Long face syndrome

Long face syndrome, also referred to as skeletal open bite,[1] is a relatively common condition characterised by excessive vertical facial development.[2] Its causes may be either genetic or environmental. Long face syndrome is "a common dentofacial abnormality."[3]: 369 [4] Its diagnosis, symptomology and treatments are complex and controversial. Indeed, even its existence as a "syndrome" is disputed.

Definition and treatment

One dental textbook defines it as: "Dolicofacial, there is excess of lower facial height usually associated with lower occlusal and mandibular plane angles." This is often associated "with vertical maxillary excess and mandibular hypoplasia."[5] Luc P. M. Tourne, a Fellow in the Department of TMJ and Craniofacial Pain at the University of Minnesota School of Dentistry, noted: "There is a clinically recognizable facial morphology, the long face syndrome, which has been incompletely described in the literature," However, her study of 31 adults with this syndrome, which included "analysis of esthetics, skeletal morphology, and occlusion" confirmed "this basic dentofacial deformity" has associations " with excessive vertical growth of the maxilla." She reported that "closed bite" and "dental open" are two of the syndrome's variants.[upper-alpha 1][7]

The treatment for young patients troubled by long face syndrome is to halt and control descent of the lower jaw and to prevent the eruption of posterior teeth. In severe cases of deformity, a mixture of orthodontics and orthognathic surgery may be the only effective solution.[8][9] The long-term (more than 6 years) effectiveness of surgical treatments for long face syndrome has been subject to study.[10]

"In the American literature, the terms long-face syndrome and short-face syndrome are often used." To be sure, there are reported "long and short face anomalies" and open bite cases. However, in the opinion of Hugo Obwegeser, there is no medical justification for naming them as a "syndrome"—the signs and symptoms do not meet the definitional threshold.[11]: 22 

There is controversy concerning the use of the descriptor "long-face syndrome." While increased anterior "total and lower face height" in many ages, combined with vertical maxillary excess in adults has been observed, the causes are controversial. Specifically, there is disagreement about possible potential environmental influences on genetic components.[12]

Anecdotally, it was said to be a genetic condition, which could only be corrected with "massive amounts" of debilitating, frequent and long dental and facial reconstructive surgery.[13]

In children, there is a concern that mouth breathing can contribute to the development of long face syndrome. A recent study finds that it is a growing problem which should be treated as "it won't just go away."[14] In addition to mouth breathing, it may be associated with sleep apnea.[15]

Because of long face syndrome's sometime association with pediatric obstructive sleep apnea (OSA) and allergic reactions, it is essential that treating physicians differentiate the conditions and the treatments; treating one may not cure the other.[16][17]

Notable people

Actor and screenwriter Craig Chester says he has had the condition.[13]

See also

Notes
  1. "Experimental evidence suggests that altered muscular function can influence craniofacial morphology. The switch from a nasal to an oronasal breathing pattern induces functional adaptations that include an increase in total anterior face height and vertical development of the lower anterior face. While some animal studies have suggested predictable growth patterns may occur, studies in human subjects have been much more controversial. Therefore, individual variations in response should be expected from the alteration of a long face syndrome patient's breathing mode."[6]

