A unilateral increase in the occlusal vertical dimension of growing rats results in mandibular deviation.

OBJECTIVE: The effects of unilateral increased occlusal vertical dimension (iOVD) on bilateral craniofacial, mandibular and alveolar development in growing rats were investigated via cone-beam computed tomography (CBCT). The role of Wnt/ß-catenin signalling in this process was examined. MATERIALS AND METHODS: Forty-eight female Sprague-Dawley rats were randomly allocated into unilateral iOVD and sham groups. At 2, 4 and 8 weeks, the rats were scanned via CBCT to analyse cranial, maxillary, mandibular and dental morphology. Changes in temporomandibular joint (TMJ) cartilage histology and Wnt/ß-catenin signalling were assessed by histochemical and immunohistochemical staining and qRT-PCR. RESULTS: Dorsal cephalograms revealed that the mandible in the iOVD group tilted approximately 4° to the right. Unilateral iOVD had little effect on cranial and maxillary growth but inhibited mandibular growth (mandibular length and ramal height), especially on the deviated side (DS). Moreover, unilateral iOVD increased the length of the lower incisors and decreased the height of the molars on the DS. Unilateral iOVD induced bilateral osteoarthritis-like changes in the bilateral TMJ condylar cartilage and activated Wnt/ß-catenin signalling in the condylar cartilage, especially on the contralateral side (CLS). CONCLUSION: Occlusion with unilateral iOVD induced mandibular deviation, significantly inhibited mandibular growth and produced compensatory changes in the alveolar bone. In the iOVD group, the mandibular body length and ramal height were greater on the CLS than on the DS. Moreover, the greater ß-catenin protein expression in the TMJ condylar cartilage on the CLS than on the DS may account for the difference in asymmetrical mandibular development.

Three dimensional evaluation of the skeletal and temporomandibular joint changes following stabilization splint therapy in patients with temporomandibular joint disorders and mandibular deviation: a retrospective study.

BACKGROUND: Three-dimensional (3D) detailed evaluations of the mandibular mediolateral position, mandibular condylar position, and temporomandibular joint (TMJ) spaces following stabilization splints (SS) therapy in patients with temporomandibular joint disorders (TMD) and mandibular deviation (MD) have not been reported in the available literature. Accordingly, this study aimed to three-dimensionally analyze the skeletal and bony temporomandibular joint changes following stabilization splint therapy in adult patients with temporomandibular joint disorders and mandibular deviation. METHODS: This study is a retrospective clinical study that enrolled 26 adult patients with TMD and MD with a mean age of 24.86 years. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) was used to diagnose TMD. SS was adjusted weekly until occlusal contact stabilization occurred, and then adjusted monthly, patients were instructed to wear it at night for at least 10 h. The SS was removed after the elimination of TMD symptoms (TMJ/muscle pain on palpation, muscle spasm, and clicking) and having both condyles completely seated in a musculoskeletally stable position. Pre- and post-therapeutic Cone Beam Computed Tomography (CBCT) was analyzed. Mandibular mediolateral position, TMJ spaces, and mandibular condyle position were analyzed three-dimensionally using Mimics 21.0 software. Paired t-test or Wilcoxon rank-sum test was performed, and the significance level was considered at P < 0.05. RESULTS: The treatment period with SS therapy was 10.07 ± 3.1 months. The deviated chin was improved in 69.23% of the sample; the range of improvement was > 0 mm ≤ 3.9 mm. The mandibular rotation was significantly decreased from 3.58 ± 2.02° to 3.17 ± 1.60. The deviated side's superior and posterior joint TMJ spaces were significantly increased from 2.49 ± 0.88 mm and 1.25 ± 0.79 mm to 2.98 ± 1.02 mm and 1.86 ± 0.72 mm, respectively. The value of the difference from the bilateral condyle head position to the X and Z axes significantly decreased from 2.50 ± 1.56 mm and 2.30 ± 1.57 mm to 1.64 ± 1.58 mm and 1.82 ± 1.11 mm, respectively. CONCLUSION: The main positional effect of the stabilization splint treatment in TMD patients with MD includes considerable correction of mandibular deviation, improving facial asymmetry, and moving the condyle into a stable condylar position; these were done by promoting the mandible to rotate around the Z (roll) and Y (yaw) axes and by forward, downward, and outward condylar movement on the deviated side, respectively.

