Cranial Dystrophy (Chapter Seven)
“I’ve been reading books of old,
The legends and the myths,
Achilles and his gold,
Hercules and his gifts,
Spiderman’s control,
And Batman with his fists,
And clearly I don’t see myself upon that list.”
As a child, you dreamed of being super, of being better than who you were, visions of glory and love, and the great big world waiting to fall captive to your magical powers. You dreamed of bending the laws of the universe, of defying gravity, watching sunrises and sunsets from the heavens above. You dreamed of tyrannical leaders and terrorized people, of victory and justice. You were a force of order in a world of chaos. Should you die, gentle hands would smooth your hair, and loving hearts would keep your grave and memory green because you died a hero.
Hence, forsaking the ones who love you for who you are, believing that beneath the greatest of ordinary lies the greatest power, with promises of super senses and superhuman strength, invisibility and invincibility, of basking in glory, love, and fame, you open your mouth and bid farewell, slipping headlong into the telephone booth.
But there was no metamorphosis of the supertype. No laser beam vision. No magical fairy wings. There was, instead, a horrible, ghastly transformation, an untoward embodiment of a disfigured comic book monster so true to life that you long to be ordinary again.
Hint: Think Medusa.
Emerging from the booth and stepping into an icy, cold world, there is no adulation of crowds. There are only paths paved with broken beliefs. The snow is everywhere, and the sky above is grey with falling flakes that will soon mask you from the world. When summer comes, no one can tell your hidden body from the rest. But there is a healer, a healer who feels your burden and suffering, that has patiently waited for you to come. As I look into your eyes, through which you first looked out upon the great big world and which your mother fondly kissed, and into these eyes, I commence my duties,
"What the hell did you do to yourself?"
Has the lower third of your face lengthened?
Strewn across your face is the wreck and ruin of an epic mistake. But how beautiful the tragic seems when it lies beneath a mask.
The face is divisible into equal horizontal thirds. The upper third extends from the hairline to the eyebrow. The middle third runs from the eyebrow to the nose. The lower third continues from the nose to the chin.
Recalling the tragic tale of the young monkeys, adopting an open mouth posture, especially during the early growing years, results in a compensatory deformation. As the angle of the jaw increases, the jawline drops down, and the lower third of the face lengthens.
You never lie. You do, however, occasionally deceive. And so you wear a mask. You wear a beautiful mask. You wear a beautiful, deceiving mask but still…I can see you.
Do you have a narrow smile?
Happiness makes you smile, and smiling makes you happy. The stretch of our smile reveals as much about ourselves as it does to others.
The interpupillary distance is the distance between the center of the pupils of both eyes. Take a look in the mirror. Is the span of your mouth, with lips closed, wide enough to reach both pupils? Put another way, would drawing a line straight drown from the center of the pupils touch the corners of your mouth.
There is a balloon of sorts in the face that fills and blows the face forward, outward, and upward when breathing through the nose. The instant air leaks out of the mouth, the balloon deflates, and the face collapses backward, inward, and downward. You can see the effect of this implosion in your narrow smile.
"You are beautiful, and I enjoy looking at beautiful people, and I will not deny myself the delicious pleasure of gazing at your wondrous smile," was something you long to be told. Does the sadness in your beautiful eyes come from your troubled smile?
Do you have a gummy smile?
Dear Doctor
I have a gummy smile. It’s been bothering me a lot lately, and I’m becoming self-conscious. When people say, “You gotta have a beautiful smile,” it makes me sad to hear that. I worry anyone I am interested in will take one look at me and be grossed out. My friends say it’s unique and that it gives me character, but I feel like they’re just saying that because the don’t know what else to say. It doesn’t help that I’m always single, and my self-esteem isn’t very high. So I would like your honest unbiassed opinion. Is my gum-t-tooth ratio a turnoff? Would someone be able to overlook it if they liked my personality?
Patient
Nay-he-he-he!
A gummy smile is evidence of cranial dystrophy. It is due to a lengthening of the maxilla or upper jaw. In other words, your upper lip is short relative to the lower third of your face that grew long from mouth breathing.
Does your smile reveal black corridors?
“Doctor, there are two who wish to marry me.”
“Choose wisely as one will bring a life of pleasure and the other one of pain.”
“How will I know whom to choose?”
“Look at their smile and be wary of the one with black corridors.”
The dark space at the edge of a smile is the result of narrow jaws. A person with a maxilla and mandible that has not expanded to its potential cannot grow to their potential.
Lurking deep in the corridor are voices that cannot be silenced, fears that cannot be surmounted, and an emptiness that cannot be filled. Look in the mirror. Is there darkness where there should be light?
