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Dental Tribune Middle East & Africa Edition | March-April 2015 15Paediatric Tribune < Page 14 aged by short-term intermaxil- lary fixation and subsequent physiotherapy, do not lead to morphological and functional problems. However, no diag- nosis of condyle fractures may lead to face asymmetries, severe malocclusion and TMJ ankylosis (5). TMJ ankylosis It is a chronic hypomobility and, if happens in growing subjects, it becomes a growth disorder (Fig- ure 5). It results from intracap- sular adhesions or ossification between the disc and temporal articular surface that attach the disc-condyle complex to the articular eminence. Its classi- fication relates to the degree of limitation (partial or complete), location of the union (intraca- psular vs. extracapsular), and type of tissues involved (fibrous, osseous, fibro-osseous). TMJ ankylosis occurs relatively in- frequently. Principle causes include trauma, previous joint surgery, systemic or local in- fections, tumors, compressive function pattern and systemic diseases (6). Regarding history, patients report limited mouth opening without any pain, the condition has been present for a long time, and, if not associated with severe dentofacial deform- ity, patients do not feel that it poses a significant problem. Muscular and Soft Tissue Asymmetries Facial disproportions could be the result of muscular and soft tissue asymmetry (e.g., hemifa- cial atrophy or cerebral palsy), muscle size disproportion in vol- ume and/or tonicity (e.g., mas- seter hypertrophy, dermatomy- ositis (Figure 6), and neoplasms (Figure 7)). Abnormal muscle function often leads to skeletal deviations (2). Functional Asymmetries Functional asymmetries can re- sult from lateral or anteroposte- rior deflections of the mandible due to occlusal interferences, which prevent proper intercus- pation in centric relation (e.g., functional crossbites) (1). Func- tional crossbites in children, if left without correction, subse- quently they may cause man- dibular asymmetry. Conclussions Face asymmetries in children and adolescents should be de- tected and diagnosed as early as possible. Early detection may be critical with regard to the prog- nosis and therapeutic manage- ment of this challenging dentof- acial deformity. References 1) Bishara SE, Burkey PS, Kharouf JG, Athanasiou AE. Dental and facial asymmetries. In: Bishara SE, ed. Textbook of Orthodontics. Philadelphia: WB Saunders Company, 2001:532- 44. 2) Melsen B, Athanasiou AE. Soft Tissue Influence in the Develop- ment of Malocclusion. Aarhus: The Royal Dental College, 1987. 3) Assael LA. Developmental disorders. In: Kaplan AS, Assael LA, eds. Temporomandibular Disorders. Diagnosis and Treat- ment. Philadelphia: WB Saun- ders Company, 1991:238-250. 4) Obwegeser HL. Mandibu- lar Growth Anomalies. Berlin: Springer, 2001:145-194. 5) Myall RW, Sandor GK, Greg- ory CE. Are you overlooking fractures of the mandibular con- dyle? Pediatrics 1987;79:639-41. 6) Vasconcelos BC, Porto GG, Bessa-Nogueira RV. Temporo- mandibular joint ankylosis. Braz J Otorhinolaryngol 2008;74:34-8. Contact details available from the publisher Figure 6. A 10-year-old boy with der- matomyositis creating a soft tissue tonicity imbalance (a) and resulting in a unilateral posterior crossbite (b). Figure 7. A 13-year-old girl with he- mangioma “infrabulbare” (a) ap- plying excessive pressure on the left maxillary teeth (b) and severely in- fluencing their position (c). Athanasios E. Athanasiou, D.D.S., M.S.D., Dr. Dent. Professor and Program Director in Orthodontics Hamdan Bin Mohammad College of Dental Medicine Mohammad Bin Rashid Uni- versity of Medicine and Health Sciences Dubai, United Arab Emirates Professor Department of Orthodontics Faculty of Dentistry School of Health Sciences Aristotle University of Thessa- loniki Thessaloniki, Greece About the Author a a b b c