Nasal patency and mandibular movement: clinical application in prosthodontics.

This case report describes a patient with a primary concern of persistent mandibular deviation during speech who experienced clinically significant improvement (mandibular movement without deviation) after improvements to nasal resistance. At the initial consultation, temporary placement of a nasal valve dilator immediately eliminated the patient's mandibular deviation during speech, indicating the need for referral to an otolaryngologist. The patient was also provided with a dental appliance to address secondary concerns of temporomandibular joint noises and cervicofacial pain. Although the dental treatment provided some relief, resolution of the patient's mandibular deviation during speech did not occur until after nasal surgery was completed. This case illustrates the importance and effects of nasal resistance and nasal patency to obtaining a reproducible mandibular position.

A Long-term Follow-up of Mandibular Deviation Caused by Congenital Cervical Lymphangioma Treated with an Orthodontic Approach.

AIM: To report a treatment case of mandibular deviation caused by congenital cervical lymphangioma with traditional orthodontic techniques, following-up by 10-year retention. BACKGROUND: Lymphangiomas, developmental anomalies, can induce various disturbances of swallowing, mastication, speech, breathing, and skeletal deformities as well as psychological stress and anxiety for the patient and their family. Lymphangiomas are benign with virtually no possibility of turning into a malignant lesion, so clinical management aims to treat the patient functionally. CASE DESCRIPTION: A girl, aged 6 years and 4 months, complained about facial asymmetry and anterior crossbite caused by congenital cervical lymphangioma. Her facial profile was the straight type with an adequate lip position. Anterior and right-side posterior crossbites were observed. On the frontal cephalogram, the menton shifted 3.0 mm to the right. A functional appliance with an expander was placed to correct her dental midline deviation and posterior crossbite. After 2-year treatment, the anterior and right-side posterior crossbites were improved. Multibracket treatment began after the growth spurt. After 44-month active treatment, a functional occlusion, including a Class I molar relationship with a proper interincisal relationship, was achieved. A functional occlusion was maintained during a 10-year retention period, while a mandibular downward growth was observed through the retention period. CONCLUSION: Conventional orthodontic techniques enable functional and stable occlusion even in patients with mandibular deviation caused by congenital cervical lymphangioma, although only using early orthodontic management by itself may have some limitations. CLINICAL SIGNIFICANCE: The hybrid technique combining functional appliance and intermaxillary elastics proves to be an effective therapy for correcting occlusal cant and mandibular deviation caused by cervical lymphangioma.

A novel method for 3D face symmetry reference plane based on weighted Procrustes analysis algorithm.

BACKGROUND: We aimed to establish a novel method, using the weighted Procrustes analysis (WPA) algorithm, which assigns weight to facial anatomical landmarks, to construct a three-dimensional facial symmetry reference plane (SRP) for mandibular deviation patients. METHODS: Three-dimensional facial SRPs were independently extracted from 15 mandibular deviation patients using both our WPA algorithm and the standard PA algorithm. A reference plane was defined to serve as the ground truth. To determine whether the WPA SRP or the PA SRP was closer to the ground truth, we measured the position error of mirrored landmarks, the facial asymmetry index (FAI) error, and the angle error for the global face and each facial third partition. RESULTS: The average angle error between the WPA SRP and the ground truth was 1.66 ± 0.81°, which was smaller than that between the PA SRP and the ground truth. The position error of the mirrored landmarks constructed using the WPA algorithm in the global face (3.64 ± 1.53 mm) and each facial partition was lower than that constructed using the PA algorithm. The average FAI error of the WPA SRP was - 7.77 ± 17.02 mm, which was smaller than that of the PA SRP. CONCLUSIONS: This novel automatic algorithm, based on weighted anatomic landmarks, can provide a more adaptable SRP than the standard PA algorithm when applied to severe mandibular deviation patients and can better simulate the diagnosis strategies of clinical experts.

The efficacy of guiding flange appliance in correcting mandibular deviation in the hemi-mandibulectomy patient. A correlative study.

