A case of severe mandibular retrognathism with bilateral condylar deformities treated with Le Fort I osteotomy and two advancement genioplasty procedures
Nakamura Masahiro, Yanagita Takeshi, Matsumura Tatsushi, Yamashiro Takashi, Iida Seiji, Kamioka Hiroshi,
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( Nakamura Masahiro ) - Okayama University Hospital Department of Orthodontics
( Yanagita Takeshi ) - Okayama University Hospital Department of Orthodontics
( Matsumura Tatsushi ) - Okayama University Graduate School of Medicine Department of Oral and Maxillofacial Reconstructive Surgery
( Yamashiro Takashi ) - Osaka University Graduate School of Dentistry Department of Orthodontics and Dentofacial Orthopedics
( Iida Seiji ) - Okayama University Graduate School of Medicine Department of Oral and Maxillofacial Reconstructive Surgery
( Kamioka Hiroshi ) - Okayama University Graduate School of Medicine Department of Orthodontics
KMID : 0361920160460060395
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.
키워드
Severe mandibular retrognathism; Condylar deformity; Orthognathic surgery; Genioplasty
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