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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