PURPOSE: This report describes the efficacy of a guiding flange appliance in correcting mandibular deviation in the hemi-mandibulectomy patient and correlates the time elapsed between surgery and placement of the appliance and the extent of initial mandibular deviation to the success rate of a guiding flange appliance in correcting the deviation. MATERIALS AND METHODS: A total of 15 hemi-mandibulectomy patients participated in the study. All had various degree of mandibular shift consequent to surgery. The patients were given a guiding flange prosthesis for about 4 months, and the efficacy of the guiding flange prosthesis was calculated in terms of percentage deviation corrected after 4 months. RESULTS: Time elapsed between surgery and prosthetic rehabilitation was in inverse relation to the percentage correction in mandibular deviation at 4 months (B = -7.668; p = 0.002). The less the initial deviation postsurgery, the better the correction (B = 9.798; p = 0.008). CONCLUSION: Percentage correction of mandibular deviation is dependent on the timing of prosthetic rehabilitation. The less the initial deviation, the better the correction.

Relationship between frontal craniofacial morphology and horizontal balance of lip-closing forces during lip pursing.

The objectives of this study were to quantitatively evaluate the relationship between frontal craniofacial morphology and the horizontal balance of the lip-closing forces (LCF) generated during maximum voluntary pursing-like movements in patients with mandibular deviation. Thirty-one subjects (median age 25·4 ± 8·9 years) without a history of orthodontic treatment were randomly selected from among the orthodontic patients who visited our hospital. Lip-closing forces was recorded in eight directions during maximum voluntary pursing-like lip-closing movements. The subjects were divided into the deviation (two males and 11 females) and non-deviation groups (four males and 14 females). There was no significant difference in the total LCF between the deviation and non-deviation groups. In the deviation group, the mean LCF value on the deviation side of the upper lip was significantly lower than that detected on the non-deviation side of the upper lip, while the mean LCF value for the deviation side of the lower lip was significantly higher than that for the non-deviation side of the lower lip. In contrast, no significant difference in upper or lower lip LCF was detected between the deviation and non-deviation sides in the non-deviation group. The difference in the LCF generated in the lower lip between the deviation and non-deviation sides was significantly positively correlated with mandibular menton deviation and significantly negatively correlated with the difference in maxillary height between the deviation and non-deviation sides. These results suggest that the horizontal balance of the upper and lower lip LCF produced during pursing-like lip-closing movements in patients with mandibular deviation is related to frontal craniofacial morphology.

Case report of a patient with mandibulectomy followed up for 11 years.

Mandibular deviation and rotation following mandibulectomy can significantly impact oral function and quality of life. The postoperative course of a 57-year-old patient who underwent mandibulectomy for oral cancer and findings over 11 years of follow-up observation to monitor changes in the mandibular position are described here. Based on the observations, it is important to raise awareness regarding the necessity of continued monitoring of mandible position and regular adjustments of prostheses for patients who have undergone mandibulectomy.

Fabrication of a 3D-Printed Interim Bite Splint for a Hemimandibulectomy Patient: A Case Report.

Mandibular continuity defects can result in varying degrees of cosmetic disfigurement. Restoration of form and function may require surgical reconstruction of the affected area. While surgical reconstruction may improve the overall prognostic outcomes for the patient, the definitive prosthetic phase can commence only after a substantial time lag for adequate hard/soft tissue healing. This interim phase often challenges the patient's masticatory ability. The traditional reconstruction of hemimandibulectomy defects has its own limitations. This case report describes the fabrication of a 3D-printed bite splint for a patient with limited mouth opening and significant malocclusion due to surgical over-correction. The prosthesis given served as an appliance to improve the masticatory ability of the patient.

Multidirectional lip-closing force in adults with mandibular deviation.

The purpose of this study was to investigate the relationship between multidi-rectional lip-closing force and facial soft tissue morphology in adults with mandibular deviation. Fifteen Japanese adults with mandibular deviation participated in this study. The deviation value was defined as the horizontal distance between soft tissue menton and the facial midline. The side of the soft tissue menton relative to the facial midline was defined as the deviated side and the opposite side as the non-deviated side. The signals of directional lip-closing force (DLCF) were investigated in 8 directions. Total lip-closing force (TLCF) was calculated by adding DLCFs in 8 directions. Correlations and differences between the variables were analysed statistically. Significant positive correlations between TLCF and DLCFs were determined in six directions with the exception of the horizontal direction. Significant positive correlations for seven pairs of opposing DLCFs were found. The lower non-deviated DLCF was smaller than the three pairs of opposing lip-closing forces. Negative significant correlation was found between the deviation value and the upper deviated DLCF (P < 0·05). In individuals with mandibular deviation, lip-closing force in the lower non-deviated direction was found to be smaller than the opposing lip-closing forces. When mandibular deviation was greater, the upper deviated lip-closing force was smaller.