Is your jaw is recessed?
Dear Doctor,
Being ugly is a death sentence. I’m stock of it. I’m sick of being forced to inhabit a piece of garbage body. My jaw is small, narrow, and underdeveloped, and I look inbred. People immediately judge me by my appearance, and I get zero sexual interest. I’m told to be confident, but it doesn’t work if you are ugly. It doesn’t matter how confident you are if the other person is always itching to get away and end the conversation. It sucks that my looks have stolen so much of my youth. Please help me before I become a middle-aged basement-dwelling virgin.
Patient
Put your finger vertically to your lips and say, “Shh!” Is there a space between your finger and chin? There shouldn’t be.
The lower jaw is recessed if both the upper and lower are set back from their ideal position due to mouth breathing. The lower jaw is additionally recessed if it fails to grow forward with the upper jaw because the mouth is open. A face set too far back constricts air passages and is unattractive.
Other maneuvers provide insight into the position of your lower jaw.
First, make a rip-roaring “snore” noise. Now, increase the air space behind the tongue by jutting your lower jaw forward until the lower teeth are in front of the upper teeth and then try making the same “snore” sound. The inability to snore as loudly with the lower jaw jutting forward is evidence of a narrow airway and recessed jaw.
Second, open your mouth and gently press your chin down and back into the neck while lying on your back. If this action makes breathing difficult, you get a sense of how the airway restricts when the lower jaw naturally falls back as your mouth opens during sleep.
Have your cheeks sunk?
The bad news is you are malformed. The good news is you could be a model. As the baby fat in your face melts away, the underdeveloped upper jaw gives your face a sunken look. Add to that a Tweety Bird smile, and you have an appearance so familiar nowadays it is accepted as normal and donned by some of the sexiest models on the planet.
All is not good when your face sinks back into your skull. In time, a diminished bony scaffold in comparison to muscles and skin permits sags and wrinkles to infiltrate the facial landscape. In time, you will look hungry, tired, and feel so very old.
Do you have a nose bump or big nose?
“Gently breathe and count backward.”
“99, 98, 97,..96…95…..94……..9,” with the cold steel beneath you and the blinding lights above, the outline of the good surgeon with a scalpel in hand fades away. A magnificent Roman nose is shaven, broken, and sculpted. You look in the mirror and revel in your beauty. Family and friends shower you with compliments. Strangers adore you. You want to be beautiful so that someone will love you, but what have you done?
Eating mush and opening your mouth made the jaws grow backward, inward, and downward as the face sank, folded, and fell. When the face deflates, the nose appears larger when it is actually smaller. Nose bumps and a big nose come from nasal tissues out of proportion to the underlying, undersized cranial frame.
Take a closer look at the picture. Is the problem his nose hump? Or is his nose hump an effect of the nose cartilage draping down over the nasal bone as his face sank? Rather than shaving and breaking his nose, is it prudent to straighten it by advancing the upper and lower jaws?
The good surgeon was correct in encouraging you to “gently breathe.” Unfortunately, what came afterward did the opposite.
Do you have a chicken head posture?
The modern evolutionary theory proposes humans descending from apelike ancestors through a lengthy transformation lasting millions of years. Ahh, but when you look in the mirror, you see something slightly different, something more like…a chicken.
When engaging someone lying unresponsive and not breathing, you tilt the head back and lift the chin to open the airway. Similarly, albeit on an unconscious level, if the lower third of your face is long and set back, you compensate by tilting your head back and lifting your chin to breathe. You can’t walk looking up at the sky, so you adapt by jutting your head forward to make your eyes level with the ground. Voila! Behold the great chicken head.
There’s more to it than just that. The head weighs as much as a bowling ball, and the musculoskeletal system can support the weight with the proper posture and alignment. However, holding a bowling ball in your outstretched hands is harder than keeping it near your core. Similarly, the musculoskeletal strain from sticking your head forward like a chicken has cascading effects right down to the feet. The extra weight deranges your spine, causes hip problems as you protrude your butt to balance the load, and ruins your knees as they adjust to the mess above.
How you carry yourself has consequences for the body and impacts how others perceive you. A strong face, broad shoulders, erect spine, and straight knees, standing in perfect balance, projects confidence, strength, beauty, health, and happiness. Whereas a weak face, hunched shoulders, twisted spine, and bent knees, leaning to one side, projects doubt, weakness, deformity, disease, and despair.
Are your teeth crooked?
The average monkey has perfectly aligned teeth. You? That's another story. It seems that everyone nowadays has crooked teeth. The traditional treatment is to undergo orthodontics in the teenage years.
