The Journal
There are various causes for skeletal
asymmetry ,developmental problems include ,
hemimandibular elongation and
hemimandibular hyperplasia, were originally
described together as condylar hyperplasia.
Hemifacial macrosomia, Achondroplasia
,Hemifacial hypertrophy ,Torticollis Hemifacial
atrophy (Parry-Romberg syndrome),
pathological problems include tumours, cysts,
or infections and also condylar fractures1.
Mandibular asymmetries can have many
causes. However, with a detailed clinical
examination and further investigations, the
correct diagnosis can be made. This is essential
as the appropriate management for the patient
must address both the patient’s concerns as
well as the cause. Extraorally note the position
of the midpoint of the chin in relation to the facial
midline. If a discrepancy exists, check if there is
a transverse cant in the maxillary occlusal plane
and note the relationship of lower dental
centreline to the midline of the chin.Intra-orally
check for dental centreline discrepancies and
occurrence of crossbites. In the presence of a
crossbite, check for a mandibular
displacement.and also radiographs like CBCT
or CT scan should be advised for evaluation and
quantification of the asymmetry.8
Functional asymmetries can be managed
orthodontically by restoration of functional
occlusion . Skeletal asymmetries are usually
corrected through surgery if patient has crossed
the growth period. Some of the surgical options
include Orthognathic surgery, Distraction
Osteogenesis, Sliding Genioplasties and Soft
tissue surgery9.
In this case report, the crossbite was resolved
by using a quad helix for unilateral expansion
with periodic activation .
Maxillary anterior crowding was resolved by
proximal stripping and mandibular crowding
was resolved by extraction of 44 and mild
proximal stripping. A differential bilateral sagittal
split osteotomy was performed with
advancement on right side and reduction on left
side to correct the mandibular asymmetry.
22
Post-surgically the soft tissue pogonion
coincided with the facial midline.
Conclusions
The relationships between the appropriate
application of diagnostic procedures, treatment
planning, and treatment execution are of prime
importance in determining the long-term
success of any patient’s care. Certainly, for this
patient, the surgical procedure was critical and
appropriate for the resolution of his dental and
facial asymmetry. Maintenance of the
preexisting mandibular arch form and
intercanine width was necessary to maintain
long term stability.
Vol. 14 No. 1
Jan-Apr 2018