Long face syndrome

Overview

Long face syndrome, also known as vertical maxillary excess (VME), is a dentofacial condition characterized by an abnormally long lower face height. It results from excessive vertical growth of the maxilla (upper jaw), which can lead to a range of aesthetic and functional issues, including an elongated facial appearance, gummy smile, and malocclusion (misalignment of teeth). The condition is most commonly diagnosed during adolescence and can impact self-esteem and oral function if left untreated.

Causes

Long face syndrome can have several contributing factors, which may be genetic, developmental, or environmental. Common causes include:

• Genetic predisposition – a family history of similar facial structures

• Vertical maxillary overgrowth – excessive downward growth of the maxilla during development

• Mouth breathing – often due to chronic nasal obstruction or allergies, which can affect jaw and facial development

• Poor oral posture – such as low tongue position or open-mouth posture in growing children

• Orthodontic issues – that are not properly managed during growth years

Symptoms

The primary features of long face syndrome are typically visible and may be associated with functional challenges. Common symptoms and signs include:

• Elongated facial appearance – especially noticeable in the lower third of the face

• Gummy smile – excessive gum exposure when smiling

• Open bite – upper and lower front teeth do not meet when the mouth is closed

• Mouth breathing – often associated with nasal airway obstruction

• Dark circles under the eyes – due to poor nasal airflow or sinus issues

• Speech or chewing difficulties – in more severe cases

• Low self-esteem or dissatisfaction with appearance

Diagnosis

Diagnosis of long face syndrome involves a thorough clinical evaluation and imaging studies to assess facial proportions, dental occlusion, and jaw growth. Diagnostic steps include:

• Clinical examination – evaluating facial symmetry, smile line, and bite alignment

• Cephalometric analysis – lateral skull X-rays used to measure jaw and facial bone relationships

• Dental and orthodontic evaluation – to assess bite and dental arch alignment

• ENT consultation – may be needed if nasal obstruction or mouth breathing is present

Early diagnosis is important, especially in growing children, to prevent worsening of the condition.

Treatment

Treatment for long face syndrome depends on the severity of the condition and the age of the patient. Options may include:

• Orthodontic treatment – to correct bite issues and manage jaw alignment in mild to moderate cases

• Orthognathic surgery – such as Le Fort I osteotomy to surgically reposition the maxilla and reduce vertical facial height in severe cases

• Functional appliances – in growing children to guide jaw development and improve oral posture

• Myofunctional therapy – exercises to correct tongue posture, breathing patterns, and muscle balance

• ENT management – for nasal obstruction or chronic mouth breathing contributing to facial elongation

Treatment is often multidisciplinary, involving orthodontists, oral and maxillofacial surgeons, ENT specialists, and speech therapists.

Prognosis

With timely and appropriate treatment, the prognosis for individuals with long face syndrome is generally very good. Surgical and orthodontic interventions can significantly improve facial aesthetics, dental function, and quality of life. If left untreated, the condition may lead to persistent functional issues, psychological distress, and worsening malocclusion. Early intervention during growth phases offers the best outcomes for long-term facial harmony and stability.