Facial asymmetry, part 2. Review of treatment methods based on the literature

Introduction
The treatment plan for a patient with facial asymmetry is determined after a clinical examination and analysis of additional tests, taking into account the causes of a defect, dental compensation, the degree of a disharmony and the patient’s age, have been performed. Due to coexisting problems, patients with facial asymmetries often require team management and cooperation between an orthodontist, maxillofacial surgeon, physiotherapist, and speech therapist.

Aim
The paper aimed to present orthodontic treatment options for patients with facial asymmetry, taking into account the need for team treatment.

Material and methods
A review of the literature was conducted using the PubMed database from 1985–2020 and the following keywords: facial asymmetry, dental arch asymmetry, treatment of facial asymmetry. The papers which were the most suitable for this subject were selected.

Results
Review of the results and discussion. Different management is required for functional, muscular, dentoalveolar or skeletal asymmetries. Functional treatment is provided in cases of a lateral functional mandibular shift in growing patients who have a normal bone structure of the facial skeleton. In the case of hypertrophy of the masseter muscle, psychological counselling, relaxation splints, anti-anxiety and muscle relaxants, analgesics, NSAIDs, physical therapy, dental restoration, and occlusion correction are used. Dentoalveolar asymmetries require asymmetrical mechanics with fixed appliances and unilateral fixed functional appliances. Minor skeletal asymmetries in growing patients can be treated with hybrid functional appliances. In cases of severe skeletal asymmetry, orthodontic-surgical team management may be necessary.

Conclusions
The key to success is identifying the patient’s expectations, proper patient’s motivation and cooperation with specialists from other branches of dentistry, maxillofacial surgery and physiotherapists.