Facial asymmetry is more common in nervous diseases and dental pathologies. Less often, injuries, ophthalmological, otolaryngological, congenital diseases become the cause of the symptom. The disorder can be static or dynamic, develop as a result of innervation disorders, edema, excess or lack of tissues. Determination of the cause of asymmetry is carried out using data from general, dental, neurological, otolaryngological examination, radiography, and other imaging techniques. Treatment before diagnosis is not indicated.
Why does facial asymmetry occur
Slight static (visible at rest) facial asymmetry is a physiological norm, found in almost all people. The difference in proportions within 3-5 degrees or 2-3 mm is considered normal.
Sometimes visually noticeable differences between the halves of the face are aggravated due to the features of facial expressions. This asymmetry (noticeable during the tension of the facial muscles) is called dynamic. The differences tend to worsen with age, since a person repeatedly strains the same muscles asymmetrically. This affects the condition of soft tissues, the features of the formation of wrinkles.
Damage to cerebral structures and meninges
Facial asymmetry is provoked by traumatic injuries, diseases of the central nervous system of various genesis. The list of pathologies includes:
- Compression of the brain. It develops acutely due to severe TBI, brain edema. Gradually progresses with hydrocephalus, tumors, cystic formations located in the cranial cavity.
- Stroke. It occurs acutely against the background of arterial hypertension, atherosclerosis, angina pectoris. It can be ischemic or hemorrhagic. The outcome of both variants of pathology is a focal lesion of the brain, causing disorders of nervous regulation and facial asymmetry.
- Encephalitis. Focal disorders are the result of not only circulatory disorders, but also inflammatory processes in the brain. Facial asymmetry is sometimes observed in patients who have undergone primary (tick-borne, Japanese mosquito) or secondary (influenza, measles, post-vaccination) forms of encephalitis.
- Meningitis. The cause of symmetry disorder may be the involvement of cranial nerves, the spread of infection to brain structures with the development of meningoencephalitis. The symptom is more often detected in purulent meningitis, basilar tuberculous meningitis.
- Neuroleukosis. It is formed as a complication of leukemia. Facial asymmetry may be caused by cranial nerve dysfunction, the occurrence of leukemic meningoencephalitis, compression of brain structures in patients with pseudotumorous form of the disease.
- Progressive hemiatrophy of the face. The gradual reduction of half of the face is due to atrophy of bones and soft tissues, presumably caused by exposure to vegetative centers. Changes appear in a limited area, eventually spread to the entire half of the face.
- Oromandibular dystonia. It is manifested by violent movements: compression, lateral movements of the jaws, opening and closing of the mouth, which are accompanied by a curvature of the lips, a violation of symmetry at the level of the cheeks. The occurrence of pathology is provoked by the lesion of the basal ganglia.
Pathology of cranial nerves
The most common disease of the cranial nerves that causes asymmetry is considered to be neuritis of the facial nerve. The cause of symmetry breaking is paresis or paralysis of facial muscles. A typical clinical picture includes smoothness of the nasolabial fold, lowering of the corner of the mouth, inability to close the eyelid, face skewed to the healthy side. A type of facial nerve paralysis is Ramsey-Hunt syndrome. Along with the weakness of facial muscles, patients have ear pain, dizziness, hearing loss.
In patients with Bogorad syndrome, the branches of the facial or excretory nerve germinate into the salivary and lacrimal glands. The disease develops at an early age, less often becomes a consequence of injuries in adults, accompanied by lacrimation, increased salivation from the lesion. The lesion of the facial nerve is manifested by paresis of the facial muscles, the abductor nerve – hearing disorders, deformation of the auricle. In children, facial asymmetry progresses as they grow.
A fairly common dental cause of facial asymmetry is diseases, the consequences of injuries, congenital anomalies of the jaws and TMJ:
- TMJ arthrosis. The symptom appears in the process of opening the mouth, due to the displacement of the lower jaw in the sick side. The disease develops gradually, accompanied by crunching, clicking, morning stiffness, dull pains.
- Ankylosis of the TMJ. The asymmetry of the face remains at rest, worsens when trying to open the mouth. The middle line of the face is shifted to the affected side. The lower jaw is retracted downwards by no more than 1 cm, horizontal movements are impossible.
- Contracture of the lower jaw. There are restrictions when opening the mouth, a decrease in the amplitude of movements of the lower jaw. The middle line also shifts in the direction of defeat. Pathology can be unstable (inflammatory) or persistent (scarring).
- Ameloblastoma. An odontogenic benign tumor that destroys the tissues of the jaw can reach significant sizes, cause significant facial deformity. The neoplasm grows slowly, asymmetry in the jaw area becomes the first symptom of the disease.
- Other benign tumors of the jaws. The symptom is often found in osteomas, osteoid osteomas, osteoblastoclastomas.
- Cancer of the upper jaw. Deformation occurs with a sufficiently large size of neoplasia, due to the growth of the tumor itself, the destruction of nearby anatomical structures, inflammatory edema.
- Cancer of the lower jaw. Facial asymmetry is noted in the case of germination of the neoplasm into nearby soft tissues, deformity of the alveolar process.
