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Deviation Facial Deformity

Homepage Star of December 2014
[ Author:Fushun Ma | Time:2015-01-29 11:50:46 |  Font Size: [Large Medium Small]
Tags: deviated face, facial mddle line, vertical line, facial deformity

Deviated face is one kind of maxillofacial deformity means that the asymmetric growth of the facial bone causing three dimensional disfigure of the face. This is due to the unbalanced development of the maxillary bones. It may related to congenital or acquired situations such as injury, improper gesture or habits. For those who suffer minor facial deviation there may be no notable abnormality. Severe facial deviation may present as badly facial deformities and rendering low self esteem to the sufferer. In fact all human faces are not perfectly symmetric and no facial mid line is perfectly straight. Everybody's face is asymmetric and facial middle line angled if take a careful analysis. Correction of deviation facial deformity is a quite complex surgery. Only those whose deviation is so serious that facial deformity is present justifies a correction surgery. Though there is not confirmed guideline to make the diagnose of Deviation Facial Deformity a common believe is that the deviation of the facial middle line exceeds 3 degrees from the vertical line of the face ( a perpendicular line to the line running through both sides of the lower edges of the bonny ocular).

The facial bones in the deviation deformity face have position abnormalities in various dimensions such as swing along the vertical axis, rotation along the sagittal axis and sliding on coronal axis. The correction surgery adjusts not only the facial middle line deviation but also the other abnormalities. The facial bonny middle line deviation of this boy was 5.7 degree, accompanied were facial bone displacement and misalignment at deferent directions and levels. During surgery the maxillary and mandibular bones were osteotomized, repositioned and swung according the calculated surgical plan based on the pre surgery facial bone CT analysis. Then solid internal fixation was applied to fix the free bones at the desired position. The deviation facial deformity of this boy was corrected satisfactorily.

facial deviation plastic surgery
After the correction surgery (the right side photo) the facial middle line is straighter and the height of the face is shorter.

The real deformity of facial bone deviation disorder may not easily be shown  on the front view photo. Nevertheless the above before surgery photo on the left side still shows the left deviation of the tip of the chin and the tilt of the mouth. In the after surgery photo the face is shorter and those problems has improved.

marked facial deviation
Before surgery (the left side photo) the facial middle line is deviated from the facial vertical line. After surgery these two lines merged.

Marked photo analysis depict the deviation degree of facial middle line more effectively. In the picture on the left side the vertical line on the right side is the facial vertical line which is the line perpendicular to the lines that running through the lower edge of both sides of the bonny oculars. The angle between the two lines is about 5 degrees. This is roughly the deviation degree of this boy's face. Though the facial middle line deviates from the facial vertical line in the photo the line connecting both corners of the mouth is still perpendicular to the facial middle line. This means that the tilt degree of the teeth occlusive plan matches the degree of the facial middle line. After the correction surgery (see the photo on the right side) the facial middle line merges into the facial vertical line indicating the deviation is corrected.

deviated face in chin down position
In chin down position the pre surgery photo shows the curved facial middle line and the tip of the chin points to the right. After surgery the facial middle line is straight and the chin points to the center.

The above photo in chin down position depicts the deviation of the facial middle line. From the before surgery photo on the left side we can see the facial middle line is curve like an reversed "C". The lips are not aligned with the lower lip staggered to the right. The tip of the chin points to the right. In the after surgery photo all these abnormalities are gone.

CT image of deviated face
CT image of deviation facial deformity, the middle line of the chin goes away from the facial vertical line and the maxillary bone is not leveled.

The degree of facial bone deviation can be precisely measured in the CT image. The two vertical line in the left side photo are the facial middle line and the facial vertical line. The angle between these two lines is 5.7 degree. At the level of the chin tip the middle line swift to the right in about 12.5mm, at the level of the nasal base arouind 4.5mm. The two transverse lines in the right side photo depict the tilt degree of the maxillary bone. The height of the maxillary bone on the left side is 6mm higher than on the right side.

teeth in deviated face
After the correction of facial deviation the malocclusion of the teeth is also adjusted. In the after surgery photo (the right side photo) less gingival is exposed under the same mouth opener due to the shortening of the maxillary bone.

The above photos show the teeth occlusion and the gingival exposure area under the same mouth opener. Take the nostrils as a reference both the upper and lower set of teeth tilts to the right side. In the before surgery photo more gingival is exposed than in the after surgery photo and the left side gingival exposure is more obvious than on the right side. During the surgery the vertical height of maxillary bone is shortened so less gingival is exposed in the after surgery photo under the same mouth opener. Because of the maxillary bone is shortened the height of the whole face is shortened too.

Controlled development, a treatment method of inducing or restrict bone development during childhood can prevent facial deviation deformity that is caused by the unbalanced growth during the development phase. However the formation of facial deviation is a insidious gradual process, plus the thick subcutaneous fat coverage in children face, it is a big challenge to most of the parents to notice the hint of facial deviation. So almost all the deviation deformity is noticed at adulthood, missing the opportunity of non surgery correction by controlled development. Surgery becomes the only selection at this time. As facial deviation correction is a major surgery not every facial deviation justify a correction surgery. Deferent surgeon has deferent criteria of surgical indication for this surgery. But most surgeons agree only those whose deviation exceeds 3 degree need the surgical attention. For those facial deviation sufferer with no surgical indication camouflage surgeries may be considered to make the facial outline back to normal.

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