iDentistry The Journal Volume 14 No.1 | Page 23

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