Have you ever taken a step back and asked yourself why your teeth are crooked? Donning the best-aligned teeth are people who have never had braces. But they are as rare as a baboon in the wild with buck teeth. Dental crowding is a sign of underdeveloped upper and lower jaws. That's why mouth breathers have crooked teeth.
The relationship between form and function warrants a moment of quiet introspection.
Do girls with crooked teeth grow into women with crooked smiles?
Do boys with crooked teeth grow into men with crooked fists?
Can you see your uvula when you stick out your tongue?
“Open your mouth wide, stick out your tongue and say ‘ahh.’”
“Ahh.”
“Oh, my.”
“What’s wrong, doctor? What do you see?”
“You know when someone tells you everything’s going to be ok, but in your mind, you think they are lying to make you feel better?”
“Yes.”
“Everything is going to be ok.”
Look in the mirror. Building on the theme of an overstuffed suitcase, when the upper and lower jaws are narrow and set back, the tongue edge scallops and creeps over the dental arches and sits high in the mouth, preventing you from seeing the thingamajig in the back of your throat. The less visualized the uvula, the more stuffed the suitcase.
Did you have teeth extracted?
The most impactful moment in life is not always apparent.
…perhaps it was when the nurse you introduced to your baby.
“It’s a girl! She’s beautiful. Congratulations.”
“A girl, my little girl!”
…or when you realize that you are going to share the rest of your life with someone.
“I love you, now and forever. Will you marry me?”
“Yes. Yes!”
…or while sitting in the dentist’s chair about to get your wisdom teeth removed.
“Doctor, will the laughing gas reduce the pain?”
“Not sure, but when you squeal, it’ll be hilarious.”
Teeth are alive because they are born. Extracting wisdom teeth or any teeth for crowding is a cruel, repugnant, and profoundly poignant moment. Extractions cause headaches, jaw pain, and bone loss in the underlying jaw, decaying the facial appearance.
Was it worth it? The good doctor has left you with a pretty smile, but it is narrow, the airway further constricted.
Do you have a big tongue?
“Kiss me. Kiss me now, for our love is sweeter than wine!”
For a moment, time stood still on that busy downtown street. Chills dash down your spine as a fire rages within. Your massive tongue thrusts out past columns of crooked teeth, pushing cravingly from between drooling lips.
“Um, on second thought, I’ll pass.”
The problem is not a tongue that is too large. The problem is jaws that are too small to house a normal-sized tongue. The tongue should sit perfectly within broad dental arches without overlapping the teeth. Stuffing a normal-sized tongue within narrow dental arches creates a scalloped or rippled tongue where it presses against your teeth.
You can add your tongue to the litany of other people in your who have told you they need more space.
Is your nasal septum asymmetric?
A Tragedy of Asymmetry
There was a love to be shared
She wanted him, and he wanted her.
There was a pain to be shared.
He could not live without her, and she could not live without him.
But it was at different times.
A nasal septum grown to its normal dimensions within a maxilla that is underdeveloped must bend. A deviated septum increases nasal resistance.
When symmetry is lost, discontent follows.
Is the roof of your mouth shaped liked the letter “U” or “V”?
The tongue is the best orthodontic appliance you will ever have, and you carry it with you 24 hours a day. It is a powerful muscle that can shape the upper jaw by exerting a pound of pressure each time you swallow. Swallowing a thousand times can exert a thousand pounds of force.
Swallowing with your mouth closed and the tongue on the mouth roof molds your upper jaw to a "U" shape, resulting in a broad facial structure with room to house all the teeth. Nature dictates the shape of the lower jaw follows that of the upper jaw.
When breathing and chewing with the mouth open, the tongue rests on the floor of the mouth. The collapsing effect of the cheek, chin, and lip muscles plays a prominent role in shaping your jaw, minimizing the expanding role of the tongue. This imbalance results in a "V" shaped palate with narrow facial features and crooked teeth. A pacifier, sippy cup, straw, or thumb placed inside the mouth impede the tongue from contacting and widening the mouth's roof. Lying directly above the mouth roof is the nasal cavity. A high-arched "V" shaped palate encroaches into the sinus cavity and increases nasal resistance.
Are you a "U" or a "V"?
Is your bite off?
Though designed to breathe through the nose, you opened your mouth at some point in your short history. You can live by breathing through your mouth but suffer tremendously from doing it, as the upper and lower jawbones distort and teeth misalign. Just like the young monkeys who had their noses plugged and jaws subsequently malformed, what makes you unique is how you maladapt.
Don't ever let anyone tell you that you are not special. You are special, and your crossbite, open bite, overbite, overjet, or last but least, underbite, prove it.
Do you eat the bottom half of our sandwich first?
Do your mouth open crookedly?