References
  1. Carano, Aldo; Siciliani, Giuseppe; Bowman, S. Jay (September 2005). "Treatment of skeletal open bite with a device for rapid molar intrusion: a preliminary report". Angle Orthodontist. 75 (5): 736–746. PMID 16283813.
  2. Schendel, S. A.; Eisenfeld, J.; Bell, W. H.; Epker, B. N.; Mishelevich, D. J. (October 1976). "The long face syndrome: vertical maxillary excess". American Journal of Orthodontics. 70 (4): 398–408. doi:10.1016/0002-9416(76)90112-3. ISSN 0002-9416. PMID 1067758.
  3. Taub, Daniel I.; Jacobs, Jordan M. S.; Jacobs, Jonathan S. (2013). "Chapter 16: Anthropometry, cephalometry, and orthognathic surgery". In Neligan, Peter C. (ed.). Plastic surgery. Vol. 2: Aesthetic. Warren, Richard J., volume editor. (3rd ed.). New York: Elsevier Saunders. pp. 354–372. ISBN 978-1-4557-4049-9.
  4. Prittinen, Jim (1996). "Orthodontic diagnosis of long face syndrome". General Dentistry. 44 (4): 348–351. PMID 8957832. Archived from the original on January 27, 2018. Retrieved December 18, 2017.
  5. Borle, Rajiv M. (February 28, 2014). Textbook of Oral and Maxillofacial Surgery. JP Medical Ltd. ISBN 9789351520092. Archived from the original on February 10, 2018.
  6. Tourne, Luc P. M. (September 1990). "The long face syndrome and impairment of the nasopharyngeal airway". The Angle Orthodontist. 60 (3): 167–176. PMID 2202236. Retrieved December 18, 2017.
  7. See Schendel, Steven; Bell, William Harrison; Eisenfeld, Jerome; Miselevich, David; Epker, William (1976). "The long face syndrome: Vertical maxillary excess". American Journal of Orthodontics and Dentofacial Orthopedics. 70 (4): 398–408. doi:10.1016/0002-9416(76)90112-3. PMID 1067758. Archived from the original on February 10, 2018. Retrieved December 18, 2017.
  8. Angelillo, J. C.; Dolan, E. A. (January 1982). "The surgical correction of vertical maxillary excess (long face syndrome)". Annals of Plastic Surgery. 8 (1): 64–70. doi:10.1097/00000637-198201000-00010. ISSN 0148-7043. PMID 7073194. S2CID 38905192.
  9. Bell, William H.; Creekmore, Thomas D.; Alexander, R. G. (January 1977). "Surgical correction of the long face syndrome". American Journal of Orthodontics. 71 (1): 40–67. doi:10.1016/0002-9416(77)90176-2. ISSN 0002-9416. PMID 264364.
  10. Gallego-Romero, David; Llamas-Carrera, José M.; Torres-Lagares, Daniel; Paredes, Vanessa; Espinar, Eduardo; Guevara, Eduardo; Gutiérrez-Pérez5, José L. (May 2012). "Long-term stability of surgical-orthodontic correction of class III malocclusions with long-face syndrome". Med Oral Patol Oral Cir Bucal. 17 (3): 435–441. doi:10.4317/medoral.17647. PMC 3476084. PMID 22143741.
  11. Obwegeser, Hugo L. (2001). Mandibular growth anomalies: terminology – aetiology – diagnosis – greatment. Berlin: Springer. doi:10.1007/978-3-662-04534-3. ISBN 978-3-642-08655-7. Archived from the original on 2018-02-10.
  12. Krishnan, Vinod; Davidovitch, Ze'ev (March 18, 2004). Pediatric Endocrinology: Mechanisms, Manifestations, and Management. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins. ISBN 9780781740593. Archived from the original on February 10, 2018.
  13. Chester, Craig (April 1, 2004). Why the Long Face?: The Adventures of a Truly Independent Actor. New York: St. Martin's Press. p. 77. ISBN 9781429971980. Archived from the original on February 10, 2018.
  14. Holohan, Ellin (May 5, 2010). "Study says a mouthful about kids' breathing". Chicago Sun-Times. Chicago, Illinois. Archived from the original on February 10, 2018. Retrieved December 17, 2017 – via HighBeam Research. Breathing through the mouth instead of the nose can lead to more than just dry tongues and palates. Chronic mouth breathers, most often children with allergies, have problems getting enough oxygen into their blood, which affects their size, weight, sleep and even school performance...
  15. Morgan, Rachel (August 14, 2017). "Symptoms: Mouth Breathing". Live Strong. Archived from the original on July 29, 2017. Retrieved December 18, 2017.
  16. Li, Kasey K. (January 1, 2006). "Study says a mouthful about kids' breathing: Examining pediatric OSA surgery: although useful for many, the popular adenotonsillectomy treatment is not a cure-all". Sleep Review. Archived from the original on December 22, 2017. Retrieved December 18, 2017 – via HighBeam.
  17. "Allergic rhinitis in children; allergic rhinitis is the most common chronic disorder affecting children". The Pediatric OSA Airway. September 2010. Archived from the original on December 22, 2017. Retrieved December 19, 2017 – via HighBeam Research. In addition, it is important to appreciate that many children with OSA have dentofacial abnormalities such as maxillomandibular constriction, maxillomandibular deficiency, and long face syndrome.
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