A true resultant deformity of the jaw
bone/bones due to congenital anomalies
or acquired during the growth and
development of an individual (trauma,
habbits, familial, pathology or post cancer
Function - Chewing
The first known correction of jaw deformity was carried out without
anaesthesia in the mid 19th century by an American, General
Surgeon Simon Hullihen.
• He was referred a patient with gross facial deformities as the result of
scarring from burns early in childhood, with a history of multiple
• He undertook initially an osteotomy of the mandible, repositioning
the anterior segment to correct an anterior open bite and
subsequently he carried out soft tissue surgery to improve the overall
appearance and functionality of the soft tissues of the lips, chin and
neck to return them to their normal position thus achieving lip closure
and a relatively normal facial profile. That was in 1848 .
• Maxillary surgery for tumour removal had been carried out in the
19th century by von Langenbeck in Germany and by Cheever in the
• It was not until the 1920’s that midface surgery as previously described
in the 19th century was specifically used to correct maxillary
deformity where there was severe maxillary retrusion often in
association with cleft palate problems.
• Martin Wassmund and Georg Axhausen were the first in Germany
to develop the procedure for midface deformity .
• Le Fort I osteotomy became widely accepted for the correction of low
midface deformity often in conjunction with mandibular surgery.
3. Pseudo/ Other Causes…
(Related to soft tissues)
• Treacher Collins–Franceschetti
syndrome or Mandibulofacial
A rare autosomal dominant
congenital disorder ,
A congenital condition of facial abnormalities in humansin which a
chain of certain developmental malformations, one entailing the next.
The 3 main features are cleft palate, micrognathia , glossoptosis
Pierre Robin sequence may be caused by genetic anomalies at
chromosomes 2, 11, or 17.
• Also known as Oculo-Auriculo-Vertebral (OAV) syndrome
• Characterized by incomplete development of the ear, nose, soft
palate, lip, and mandible.
• Crouzon in 1912
• Crouzon syndrome (craniofacial dysostosis)is a genetic disorder
known as a branchial arch syndrome.
• This syndrome affects the first branchial (or pharyngeal) arch, which
is the precursor of the maxilla and mandible.
• Classified by apert in 1906
• Apert syndrome is a form of acrocephalosyndactyly, a congenital
disorder characterized by malformations of the skull, face, hands and
• It is classified as a branchial arch syndrome, affecting the
first branchial (or pharyngeal) arch, the precursor of
the maxilla and mandible.
Hypoplasia of maxilla
Failure of eruption of permanent teeth.
Frontal Bossing (bulging) of the forehead.
Open skull sutures, large fontanelles.