Maxillary Retrognathia: Causes, Symptoms & Treatment

In maxillary retrognathia, the upper jaw is underdeveloped and the normally developed lower jaw protrudes beyond it. The phenomenon is an abnormality of the jaw-skull relationship and can occur as part of hereditary malformation syndromes or in acquired form after trauma. The treatment of patients corresponds to a special form of osteotomy.

What is maxillary retrognathia?

Prognathisms are orthodontic malocclusions in which the upper jaw is too far forward with respect to the base of the skull. Dental malocclusions with the anterior teeth of the upper jaw too far forward are also sometimes referred to as prognathism. Maxillary retrognathia is also called false genius and corresponds to hypoplasia of the upper jaw. In medicine, hypoplasia means underdevelopment. The underdeveloped upper jaw of the patients falsely leads to the impression of prognathism in this phenomenon. The phenomenon is also called opisthognathia, maxillary retrognathism and maxillary retrognathia. In most cases, the underdevelopment of the maxilla corresponds to a shortening. For this reason, the normally developed lower jaw protrudes beyond the underdeveloped upper jaw. Maxillary retrognathia is one of the anomalies of the jaw-skull relationship. Often, there is a hereditary basis to the appearance. However, maxillary retrognathia may also be acquired under certain circumstances. The phenomenon is the second most common dysgnathia. As such, maldevelopments of the teeth and jaw are summarized.

Causes

In most cases, maxillary retrognathia is hereditary. In this context, the phenomenon may be present, for example, in the context of syndromes such as Crouzon syndrome, with the primary cause being a genetic mutation. Hypoplasia of the maxilla corresponds to growth retardation in congenital cases. Maxillary retrognathia thus occur, for example, in the context of dysostosis cranio-facialis as craniofacial malformations or and associate the symptoms of acrocephalosyndactyly. However, rethrognathia can also be acquired and occur in this context, for example, after surgery. Sometimes most often occurs after surgical procedures on a cleft lip and palate, which take place in childhood. If a patient has teeth extracted in childhood or otherwise irreversibly loses maxillary teeth, this loss can also promote acquired maxillary retrognathia. Except for those affected by a hereditary disease, most patients with maxillary retrognathia are completely healthy apart from the maxillary anomaly. Acquired forms may be preceded by trauma to the jaw or skull that has been inadequately treated. In this context, the phenomenon is a local complication.

Symptoms, complaints, and signs

Patients of maxillary retrognathia suffer from an abnormal relationship between the jaw and the base of the skull. The patients’ chin is too far forward in significant portions compared to the maxilla. For this reason, the patients have a concave facial profile. The maldevelopment makes the nose and the nasolabial fold extremely dominant. Patients often complain of difficulty breathing through the nose, since nasal breathing is restricted by the offset of the jaw. Which additional symptoms are present depends on the cause of the maxillary retrognathia. In the context of malformation syndromes, many other malformations of the craniofacial system are usually present. In acquired cases, the anomaly is usually an isolated phenomenon. Under certain circumstances, the maldevelopment may be associated with pain, especially in cases of traumatic causes. Problems with eating or drinking can occur when the anomaly reaches a certain degree. In addition, all malocclusions and incorrect loading of the jaw can cause complaints such as headaches or tension.

Diagnosis and course of the disease

In the context of diagnosis, maxillary retrognathia must be differentiated from mandibular prognathies. In these maldevelopments, there is not a shortened maxilla but an elongated mandible that protrudes beyond the maxilla. At first glance, maxillary retrognathia appears to be a prognathism, but it does not correspond to the same anomaly in any way.The diagnosis is made by the dentist or the oral surgeon. In most cases, the prognosis is excellent. This is true at least after early diagnoses of the anomaly.

Complications

In this disease, affected individuals usually suffer from various complaints in the area of the jaw. In the process, changes and deformities occur in the face, so that those affected suffer primarily from limited aesthetics. Children in particular can also suffer from bullying or teasing. It is not uncommon for this condition to also result in greatly reduced self-esteem or even inferiority complexes. Sometimes the disease also leads to breathing difficulties, so that in the worst case patients can also lose consciousness. The internal organs are also supplied with less oxygen. Malformations can also occur in the face. The disease also leads to tension in the neck and jaw and not infrequently to headaches. Malpositions can also occur. The intake of food and liquids may be accompanied by difficulties. The treatment of this disease is carried out with the help of various interventions. As a rule, no particular complications occur. Many malpositions and complaints can be corrected. The patient’s life expectancy is also not usually reduced by the disease.

When should you see a doctor?

