The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
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A case of severe mandibular retrognathism with bilateral condylar deformities treated with Le Fort I osteotomy and two advancement genioplasty procedures

  • Nakamura, Masahiro (Department of Orthodontics, Okayama University Hospital) ;
  • Yanagita, Takeshi (Department of Orthodontics, Okayama University Hospital) ;
  • Matsumura, Tatsushi (Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences) ;
  • Yamashiro, Takashi (Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University) ;
  • Iida, Seiji (Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences) ;
  • Kamioka, Hiroshi (Department of Orthodontics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences)
  • Received : 2015.12.17
  • Accepted : 2016.04.14
  • Published : 2016.11.25
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Abstract

We report a case involving a young female patient with severe mandibular retrognathism accompanied by mandibular condylar deformity that was effectively treated with Le Fort I osteotomy and two genioplasty procedures. At 9 years and 9 months of age, she was diagnosed with Angle Class III malocclusion, a skeletal Class II jaw relationship, an anterior crossbite, congenital absence of some teeth, and a left-sided cleft lip and palate. Although the anterior crossbite and narrow maxillary arch were corrected by interceptive orthodontic treatment, severe mandibular hypogrowth resulted in unexpectedly severe mandibular retrognathism after growth completion. Moreover, bilateral condylar deformities were observed, and we suspected progressive condylar resorption (PCR). There was a high risk of further condylar resorption with mandibular advancement surgery; therefore, Le Fort I osteotomy with two genioplasty procedures was performed to achieve counterclockwise rotation of the mandible and avoid ingravescence of the condylar deformities. The total duration of active treatment was 42 months. The maxilla was impacted by 7.0 mm and 5.0 mm in the incisor and molar regions, respectively, while the pogonion was advanced by 18.0 mm. This significantly resolved both skeletal disharmony and malocclusion. Furthermore, the hyoid bone was advanced, the pharyngeal airway space was increased, and the morphology of the mandibular condyle was maintained. At the 30-month follow-up examination, the patient exhibited a satisfactory facial profile. The findings from our case suggest that severe mandibular retrognathism with condylar deformities can be effectively treated without surgical mandibular advancement, thus decreasing the risk of PCR.

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References

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