*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
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Vol. 14 No. 1
Jan-Apr 2018