Facial deformity may be congenital or acquired and may
involve both hard and soft tissues.
This is present at birth and may be related to an inherited condition.
Cleft lip and palate is an example of a congenital deformity. Treatment
involves a multidisciplinary approach involving Orthodontists, Maxillofacial
Plastic and ENT Surgeons. Treatment is complex and involves multiple operations
during the periods of growth.
The causes of acquired deformity include:
In the UK there are over 500,000 facial injuries/annum. A significant
minority of injuries cause permanent physical or psychological disability
or even death. Injuries are most common in males between the ages of 15-25
years. Much of the remit of maxillofacial surgery is directed towards
the treatment of this group of patients with respect to the management
of facial fractures and facial scarring using modern techniques such as
the Erbium YAG laser in the treatment of facial scars and skin resurfacing.
ii) Disorders of Growth
Disorders of facial growth may affect the hard and soft tissues and are
often genetically determined. Facial deformity related to abnormal growth
is often seen with concomitant malocclusion of the teeth. Maxillofacial
surgeons and Orthodontists diagnose, plan and manage these patients in
multidisciplinary clinics. These deformities have complex relationships
with other structures in the face, especially the nose, and may adversely
affect the outcome of rhinoplasty if not addressed.
The commonest diseases to affect the facial area are dental caries and
gum disease (periodontal disease). The importance of premature loss of
teeth and the association with facial deformity is not generally appreciated.
Muscle tone is altered, jaw bones resorb, lip support collapses, skin
wrinkles and furrows are pronounced. Jowling of the lower jaw may develop.
Such deformities :-
• may be confused with the process of ageing.
• may complicate the aesthetics of ageing.
The face as a whole must be considered if the optimum outcome of cosmetic
surgery is to be achieved. Solutions may include the use of dental implants
and overdentures and/or surgery to the jaws.
iv) Head and Neck Surgery
Head and neck surgery and the resection of tumours leave patients with
hard and soft tissue cosmetic defects, as well as functional defects.
Cosmetic face lift incisions are now used in the removal of parotid salivary
gland tumours to avoid facial scarring. In other cases surgical treatment
may be long, complex and associated with significant complications. Patients
are often reconstructed with microvascular free flap techniques. Tissue
is harvested from a second donor site on the patient for reconstruction,
which often bares little resemblance to normal anatomy. Engineering Assisted
Surgery™ planning techniques attempts to address these some of these problems.