Q: Dr. Eppley,I am interested in exploring corrective surgical measures in order to minimize a facial asymmetry. I have attached a current photograph, in addition to two x-rays taken several years ago for dental work. These illustrates the cant of the maxillia & mandible. There is also a front/back asymmetry to the cheek bones as they appear to have grown/developed differently over time. This has caused jaw pain, compounded by bruxism, and damage to my teeth in general; not to mention a life long aesthetic concern. I am interested in hearing the your interpretation, possible solutions and any other guidance that might result from this cursory review. Thank you.
A: I can appreciate your facial asymmetry which is more easily discernible in your x-rays. You have an obvious skeletal-based facial asymmetry that is easily seen in the cant of your occlusion. In treating this type of facial asymmetry, the first decision that has to be made is whether you are going to treat the fundamental cause of the problem through osteotomies/bone repositioning or whether you are going to leave the occlusion alone and do camouflaging procedures around it. This decision influences everything that would be done and how it would be done.
In treating the fundamental problem, maxillary and mandibular osteotomies needs to be done to level out the occlusion and straighten the lower part of the face. Whether this would require orthodontic preparation or can be done with the way your occlusion is now requires more information. Once that is done then a second stage for other procedures such as rhinoplasty may be needed.
In working around the existing occlusion and its cant, the longer or shorter side of the lower jaw needs to be changed. (whether the long side needs to be shortened or the short side lengthened remains to be determined) This would be combined with a rhinoplasty and other facial asymmetry procedures that may be deemed helpful.
As you can see the two choices are radically different and what you want to do with your occlusion is the key decision.
Dr. Barry Eppley