Vertical Facial Excess

Abstract

The etiology responsible for the morphologic designation of the long face is multifactorial and variable. The most common skeletal cause of vertical facial excess is vertical maxillary excess. This may or may not be seen in association with an anterior open bite. Less common causes of the long face are vertical ramus deficiency in the mandibular micrognathic individual and anterior vertical mandibular excess, which is frequently seen in association with mandibular prognathism. These etiologies may occur alone or in some combination. Because the etiologic spectrum is so variable, the overall facial morphology seen in the long-face patient is also quite variable. However, the common morphologic denominator found in all of these patients, regardless of etiology, is a quantitative increase in the vertical dimension of the lower face relative to the midface. This is quantitatively defined as the vertical dimension from subnasale to menton being in excess of the vertical dimension measured from subnasale to glabella, as demonstrated in Fig. 9-1.