Craniofacial medicine : Understanding its role in dental medicine

- Dr Mriganka Shekar Bose

Craniofacial Medicine - Understanding its Role in Dental Medicine

I. Introduction

Craniofacial Medicine is a branch of allopathic medicine that deals with the study of craniofacial anomalies and their treatment. Anomalies of the craniofacial complex are of major concern, not only for oral health but also for mental health and social well-being. Craniofacial Medicine involves doctors from various fields such as Dentistry, Plastic Surgery, Neurosurgery, Pediatrics, and ENT Surgery. Specialist doctors from dental medicine such as Oral & Maxillofacial Surgeons, Orthodontists, Pediatric Dentists, and Prosthodontists are also involved in planning and providing treatments to patients with craniofacial anomalies. The catch with craniofacial medicine is that the anomalies are very vast and varied. In many cases, it can be challenging to pinpoint a single cause of a particular condition or disorder. Instead, these conditions often present as a combination of symptoms that are collectively referred to as a "syndrome." As such, identifying and treating syndromes typically requires a multidisciplinary team approach, involving healthcare professionals from a variety of disciplines. This collaborative approach may involve physicians, nurses, psychologists, physical therapists, occupational therapists, speech-language pathologists, and other specialists working together to develop an individualized treatment plan that addresses the various symptoms associated with the syndrome. By taking a holistic approach to care, the multidisciplinary team can better identify the underlying causes of the syndrome and develop targeted interventions to address them. Overall, the complex nature of many syndromes underscores the importance of a comprehensive, team-based approach to diagnosis and treatment.

II. Syndromes and their Classification

A syndrome can be defined as an aggregate of signs and symptoms associated with many morbid processes and constituting together the picture of the disease, related to each other. Richard & Goodman classified syndromes into six types based on different factors such as chromosomal abnormality, gene abnormality, environmental factors, embryological classification, single germ layer involved, and all three germ layers involved.

III. Mid-Face Deficiency Syndromes and the Role of Dentists

Mid-face deficiency syndromes are a group of conditions that affect the mid-face area and involve malformations of the bones and soft tissues. These syndromes are caused by a variety of genetic and environmental factors and can lead to severe functional and aesthetic problems. Dentists play a crucial role in the diagnosis and treatment of these syndromes. Some common mid-face deficiency syndromes and their treatments are discussed below:

A. Achondroplasia

Achondroplasia is an autosomal dominant disorder with class 3 malocclusion and short-limb dwarfism. About 90% of cases show gene mutation, and old parent age is a contributing factor. The frequency of Achondroplasia is about 1 in 5000 births. Treatment involves LeFort 3 osteotomy for mid-face advancement.

B. Treacher Collins Syndrome

Treacher Collins Syndrome is an autosomal dominant disorder with mandibular defects, open bite, micrognathia, macrostomia, and auricular defects. Its incidence is 1 in 25000 births. Treatment involves zygomatic and orbital reconstruction, maxillo-mandibular reconstruction, nasal reconstruction, and soft tissue and external ear reconstruction.

C. Apert Syndrome

Apert Syndrome is an autosomal dominant disorder with cranial and dental abnormalities such as dental crowding, delayed eruption, ectopic eruption, class 3 malocclusion, flat faces, and shallow orbits. The frequency of Apert Syndrome is 1 in 16000 births. Treatment involves surgery to increase intracranial space and orbital volume, enhance forehead and upper orbits morphology, and orthodontic treatment.