iDentistry The Journal Volume 14 No.1 | Page 13

*Dr. Pallavi Venkatesh **Dr. Vinod Kumar Yadav ***Dr. Anup Belludi ****Dr. Pushpalatha The Journal Asymmetries of the Dentofacial Complex Diagnosis, Treatment planning and Surgical Management : Case Report INTRODUCTION: The Class III malocclusion with mandibular asymmetry and prognathism can involve many factors, among which are excessive mandibular growth, environmental factors, and trauma to the jaws. The correction of this malocclusion can involve an orthodontic or a combined orthodontic-orthognathic approach. DIAGNOSIS : In this oral presentation, A 19 year old male patient presents a class III skeletal and facial asymmetry with chin deviation towards right by 3.5mm. Patients’s pre and post-surgical radiographs and photographs were taken along with study models and differential BSSO was performed to eliminate skeletal class III and asymmetry. TREATMENT OUTCOME: The mandibular skeletal asymmetry and prognathism was corrected, the patient’s facial symmetry was much improved. The unilateral posterior crossbite was eliminated, and the dental midline was coincident and the minor crowding of the maxillary arch and mandibular arch was resolved. CONCLUSION : Orthodontic treatment alone is a difficult option in this situation. Patients with facial asymmetry and a skeletal Class III malocclusion are usually treated by orthognathic surgery even if there is no facial asymmetry to correct the mandibular prognathism. For this patient, the surgical procedure was critical and appropriate as a differential BSSO was performed to resolve his dental and f acial asymmetry. Mandibular arch form and inter-canine width was maintained post-surgically. Introduction The presence and severity of dentofacial asymmetries have been the subjects of many commentaries and investigations 1 . In 1931, Woo stated: “The human skull is definitely and markedly asymmetrical. It is not a question of bones of individual crania differing from a symmetrical type, but the type cranium is itself 3 asymmetric. Over a half-century later, Cook stated: “Asymmetry of the cranio-facial structures can have secondary effects on the dentition and the occlusion.” Cook also remarked on the continuum of cranio-facial asymmetries, which range from the unnoticeable to the severely 3 disabling 4 . Generally, when we establish the treatment plan for patients with facial asymmetry, surgery is included because facial asymmetry is usually caused by skeletal problems. Orthodontic treatment alone is a difficult choice in this situation. Patients with facial asymmetry and a skeletal Class III malocclusion are usually treated by orthognathic surgery even if there is no facial asymmetry to correct the mandibular prognathism. However, more consideration is needed to treat patients with facial asymmetry and a skeletal Class I relationship. Because correction of the asymmetry is the only goal of the orthognathic surgery in such cases 2 . Diagnosis and Etiology The patient was a 19-year-old male patient who visited KLE Society’s institute of Dental science and Hospital in Bangalore for an orthodontic consultation. No specific medical problems or temporomandibular joint symptoms were observed. He had a skeletal Class III relationship and facial asymmetry, with the chin deviated 3.5 mm to the right and a vertical * Post Graduate student, KLE Society’s Institute of Dental Science and Hospital, Bengaluru-560022 ** Post Graduate student, KLE Society’s Institute of Dental Science and Hospital, Bengaluru-560022 ***Professor, KLE Society’s Institute of Dental Science and Hospital, Bengaluru-560022 ****Chief Dental Health Officer, K.C. General Officer, Malleshwaram, Bengaluru 12 Vol. 14 No. 1 Jan-Apr 2018