Another cause of asymmetry is jaw defects, which can be congenital or acquired: caused by injuries, osteomyelitis, tuberculosis, syphilis, operations for oncological diseases. With a defect of the upper jaw, the symptom appears due to the sinking of the cheek, may be accompanied by the formation of oronasal and oroanthal anastomoses.
The defect of the lower jaw is characterized by a violation of the oval of the face. Due to the displacement of the jaw towards the median line, the asymmetry is aggravated during the opening of the mouth. A violation of symmetry is also often manifested by micrognathia – a decrease in the jaw due to underdevelopment or previous injuries. With upper micrognathia, the lower teeth overlap the upper ones (reverse overlap), with the lower variant of the pathology, a beveled chin is observed.
Diseases of the salivary glands
Inflammatory processes and voluminous formations of the salivary gland cause deformation of the lower part of the face, cause asymmetry.
- Purulent mumps. A rapidly increasing painful swelling appears in the projection of the parotid salivary gland. There is an increase in temperature, symptoms of intoxication.
- Mucocele. Causes facial asymmetry as a result of damage to the salivary glands located in the auricular and submandibular areas. The swelling is painless, the condition is satisfactory, there are no signs of inflammation.
- Cyst. As in the previous case, the symptom is observed with the involvement of the parotid, submandibular gland, pain and inflammatory manifestations are not observed. Against the background of infection, subfebrility, local soreness are possible.
- Adenoma. A benign tumor with slow growth. With an increase in size, along with asymmetry, unpleasant sensations are noted, a decrease in salivation.
- Tumors. Benign lipomas, neurinomas, and angiomas are formed in the salivary glands. According to clinical manifestations, neoplasms resemble adenoma. The list of malignant neoplasias includes sarcomas and carcinomas, which are characterized by rapid growth, destruction of soft tissues. Pathologies are often accompanied by paresis of the facial nerve.
Other dental diseases
Other inflammatory dental pathologies that can cause facial asymmetry include:
- Periostitis of the jaw (flux). Only the periosteum suffers, the jaw itself remains intact. Flux is more often caused by dental diseases. The cause of the asymmetry is local edema, the formation of an abscess under the periosteum.
- Periapical abscess. An abscess forms in the tissues around the root of the tooth, provoked by acute periodontitis. It is manifested by a strong throbbing pain in the area of the affected tooth. Facial deformity is caused by the spread of edema to the surrounding soft tissues.
- Parotid abscess. It develops with dental lesions, inflammatory processes in the surrounding tissues. It is accompanied by a violation of the general condition, toothache, dense edema, in the center of which a fluctuation site is subsequently formed.
Non-inflammatory causes of asymmetry include crossbite – a condition in which the dentition is crossed during the closing of the jaws. It can be congenital or acquired. It is characterized by a shift of the chin to the side, a sinking of the lip on one side, a flattening of the lower parts of the face on the other.
Temporary facial asymmetry caused by soft tissue edema is observed with soft tissue bruises, facial hematomas. Occurs after a blow or fall, increases rapidly within a few hours, gradually disappears within 1-2 weeks. At the stage of recovery, “fading” is noted – a consistent change in skin color in the areas of hemorrhages. In fractures, asymmetry is caused not only by edema, but also by displacement of the solid structures of the facial skull. The cause of the symptom is:
Fracture of the lower jaw. The symmetry breaking is more noticeable on the outer or lower edge of the cheek. In the oral cavity, a step (violation of the continuity of the dentition) is found in the fracture area.
Congenital and childhood pathologies
Facial asymmetry is diagnosed in the following congenital diseases and pathologies of childhood:
- Sturge-Weber syndrome. A congenital disease in which angiomas form on the skin and meninges. With hydrocephalus, hemiparesis, facial asymmetry develops on the side opposite to the location of angiomas.
- Torticollis. The congenital form is caused by underdevelopment of the nodding or trapezius muscle, acquired – by various diseases, injuries. The ear, eyebrow and eye of the child on the sick side are located lower than on the healthy side. The eye slit is somewhat narrowed.
- Lermitt-Duclos disease. A genetically determined pathology, the main manifestation of which is a neoplasm of the cerebellum. Even before the tumor begins to grow, the disease can be suspected by the asymmetry of the facial skeleton, gum hyperplasia, congenital anomalies of the hands, and some other signs.
- Acute intermittent porphyria. Hereditary disease, manifested by seizures caused by disorders of porphyrin metabolism. Facial asymmetry is observed in severe cases, occurs about a week after the onset of symptoms from the gastrointestinal tract, combined with other neurological disorders.
- Harelip. An anomaly of development, in which one or two cleft upper lip is detected, located on the sides of the median line. With concomitant cleft palate, the deformation is aggravated by a “dip” in the middle part of the face, a violation of the shape of the nose.
- Stigmas of embryogenesis. A violation of symmetry can be determined with a number of small anomalies: a change in the shape of the skull, deformities of the nose, eyes, and the maxillary system.
The list of other possible causes of facial asymmetry includes:
- Poisoning with hydrogen peroxide. The symptom is found in violation of cerebral circulation, supplemented by impaired speech, hearing, coordination of movements.
