For example, the drape of the upper lip can mask the maxillary deficiency to such an extent that it presents as a normal soft tissue profile (REF). Para-nasal hollowing is a key indicator of underlying maxillary deficiency. It is most common in class III patients, but can also present in some class II cases, with bilateral maxillary retrusion.Assessing a patient for vertical and horizontal excess:
Arguably the main observation to carry out in a patient to assess maxillary excess or deficiency is the upper incisor/gum show when at rest and smiling. In other words, the relationship between the upper lip and upper central incisors when at rest and smiling. Ensure the patients head posture is correct and the lips are at rest to establish the resting lip line. Similarly, to assess the incisor/gum show on smiling, the patient needs to fully smile to allow the upper lip to rise to its maximum height. The average showing of the incisors when the lips are at rest is 1/3 of its clinical crown height. With maxillary excess, more than 1/3 of the incisors would show. When the patient smiles, maxillary excess would manifest as the entire clinical crown and a portion of the gums showing as well. This is regarded as a ‘gummy smile.’
As alluded to previously, the paranasal region is important to consider when assessing a patient for IDD or EDD. Observing the patient from the side view allows a clearer perspective.
There are also studies in mice and dogs reported the protective effect of folic acid supplementation to prevent cleft lip palate occurrence. Treatment
Jaw abnormalities are commonly treated with combined surgical (orthognathic surgery) and orthodontic treatment. The procedure is carried out by oral and maxillofacial surgeons and orthodontists in close collaboration.In most cases, the orthodontist will first align the teeth with braces or other appliances, which may worsen the occlusion until after the surgery. This is carried out to show the full degree of abnormality, and to create sufficient space for full correction in the bones.Orthognathic surgery, also known as corrective jaw surgery, is performed to normalise dentofacial deformity and reposition part/all of the upper and/or lower jaws to improve occlusion stability and facial proportions. It is the mainstay treatment for patients who are too old for growth modification and for dentofacial conditions that are too severe for either surgical or orthodontic camouflage.The surgery usually involves gaining access to the bone from inside the mouth, revealing and moving the bone into a correct functional position, and fixing it in position with metal plates and screws. These plates are most often left in the bone, but at times require removal due to infection, which would require another operation. Most orthognathic surgeries are performed inside the mouth without any external scarring. Mandibular surgery
There are numerous surgical techniques available to correct the position of the mandible.