|Year : 2008 | Volume
| Issue : 2 | Page : 57-59
Facial hemihypertrophy and facial hemiatrophy: Report of 2 cases
Atul Indurkar, Shirish Degwekar, Shailesh Gondivkar
Department of Oral Diagnosis, Medicine and Radiology, Sharad Pawar Dental College and Hospital, Sawangi (M), Wardha, Maharashatra, India
Dept. of Oral Diagnosis, Medicine and Radiology, Sharad Pawar Dental College and Hospital, Sawangi (M), Wardha - 442004 Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Facial hemihypertrophy and facial hemiatrophy are rare developmental anomalies. These conditions are characterized by an asymmetric growth of one or more parts of the tissues on one side of the face. The facial asymmetry may be total or partial. The unilateral overgrowth of the mandible seen as the facial asymmetry occurs in case of the congenital mandibular hemihypertrophy, whereas, the facial or mandibular hemiatrophy results in the hallowing or depression on one side of face. The hormonal imbalance, chromosomal abnormalities, trauma, trophic malfunctions of cervical sympathetic nervous system are the factors which are considered to be attributed to the mandibular or facial asymmetry.
Keywords: Facial asymmetry, mandibular hemiatrophy, mandibular hemihypertrophy
|How to cite this article:|
Indurkar A, Degwekar S, Gondivkar S. Facial hemihypertrophy and facial hemiatrophy: Report of 2 cases. J Indian Acad Oral Med Radiol 2008;20:57-9
|How to cite this URL:|
Indurkar A, Degwekar S, Gondivkar S. Facial hemihypertrophy and facial hemiatrophy: Report of 2 cases. J Indian Acad Oral Med Radiol [serial online] 2008 [cited 2021 Jan 17];20:57-9. Available from: https://www.jiaomr.in/text.asp?2008/20/2/57/44366
| Introduction|| |
A mild degree of facial asymmetry is present in nearly all persons and this is often imperceptible to even close observation. Marked facial asymmetry is caused by unilateral enlargement or atrophy of hard and soft tissues.  The facial asymmetry may be total or partial. Total if an entire side of the body is involved or partial if only a portion.  In this article, two cases of mandibular asymmetry are discussed.
Congenital mandibular hemihypertrophy is expressed in facial asymmetry resulting from unilateral overgrowth of the mandible.  Yoshimoto et al . showed that neutralizing antibody against basic fibroblast growth factor are effective to partially block fetal calf serum-induced DNA synthesis. These results suggest that fibroblast growth factor and its receptor signal transduction axis may be selectively involved in affected osteoblasts leading to progression of congenital hemimandibular hypertrophy.
Facial or mandibular hemiatrophy of some or all tissues on one side of face, occasionally extending to other parts of the body.
A variety of factors are attributed to mandibular hemiasymmetry. These include hormonal imbalance, chromosome abnormalities, vascular abnormalities, trauma, trophic malformations of the cervical sympathetic nervous system. 
| Case Report|| |
Case 1: Mandibular hemihypertrophy
A female patient aged 38 years reported to the department of Oral Medicine and Radiology, SPDC, Wardha with the chief complaint of poor esthetics due to progressive, diffuse swelling on the left side of lower jaw since one year.
Patient gave no history of any systemic illness or any trauma to the head, neck face region. Clinical examination revealed non-painful, diffuse enlargement of left side of mandible. There was deviation of mandible to the right side on opening the mouth. The interincisal opening was 30 mm. The occlusion was in Angle's class I molar relationship.
The orthopantomograph revealed increased size of ramus, body of the mandible and larger condyle on left side. Clinicoradiographically, the condition was diagnosed as mandibular hemihypertrophy. The patient was explained of diagnosis and about the probable prognosis and was advised regular follow-up after every 3 months [Figure 1],[Figure 2],[Figure 3].
Case 2: Mandibular hemiatrophy
A female patient aged 18 years reported to the department of Oral medicine and radiology, SPDC, Wardha with the chief complaint of poor esthetics due to hallowing of lower jaw. Patient gave no history of any systemic illness or any trauma to the head, neck face region.
The extraoral clinical examination revealed depression on left side of mandible resulting in hallowing of lower face. The interincisal opening was normal. The temporomandibular joint movements of both the sides were symmetrical and synchronous. The occlusion was in Angle's class I molar relationship.
The orthopantomograph showed decrease in the size of left ramus and body of mandible. On the basis of clinical and radiological findings, the diagnosis of mandibular hemiatrophy was made. The patient was explained of prognosis and was advised regular follow-up [Figure 4],[Figure 5],[Figure 6].
| Discussion|| |
Beck in 1836, first described facial hemihypertrophy which aroused some interest in the early part of this century among European and American clinicians.  Mandibular hemiasymmetry is a rare developmental anomaly characterized by asymmetric development of mandible. It occurs either isolated or associated with one of several syndromes. Syndromes associated with facial hemihypertrophy are Proteus syndrome, Klippel-Trenaunay- Weber syndrome More Details.
Clinically mandibular hemihypertrophy appears as enlargement of one side of mandible.  In some cases, this is obvious even at birth. The enlarged side grows at a rate proportional to uninvolved side. Intraorally, sometimes there is enlargement of tooth/teeth. Characteristically, the permanent teeth on the affected side develop more rapidly and erupt before their counterparts on the uninvolved side. The bone of the mandible is also enlarged being wider and thicker, sometimes with altered trabecular pattern. Finally, facial hemihypertrophy may be secondary to a bone lesion as found in more or less diffuse fibrous osteopathies or possibly hypercondylar disorders, the absence of tongue lesion being a diagnostic factor. 
Clinically, mandibular hemiatrophy appears as a hallowing of cheek. The onset of the condition is usually noticed in the first or second decade of life as white line, furrow or mark on one side of face. This initial lesion then extends progressively to atrophy of skin, muscle and bone resulting in facial deformity. The roots of the teeth may exhibit deficiency of root development and reduced growth of jaws on affected side. Eruption of the teeth on the affected side may also be retarded.
There is no specific treatment for the condition other than attempts at cosmetic repair. It has been found that typically the disease will be progressive for a period of some years and then remain unchanged for the rest of the patient's life.
| References|| |
|1.||Viteporn S. Surgical-orthodontic treatment in hemifacial hypertrophy: A case report. Int J Adult Orthodon Orthognath Surg 1993;8:55-62. [PUBMED] |
|2.||Khanna JN, Andrade NN. Hemifacial hypertrophy: Report of two cases. Int J Oral Maxillofac Surg 1989;18:294-7. [PUBMED] |
|3.||Yoshimoto H, Yano H, Kobayashi K, Hirano A, Motomura K, Ohisuru A, et al . Increased proliferative activity of osteoblasts in congenital hemifacial hypertrophy. Plest Reconstr Surg 1998;102:1605-10. |
|4.||Shafer WG, Hine MK, Levy BM. A textbook of oral pathology. 4 th ed. 1993. p. 8-10. |
|5.||Sculerati N, Jacobs JB. Congenital facial hemihypertrophy: Report of a case with airway compromise. Head Neck Surg 1985;8:124-8. |
|6.||Neville BW, Damm DD, Allen CM, Bouquet JE. Oral and maxillofacial pathology. 2 nd ed. 2003. p. 37-8. |
|7.||Gordeeff A, Mercier J, Bedhet N, Delaire J. The tongue in facial hemihypertrophy. Rev Stomatol Chir Maxillofac 1986;87:320-6. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]