A patient with thalassemia intermedia or major often develops a number of changes in facial appearance. These are causes by an expansion of the facial bones due to the erythroid hyperplasia that occurs as a result of the disease.
Synonym: facies Cooley (from Asbell)
Onset: in childhood
Facial features:
(1) significant maxillary enlargement with high and prominent cheek bones
(2) mandibular enlargement that is less than the maxillary enlargement, resulting in disproportion between the 2 dental arches
(3) dental malocclusion with open bite, cross bite and/or overbite
(4) relatively narrow face
(5) retraction of the upper lip
Other findings
(1) pallor to the oral mucosa
(2) gingivitis and dental caries if there poor dental hygiene
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