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Bilateral Asymmetric Hemifacial Microsomia with an Unusual Expression: Report of two cases

Aydin Sohrabi
Assistant Professor, Dept. of Orthodontics, Dental School, Tabriz University of Medical Sciences
Somayeh Naghinejad
Postgraduate Student , Dept. of Orthodontics, Dental School, Tabriz University of Medical Sciences
Farzaneh Rasouli
Postgraduate Student , Dept. of Orthodontics, Dental School, Tabriz University of Medical Sciences
Sareh Keshavarz
Postgraduate Student , Dept. of Orthodontics, Dental School, Tabriz University of Medical Sciences
Arman Saeedi
Postgraduate Student , Dept. of Orthodontics, Dental School, Tabriz University of Medical Sciences

Objective:
Hemifacial microsomia is the second most common cause for facial asymmetry. The usual expression is a deficient mandible deviated to the more dominantly involved side of the face due to the smaller mandibular ramus and body length. Here is the presentation of two cases with mandibular deviation to the less severely affected side because of the special geometry of the mandibule.
Methods & Materials:
These cases are Hemifacial microsomia patients manifesting more deficient growth on the right side, despite the remarkable mandibular deviation to the left. Right side straightening of the mandibular body plus more obtuse right gonial angle has lead to a noticeable increase in the efficient length of the right hemi-mandibular geometry. The increased efficient length along with the anterior positioning of the right mandibular condyle which might have been due to decreased muscular tonicity of the facial right side, have ended in this unexpected mandibular deviation to the less involved facial half.
Results:
These cases show that mandibular deviation is strongly related to the special geometry of the asymmetry and differential muscular tonicities at the contra-lateral sides of the face. Considering the different etiologies and patterns of frontal asymmetry, detailed diagnosis and treatment planning appears mandatory. Anatomic modification of the bony structure in accordance with the patient specific geometry by means of contemporary techniques such as distraction histogenesis along with soft tissue rehabilitations if possible, may dominate the future protocols of facial asymmetry treatment planning.
Conclusion:
These cases and many similar dentofacial deformity cases witness the inadequacy of conventional orthognathic surgery approaches as the ideal treatment, since they somehow disregard the geometric variations of a single clinical problem among different patients.


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محل نشر یا ارائه:  کنگره 10 انجمن ارتودنتیست ها
سال ایرانی :  1391
موضوع:  ارتودنسی
Level:  Postgraduate

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