Long Face Syndrome

What is Long Face Syndrome?

The Long facial appearance with narrow facial structure is the syndrome termed as “Long face syndrome”. The detail skull structure in Long face syndrome can be described as constricted maxillary curve and an elevated formation of the palate. In addition, the orifice of the nasal cavity is smaller in size and have less breadth between the pterygoid plates. Resultant of this structural deformity causes constricted airway, which cause obstructed air passage through nostrils and that increase the risk of the airway collapse. It is a perception impression rather than subjective impression^1,2,3.

Anatomical and related abnormality

Narrow nostrils, dark circle formation around the eyes and beneath the eyes, lips are open constantly¹.

Detail Structural Abnormality

Some possible abnormality combined or isolated form can trigger the Long Face syndrome and associated complications like open bite, erect maxillary hyperplasia, anterior upright mandibular hyperplasia, constricted face, indistinct chin, and neck definition^1,,3.

Contributing Factors Of Illness

• During gestation immunological factors are not transported from mother to fetus through placental barrier.
• Airway size reduced due to development of edema, obstruction, and involvement of genetic factors
• Contaminants come from daycare
• Lack of Hygiene practice
• Exposure to environmental pollution
• Epidemic bacterial and viral infection
• Increased stress level
• Inadequate nutrition
• Low economic status^1,2

Symptoms

Long Face syndrome symptoms mainly aggravated at night, specifically during sleep. Following are some symptoms, which are generally associated with Long Face syndrome:

• Snoring
• Sleep apnea
• Nightmares
• Sleep deficit
• Uncontrolled sleepiness at bedtime
• Awakenings at night
• Compromised sleep regularity and sleep duration^1,2

Treatment

The aim of the treatment is to avoid complications and correction of the abnormality of the anatomical structure.

• Some clinician suggested that audio and video recording of the affect children during sleep can help to detect the sleep apnea and sleep disorders can be possibly detected.
• If children are frequently affected by allergy, then it is necessary to detect the allergen, which mostly triggers the allergic reaction to the children. In case food allergy avoids the food items which increase allergy incidence. Minimize the contact with dust and other environmental pollutants. Some children are having allergy with fibers, which are used to made pillows, mattress etc. Therefore, cover all these bed linen properly, remove carpets.
• Some clinicians prefer to use allergy shots to reduce the incidence rate and improve the quality of life of the patients.

Dentistry correction and surgery

Apart from the above mentioned therapeutic approaches, some dentistry correction and surgical interventions are also required for some cases.

• A dentistry appliance may apply to expand the upper jaw due to the molar teeth positioning is the cause of upper jaw constriction.
• Some surgical intervention can also apply to correction for dentofacial deformity.
• Facial height and proper alignment can also be corrected by surgical reduction
• Osteotomy and orthodontic treatment are also applied to improve the aesthetic balance between the chin, nose, teeth, and upper lip and to accomplish lip competency^2,4.

Complications

Abnormal craniofacial features associated with Long Face Syndrome has a close association to develop the risk of obstructive sleep apnea syndrome (OSAS). Obstructions of air passage obtain due to persistently congested nasal passages or tonsillitis, which occurs due to distended tonsil gland. These factors may negatively impact face growth. Sleep apnea during the night is usual cause of sleep disturbance and sleep deficit.

Therefore, daytime sleepiness is common in Long Face Syndrome. These may also interfere and provides health effects of the affected children, which include a headache, hyperactivity, lack of concentration etc. All these effects may cause learning difficulty. Some children also develop bedwetting habits due to nightmares.

Long face syndrome also increases the susceptibility towards allergy. It has been found that most infants are having food allergy with eggs, peanuts, milk, soy, fish, wheat.

Long face syndrome affected children unable to breathe properly through nostrils. Therefore, they used to take a breath through the mouth. This trigger several complications, such as frequent incidence of infection. Because when breathing is taking through nose, the air become warm, filtered and moist due to the environment of nasal cavity assist in this and has lesser risk to get pollutant, allergen, infectious agent through nasal cavity, but entry of this substance through air passage through oral cavity increase the susceptibility towards infections, allergies etc.

Air passage via oral route also dry in nature and contain less amount of oxygen in comparison with moist air. Therefore, the affected individual frequently becomes fatigued due to lack of oxygen.

A typical biting ability is noticed in affected children. The upper jaw is abnormally condensed structure provide unstable muscle strength and tongue is protruded out through the incisor teeth and the teeth structure is forced toward an outer direction^2,3.

Before And After Pictures

References

1. Long Face Syndrome; Retrieve from http://www.brianpalmerdds.com/pdf/adsm_section_d.pdf
2. Looking at “Long Face Syndrome” ; Retrieve from http://www.dentistryiq.com/articles/wdj/2004/09/looking-at-long-face-syndrome.html
3. Hernández-Alfaro F.; [The long face syndrome]. Orthod Fr. 2016 Dec;87(4):479-489. Epub 2016 Dec 12. Retrieve from https://www.ncbi.nlm.nih.gov/pubmed/27938659
4. Bell WH, Creekmore TD, Alexander RG. Surgical correction of the long face syndrome. Am J Orthod. 1977 Jan;71(1):40-67. Retrieve from https://www.ncbi.nlm.nih.gov/pubmed/264364