Facial Deformity

Facial deformity may be congenital or acquired and may involve both hard and soft tissues.

a) Congenital

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.

b) Acquired

The causes of acquired deformity include:

i) Trauma

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.

iii) Disease

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.