Midface retrusion describes a structural deviation where the central portion of the face is positioned too far backward relative to the forehead and the lower jaw. This condition involves the underdevelopment of the facial skeleton, creating a flattened or concave profile. The midface region extends from the eye sockets down to the upper teeth, encompassing the nasal bridge, cheeks, and upper jaw. While primarily a deviation in bone structure, its impact can affect several important bodily functions beyond appearance.
Understanding Midface Structure
The midface is supported by a complex arrangement of bones. The maxilla, or upper jawbone, is the central component, providing the foundation for the upper teeth, the floor of the eye sockets, and the lateral walls of the nasal cavity. The paired zygomatic bones (cheekbones) articulate with the maxilla and skull base, giving the face its projection and width.
Midface retrusion occurs when the growth of these bony elements is deficient, causing them to sit in a recessed position. This backward positioning makes the face look “sunken” below the eyes when viewed from the side. The alignment of the midface dictates the positioning of the upper dental arch and supports the soft tissues of the nose and cheeks.
What Causes the Midface to Recede?
The posterior positioning of the midface is most frequently linked to developmental or genetic factors. Several craniofacial syndromes, including Crouzon and Apert syndromes, are associated with midface retrusion. These genetic conditions often involve craniosynostosis, where the skull’s growth plates fuse prematurely, restricting the forward growth of the midfacial bones.
A history of cleft lip and palate (CLP) is another developmental factor. Individuals with CLP often exhibit maxillary hypoplasia (underdevelopment of the upper jaw) due to intrinsic growth deficiencies or early surgical repairs that impede subsequent facial growth. This results in the upper jaw and surrounding structures failing to achieve normal projection.
Acquired causes, particularly severe facial trauma involving fractures of the midface bones, can also lead to retrusion. High-impact injuries can displace the maxilla and zygoma backward. If these fractures are not perfectly reduced, a permanent recessed position can result.
How Retrusion Affects Appearance and Function
Midface retrusion results in a characteristic flattened facial profile. The lack of forward projection in the cheekbones and upper jaw can make the forehead and chin appear overly prominent. This skeletal imbalance often leads to a relative underbite, a malocclusion where the upper teeth sit behind the lower teeth.
The functional consequences of a recessed midface can be substantial. Shallow eye sockets, known as exorbitism, leave the eyes poorly protected and can cause them to appear bulgy. In severe cases, this lack of orbital depth can prevent the eyelids from closing properly, leading to dry eyes and corneal irritation (keratoconjunctivitis).
A primary functional concern is the compromise of the upper airway. The recessed maxilla reduces the space behind the nose and soft palate. This narrowing contributes to chronic nasal obstruction and is a frequent cause of obstructive sleep apnea (OSA). Correcting the skeletal position is often necessary to improve breathing function and overall health.
Identifying Midface Retrusion
Identifying midface retrusion begins with a thorough physical examination by a specialist, such as a craniofacial surgeon or orthodontist. Clinicians assess the patient’s profile and the alignment of the upper and lower jaws to determine the extent of the skeletal discrepancy. This initial assessment is followed by advanced imaging techniques to quantify the degree of retrusion and plan for correction.
Imaging usually involves X-rays, including specialized lateral cephalometric analysis, or three-dimensional computed tomography (CT) scans. These images allow the medical team to precisely measure the position of the maxilla and zygoma relative to the cranial base and the lower jaw. Comparing these measurements to established norms determines the exact nature and severity of the structural deviation.
Corrective Treatment Options
The approach to correcting midface retrusion depends on the patient’s age and the severity of the skeletal deficiency. For younger patients whose facial bones are still growing, specialized orthopedic appliances or orthodontics may be used to gently guide the maxilla forward. This early intervention aims to modulate the growth pattern and improve the skeletal relationship before the bones fully mature.
For adolescents and adults with fully formed facial skeletons, surgical correction is required to achieve a stable, functional, and aesthetic result. The most common procedure is the Le Fort osteotomy, which involves surgically cutting and repositioning the recessed bone segment.
Le Fort Osteotomy Types
The Le Fort III advancement is used for the most severe cases, moving the entire midface, including the eye sockets and cheekbones, forward.
The Le Fort II osteotomy focuses on advancing the nasal bridge and maxilla.
The Le Fort I is used primarily to move the upper jaw and correct the bite.
In instances of severe retrusion, distraction osteogenesis may be employed. This technique involves gradually pulling the bone forward over several weeks using specialized external or internal devices. This gradual advancement promotes the simultaneous lengthening of the bone and surrounding soft tissues, leading to a stable correction and improved airway function.