The chief complaint with this patient is an always present temporal headache. He does not experience any other type of headache and says it is always present day and night. The pano looks normal except it should be noted that the patient can not breathe through his left nostril, but does not complain of any sinus issues.

Small changes of pitch, yaw and roll of the bones in the skull in growth do not allow the mandible and its condyles to center equally left and right. The skeletal analogy is like if you grew on leg shorter than another. The smile face picture shows how the upper left maxilla is down and inside compared to the right. The inside line of the maxilla makes this occlusion work like a unilateral crossbite case. Instead of the lower bone looking class III, the mandible has the ideal bone growth and it’s the left maxilla that has asymmetry.