Postural cranio-cervico-brachialis re-equilibrium as effect of the orthognathic surgery

Background and Objectives: From many years we observed that in subjects with facial asymmetries, especially when vertical and/or transversal dimensions are involved, a high incidence of cranio-cervical-brachialis disorders associated with painful syndromes and functional limitations are present. Methods: We have planned a research based on anatomical study, clinical observations, diagnostic analysis by imaging (computed tomography [CT], CT-3D and magnetic resonance) and electrophysiological plans. These studies, revealed in these subjects a constant cranio-cervical musculoskeletal alteration that involve skull-base, cranio-axial junction and cervical spine, causing postural modifications and, in a documentable temporal succession, inflammatory-degenerative disorders of the small inter-somatic joints. The patients underwent to orthognathic surgery operations (maxillary, mandibular or bi-maxillary osteotomies) with some surgical expedient as correction with limited displacement of the bones, wide para-osteotomic periosteal detachments, semi-rigid mandibular fixation. Results: We observed an immediate or gradual disappearance of the painful symptomatology in over the 70% of the symptomatic cases after the orthognathic surgery correction of the facial asymmetry. Consequently not only the restoration of the correct occlusion and of the aesthetic should be the objectives of the orthognathic surgery, but also the postural re-equilibrium for the treatment of the painful syndromes associated to the dysmorphism. The realisation, by the corrective operation, of a new muscular-skeletal equilibrium of the facial structures makes possible an analogous re-equilibrium on the connected cranio-vertebral structures. Conclusions: The realisation, by the corrective operation, of a new muscular-skeletal equilibrium of the facial structures makes possible an analogous re-equilibrium on the connected cranio-vertebral structures.