Guide devices in the rehabilitation of interrupting mandibular bone defects: a proposal for a new classification.

Interrupting mandibular surgical resections may lead to mandibular deviation toward the resected side. This further complicates future surgical and prosthodontics reconstructions. The rehabilitation of this mandibular deviation by the specialist in maxillofacial prosthodontics is often done by guide devices. This helps to prevent or reduce postsurgical mandibular deviation. The current literature lacks data on a standard classification of these devices despite the various clinical situations that require different rehabilitation techniques. After a deep appraisal of the current literature on this topic and many years of experience, the authors propose an overview of the indications, the types, and an original classification of these prosthetic devices. We believe this new classification will facilitate communication among practitioners, the development of treatment plans, and the comparison of outcomes among different expert centers.

Three-dimensional evaluation of upper pharyngeal airway, hyoid bone, and craniocervical changes following stabilization splint therapy in adult patients with temporomandibular joint disorders and mandibular deviation: A retrospective study.

OBJECTIVE: This study aimed primarily to analyze the three-dimensional (3D) changes in the pharyngeal airway (PA), and secondarily, the hyoid bone (HB) and the craniocervical (CC) following stabilization splint (SS) therapy in adult patients with temporomandibular joint disorders (TMD) and mandibular deviation (MD). METHODS: Thirty-five adult patients with TMD and MD, who were treated using SS with a mean age of 25.14 ± 6.11 years, were enrolled in this retrospective clinical study. Pre- and post-therapeutic cone-beam computed tomography (CBCT) scans were analyzed. PA dimension,nasopharyngeal, oropharyngeal, hypopharyngeal, sub-hypopharyngeal, and total pharyngeal airway spaces were measured in surface area, volume, minimum constricted area (MCA) and width, HB position, and CC posture were analyzed three-dimensionally using InVivo 6.0.3 and Dolphin 11.95 software. Wilcoxon rank-sum or Paired t-test was conducted, and P < 0.05 was considered significant. RESULTS: SS therapy was administered for a period of 9.49 ± 4.02 months. The oropharyngeal airway space showed a significant decrease in sagittal width. The hypopharyngeal surface area, volume, MCA, and sagittal width decreased significantly. In terms of HB, hyoid-mandibular plane (H-MP), retrognathia-third vertebra's most inferior-anterior (RGN-C3ia), and retrognathia-Sella (RGN-S) distances significantly decreased. The Nasion-Sella line and the line that passes through C2ip to the odontoid process posterior tangent (NSL-OPT) angle in CC posture also decreased significantly. CONCLUSION: SS therapy in TMD patients with MD mainly results in narrowing of the hypopharyngeal region, no change in HB position and improvement in head posture. These results undoubtedly assist in diagnosis and treatment of clinical conditions.

BSSRO Improves Mandibular Morphology Mainly through Correction of Body Length and Volume in Patients with Asymmetric Mandibular Prognathism.

Purpose: The purpose of this study is to analyze the change and stability of mandibular morphology in patients with asymmetric mandibular prognathism after bilateral sagittal split ramus osteotomy (BSSRO). Methods: We retrospectively analyzed fifty patients with asymmetric mandibular prognathism from the West China Hospital of Stomatology, Sichuan University, between January 2018 to March 2021. The spiral CT data before surgery, within two weeks after surgery, and at more than six months after surgery of each patient were collected. According to the deflection direction of the chin, the bilateral mandibles were defined as the long side and the short side. The morphological data of the bilateral condyle, the mandibular ramus, and the mandibular body were analyzed to determine the effect and stability of BSSRO on asymmetric mandibular prognathism. Results: It was found that the long-side mandible had greater condylar volume and diameter, mandibular ramus height and volume, and mandibular body length and volume (p < 0.05) before surgery. After surgery, the volume of the mandibular ramus increased, while the length and volume of the mandibular body decreased (p < 0.05) at the long side of the mandible; the morphological changes of the mandibular ramus and body at the short side of the mandible were not statistically significant (p > 0.05). When comparing the long and short sides of the mandible, the long side still had greater height and volume of the mandibular ramus (p < 0.01). The volume difference of the mandibular body from the two sides was corrected (p > 0.05), and the length difference of the mandibular body from the two sides was overcorrected (p < 0.05). At more than six months after surgery, the volume of the mandibular ramus and body increased, while their height decreased at the long side of the mandible (p < 0.05). For the other side, or the short side, the volume of the ramus and body increased, too. However, their height decreased (p < 0.01). Conclusion: The results of this study suggested good effect and stability of BSSRO on asymmetric mandibular prognathism, except for the correction of ramus height and volume.

