Acquired maxillofacial deformities

Acquired maxillofacial deformities are the defacements or damages of the face and jaws that can occur during the person’s life. In such cases, a person is born with a normal appearance. However, a sudden event or a developing health problem can alter or interfere with the normal facial anesthetics. 

Patients with maxillofacial deformities often experience emotional stress associated with poor self-esteem and social anxiety. Sometimes, it can result in functional issues such as difficulties in breathing, talking, chewing, malocclusion, and sinus disorders. In the long run, this reduces the patient’s general quality of life. 

Main Categories of Acquired Maxillofacial Deformities 

Maxillofacial deformities can be classified as intraoral, extraoral, and composite defects based on the exact location. Intraoral comprises maxillary, mandibular, and velo-pharyngeal, while extraoral includes ocular defects, nasal defects, auricular defects, orbital defects, and lip and cheek defects. 

Furthermore, acquired facial deformities are categorized into three groups according to the leading causes. It includes;  

Trauma: 

Mostly, acquired maxillofacial deformities arise due to trauma. The common causes of facial trauma can include; 

• Sports associated injuries 
• Interpersonal violence 
• Motor vehicle and work-related accidents 
• Severe burns 
• Attacks by animals 
• Falls from tall heights 
• Gunshots or blasts 

The patient with trauma associated condition can be treated using various treatment alternative. This is without necessarily reminding them of the actual event or the extent of the sustained facial deformity. However, this mode of treatment depends on the overall health state of the patient and the severity of the condition or injury. 

In most cases, a severe facial injury results in intense functional impairment. While trauma-related deformities transpire unexpectedly, it’s difficult for most people to accept the consequences. This can either be the abrupt loss of facial or jaw esthetic or functional aspect. 

Health conditions: 

In other cases, acquired maxillofacial deformity can gradually occur as a result of certain diseases that impact the facial appearance. Some of these diseases are; 

• Unilateral condylar hyperplasia 
• Idiopathic resorption 
• Rheumatic arthritis of the mandibular condyles 
• Facial hemiatrophy 
• Acromegaly 
• Duchenne’s muscular atrophy 

Surgical procedure: 

Surgeons can perform extensive surgeries to address cancerous and other non-cancerous conditions. This can sometimes result in the loss of the facial structures. In a case where the patient has a chronic tumor, the doctor can recommend sacrificing facial harmony and balance. This is usually the best alternative to save the patient’s life and prevent the tumor from advancing. However, post functional issues may arise afterward, resulting in facial and jaw deformities. 

The common tumors affecting these areas include; 

• Salivary gland tumors, including pleomorphic adenoma and adenoid cystic carcinoma 
• Benign mesenchymal tumors, including angioblastoma, hemangioma, fibroma, fibrolipoma, myxoma, and angioleomtoma 
• Epidermoid carcinoma- mainly occurs in the maxillary sinus  

Classification of Acquired Maxillary Deformities 

On the other hand, acquired maxillary (jawbone) deformities can be divided according to the extent. In case the two maxillae are resected, then the issue is referred to as total maxillectomy. However, if it’s a resection of a single or just a section of the palate or maxilla, it’s considered partial maxillectomy. 

Therefore, the classification of acquired maxillary deformities according to the extent includes the following; 

Classification 1: This is the unilateral deformity affecting one half of the arch that extends towards the midline. Basically, this is the most prevalent maxillary deficiency diagnosed. 

Classification 2: A defect that impairs a single section of the arch behind the canine teeth. This is especially if the teeth near the canine are missing or absent. 

Classification 3: A deformity affecting the central part of the hard palate. It can also include the soft palate, especially if all teeth are intact. 

Classification 4: This is a two-sided deformity that crosses the middle line and affects the two sections of the maxilla. 

Classification 5: A two-sided posterior deficiency that occurs when the teeth anterior to the second premolar are intact. 

Classification 6: This involves two-sided anterior deformity that occurs when the teeth anterior to the second premolar are missing or absent. 

Treating Acquired Maxillofacial Deformities 

The objective of treatment is to restore the standard functionality, including swallowing, chewing, and speech. It also aims to restore the altered facial appearance. This is achievable through a reconstruction surgery or artificial closure of the affected area. 

