By Alexander Germanis
Even some of the most aesthetically-pleasing people and the most beautiful models mention how awkward they looked in their youth. During their years of growth, different parts of their bodies grew at different rates, resulting in a gangly or even distorted appearance.
For some people, the rates of growth do not eventually even out. When the mandible, or lower jawbone, grows at a different rate from the maxilla, or upper jawbone, the result can be more than aesthetically challenging; it can cause a myriad of functional problems. These problems can include issues with one’s oral health, chewing, and breathing; uneven growth can also cause temporomandibular joint (TMJ) pain and even adversely affect speech.
To restore proper function and bring with it aesthetic harmony, maxillofacial surgeons like those at Doran, Capodice, Efaw and Ocheltree, LLC in Bloomington ply their craft.
Before resorting to outright surgery, however, Dr. David Efaw, MD, DDS says some types of this uneven growth can be treated non-surgically, if caught soon enough. “There’s a way to treat some of them through dental-facial orthopedics,” he says. “You can use a functional appliance on a child’s growing face to slow down the growth in the upper and lower jaw. And we’re all for that.” But for those who have not noticed the facial discrepancy until later, orthognathic surgery is still an option.
Beginning in the computer, the planning stage for the surgery has evolved considerably over time. “Twenty years ago, you would trace X-rays taken of the skull from the front and side,” explains Dr. Jack Capodice Jr., MD, DMD. “From those, you would make cut-outs, moving the jaws—upper and lower—back and forth, depending on where they need to be.”
“We used to take impressions, mount them on the machine, and do the movements using plaster casts, wax, and resin, so we knew exactly what would happen,” Dr. Efaw continues.
Now these first crucial planning and treatment stages are done in the computer. “Now, we can actually measure volumetrically; we can do 3-D imaging of the soft and hard tissues as well,” Dr. Efaw says.
Because so much of the treatment stage is done digitally, including the cephalometric analysis, or the study of skeletal relationships in the head, the actual surgical process has been reduced considerably. “The lower jaw surgery takes an hour and a half,” Dr. Capodice says. “It’s outpatient, and it’s comparable to a difficult set of wisdom teeth as to recovery.”
The surgery and recovery times are not the only things that have shrunk. “The screws we use are about the size of what you find in your sunglasses,” Dr. Efaw states.
The titanium screws, plates, and hardware are not the only structures that can be used in establishing a proper jaw size. The body itself can be coaxed to lay down new bone in a process called distraction osteogenesis. In a system once employed with the orthodontia device called a hyrax, it was discovered that the body will lay down new bone tissue in any newly-introduced gaps, thus expanding the overall size of the bone.
Ultimately, both the patients’ and the doctors’ goal is to avoid the surgery. “We try to do the most conservative approach,”Dr. Capodice says. “Overall, we’re doing less of it, because there’s earlier diagnosis.”
There are typical cut-off ages for both boys and girls, however, after which—should jaw growth discrepancies be diagnosed—surgery may be necessary. “Typically, we consider skeletal facial maturity is at ages 14–15 for girls and 16–17 for boys,” indicates Dr. Efaw.
Regardless of age, each case should be evaluated by a skilled maxillofacial surgeon, because there may be other forms of treatment available, and the balance of function and aesthetics may yet be achieved.
If you missed the first article in this series, you may find it online at www.HealthyCellsBN.com, or contact Cheryl Eash at ceash7@gmail.com or 309-664-2524.
Drs. Doran, Capodice, Efaw, and Ocheltree provide a full scope of oral and maxillofacial surgery with expertise ranging from wisdom tooth removal and dental implants to bone grafting procedures, corrective jaw surgery, and cosmetic facial surgery. Their office is located at 109 Regency Dr. in Bloomington with satellite offices in Watseka and Lincoln. For more information, you may call 309-663-2526, or visit them online at www.dceooms.com.
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