Dentofacial Deformity

A dentofacial deformity is an imbalance of the position, size, shape, or orientation of the bones that comprise the upper and lower jaws. Dentofacial deformities requiring surgery exist in about 2% of the population.

Patients can be seen by Texas Children's experts in Plastic and Craniofacial Surgery.

Causes & Risk Factors

The causes of dentofacial abnormalities are extremely varied and not always completely known.Some dentofacial deformities, such as mandibular prognathism (where the lower jaw outgrows the upper, resulting in an extended chin), may be inherited. 

Apert syndrome, Crouzon syndrome, and many other genetic conditions have distinctive dentofacial deformities.  Cleft lip and palate and craniofacial microsomia are examples of non-genetic congenital dentofacial deformities.  Trauma to the facial skeleton can also lead to dentofacial deformities.  Habits like digit sucking and mouth breathing can contribute to dentofacial deformities.

Symptoms & Types

Symptoms of dentofacial deformities may include the inability to chew properly, impaired breathing (which may lead to sleep dysfunction), speech impediments and pyschosocial challenges resulting from facial imbalance.  The spectrum of dentofacial deformities is wide and includes: 

  • Excessive overjet, also know as a Class II malocclusion, which can be caused by excessive maxillary growth (where the upper jaw grows too much) or deficient mandibular growth (where the lower jaw has not grown enough)
  • An underbite, also known as a negative overjet or a Class III malocclusion, which can be caused by deficient maxillary growth or excessive mandibular growth
  • An openbite, which is a gap in between the upper and lower teeth
  • Facial asymmetries or occlusal cants (also known as a crooked smile)
  • Excessive vertical growth of the upper jaw leading to too much of the gum showing below the lip

Diagnosis & Tests

Dentofacial deformities are diagnosed through a combination of specific x-rays, photographs, dental models and thorough clinical exams.  Other tests such as sleep studies and thorough speech evaluations may also be indicated depending on the specific presentation of the deformity.   

While some of the more severe dentofacial deformities can be identified at birth or a very young age, some dentofacial deformities do not become apparent until late childhood or early adolescence.

Treatment & Care

Correction of a dentofacial deformity is a complex task requiring the expertise of a team of health care professionals, including plastic surgeons, oral surgeons, orthodontists, prosthodontists, psychiatrists and speech pathologists.  Every patient’s specific treatment is individualized, but most treatment plans to correct a dentofacial deformity include comprehensive orthodontic treatment and corrective jaw surgery.   

The timing of dentofacial deformity correction depends on the severity of the deformity along with other associated impairments, such as breathing problems.  Sometimes surgical correction may be indicated as early as a few months of age.  Other deformities may not be corrected until late adolescence when growth is complete. 

Texas Children’s plastic and craniofacial surgeons utilize a multidisciplinary team approach to combat the unique challenges presented by certain conditions that require plastic surgery.

References & Sources

Surgical Correction of Maxillofacial Skeletal Deformities, David A. Cottrell, DMD, Sean P. Edwards, DDS, MD , Jack E. Gotcher, DMD, PhD Journal of Oral and Maxillofacial Surgery, Volume 70, Issue 11, Supplement 3, November 2012, Pages e107–e136

Orthodontic Management of Dentofacial Skeletal Deformities, John Grubb, DDS, MSD, Carla Evans, DDS, DMSc Clinics in Plastic Surgery, Volume 34, Issue 3, July 2007, Pages 403–415