Midface retrusion describes a condition where the central part of the face, encompassing the cheeks, nose, and upper jaw, appears recessed or set back. This affects the overall harmony of facial features and can arise from various underlying factors.
Understanding Midface Retrusion
This condition presents as a flattened appearance where the areas around the nose, cheeks, and upper jaw are underdeveloped or positioned posteriorly. This can result in a less prominent nose and a receding upper jaw, making the lower jaw appear more protrusive than usual. From a profile view, the middle part of the face lacks projection, while the frontal view might show a sunken or concave appearance.
The extent of midface retrusion can vary considerably among individuals. In some cases, the eyes may appear larger or “bug-eyed” due to the underdevelopment of the cheekbones and eye sockets. This condition is also known as midface hypoplasia, midface deficiency, or hypotrophic midface. The skeletal system plays a significant role in facial structure, and issues within this system can contribute to midface retrusion.
Common Causes
Genetic predispositions are a common cause, often seen in specific syndromes. Conditions such as Crouzon syndrome, Apert syndrome, and Pfeiffer syndrome are characterized by abnormal skull and facial growth, frequently including midface retrusion. Achondroplasia, the most common cause of disproportionate short stature, also presents with characteristic facial features, including midface retrusion and frontal bossing.
Developmental issues during growth can also lead to this condition, affecting how the facial bones form and position themselves. Traumatic injuries to the facial bones, particularly during childhood when the face is still developing, can disrupt normal growth patterns. Certain medical conditions or infections that impact facial structure during critical growth periods may also result in midface retrusion.
Functional and Aesthetic Impacts
Breathing can be impacted, as the underdeveloped midface can narrow the airways, potentially causing nasal obstruction and sleep apnea. Individuals may experience difficulty with chewing and eating due to dental misalignment, also known as malocclusion, where the upper and lower teeth do not meet correctly.
Speech impediments can also arise from structural issues in the mouth and jaw caused by the retrusion. Eye protection can be compromised when the eye sockets are shallow, leading to protuberant eyes that may not close properly, causing severe drying of the eyes. Midface retrusion also impacts facial harmony and balance, potentially leading to self-consciousness.
Treatment Options
Treatment for midface retrusion is highly individualized, considering the severity of the condition and the patient’s age. Surgical interventions are frequently employed to correct the underlying skeletal issues. Orthognathic surgery, for example, can involve moving the upper jaw forward to improve alignment and facial balance.
For more severe cases, especially in children with poor growth of the cheekbones and eye sockets, a procedure called LeFort III advancement may be performed. This surgery brings all the bones of the upper face forward, improving the position of the nose, eyes, upper jaw, and teeth.
Distraction osteogenesis is another surgical technique used for severe midface retrusion, involving the gradual advancement of bone segments to achieve correction. Orthodontic treatments are often used in conjunction with surgery to address dental misalignment. While non-surgical cosmetic options like fillers may offer limited improvement for very mild cases, they do not address the underlying skeletal deficiency.