Facial Asymmetry

Full facial symmetry does not exist in humans, and the mandible is usually responsible for asymmetrical conditions. Maxillary asymmetry is usually a sequel of mandibular hypoplasia or hyperplasia. Facial asymmetry can be caused by a number of conditions such as trauma, tumors, congenital alterations, or simply developmental disorders of mandibular growth. Over the years, we have developed protocols to manage asymmetrical patients with an “as soon as possible” (ASAP) policy in relation to the onset of the problem. If diagnosed during infancy, and once the presence of a tumor process has been ruled out, we usually decide to “wait and see,” unless asymmetric mandibular growth causes compensatory malformations of the maxilla. If asymmetric growth proves to be active in young adults, our choice is to perform an early proportional condylectomy. This would be the case of condylar hyperplasia causing vertical asymmetric growth with the early onset of compensations in the maxilla. Hypoplastic conditions caused by trauma or rheumatoid arthritis should be managed early with orthopedics and eventually with surgery in order to avoid compensatory malformations in the rest of the facial skeleton.