Correction Of Facial and Postural Asymmetry

By Maribel Vann, DDS

Dental malocclusion (incorrect bite fit) can be a clue to an underlying facial distortion, postural asymmetry and airway (breathing) problems. The question is whether it has a bearing on the oral structures (mouth) and oral function. The answer is yes. It is also commonly associated with temporo-mandibular (TMJ) disorder. Even children as young as eight years old can suffer from TMJ disorder.

Facial Assessment

The photograph below shows the patient at age seven (before treatment). The facial appearance shows

The right eye and eyebrow are up to

the right.

The right ear is up to the right and

flared.

The left ear is low and flat against

the skull.

The right nostril is up.

The lip line is also up to the right.

The photograph of the back view skull x-ray shows the upper jaw is up to the right as well. The cervical spine is leaning towards the right.

This is a characteristic of a right torsion. There is also a rotation of the upper jaw up to the right, carrying the right half of the face upwards with it. This is the reason why the right eye and eyebrow, ear, nostril, and lip line are up to the right.

Postural Assessment

An assessment of the patient's posture by viewing the frontal photograph shows the head is tilted to the left and the right shoulder is low. The left shoulder and arm are rotated forward. The side view photograph shows a forward head and body posture.

Patient History

Severe bruxing (teeth grinding)

Thumb sucking

Has an under bite

Her mother noticed that her face was crooked (facial asymmetry)

Breathing problem (sleeps with her mouth open)

Has difficulty with speech

Has difficulty making her teeth fit together

After Treatment

This patient was treated with an upper and lower ALF appliances. The facial characteristics shows

The right eye and eyebrow are level.

The right ear is level with the left ear.

The right nostril is level.

The lip line is straight.

The back view skull x-ray after treatment shows the upper jaw is level and the cervical spine is straight.

The front posture photograph shows the shoulders are level and the head is straight. The side view posture photograph after treatment shows the head posture is straight.

Conclusion

In particular, the improvements in facial and postural asymmetry should be noted on the after treatment photographs and the back view skull x-ray. Although this was a mild malocclusion from a dental standpoint, the patient illustrates the importance of recognizing and treating the underlying jaw misalignment, in this case a right torsion.

The teeth grinding, thumb sucking, under bite, facial asymmetry, breathing problem, difficulty with speech and difficulty making her teeth fit together were resolved over the course of treatment.