Facial asymmetry correction with surgical-orthodontic treatment. Case report

Abstract

A case report of a 19-year-old female patient who attendedthe Orthodontics Department, Faculty of Dentistry, NationalAutonomous University of Mexico without any apparent pathological data is hereby presented. Upon interrogation, the patient referred to have had a previous surgical replacement of the left ear lobe. Physical examination revealed a severe facial asymmetry with mandibular deviation to the left side, straight profile, upper lip retrusion and gibbous nose. Intraorally the patient showed crowding, non-coincident dental midlines, squared arches and class III molar and canine relationship with left crossbite. Radiographically all dental organs were present and mandibular asymmetry could beobserved. Cephalometric analysis showed skeletal a class III due to maxillary retrusion, vertical growth pattern, left laterognathia, proclination of upper incisors and upper lip retrusion. Treatment consisted of three phases: 1 presurgical orthodontics with 0.018” slot Alexander appliances and an archwire sequence suitable to the problem that the patient presented. Subsequently, surgical phase 2 was initiated with a sagittal osteotomy for bilateral laterognathia correction. During phase 3, postsurgical orthodontics, the case was detailed, muscular patterns were corrected and the occlusion was settled. Treatment was completed in 36 months. The profile and facial harmony were improved, the positive smile was maintained and the crossbite corrected. Bilateral canine and molar class I was obtained, the dental midlines were centered and arch form was improved as were the overbite and overjet.