A Recurring Nightmare (with a twist)
…you awaken. The clock shows 3 AM, and your face feels filthy. You figure your dog had been licking you, but he died days ago. You look out the window, and the world outside is black. You can't see much, just the silhouette of a dying tree against a crescent moon. But there's something perched in the tree, and it's leering at you. It isn't smiling. It isn't snarling. It's just there. As quickly as you see it, you don't. You blink. When your eyes open, it's in front of you, its peculiarly twisted mouth pressing itself against the glass. You panic and run. The window breaks, and it leaps inside. You dash out the room, weaving around corners and furniture, falling and picking yourself up until you reach the front door. It is locked. You spin around to find another way out, but there it is, standing in front of you. Now you can see it, all of it: the blackness in the eyes, the coil of the snout, and the rottenness of the teeth. It lurches forward and embraces you. Its cold extremities wrap around you. It pulls you next to its face. It opens its foul mouth ever so slowly with a curiously wicked slant. Pushing through its contorted fangs is a long, meaty tongue. It runs across your face, leaving a trail of rotten grime. Then, as it readies to consume, its claws piercing your flesh…(story repeats)
Look in the mirror and open your mouth slowly. Does it open smooth and straight? Or does it open slanted, zig-zag, or otherwise, curiously skewed? The latter is a sign of malformed jaws.
The only thing worse than a recurring nightmare is realizing you are the antagonist in the story.
Is your nose pinched?
The journey of air to the lungs begins in the nose. The nasal valve is the narrowest portion of the nasal passages. Essentially, it’s where the nose pinches.
A minuscule nasal valve narrowing causes a massive increase in nasal resistance. Trying to pull air through an overstuffed face creates a suction pressure that collapses the nasal valves. Collapsed nasal valves, in turn, further restrict airflow. As inhale turns to exhale, the suction pressure releases, and the nasal valves open to their original position.
Are your nares pinched? Does quickly inhaling collapse your nostrils?
Sometimes the smallest thing makes the biggest difference
Does your jaw snap, crackle, and pop?
"Doctor, I hope I'm not coming across too forward, but when I grind, I pop! Is that TMI?"
"No sir, that's TMJ."
The temporomandibular joint connects the skull and the lower jaw. The hinge and sliding motion allow the lower jaw to move up and down and side to side, so you can talk, chew, yawn, et cetera. It does this by using discs to stabilize and guide the movement. However, the discs can displace if the jaw is incorrectly positioned, causing snaps, crackles, and pops when your mouth opens and closes. Clenching and grinding your teeth during sleep further tightens and inflames the temporomandibular joint's muscles, tendons, and ligaments. Overloading the ordinary capabilities of the jaw joint results in head, neck, facial, jaw, ear, shoulder, and back pain known as "TMJ."
Open your mouth, and let's hear some snap, crackle, and pop.
Is your skeletal midline off?
Do you have deep nasolabial folds?
Do you have rotten teeth and gums?
On Being a Sleep Doctor
It’s hard being a sleep doctor. No one is ever in a good mood when they come to my office. They are nervous and upset or even crying. I know it’s not personal, but it still hurts. It’s tough to be the bad guy, the villain who is there to tell them why their life is screwed up. It’s only my job. I’m actually a nice guy. I love sleep and the anatomy of the face. It tells you a lot about someone, like what they eat and how they live. It even shows you what kind of person they are, if they’re anxious or calm, careless or cautious. I can pretty much know someone just by looking at their face. The teeth whisper to me. It’s too bad my patients are miserable when they come. There was one person, Emily, who loved her visits. She was my favorite patient. No matter how many scopes, scans, and studies I performed, she always had a smile on her face. It was refreshing. And her teeth? Wow, they were beautiful. Perfectly placed, naturally straight like keys on a piano. She grew up on a farm and once told me how she wished she could have had braces. She thought they were like jewelry for the teeth, but she didn’t need them. Her teeth were movie-star white from eating wholesome food. No fancy bleaching gimmicks, not even brushing or rinsing, just a clean diet. The others were never as good as Emily. Every time I told them what their yellow, chipped, cracked, and ground down teeth meant, they sneered. Emily, though, was always smiling. Unfortunately, Emily met an untimely end. Her shining light has been extinguished. It was a difficult time. Her perfect facial symmetry and beautifully aligned teeth are gone forever. She can no longer tell me how her day was, what she wanted to do with her life, or how much she loved her family.
The body deals with a narrow airway by clenching and grinding teeth, which activates the genioglossus muscle to move the tongue forward and open the airway. Unfortunately, the collateral damage is ground, chipped, cracked teeth, and recessed gums.
Chapter Seven Conclusion