Pruzansky III

Pruzansky III is the most severe subtype characterized by:

Mandible
The mandible is severely deformed. At its mildest only the upper part of the mandibular ramus is missing. At its most severe the whole of the ramus and part of the body are missing.

TMJ
Absent

Note: It is possible to have a Pruzansky III mandible with no condyle or functional TMJ but with a rudimentary zygomatic arch and apparent glenoid fossa.

Occlusion
Severe occlusal cant upwards on the affected side. Various degrees of severity will be observed. The class II pattern of malocclusion predominates.

In addition to the above, the following may be found:

Ear
Every range of ear presentation is possible from a completely normally shaped and positioned external ear with normal middle ear and inner ear structures and normal hearing all the way through to complete anotia with conduction hearing loss.

Orbit
The position of the orbit and the eye on the affected side can be normal but varying degrees of vertical and horizontal dystopia can occur. Microphthalmia and anophthalmia can also occur.

Soft tissues
The soft tissues on the affected side of the face can exhibit a range of severity from effectively normal to severely hypoplastic or absent.

Facial nerve
The branches of the facial nerve on the affected side can function completely normally but can also show a varying range of reduced function (palsy) from mild to severe and affecting one or more of the nerve branches.