Hemimaxillofacial dysplasia: a newly recognized disorder of facial asymmetry, hypertrichosis of the facial skin, unilateral enlargement of the maxilla, and hypoplastic teeth in two patients

Hemimaxillofacial dysplasia is a newly recognized disorder consisting of unilateral enlargement of the maxillary alveolar bone and the gingiva associated with hypoplastic teeth, facial asymmetry, and hypertrichosis of the facial skin on the ipsilateral side. The overall pattern of abnormalities in both of the patients presented in this article differs significantly from previously reported types of maxillofacial asymmetry. The occurrence of the same abnormalities in two or more unrelated patients suggests, but does not prove, that pathogenesis in both cases may be the same. The present disorder needs further delineation. At present, neither the cause nor the pathogenesis is understood.

Primary hemihypertrophy of the face: review and report of two cases

Two patients who underwent surgical correction for facial hemihypertrophy are presented with a one year follow-up. The aid of computerized tomography in planning the procedures and assessing the stability of the result is discussed.

Juvenile nasopharyngeal angiofibroma presenting as a facial swelling. A case report

Juvenile nasopharyngeal angiofibroma is a rare benign neoplasm occurring almost exclusively in adolescent males. When it is confined to the nasopharynx, surgery is often curative. In 20% of cases, there is intracranial extension, and radiotherapy may be used to avoid the risk of life-threatening haemorrhage. The authors report an unusual case which presented with a swelling of the cheek and an abducens nerve palsy. The lesion extended from the nasopharynx across the pterygomaxillary fissure, as well as intracranially. Radiotherapy was given, and the patient remains disease-free after one year.

Geography of the nose: a morphometric study

The noses of 34 attractive young North American Caucasian women were analyzed quantitatively, based on 19 nasal measurements (6 single and 7 paired linear measurements, 3 angles, and 3 inclinations) and 15 craniofacial measurements (10 linear measurements and 5 inclinations) taken directly from the face of the women. The relationship between the nasal measurements was studied in 16 proportion indices and the relationship between the nasal and the other craniofacial measurements in 13 interareal indices. The findings were also compared with those in 21 women with below-average faces. Two types of facial harmony disruption were identified: disharmony, a normal index with a visually apparent failure of proportionality, and disproportion, an index value outside of the normal range. The percentage of disharmonies and disproportions was significantly higher in the group of 21 women with below-average faces. The study revealed a wide variety of "ideal" noses. Only a small portion of the measurements (12%) and proportion indices (7%) were at the mean value. At least two-thirds of the interareal proportion indices were located in the mean +/- 1 standard deviation portion of the normal range. Only about one-fifth of the interareal indices were disharmonious and 2.8% disproportionate. The disproportions were more areal in the attractive faces and more interareal in the below-average faces. The greatest disproportion in the attractive face was the moderately short columella in relation to the tip protrusion and in the below-average face the long nasal bridge related to the upper-lip height. Disproportions were associated with combinations of normal and abnormal measurements, or with two normal measurements of unequal quality, which resulted in a slightly smaller disfigurement. Analysis of ethnic and racial differences showed the soft nose as the main feature of the most characteristic differences. The study revealed that the key to restoration of facial harmony is the renewal of the uniformity of proportion index qualities by elimination disharmonies and/or disproportionate relationships.

Condylar hyperplasia. A clinico-pathological analysis of 22 cases

A series of 22 cases of unilateral condylar hyperplasia is presented with the emphasis on histopathological aspects. It is concluded that there are two types of condylar hyperplasia. The first manifests itself in the adolescent or the young adult and represents an exaggerated, normally proceeding growth and maturation process. The histological structure of the condyle in these cases is age-dependent as is shown by a conversion of hyaline growth cartilage into fibrocartilage occurring at about 20 years of age. The second type of condylar hyperplasia, seen in older people, probably represents reactive growth as a response to an eliciting agent that mostly can be identified. In these cases the histological architecture of the condyle is distorted by large masses of hyaline cartilage while there are concomitant degenerative changes in the form of arthrosis. In contrast to the patients suffering from the first type of condylar hyperplasia, the latter ones complain of additional joint symptoms, mostly pain. Moreover it is concluded that joint scintigraphy does not clearly discriminate between genuine condylar hyperplasia and reactive processes due to arthrosis, which may have clinical implications.

