Disease Description (Causes and Symptoms)
- Definition: A condition in which the left and right facial lengths, areas, or structures do not match, causing deviation of the facial midline and asymmetry in the shape of the eyes, nose, and mouth, or in the corner of the mouth when smiling.
- Main causes
- Skeletal causes: Asymmetry of the jawbones or cheekbones caused by congenital conditions (hemifacial microsomia, craniofacial deformities, etc.) or trauma and abnormal growth.
- Soft-tissue causes: Atrophy of the skin, fat, and muscles on one side due to progressive hemifacial atrophy (Parry–Romberg syndrome, etc.).
- Other causes: Unilateral chewing habits, malocclusion, and muscle imbalance caused by facial nerve palsy.
- Pathophysiology (briefly): Abnormal growth and development of the skeleton or atrophy/excessive development of soft tissue disrupts left-right balance, resulting in deviation of the facial midline, malocclusion, and asymmetric facial muscle strength during expressions.
- Main symptoms
- Asymmetry in the position and shape of the eyes, nose, and mouth; elevation of one corner of the mouth when smiling; misalignment of the facial midline
- Malocclusion, a habit of chewing only with the molars on one side, and head tilting
- In some cases, ear deformity, sensory abnormalities, and psychological discomfort
Treatment Methods
- Diagnostic tests (essential before treatment)
- Clinical photographs (front, side, and smiling), dental occlusion examination, dental models, facial bone X-rays and CT (3D), and computer analysis (simulation).
- Conservative/non-surgical treatment
- Orthodontic treatment (correction of dental occlusion) to improve function and prepare for surgery.
- Temporary improvement of mild soft-tissue imbalance with Botox, fillers, etc. (limited depending on the cause).
- Fat grafting: Used to improve appearance in cases of soft-tissue atrophy (Parry–Romberg syndrome). Recently, attempts have been made to improve graft survival by combining it with SVF (stromal vascular fraction derived from adipose tissue).
- Surgical treatment
- Skeletal asymmetry: Bimaxillary surgery (movement of the maxilla and mandible), jawbone reconstruction, cheekbone correction, bone lengthening, etc.—often requiring multistage, long-term treatment.
- Soft-tissue reconstruction: Fat grafting, flap surgery (if necessary), etc.
- Children: Timing-based surgical plans for the lips, ears, jaw, etc. (e.g., lip correction at 1–2 years of age, ear surgery in the early elementary-school years, and temporomandibular joint reconstruction during childhood, etc.).
- Post-treatment care and expected recovery
- Swelling and bruising after surgery peak on days 1–3 and generally improve within 3 weeks. Daily activities are possible from about 1 week later, but final stabilization takes several months.
- Bimaxillary surgery: Hospitalization for 2–3 days, return to daily life in 3–4 weeks, and concurrent orthodontic treatment (several months to more than 1 year) are necessary.
- Precautions when choosing treatment
- Skeletal asymmetry requires complex treatment (orthodontics + surgery + soft-tissue surgery), and treatment is lengthy and carried out in multiple stages.
- It is important for safety and outcomes that treatment be performed by medical staff with extensive surgical experience and at an appropriately equipped facility.
- New techniques such as SVF have institution-specific differences, advantages, and disadvantages; thorough consultation with the attending physician is necessary.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items/materials to prepare
- List of currently used medications and supplements (especially anticoagulants, antiplatelet agents, antihypertensive drugs, etc.)
- Past medical history (trauma, surgery, facial paralysis, etc.) and family history
- Previous test results (dental orthodontic records, X-rays/CT, dental models, etc.)
- When symptoms began and how they have progressed (recording changes in symptoms with photographs can be helpful)
- Expected changes (priorities: functional improvement vs. cosmetic improvement)
- Photographs to show the doctor during the outpatient visit
- Front view (at rest), front view (smiling), left and right side views, and photographs with the upper and lower jaws in a natural position
- Example questions (items to check personally before asking the doctor)
- Are the symptoms gradually worsening? (Are they progressive or stable?)
- Is there a history of facial trauma or jaw problems during childhood?
Examples of General Questions to Ask the Doctor
- In my case, is the main cause of the asymmetry skeletal or soft-tissue related?
- What treatment options do you recommend, and what are the advantages and disadvantages of each option (recovery period, complications, and possibility of recurrence)?
- If surgery is necessary, how long will orthodontic treatment take before and after surgery?
- What are the major complications of surgery (reduced sensation, infection, bleeding, recurrence, etc.), and how are they managed?
- What can I expect during recovery (swelling, pain, dietary restrictions, etc.), and when can I return to daily activities?
Examples of Disease-Specific Questions
- If soft-tissue atrophy (such as Parry–Romberg syndrome) is suspected: "How can I determine whether my condition is progressing or has stopped? What additional follow-up tests (photographs, imaging) are recommended?"
- If skeletal asymmetry is suspected: "If bimaxillary surgery is recommended, can I see a specific simulation of the orthodontic schedule before and after surgery and the final facial changes? What is the risk of reduced sensation (inferior alveolar nerve injury), and how likely is recovery?"
(Medical decisions should be made based on examination by the attending specialist and the results of diagnostic tests. Please discuss any questions in detail during your medical consultation.)