Correction of Severe Orofacial Malformation with a Combination of Orthodontics and Orthognathic Surgery

Abstract

This case report presents the multidisciplinary treatment of severe orofacial malformation in a female Caucasian patient aged 24 years and 10 months. Clinical examination showed mandibular deficiency, severe skeletal Class II and skeletal open bite with backward chin posture. The patient displayed noticeable facial asymmetry, a narrow upper jaw with unilateral crossbite, shifted midlines, incompetent lips up to 7 mm and hypertonic musculus mentalis when trying to put lips together. The Orthodontic phase of the treatment aimed at a) correction of the transversal discrepancy through Surgically Assisted Rapid Maxillary Expansion (SARME) using bonded acrylic Hyrax appliance, b) midline correction and c) creation of sufficient space for the alignment of all teeth and for insertion of implants to teeth 14 and 27. Surgical correction in the upper jaw was performed by Le Fort I corticotomy, Bilateral Sagittal Split Osteotomy (BSSO) in the lower jaw and chin genioplasty. The total time taken to accomplishing the treatment goals and to meet patient's expectations was three years and five months. The patient was very satisfied with her new appearance due to corrected open bite, new position of the teeth and mandibular deficiency reduction, resulting in better face appearance, and her self-confidence increased tremendously. Follow-up checks have taken place over a period of six years since completion of treatment in order to maintain the stability of the results and it is anticipated that long-term cooperation with the patient will continue.