Hemimandibular hyperplasia--hemimandibular elongation

Clinical and radiographic experience as well as histological findings leave no doubt that the term "condylar hyperplasia" refers only to hyperplasia of the condyle alone and should therefore not be used to mean the two hemimandibular anomalies as is the case in the literature today. There are two basically different malformations of one side of the mandible which we call hemimandibular hyperplasia and hemimandibular elongation respectively. We are convinced that there exist pure and mixed forms of both growth anomalies because we have observed several such clinical cases. The stimulus for the abnormal growth either lies within the fibrocartilaginous layer or is produced by it. Different histological patterns within the condylar growth zone were seen in the two anomalies. The pathophysiological bases of the abnormal growth are discussed. They seem to contribute to the understanding of the normal and abnormal mandibular growth and consequently also of many of the mandibular anomalies. The explanations are demonstrated by the illustrations of some cases.

The mandible in mandibulofacial dysostosis: a cephalometric study

The lower border of the mandible in mandibulofacial dysostosis is characteristic of the syndrome. Evaluation of the cephalograms by means of the medial axis analysis and inflectional tangents captures the shape deformity. Morphometric data from lateral cephalograms on seven patients, ages 3 through 20 years, are reported: a total of 22 observations on three males and four females. These forms were compared to normal mandibular forms from the University of Michigan University School Study. The curvature of the gonial angle in the study population is not distinguishable from the normal curvature. Relative to this apparently normal region, there is a marked downward displacement of the symphysis that results in the curvature typical of the lower mandibular border in this syndrome. These findings are not consistent with earlier reports.

Basilar multiplane cephalometric analysis

This article presents a method of cephalometric tracing and analysis using the basilar view cephalogram and discusses its role in diagnosis and treatment planning. Landmarks and structures found in each of three separate basilar planes are defined and instructions for tracings are presented. The analysis is applied to the study of orbital hypertelorism, craniofacial synostosis, and hemicraniofacial microsomia. The multiplane tracing technique is demonstrated to provide a three-dimensional concept of deformities in the craniofacial skeleton. A method to determine an anteroposterior midline construct from structures in the cranial base is described. As is practiced with the lateral cephalogram, presurgical tracings of the basilar film may be manipulated to simulate the skeletal changes anticipated in surgery.

Craniofacial polyostotic fibrous dysplasia

Three cases of gross craniofacial polyostotic fibrous dysplasia are presented, together with a brief review of the condition, and pertinent points regarding the cases are discussed. As complete excision of the lesion and immediate reconstruction is rarely feasible or possible, and partial excision may result in accelerated growth of the lesion during the patient's active growth phase, resection only to protect, maintain or restore certain important functions (e.g. vision) during this period are advocated, after which close follow-up is mandatory until the lesion becomes quiescent, when further surgical procedures may be undertaken.

Inherited craniofacial fibrous dysplasia

Craniofacial fibrous dysplasia occurring in a mother and two of her three daughters is reported. In all three patients, the condition was characterized by extensive bilateral and bimaxillary involvement. All patients exhibited radiographic evidence of abnormal maxillary and mandibular bone and tooth displacement. Morphologic examination of deciduous teeth from the daughters showed replacement of normal pulp tissue by fibro-osseous lesion. Because of the familial occurrence of the cases, it is proposed that they comprise an example of inherited craniofacial fibrous dysplasia.

