Prognathism is the positional relationship of the mandible and/or maxilla to the skeletal
base where either of the jaws protrudes beyond a predetermined imaginary line in the coronal
plane of the skull.
In general dentistry, oral and maxillofacial surgery and orthodontics, this is assessed
clinically or radiographically.
The word 'prognathism' derives from Greek pro and gnathos.
One or more types of prognathism may result in the common condition of malocclusion, in
which an individual's top teeth and lower teeth do not align properly.
Presentation The vast majority of prognathism in humans
is due to normal variation among phenotypes.
In human populations where prognathism is not the norm, it may be a malformation, the
result of injury, a disease state or a hereditary condition.
Prognathism is considered a disorder only if it affects mastication, speech or social
function as a byproduct of severely affected aesthetics of the face.
Clinical determinants include soft tissue analysis where the clinician assesses nasolabial
angle, the relationship of the soft tissue portion of the chin to the nose, and the relationship
between the upper and lower lips; also used is dental arch relationship assessment such
as Angle's classification.
Cephalometric analysis is the most accurate way of determining all types of prognathism,
as it includes assessments of skeletal base, occlusal plane angulation, facial height,
soft tissue assessment and anterior dental angulation.
Various calculations and assessments of the information in a cephalometric radiograph
allow the clinician to objectively determine dental and skeletal relationships and determine
a treatment plan.
Maxillary prognathism is a protrusion of the maxilla, and is also a common feature of many
populations.
It is not to be confused with micrognathism, although combinations of both may be found.
It affects the middle third of the face, causing it to jut out, thereby increasing the facial
area.
Mandibular prognathism is a protrusion of the mandible, affecting the lower third of
the face.
Alveolar prognathism is a protrusion of that portion of the maxilla where the teeth are
located, in the dental lining of the upper jaw.
Prognathism can also be used to describe ways that the maxillary and mandibular dental arches
relate to one another, including malocclusion.
When there is maxillary and/or alveolar prognathism which causes an alignment of the maxillary
incisors significantly anterior to the lower teeth, the condition is called an overjet.
When the reverse is the case, and the lower jaw extends forward beyond the upper, the
condition is referred to as retrognathia.
Classification Alveolar prognathism
Not all alveolar prognathism is anomalous, and significant differences can be observed
among different ethnic groups.
Harmful habits such as thumb sucking or tongue thrusting can result in or exaggerate an alveolar
prognathism, causing teeth to misalign.
Functional appliances can be used in growing children to help modify bad habits and neuro-muscular
function, with the aim of correcting this condition.
Alveolar prognathism can also easily be corrected with fixed orthodontic therapy.
However, relapse is quite common, unless the cause is removed or a long-term retention
is used.
Maxillary prognathism In disease states, maxillary prognathism is
associated with Cornelia de Lange Syndrome; however, so-called false maxillary prognathism,
or more accurately, retrognathism, where there is a lack of growth of the mandible, is by
far a more common condition.
Prognathism, if not extremely severe, can be treated in growing patients with orthodontic
functional or orthopaedic appliances.
In adult patients this condition can be corrected by means of a combined surgical/orthodontic
treatment, where most of the time a mandibular advancement is performed.
The same can be said for mandibular prognathism.
Mandibular prognathism Pathologic mandibular prognathism is a potentially
disfiguring genetic disorder where the lower jaw outgrows the upper, resulting in an extended
chin.
It is sometimes a result of acromegaly.
This condition is colloquially known as Habsburg jaw, Habsburg lip or Austrian Lip due to its
prevalence in that bloodline.
The trait is easily traceable in portraits of Habsburg family members.
This has provided tools for people interested in studying genetics and pedigree analysis.
Most instances are considered polygenetic.
It is alleged to have been derived through a female from the princely Polish family of
Piasts, its Masovian branch.
The deformation of lips is clearly visible on tomb sculptures of Mazovian Piasts in the
St. John's Cathedral in Warsaw.
However this may be, there exists evidence that the trait is longstanding.
It is perhaps first observed in Maximilian I.
Traits such as these that were common to royal families are believed to have been passed
on and exaggerated over time through royal intermarriage which caused acute inbreeding.
Due to the large amount of politically motivated intermarriage among Habsburgs, the dynasty
was virtually unparalleled in the degree of its inbreeding.
Charles II of Spain is said to have had the most pronounced case of the Habsburg jaw on
record.
His jaw was so deformed that he was unable to chew.
Many dog breeds have underbite, particularly those with short faces, like Shih Tzus and
Boxers.
This may be due, as in the case of bulldogs, to a slower growing maxilla in relation to
the mandible.
Treatment
The most common treatment for mandibular prognathism is a combination of orthodontics and orthognathic
surgery.
The orthodontics can involve braces, removal of teeth, or a mouthguard.
History Prognathism is well recorded as a trait of
several historical individuals.
The most famous case is that of the House of Habsburg, among whom mandibular prognathism
was a family trait; indeed, the condition is frequently called "Habsburg Jaw" as a result
of its centuries-long association with the family.
Among the Habsburgs, the most prominent case of mandibular prognathism is that of Charles
II of Spain, who had prognathism so pronounced he could neither speak clearly nor chew as
a result of generations of politically motivated inbreeding.
See also Craniofacial anthropometry
Forensics Chin