Progressive hemifacial atrophy
A 45-year-old male patient reported to our Department of Oral Medicine and Radiology, Vasantdada Patil Dental College and Hospital, Kavlapur, Tal-Miraj, Dist. Sangli, Maharashtra, India, with the chief complaint of facial asymmetry and missing teeth in the upper right posterior region.\nThe patient had noticed shrinkage of the right side of the face when he was 20 years old. The patient had visited a local physician, who suggested cosmetic correction for the same, but could not carry out the treatment because of financial reasons. The patient's past dental, medical and family history were non-contributory.\nOn inspection facial asymmetry was detected on right side []. The face on the affected side appeared smaller. Eyes appeared normal and of the same size. The pinna of the ear on the right side was pulled towards the front giving it a bat ear appearance. Ala of nose on right side was small as compared to normal side [].\nThe zygomatic bone appeared more prominent on right side due to depression in the cheek region.\nOn inspection the tongue was normal but on protrusion it deviated slightly towards the affected right side. The corner of mouth on right side was retracted. When patient was asked to clench, the prominence of the masseter muscle could not be palpated on right side.\nOn palpation, the ramus area and the depression below the zygomatic bone felt bony hard as there was absence of muscles. The skin on right side of the face was taut and not of the same texture when compared with the other side.\nLocal examination, measurements were taken from the nasion to the tragus, nasion to angle of mandible, and mid chin to tragus of both right and left side []. The measurements showed hemifacial atrophy of the right side.\nThe intraoral examination revealed edentulous area in first quadrant []. The ridge in first quadrant was thin. Patient also gave history of absence of deciduous and permanent teeth in the first quadrant. Generalized periodontitis was seen with the remaining teeth. Patient also gives history of exfoliation of lower molars on right side 10 years back.\nBased on the clinical features and facial measurements, a diagnosis of Parry-Romberg syndrome was made. Routine blood investigations were carried out which revealed all values within normal limits.\nAs a part of radiographic investigations an orthopantomogram, posterior-anterior cephalogram, transcranial, posterior-anterior chest X-ray and CT and MRI was made.\nThe orthopantomogram revealed that the changes in the mandible were more apparent than in maxilla. There was absence of maxillary teeth on right side. The affected right side of the jaw was small in overall dimension than the opposite side.\nThe condyle and coronoid process of mandible were normal in shape but smaller in size on right side. The body of the mandible was reduced in size on the affected side. Prominent antegonial notch on the affected side was evident []. The midline of the jaw was deviated towards the affected side. Transcranial radiograph and chest X-ray did not show any abnormality.\nComputerized tomogram (CT) of head and neck showed, hypoplastic right mandible and its condyle, absence of right masseter muscle as well as absence of right parotid and submandibular salivary glands [Figures and ].\nMRI also confirmed the absence of right masseter muscle and right parotid and submandibular salivary glands [].