Craniofacial disproportions in Apert's syndrome: an anthropometric study

Twenty craniofacial indices composed of 26 surface measurements taken directly from the head and face were determined in 14 Apert's syndrome patients 18 days to 5 years old (younger subgroup) and 14 patients ages 6 years to 15 years old (older subgroup). All of the patients were North American Caucasians who had undergone early suture release but no facial repair. The indices were compared with those in healthy controls of the same age and sex. The wide intercanthal distance in relation to the narrow soft nose was the most frequent (81.5%) and extensive (17.7% above the maximum normal index value) disproportion. Abnormal indices occurred most often with the combination of one abnormal and one normal measurement (61.0%). All seven of the 16 disproportions seen in both age subgroups increased in frequency nonsignificantly with age: the supernormal cephalic, intercanthal, nasal, and vertical mandibulofacial indices and the subnormal nasofacial, upper face, and jaws' arcs indices. Of the six disproportions that decreased in frequency with age, four changed significantly (the supernormal frontoparietal and frontozygomatic indices and the subnormal mandibulofacial and nasozygomatic indices) and two changed nonsignificantly (the supernormal intercanthoalar and subnormal cheilozygomatic indices). With the exception of two nasal proportions, the extent of the disproportionality decreased in all of the indices that increased with age.

Bone scanning with 99mtechnetium phosphate to assess condylar hyperplasia. Report of two cases

Condylar hyperplasia poses a problem in planning treatment because it is a self-limiting process for some but not all patients. Continued growth creates a progressive deformity that requires condylectomy, whereas an enlarged condyle can be left in place after hyperplastic growth ceases, even if ramus surgery is needed to correct asymmetry. Bone scan with 99mtechnetium phosphate can be used to assist in making the differential diagnosis. In the two patients reported here, abnormal metabolic activity revealed by bone scans supported clinical and historical evidence that the condylar hyperplasia was active and required surgical correction, including condylectomy. The two cases demonstrate different approaches to postsurgical orthodontic treatment, depending on the amount of normal growth expected.

Morphologic asymmetries of the face: a review

It has been suggested that asymmetries in the morphological properties of the face contribute to or produce asymmetries in facial emotional expression. Over 50 years of research on hard tissue, soft tissue, and facial surface asymmetries is reviewed here. Generally, it appears that if consistent asymmetry characterizes facial morphology, it is extremely small in magnitude or characterizes regions yet to be examined. In contrast, marked homology and asymmetry in regional size and area has been noted often. At present, it does not appear that asymmetry in facial morphology is associated with facial expressive asymmetry, with the latter more likely to be an outcome of functional brain asymmetry.

[Hemifacial microsomia. Description of a case with associated rare multiple visceral anomalies]

A case of hemifacial microsomia is reported in association with rare cardiac, lung and laryngeal abnormalities. Our case presents both atrial and ventricular septal defects, hypoplasia of the right lung and of the larynx. This variety of malformations is rarely present in other reported cases. The literature of hemifacial microsomia is reviewed and differential diagnosis is discussed.

Progressive facial asymmetry as a result of early closure of the left coronal suture

A longitudinal growth analysis of a patient with premature closure of the left coronal suture is presented. The resultant facial asymmetry of patients with unilateral synostosis of the coronal suture is accompanied by diagnostic facial characteristics and radiographic skull distortions. The midfacial structures distort and grow toward the site of synostosis while the lower face grows away from the site of synostosis. Unilateral craniosynostosis of the coronal suture results in distortions and compensations within the cranial vault and the cranial base. Therefore, with growth of the contiguous facial structures, the facial distortions are magnified.

The use of morphanalysis in orthognathic surgery

A method of analysing and planning orthognathic surgery is described using morphanalysis in conjunction with standard photographic techniques, cephalometry and dental study models.

Bilateral facial microsomia associated with separation of the posterior portions of the maxilla. A case report

A case of bilateral facial microsomia associated with separations of the posterior portion of the maxilla is presented. The X-ray findings revealed hypoplasia of the condyles, absence of the coronoid processes of the mandible, and displacement of the pterygoid processes. Cephalometric analysis revealed a characteristic feature of the facial skeleton a rotation clockwise to the anterior cranial base.