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Cerebral Palsy pp 1–16Cite as

Management of Skeletal Facial Deformation and Malocclusion in Cerebral Palsy

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Abstract

Skeletal facial deformation and malocclusion are commonly found in children with cerebral palsy (CP). Skeletal facial deformations represent abnormalities in the position, size, and/or shape of the facial bones. Malocclusion represents disharmony in the relationship of upper and lower teeth. Malocclusions may be skeletal or dental in nature. Thus, the cause may be related to malposed teeth, a malposed or misshapen maxilla or mandible, or a combination thereof. These types of deformities may create functional impairment as well as problems with facial cosmetic appearance. The functional deficits can be debilitating, leading to issues with mastication, respiration, speech, and communication. They may also contribute to drooling and difficulty with oral hygiene.

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Author information

Authors and Affiliations

  1. Division of Pediatric Plastic and Maxillofacial Surgery, Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Joseph A. Napoli

  2. Sydney Kimmel Medical College, Thomas Jefferson University, Wilmington, DE, USA

    Joseph A. Napoli

  3. Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Stephanie Drew & Tim C. Jaeger

Authors
  1. Joseph A. Napoli
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  2. Stephanie Drew
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  3. Tim C. Jaeger
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Corresponding author

Correspondence to Joseph A. Napoli .

Editor information

Editors and Affiliations

  1. Alfred I. duPont Institute, Wilmington, DE, USA

    Freeman Miller

  2. Cerebral Palsy Program, AI DuPont Hospital for Children , Wilmington, DE, USA

    Steven Bachrach

  3. AI DuPont Hospital for Children , Wilmington, DE, USA

    Nancy Lennon

  4. Drexel University, PHILADELPHIA, PA, USA

    Margaret O'Neil

Section Editor information

  1. Department of Pediatrics (Emeritus), Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Steven J. Bachrach

  2. Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA

    Steven J. Bachrach

  3. Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Freeman Miller

Glossary of Terms

Skeletofacial deformation

Abnormalities in the position, size, and/or shape of the facial bones

Malocclusion

“Bad bite,” misalignment of the upper and lower teeth in relation to one another

Maxilla

The upper jawbone as formed by the fusion of two maxillary bones

Mandible

The lower jawbone

Orofacial Motor Function Assessment Scale (OFMFAS)

Quantitative scale for the assessment of oral-motor skills in children with cerebral palsy

Molar

A posterior tooth with a broad, flat biting surface adapted for crushing and grinding, with most adults having three per quadrant of the mouth

Molar class relationship

Malocclusion classification describing the relationship of maxillary first molar cusps to mandibular first molar cusps. In a class 1 (normal) molar relationship, the mesiobuccal cusp of the maxillary first molar occludes with the buccal groove of the mandibular first molar. In a class II (retrognathic) molar relationship, the mesiobuccal cusp of the maxillary first molar occludes anterior to the buccal groove of the mandibular first molar. In a class III (prognathic) molar relationship, the mesiobuccal cusp of the maxillary first molar occludes posteriorly to the buccal groove of the mandibular first molar.

Apertognathia

“Anterior open bite,” a type of malocclusion characterized by premature occlusal contact of posterior teeth and absence of anterior occlusal contact

Overjet

Measurement of the extent of anterior-posterior overlap of the maxillary central incisors over the mandibular central incisors

Incisor

An anterior tooth with a narrow biting surface adapted for cutting, with most adults having two per quadrant of the mouth

Orofacial cleft

Congenital malformation of the lip, palate, and/or face that occurs when tissues of the face fail to properly fuse during development

Functional matrix theory

Theory of skeletal adaptation first presented by Dr. Melvin Moss in 1962, stating, “The origin, development and maintenance of all skeletal units are secondary, compensatory and mechanically obligatory responses to temporally and operationally prior demands of related functional matrices.”

Sphenomandibular ligament

A thin band of tissue that spans from the lingula of the mandible to the sphenoid bone of the skull, one of the two extrinsic ligaments of the mandible

Mandibular ramus

The broad, vertically oriented processes of the mandible located between the mandibular angle and condyle on each side of the face

Overbite

Measurement of the extent of vertical (superior-inferior) overlap of the maxillary central incisors with the mandibular central incisors

Crossbite

A type of malocclusion characterized by lateral misalignment of one or both dental arches; i.e., teeth are too close to the cheek or tongue

Nonnutritive sucking habit

Habitual sucking used not for feeding but for psychological comfort

Parafunctional habit

Habitual behavior or functioning of a body part in a way other than the most common use of that body part

Tongue thrust

A behavior pattern in which the tongue is habitually pushed between the upper and lower front teeth

Craniofacial angle

The degree of flexion or extension of the skull in relation to the cervical vertebrae

Clockwise rotation

Clockwise description of lower facial anterior-posterior growth pattern as seen on a lateral cephalogram or right-sided view of a patient’s face

Lateral cephalogram

A lateral facial plain film radiograph

Supraeruption

Tooth migration in an occlusal direction

Retrognathism

A type of malocclusion characterized by abnormal posterior positioning of the mandible relative to the facial skeleton

Prognathism

A type of malocclusion characterized by abnormal anterior positioning of the mandible relative to the facial skeleton

Temporomandibular joint disorder

Any of several related conditions affecting the muscles of mastication and temporomandibular joint

Lip competence

Ability to create a closed mouth posture of the lips at rest

Sibilant consonant

Hissing sound made by directing a stream of air along the palate with the tip of the tongue

Bilabial consonant

Sound made by stopping airflow with upper and lower lip and then releasing the air

Fricative consonant

Sound produced by forcing air through a narrow channel created by two articulators placed close together (i.e., tongue and palate)

Hypopharyngeal airway

The portion of respiratory tract bounded by the base of tongue, lateral pharyngeal wall, aryepiglottic folds, and epiglottis

Obstructive sleep apnea

A breathing disorder that results in repeated temporary cessation or significant decrease in airflow during sleep

Manual Ability Classification System (MACS)

A five-point ordinal classification system to describe a child’s typical use of both hands and upper limbs

Communication Function Classification System (CFCS)

A five-point ordinal classification system to describe how a patient expresses and receives information

Anticipatory guidance

The process of providing practical, developmentally appropriate information about children’s health to prepare parents for significant physical, emotional, and psychologic milestones during growth

Orthodontics

The treatment of malposed teeth within the jaws

Twin block appliance

A functional orthopedic appliance that utilizes blocks of acrylic on the maxillary and mandibular teeth to guide the movement and development pattern of the jaws

Occlusal splint

An orthotic appliance used to reduce wear on teeth due to bruxism and to treat certain types of temporomandibular joint disorders

Orthognathic surgery

The surgical repositioning of malposed jawbones

Compensated occlusion

Dental patterns that develop to maximize function within a state of skeletal deformity

Curve of Spee

The curvature of the mandibular occlusal plane in the anterior-posterior dimension

Alveolar bone

The bony processes of the maxilla and mandible that hold teeth

Surgically assisted palatal expansion

A combination of surgical and orthodontic treatment used to provide width expansion of the maxilla

Polysomnography

A study that electronically records biophysiological changes that occur during sleep in order to diagnose sleep disorders

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Napoli, J.A., Drew, S., Jaeger, T.C. (2018). Management of Skeletal Facial Deformation and Malocclusion in Cerebral Palsy. In: Miller, F., Bachrach, S., Lennon, N., O'Neil, M. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-50592-3_80-1

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  • DOI: https://doi.org/10.1007/978-3-319-50592-3_80-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-50592-3

  • Online ISBN: 978-3-319-50592-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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