However, surgical procedures are the most common and effective way of treating and repairing maxillofacial deformities. Besides, the type of surgery to perform can vary from one patient to another depending on underlying factors such as; 

• The severity of the facial deformity 
• The extent of the functional impairment 
• Type of tissues altered or lost 
• The overall health state of the patient 

Overall, the common types of surgeries can include the following; 

• Free vascularized transfer of tissues 

Free vascularized transfer is a procedure to correct bone loss, soft tissue loss, or sometimes both. It involves the removal of grafts from other healthy parts of the body, including the draining vessels and feeding artery. The obtained graft is then placed in the defect region and firmly stitched to the tissue bed. 

On the other hand, the two veins and artery are linked to the local blood vessels with the help of a microscope. Once the link to the systemic circulation is obtained, the grafts are perfused instantly to shield it. 

Doctors usually recommend this procedure if other reconstructive methods fail or the situation involves a huge quantity of tissue loss. 

• Polyethylene custom made grafts and stereolithographic facial models use 

If the facial injuries and fractures heal in a nearly dislocated manner, one can easily identify a defect in the projection of tissues. A similar issue can also arise when some facial structures, including temporalis muscle and frontal bone, are missing. 

To address such an issue, the doctor can first conduct a CT scan to acquire images of the facial structures. This helps determine the defect and design a custom-made graft to help augment the tissue projection of the affected area. Since the size and shape of the graft are carefully estimated based on the model, it effectively fits the target region. This eventually gives the best aesthetic outcome. 

• Orthognathic surgery 

This comprises various surgical procedures that aim at restoring the facial imbalances. This can be accomplished by moving or adjusting the lower jaw, upper jaw, and chin into the normal position. With this, the facial aesthetic appearance will gradually improve. 

• Flaps (local, regional, and distal)

To address soft tissue condition, the surgeon can use either the local or distal flaps. This is to enhance and correct residual esthetic defects. This can be accomplished by obtaining a section of the soft tissue from the donor and moving it to the recipient site with good blood flow. After that, the flaps are linked to the donor site and carefully fixed on the recipient part. This is without necessarily cutting them from the original anatomy position. 

• Bone grafts 

In a situation where the patient suffers a bone loss, the surgeon can address the problem by obtaining bone grafts from other body parts. It can be the ribs, tibia, pelvis, or calvarium to correct the deformity and restore the normal bone volume. 

• Skin grafting 

Skin grafting is a procedure to address missing, damaged or dead skin. It involves removing a small piece of the skin and using it to cover the affected area. There are several donor sites that doctors can use for skin grafts. However, this usually depends on the amount required and the matching type of skin between the recipient and donor site. 

• Total temporomandibular joint replacement 

This procedure addresses idiopathic resorption and the pathology of the mandibular condyle. These conditions can result in inference or distortion of the facial esthetic and its functionality. It involves the use of custom made polyethylene or titanium artificial joint to help replace and repair the impaired joint. 

Usually, the surgeon designs the prosthesis to exactly replicate the function and mobility of a healthy joint. Besides, they use stereolithographic skull mold to efficiently make the joints based on the anatomy of the patient. 

• Implant supportive facial prosthesis 

This is a procedure that surgeons use to for reconstruction purposes or to repair missing structures. It can be around the eye, nose, and auricle. This is accomplished by fabricating a silicon prosthesis that perfectly matches the shape and size of the missing structure. When in the target position, the surgeon stabilizes the prosthesis on the titanium implants, improving overall facial appearance. 

• Laser procedure 

Surgeons usually apply this technique in a situation of hypertrophic surgery scars. It can also include other medical conditions that affect the facial structure. It aims at improving the overall texture of the skin and giving the patient a better aesthetic appearance. 

Conclusion 

Acquired maxillofacial deformities refer to malformations and irregularities of the soft tissues and bones of the face and jaws. These deformities can range from mild to chronic and can result in aesthetic or functional impacts, or sometimes both. Besides, the treatment alternatives for maxillofacial deformities can vary depending on the extent of the damage or injury. 

CloudHospital specializes in assessing, treating, and correcting a wide range of acquired maxillofacial deformities. It works with several medical experts to help repair and restore the impaired aesthetic appearance and functionality.