What is Retrognathia: Causes, Complications and its Treatment in Babies, Children, Adolescent and Adults

Retrognathia is a condition in which the lower jaw is abnormally positioned. It sets back further compared to the upper jaw and gives the appearance of severe overbite.⁽¹⁾ The difference in the placement is noticeable when viewed from the side.

Retrognathia is difficult to manage. Physically, the condition affects the ability of the person to sleep and eat. Retrognathia also affects self-esteem and confidence. This makes the condition visually noticeable.

Many people are born with retrognathia, while others develop it later in life. Mild cases are not diagnosed until childhood or adolescence.

The common causes of retrognathia include:

• Pierre-Robin Syndrome: This syndrome leads to the affection of the jaw and the tongue and blocks the airways.
• Hemifacial Microsomia: In this condition, one side of the face is underdeveloped.
• Nager Syndrome: This is a rare condition that affects both the jaw and cheeks. It also affects the development of hands and arms.
• Treacher Collins Syndrome: In this condition, various bones of the face including the jaw are affected.
• Surgery to Remove a Tumor: Removing a tumor from the mouth can alter the lower jaw leading to retrognathia.
• Facial Trauma or Fractures: Trauma or fractures in childhood can affect the proper development of the jaw.

With retrognathia, there can be a difficulty with jaw misalignment and further affect the ability to eat or sleep. Patients also experience intense jaw pain.

Babies with the condition have trouble using bottles or nursing as it gets difficult for them to latch on the nipple. The teeth get misaligned as the baby gets older. They also get crowded together or positioned unusually.

This irregular positioning of the teeth makes it hard to bite and chew food. There is also a tendency to develop a temporomandibular joint disorder that causes pain and muscle spasms.

There may be trouble in breathing especially on sleeping. The person might snore due to the restriction of the airway. There might be sleep apnea due to the stopping of breath multiple times at night.

Depending on the severity of retrognathia, treatment is advised.

• Babies born with retrognathia are evaluated by the doctor for the best treatment possible.
• Firstly, the baby’s ability to breathe is monitored. X-ray and sleep study are done.
• For babies with obstructive sleep apnea, plastic surgery and pulmonary departments are considered for a favorable jaw.

The most common surgeries performed on the baby are:

• Bilateral sagittal split ostomy (BSSO): In this surgery, the lower jaw is cut on both sides and moved to an ideal position, where it is held in place with metal plates.
• Distraction Osteogenesis: In this surgery, metal hardware is placed inside the jawbone and the extensions are placed on either side of the mouth, inside or outside. To stimulate the new bone formation, a device is activated.

Distraction osteogenesis is mostly preferred as there is less blood loss and decreased nerve injury.

As the healing completes, the baby can easily eat and chew.

• In children, if retrognathia is not severe it is not noticed until early childhood. To modify growth and improve the teeth alignment, the child is often treated with dentofacial orthopedics or orthodontics.
• Biomechanical treatments like orthodontic appliances are used in dentofacial orthopedics to change the jaw position and muscle activity.
• Special headgears are made to make the upper jaw grow slowly so that both upper and lower jaws are more or less equal.
• The lower jaw is placed in a forward position by functional appliances. These appliances promote mandibular growth.

• In adults maxillomandibular advancement (MMA) surgery may be needed if the jaw is still retrognathic once it has stopped growing.
• In MMA surgery both the upper and lower jaw is advanced. Orthodontics is used to align the teeth before the surgery.
• In the cases where retrognathia is contributing to sleep apnea, continuous positive airway pressure (CPAP) machine is used to improve breathing.

Every case is unique. If seeking treatment for retrognathia, speak with a medical professional for more information. The doctor may evaluate, diagnose, and treat the condition according to a person’s condition and need.