Condylar morphology and position changes after miniscrew-assisted rapid palatal expansion in skeletal Class III malocclusion adult patients with mandibular deviation and unilateral posterior crossbite.

BACKGROUND: To evaluate the morphological and positional changes of mandibular condyle after miniscrew-assisted rapid palatal expansion (MARPE) in skeletal Class III malocclusion adult patients with horizontal mandibular deviation (MD). METHODS: The sample consisted of 15 patients with MD (6 males and 9 females, mean age 21.58 ± 3.12 years). The CBCT scans were taken before and after MARPE immediately. The pre- and post-registered images of the cranial base and mandible were measured, respectively, by Mimics. RESULTS: After expansion, the distance between superior condylar point and the Frankfort horizontal plane on the deviated side and the non-deviated side increased by 0.96 ± 0.60 mm (P = 0.011) and 0.70 ± 0.65 mm (P = 0.046); coronal condylar angle of the deviated side increased by 0.39° ± 0.34 (P = 0.028) and 0.06° ± 0.49 (P = 0.917) on the non-deviated side. No statistically significant differences were found when comparing the condylar position on both sides before and after treatment. The degree of mandibular deviation decreased 0.43 mm (P = 0.270). CONCLUSIONS: This study suggested that for skeletal Class III malocclusion adult patients with horizontal MD, the condyle on the deviated side rotated toward the non-deviated side in the coronal direction; the condylar remodeling occurred mainly on the deviated side after MARPE in the vertical direction.

Landmark annotation and mandibular lateral deviation analysis of posteroanterior cephalograms using a convolutional neural network.

BACKGROUND/PURPOSE: Facial asymmetry is relatively common in the general population. Here, we propose a fully automated annotation system that supports analysis of mandibular deviation and detection of facial asymmetry in posteroanterior (PA) cephalograms by means of a deep learning-based convolutional neural network (CNN) algorithm. MATERIALS AND METHODS: In this retrospective study, 400 PA cephalograms were collected from the medical records of patients aged 4 years 2 months-80 years 3 months (mean age, 17 years 10 months; 255 female patients and 145 male patients). A deep CNN with two optimizers and a random forest algorithm were trained using 320 PA cephalograms; in these images, four PA landmarks were independently identified and manually annotated by two orthodontists. RESULTS: The CNN algorithms had a high coefficient of determination (R 2 ), compared with the random forest algorithm (CNN-stochastic gradient descent, R 2  = 0.715; CNN-Adam, R 2  = 0.700; random forest, R 2  = 0.486). Analysis of the best and worst performances of the algorithms for each landmark demonstrated that the right latero-orbital landmark was most difficult to detect accurately by using the CNN. Based on the annotated landmarks, reference lines were defined using an algorithm coded in Python. The CNN and random forest algorithms exhibited similar accuracy for the distance between the menton and vertical reference line. CONCLUSION: Our findings imply that the proposed deep CNN algorithm for detection of facial asymmetry may enable prompt assessment and reduce the effort involved in orthodontic diagnosis.

Mandibular lateral deviation induces alteration in vascular endothelial growth factor expression and oxidative stress/nitric oxide generation in rat condyle, synovial membrane and masseter muscle.

