Facial deformities encompass a large number of alterations that are characterized by involving different elements of the facial skeleton. Generically they could be classified as congenital or acquired deformities.
Congenital facial deformities: when the person is born with them.
Congenital deformities are already present in the person from birth. The most frequent is the cleft lip and palate. It is a problem caused by an incomplete fusion of the two hemimaxillae and hemilabials during intrauterine development.
Other less frequent congenital deformities are craniofacial dysostoses, which are caused by the premature fusion of different structures of the craniofacial skeleton. Among these, it is also important to highlight Crouzon’s and Apert’s syndrome.
Acquired facial deformities, why do they occur?
Acquired facial deformities can be divided into four different groups, according to their causes:
- Facial trauma. These are alterations that appear at a specific moment in life and are basically due to a blow or impact. These facial alterations have decreased in the West, especially thanks to the mandatory use of seat belts and motorcycle helmets.
- Deformities of tumor origin. Some neoplasms can lead to various malformations, and the demolitive surgery associated with their treatment causes even worse malformations. Their reconstruction is included in maxillofacial reconstructive surgery.
- Developmental anomalies. They are caused by an insufficient or excessive development of one or several elements of the facial skeleton. It is a disorder that usually appears in childhood and is accentuated in the period of craniofacial growth (at 18-20 years of age, depending on sex). The disharmony of the skeleton during development leads to increasingly large bone discrepancies, caused because one part of the skeleton suffers a deficit or excess of growth, but other parts have a normal development. If this affects the maxilla and/or mandible it is easy to deduce that the facial alteration will be accompanied by an occlusal alteration or malocclusion.
- Deformities or atrophy of the jaws due to edentulism. It is an acquired deformity. The early loss of teeth causes in the medium term a progressive atrophy of the skeletal bases (especially of the maxilla) which, eventually, also conditions an alteration of the harmony of the face.
Types of patients with facial deformities and how to deal with them
Normally there are two types or profiles of patients who come to the consultation of the specialist in Oral and Maxillofacial Surgery, depending on the first fact that motivates the consultation:
- The first group of patients is made up of those who come directly to the specialist seeking aesthetic correction of a problem that they themselves or someone in their environment considers skeletal or bone-dependent. They are generally patients who are dissatisfied with their facial appearance and comment in consultation: “my chin looks too much”, “my facial appearance is aged”, “my nose is too big” or “I do not like my face but I do not see where the problem is”.
- The second group of patients are usually referred by the orthodontic specialist, to whom they have come to try to solve what many patients consider to be the only problem of their deformity: malocclusion. After a visit with the orthodontist, the idea that this alteration does not depend only on the position of the teeth but also on a problem in the jaws and, therefore, requires orthodontic-surgical treatment is demonstrated. The specialist will make the patient see that this alteration in the jaws, in addition to causing malocclusion, causes an aesthetic alteration at different levels that can be corrected. By means of orthofacial surgery it will be possible to achieve an optimization of aesthetic and occlusal objectives at the same time.
In any case of malformation it is important to have a meticulous interview with the specialist where the patient can express all his concerns or point out which elements of his face he would like to change.