albright Syndrome - jaw deformityWaardenburg syndrome types I - broad jawWaardenburg syndrome type 2 - broad jaw

• Treacher Collins–Franceschetti syndrome or Mandibulofacial Dysostosis.

Treacher-Collins syndrome

A rare autosomal dominant congenital disorder ,

characterized by craniofacial deformities

Pierre Robin's syndrome

A congenital condition of facial abnormalities in humansin which a chain of certain developmental malformations, one entailing the next.

The 3 main features are cleft palate, micrognathia ,  glossoptosis 

Pierre Robin sequence may be caused by genetic anomalies at chromosomes 2, 11, or 17.

Hemifacial microstomia (Goldenhar syndrome)

• Also known as Oculo-Auriculo-Vertebral (OAV) syndrome• Characterized by incomplete development of the ear, nose, soft

palate, lip, and mandible.

GORLIN-GOLTZ SYNDROME

Multiple recurring OKC (in 90% cases)

Multiple nevoid basal cell carcinoma

Skeletal abnormalities

Hypertelorism

Palmer planter pits

22

GORLIN-GOLTZ 1960

Calcification of falx cerebri

CNS & ocular lesion

Cleft lip & cleft palate

Mandibular prognathism

Ovarian fibroma

23

HYPERTELORISM

SWELLING

24

MANDIBULAR PROGNATHISM

X-RAY CHEST

25

Crouzon syndrome• Crouzon in 1912• Crouzon syndrome (craniofacial dysostosis)is a genetic disorder

known as a branchial arch syndrome. • This syndrome affects the first branchial (or pharyngeal) arch,

which is the precursor of the maxilla and mandible.

Apert syndrome• Classified by apert in 1906• Apert syndrome is a form of acrocephalosyndactyly, a congenital

disorder characterized by malformations of the skull, face, hands and feet.

• It is classified as a branchial arch syndrome, affecting the first branchial (or pharyngeal) arch, the precursor of the maxilla and mandible.

Cleidocranial dysostosis (Yunis Varon syndrome )

• Hypoplasia of maxilla• Failure of eruption of permanent teeth.• Frontal Bossing (bulging) of the forehead.• Open skull sutures, large fontanelles.• Hypertelorism.

McCune-Albright Syndrome - jaw deformity

• endocrine hyperfunction (autonomous) • Polyostotic fibrous dysplasia• Unilateral Café-au-lait spots

Cleft lip &

cleft palate

Developmental anomaly

PREMATURE SYNOSTOSIS

Adverse habits

• Teeth grinding• Jaw clenching

Temporomandibular joint

pain & dysfunction syndrome

Pathological

• Inflammatory condition• Arthritis of jaw• Rheumatoid arthritis

• Tumour of jaw• Ameloblastoma• Tumour of lymphoid tissue surrounding jaw• Burkitt's lymphoma• Metastatic deposits in jaw bone

• Infectious condition• Mumps• Sinus infection (swelling of upper jaw)

Arthritis of jawRheumatoid arthritis

CYST & TUMORSA case of Ewing sarcoma

Ameloblastoma

Sinus infection (swelling of upper jaw)

Severe burns

Treatment consideration

Assessment

Treatment planning

Complications

References