OBJECTIVE: We aimed to investigate alteration in cellular signaling mediated by vascular endothelial growth factor (VEGF) and parameters of oxidative stress/nitric oxide generation, superoxide dismutase (SOD) and neuronal nitric oxide synthase (nNOS), underlying altered functional mechanical loading of TMJ (temporomandibular joint) during lateral mandibular deviation. DESIGN: Thirty-eight 5-week-old male Wistar rats were divided into experimental group, which received acrylic resin appliance that shifted mandible to the left during closure, and control group. Computed tomography and histomorphometry were used for condyle analyses, while samples of condyle, synovial membrane and m. masseter were analyzed with enzyme-linked immunosorbent assay and spectrophotometry to determine VEGF and nNOS protein concentrations, and SOD activity. RESULTS: Experimental group of rats developed smaller and asymmetrical mandibles. Less of new bone and cartilage formation and larger bone marrow cavities area were found in the experimental group. Higher VEGF expression in condyle and m. masseter as well as higher nNOS expression in m. masseter and synovial membrane were found in the experimental compared to the control group. Alteration of SOD activity was found in m. masseter and synovial membrane in the experimental group. CONCLUSIONS: Lateral mandibular deviation induces mandibular and condylar morphological changes as well as significant cellular signaling alterations in condyle, synovial membrane and masticatory muscle. Cellular VEGF protein overexpression and oxidative stress/nitric oxide disbalance could be the mechanisms underlying unbalanced functional TMJ loading due to mandibular deviation.

Prosthetic Rehabilitation of Hemimandibulectomy Defect with Removable Partial Denture Prosthesis Using an Attachment-Retained Guiding Flange.

The restoration of normal function and esthetics is often challenging in the prosthetic rehabilitation of patients with hemimandibulectomy defects due to unstable occlusion and mandibular deviation. The extensive period of time for completion of healing of the reconstructed mandible through reconstructive plastic surgery and/or implant-assisted prosthesis may compromise the masticatory function by causing delay in the fabrication of definitive prosthesis. This case report describes a novel technique for the construction of customized attachment-retained mandibular guiding flange prosthesis for immediate rectification of the frontal plane rotation occurring after hemimandibulectomy.

Prosthodontic management of hemimandibulectomy patients to restore form and function - A case series.

Surgical resection of mandible owing to benign, malignant neoplasm, osteoradionecrosis is common. The resection can be total or segmental depending on the lesion. Loss of mandibular continuity causes deviation of remaining mandibular segment towards the resected side and rotation inferiorly due to muscle pull and scar contracture affecting mastication and esthetics. Surgical reconstruction may not be always possible. Prosthetic rehabilitation plays a major role in these patients. This case series describes different types of guiding flange (GF) prosthesis with modifications for three hemimandibulectomy patients at different time interval after surgery. The article details GF prosthesis combined with physiotherapy to correct deviation of mandible thereby improving mastication, esthetics and speech and thus enhancing the quality of life.

Research progress on the structural features, treatments, and association with temporomandibular disorder in patients with skeletal class Ⅲ malocclusion with mandibular deviation / 口腔疾病防治

@#Skeletal angle class Ⅲ malocclusion with mandibular deviation involves the rotation and translation of the cranial base, maxilla, mandible, and soft tissue. It compromises the patients’ appearance and stomatognathic function. The treatment outcome is not satisfactory, and correct evaluation is of great significance. The causal relationship between skeletal Class Ⅲ with mandibular deviation and TMD remains controversial. This review focuses on the structural alterations of hard and soft tissue, the etiology, the choice of treatment methods, and the association with TMD in patients with skeletal class Ⅲ malocclusion with mandibular deviation. The results show that mandibular deviation is a complex disease with unclear etiology. It involves morphological changes, rotation and displacement of the cranial base, maxilla and mandible, morphological changes of the soft tissue, and occlusal changes, which also compromise the temporomandibular joint and mandibular function. Skeletal Class Ⅲ malocclusion is common in patients with mandibular deviation. Early treatment is needed; however, the treatment methods vary. The correct evaluation of the morphological changes of soft and hard tissues leading to facial asymmetry is the premise of treatment. Orthodontic and orthognathic treatment (combined with soft tissue repair when necessary) is an effective method for the treatment of skeletal class Ⅲ malocclusion with mandibular deviation. In addition, there is a close relationship between mandibular deviation and TMD, which needs to be fully considered in the design of treatment.

Facial asymmetry in young adults with condylar hyperplasia-unusual changes in the facial bones.

Facial asymmetry can be caused by various pathological conditions, condylar hyperplasia (CH) is one of such condition, characterized by unilateral or bilateral mandibular condylar overgrowth, causing facial asymmetry, mandibular deviation, malocclusion and functional impairment. Advanced imaging and scintigraphic methods, helps the clinicians in diagnosing and monitoring its macroscopic aspects. Here we report three interesting and illustrative cases of facial asymmetry with unilateral CH discussing the unusual changes in the facial bones.