- Actinomycosis. Asymmetry is observed in maxillofacial actinomycosis, caused by the formation of infiltrate in the area of masticatory muscles, the development of trism.
- Kallman syndrome. In this form of hypogonadism, the symptom is caused by malformations and small facial anomalies, combined with eunuchoidism, cardiovascular disorders, gynecomastia.
- Botulism. It is accompanied by facial asymmetry in neurological disorders that cause paresis or paralysis of facial muscles.
The determination of the cause of facial asymmetry is most often carried out by dentists or neurologists. If the corresponding symptoms are detected, the patient is referred to otolaryngologists, oncologists, endocrinologists, and other specialists. The examination plan may include the following diagnostic procedures:
- Survey, physical examination. The doctor determines the time and circumstances of the appearance of the symptom, asks the patient about other manifestations of the disease. Evaluates the severity of asymmetry at rest, with facial and chewing movements. It reveals other changes: swelling, redness, paleness, increase in local temperature, tumor-like formations.
- Dental examination. It includes the study of the condition of teeth, gums, hard and soft palate, mucosa of other areas, bones of the facial skeleton. Allows you to confirm the presence of diseased teeth, inflammation, trauma, suppuration, tumors.
- Neurological examination. The specialist studies the innervation of the facial muscles, offering the patient to perform certain movements: to wrinkle his forehead, raise and lower his eyebrows, inflate his cheeks, show his tongue, show his teeth, follow the movements of the neurological hammer with his eyes. Then the neurologist performs palpation of the available nerve exit points.
- Otorhinolaryngological examination. Provides for the conduct of special studies. If there is a suspicion of pathology of the paranasal sinuses, an echosinusoscopy or diagnostic puncture can be performed. In case of complaints of hearing impairment, audiometry, tuning fork examination, etc. are performed. Vestibulometry and rotational tests are recommended for vestibular disorders.
- Radiography. Taking into account the revealed pathological changes, the patient is prescribed an X-ray of the tooth, an X-ray examination of the jaw or paranasal sinuses. In some cases, radiographs of the skull and cervical spine are necessary.
- Ultrasound examination. During the examination, sonography of the salivary glands, paranasal sinuses, and soft tissues can be performed. If signs of compression of the brain are detected, echoencephalography is indicated.
- Other visualization techniques. Most often, CT or MRI are used to clarify the diagnosis, to study in detail the nature of changes, the volume and location of the pathological focus. In case of neurological pathology, PET-CT, brain SPECT may be prescribed.
- Laboratory tests. According to the general blood test, the presence and severity of inflammation are judged, according to the results of a microbiological study, the pathogen and its sensitivity to antibiotics are determined. With volumetric formations, histological and cytological examination of smears, punctures, biopsies is carried out.
Treatment of facial asymmetry
The etiology of facial asymmetry is very diverse. Many diseases accompanied by this symptom can pose a serious threat to the patient’s health, especially at the late start of treatment. Self-medication in such cases is unacceptable, the appearance of this sign should be considered as a reason for immediate medical treatment.
The plan of therapeutic measures varies taking into account the peculiarities of pathology. In many cases, a special diet is recommended. Dental diseases can be treated for caries, pulpitis, periodontitis. Patients with facial asymmetry are prescribed medications of the following groups:
- Analgesics. They are indicated for severe pain syndrome. Intramuscular injections or tablet forms are possible.
- NSAIDs. They are required to reduce the severity of inflammation, edema, pain syndrome. General-action drugs are taken in short courses to reduce the risk of side effects from the liver and gastrointestinal tract.
- Antibiotics. They are necessary for general bacterial infections, local inflammatory processes. Initially, broad-spectrum drugs are used, after receiving the result of microbiological analysis, the antibiotic therapy regimen is adjusted taking into account the sensitivity of the pathogen.
- Antiseptics. Topical medications are used in the form of rinses. Recommended in the presence of inflammation, wounds on the mucous membrane, after surgery.
In some cases, drug therapy is supplemented with physiotherapy. In the treatment of diseases that provoke facial asymmetry, electrostimulation, UHF, medicinal electrophoresis, and other methods may be prescribed. In case of oncological pathologies, chemotherapy and radiation therapy are performed.
Taking into account the nature of the diseases , the following operations are performed:
- Nervous: endoscopic or transcranial evacuation of hematomas, removal of crushed brain areas during TBI, excision of tumors and abscesses, shunting interventions, static hanging of the corner of the mouth, dynamic hanging of the corner of the eye or mouth.
- Dental: tooth extraction, excision of a cyst or tumor of the salivary gland, opening of abscesses of the oral cavity.
- Maxillofacial: arthrocentesis, therapeutic arthroscopy, lavage, TMJ endoprosthetics, opening of abscesses and phlegmon of soft tissues, rhinocheiloplasty, rhinocheilognathoplasty, other methods of correction of facial cleft.
- In case of injuries: osteosynthesis of the jaw, conventional and interdigital ligature binding, splinting of the jaw.
- Otolaryngological: removal of cysts of the paranasal sinus.