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Authors: Dr. Suraj Prasad Sinha, Dr. U.S. Krishna Nayak

A 25 year old femalereported to the department with the chief complaint of deviated mandible to the left side. She gave history of trauma due to fall when she was 5 months old and underwent surgery for the same. Patient had undergone orthodontic treatment at 12 years of age with the extraction of all first premolars.

CLINICAL EXAMINATION

On Intra oral examination, all permanent teeth were present except the 4 premolars. The maxillo-mandibular relationship can be summarized with both the Molar and Canine relationship being Class II bilaterally. The Incisor relationship was Class II Div 1 pattern with 13 mm of overjet and 6.5 mm of overbite. Crossbite was seen in the right segment of the arch in relation to 45, 46 and 47. The lower midline was shifted to left by 7 mm.

 


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On Functional analysis, the mandibular midline shift was evident in habitual occlusion and in rest position. The maximum interincisal distance was 33 mm. there were no deviations in lateral and frontal path of opening and closure.

RADIOGRAPHIC EXAMINATION

Pretreatment Orthopantomograph (OPG), PA view and Lateral Cephalogram were made. Various cephalometric analysis were done including Steiner’s, Down’s, Tweed’s, McNamara’s and others. The patient had Class II skeletal apical base with orthognathic maxilla (SNA=82 ̇) and retrognathic mandible (SNB=71 ̇) ; WITS appraisal of +11 mm ; average growth pattern ; reduced interincisal angle (116 ̇) ; increased upper facial height ; decreased lower facial height ; reduced body length of mandible.
 


DIAGNOSTIC SUMMARY

Skeletal Class II malocclusion due to retrognathic mandible with reduced mandibular body length and chin length ; Angle’s Class II Molar and Canine relationship bilaterally ; overjet of 13 mm and overbite of 6.5 mm ; crossbite in the right segment of the arch in relation to 45, 46 and 47 ; shift in the lower midline by 7 mm were observed.
 
 
 
 


RELEVANT CEPHALOMETRIC VALUES

ANGLES

PRE-TREATMENT

PRE – SURGICAL

POST – SURGICAL

SNA

82̇ ̇

82

80

SNB

71 ̇

70

73

ANB

11 ̇

12

7

Sn – Go Gn

30 ̇

35

45

Sn – Occl. Pl.

20 ̇

16

26

U1 - NA

29 ̇ / 9 mm

22  ̇/ 5 mm

25  ̇/ 4mm

L1 – NB

24 ̇ / 10 mm

35  ̇/ 12 mm

40  ̇/15 mm

L1 – MAND. PLANE

100

102

102

N- ANS

56

56

54

ANS – Gn

50

50

61

Go- Pg

50

50

53



 
 
 


DIAGNOSIS

PROBLEM LIST
  • Facial asymmetry
  • Class II skeletal base due to retrognathic mandible
  • Scissor bite on right side
  • Decreased mandibular body length
  • Recessive Chin
  • Occlusal cant to left side
  • Increased upper facial height
  • Angle’s Class II Molar and Canine relationship
  • Maxillary anterior proclination and mandibular anterior crowding
  • Convex profile
  • Everted lower lip

TREATMENT PLAN
 
  • Pre Surgical Orthodontic Phase :

  • o Initial levelling and alignment
  • Surgical Plan :

  • o Lefort I Osteotomy with maxillary impaction and Cant correction
    o Bilateral saggital split osteotomy with advancement and rotation of mandible using iliac graft on left side
    o Advancement Genioplasty

  • Post Surgical Orthodontic Phase:

  • o Final detailing and settling of occlusion


PRE SURGICAL PHOTOGRAPHS :

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