Retrognathia (Recessed Jaw)

When a Simple Overbite Can Become a Real Problem

Carol Burnett
Carol Burnett, TV comedian and actress, underwent surgery to correct a recessed jaw (retrognathia). Michael Loccisano/Getty Images

Some people will remember when comedian and actress Carol Burnett underwent jaw surgery in 1983 to correct facial features she considered problematic: a visibly recessed chin and overbite.

The condition, known as retrognathia, is more common than many of us realize and can often interfere with more than one's physical self-image. In some cases, it may cause eating pain and even interfere with a person's ability to sleep.

Retrognathia Feature

Retrognathia is defined as having a recessed jaw, most commonly the lower jaw called the mandible. It doesn't necessarily mean that the jaw is small, just that it is set back when the face viewed in profile.

In many cases, a person with retrognathia will be referred to by others as "having an overbite." It is not considered in any way abnormal or unattractive and is generally proportionate to the rest of the face.

However, when the jaw is abnormally small and out of proportion, the person is said to have micrognathia.

Causes of Retrognathia

The anatomical structure of the face is based, at least in part, on a person's genetics. So people with retrognathia will often have a jaw structure similar to that of other family members. (Burnett herself referred to her condition as the "Burnett family lip."

There are rare genetic conditions that can cause severe malformations of the mandible.

These include Pierre-Robin syndrome, a disorder characterized by abnormally small and recessed jaw that can interfere with a person's ability to breathe.

Facial trauma in a child's early development may also cause displacement of the jaw and a "set back" appearance.

Problems Associated With Retrognathia

Retrognathia may cause problems from as early as birth, with some babies unable to adequately feed from a breast or bottle when the upper and lower jaw are unable to latch onto a nipple properly.

As the person grows up, misalignment of the teeth may affect the ability to bite or chew food If the lower jaw is smaller, the teeth may become crowded or irregularly positioned.

Retrognathia can contribute to disrupted breathing, especially during sleep. Snoring and sleep apnea are not uncommon in people with retrognathia, caused when the recessed position of jaw allows the tongue to slip back toward the airway. This can lead to abnormal pauses in breathing, gasping, and choking.

Treating Retrognathia

Depending on the severity of retrognathia, treatment may or may not be necessary.

If identified early in a child's development, orthodontic treatments that may be effective in minimizing the recessed appearance of the jaw. One method involves the use of special headgear to slow the growth of upper jaw (maxilla) so that the two can become better aligned.

In late adolescence or adulthood, once growth is completed, the surgical procedure known as maxillomandibular advancement (MMA) can be used to move both jaws forward. The advantage of this technique is that braces aren't needed to realign the teeth. By contrast, Burnett's surgery employed mandible osteotomy in which the jaw is actually detached and moved forward in one unit.

The downside to both surgeries is the cost: anywhere from $50,000 to $100,000 and sometimes even higher. Some health insurance will cover at least part of the costs.

If retrognathia is causing sleep apnea, standard treatments such as continuous positive airway pressure (CPAP) and an oral appliance will typically help.

If ever you feel concerned about the health impact of your jaw positioning, speak with your doctor or dentist who may be able to offer advice on surgical and non-surgical approaches to treatment.

Sources:

Al-Hashmi, A. and Al-Saadi, N. "Surgical correction of mandibular retrognathia as a treatment for temporomandibular joint disorders." Oral Maxillo Surg. 2015; 44(Suppl 1):e25.

Joshi, N.; Hamdan, A.; and Fakhouri, W. "Skeletal Malocclusion: A Developmental Disorder With a Life-Long Morbidity." J Clin Med Res. 2014; 6(6):399-408.

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