Korean J Orthod.  2016 Nov;46(6):395-408. 10.4041/kjod.2016.46.6.395.

A case of severe mandibular retrognathism with bilateral condylar deformities treated with Le Fort I osteotomy and two advancement genioplasty procedures

Affiliations
  • 1Department of Orthodontics, Okayama University Hospital, Okayama, Japan. yanagita@md.okayama-u.ac.jp
  • 2Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
  • 3Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka, Japan.
  • 4Department of Orthodontics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.

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.

Keyword

Severe mandibular retrognathism; Condylar deformity; Orthognathic surgery; Genioplasty

MeSH Terms

Cleft Lip
Congenital Abnormalities*
Female
Follow-Up Studies
Genioplasty*
Humans
Hyoid Bone
Incisor
Jaw
Malocclusion
Malocclusion, Angle Class III
Mandible
Mandibular Advancement
Mandibular Condyle
Maxilla
Molar
Orthognathic Surgery
Osteotomy*
Palate
Polymerase Chain Reaction
Retrognathia*
Tooth

Figure

  • Figure 1 Initial facial and intraoral photographs of our patient who 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 at 9 years and 9 months of age.

  • Figure 2 Initial dental casts.

  • Figure 3 Initial panoramic and cephalometric radiographs.

  • Figure 4 Superimposition of cephalometric tracings obtained before, during, and after the first phase of interceptive orthodontic treatment. A, Superimposition on the sella– nasion plane at the sella. B, Superimposition on the palatal plane at the anterior nasal spine (ANS) and the mandibular plane at the menton. C, Superimposition on the ramus plane at the articulare.

  • Figure 5 Facial and intraoral photographs obtained before the second phase of treatment for our patient who exhibited severe mandibular retrognathism with bilateral condylar deformities after growth completion.

  • Figure 6 Dental casts fabricated before the second phase of treatment.

  • Figure 7 Panoramic and cephalometric radiographs obtained before the second phase of treatment.

  • Figure 8 Computed tomography images of the bilateral condyles for our patient with bilateral condylar deformities after growth completion. The arrowheads show bone surface absorption.

  • Figure 9 Facial and intraoral photographs obtained after Le Fort I osteotomy with two advancement genioplasty procedures followed by fixed orthodontic treatment.

  • Figure 10 Dental casts fabricated after treatment.

  • Figure 11 Panoramic and cephalometric radiographs obtained after treatment.

  • Figure 12 Superimposition of cephalometric tracings obtained before the second phase of treatment and after Le Fort I osteotomy with two advancement genioplasty procedures followed by fixed orthodontic treatment and after retention. A, Superimposition on the sellanasion plane at the sella. B, Super impo s i t ion on the palatal plane at the posterior nasal spine (PNS). C, Superimposition at the gonion.

  • Figure 13 Computed tomography reconstructions obtained before (A–D) and after (E–F) Le Fort I osteotomy with two advancement genioplasty procedures followed by fixed orthodontic treatment and retention for our patient who exhibited severe mandibular retrognathism with bilateral condylar deformities after growth completion.

  • Figure 14 Assessment of the airway space after treatment. A, Superimposition of cephalometric tracings with the pharyngeal area (black, before treatment; red, after treatment). B, Airway volume measurements obtained using the Dolphin 3D software (Dolphin Imaging and Management Solutions, Chatsworth, CA, USA) for airway analysis.

  • Figure 15 Facial and intraoral photographs obtained at 30 months after treatment.


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