People who suffer from an optical change in the shape of the face should consult a doctor. In particular, if the upper and lower jaws are not overlapping, there is cause for concern and it could be an indication of Maxillary Retrognathia. If there is a significant overbite, a visit to the doctor is recommended so that the jaws can be corrected. If problems with food intake develop due to the malocclusion, a doctor should be consulted. If food cannot be crushed properly by chewing because of the discomfort, consultation with a doctor is recommended. If there is a refusal to eat or an exclusive intake of liquid or mushy foods, a visit to the doctor is necessary. In many patients, due to the malformations, there are impairments in the usual respiratory activity. If breathing is difficult, sleep disturbances occur as a result, or anxiety occurs due to the shortness of breath, a doctor is needed. In case of headache, muscle discomfort or tightness in the shoulder and neck area, a doctor should be consulted. If the affected person also suffers from a mental disorder, a visit to the doctor should also be made. In case of a social withdrawal, a depressive mood as well as behavioral problems, medical and therapeutic help is needed. In the case of low self-esteem, a reduced zest for life or a significant loss of well-being, a visit to the doctor is necessary.

Treatment and therapy

Patients of maxillary retrognathia must be treated as early as possible. If left untreated, the anomaly of the jaw can cause severe damage to the teeth and supporting apparatus. These complications must be avoided by means of early treatment. Treatment is usually causal and takes place under orthodontic care. There are no conservative treatment options for the phenomenon. Surgical procedures should be given priority. The oral surgeon usually resolves the malformation in the course of a special osteotomy. Osteotomies are surgical procedures for the targeted cutting of bones that can correct malpositions. In this context, there is often talk of a so-called corrective osteotomy. An osteotomy is followed by osteosynthesis, in which the severed bones are brought into position and fixed. In patients with maxillary retrognathia, osteotomy and osteosynthesis serve to advance the maxilla. In this case, the operation is preferably performed according to the technique of a Le-Fort-I osteotomy. In most cases, surgery can correct the anomaly at least to the extent that complications such as tooth damage or damage to the retaining apparatus are excluded.

Outlook and prognosis

The positive prognosis in maxillary retrognathia is true in most cases. However, the condition is early diagnosis. Shortening of the mandible may be hereditary. However, it can also be caused by other circumstances, such as trauma to the facial region. Maxillary retrognathia must be distinguished from an ordinary underbite.This is caused by the upper jaw protruding too far. As a result of maxillary retrognathia, those affected suffer from an unusual appearance. They have deformities of the head and numerous complaints. Respiratory problems may occur. Maxillary retrognathia does not affect the life span. However, it can reduce the quality of life. This is especially true if food intake becomes difficult or breathing becomes difficult. Aesthetic issues are also affected by Maxillary Retrognathia. Orthodontic treatment of Maxillary Retrognathia is essential. It can usually be completed with good results. The facial and jaw deformities occurring in Maxillary Retrognathia usually have to be corrected by maxillofacial surgery. The aim is to ensure the ability to chew, unhindered breathing and a more attractive appearance. Psychological sequelae such as inferiority complexes or depression are common. If these are subjected to psychotherapeutic treatment, the prognosis is good overall. This is especially true if there is a prospect of improvement with oral surgery.

Prevention

Maxillary retrognathia in the context of malformation syndromes is difficult to prevent. However, acquired anomalies of this type can be excluded by performing surgery on the infantile jaw or cleft palate only after a certain age and with the necessary preoperative and postoperative care.

Aftercare

The treatment of the jaw malocclusion or teeth malocclusion by the orthodontist can be completed in some cases with the help of a special aftercare. This is discussed with the treating orthodontist. This must be decided individually in each case. The cause of the jaw and teeth misalignment is closely related to the type of aftercare. If it is simply a case of unevenly grown teeth, it may be helpful under certain circumstances to continue wearing a stabilizer for a certain period of time after the classic treatment with braces. This is adjusted by the orthodontist and secures the result of the treatment in the long term.

What you can do yourself

If maxillary retrognathia is suspected, a doctor or orthodontist should be consulted immediately. Immediate treatment is necessary to prevent severe damage to the teeth and supporting apparatus and to ensure a speedy recovery overall. The treatment itself can be supported by those affected through good dental and oral hygiene. Increased tooth brushing and the use of a medicated mouthwash reduce the risk of inflammation, especially in the case of existing damage to the periodontium. If no damage has yet occurred, the most important measure is to compensate for the impeded nasal breathing by conscious mouth breathing. This is particularly important in the case of severe malformations of the jaw, because a pronounced offset can cause severe breathing difficulties and subsequently a chronic lack of oxygen. In addition, action must be taken against the individual symptoms. Headaches can be reduced by conscious relaxation and fresh air. Effective remedies from natural medicine include valerian and chamomile. A gentle massage helps against tension in the area of the jaw. Here, too, conscious relaxation can reduce the discomfort. However, a doctor should be consulted if symptoms are pronounced.