PMC9164669_01
Preoperative photography (a) Inferior view, (b and c) frontal lip closed and smile views, (d) Superior view, (e and f) Right oblique lip closed and smile views, (g and h) Left oblique smile and lip closed views, (i and j) Right profile lip closed and smile views, (k and l) Left profile smile and lip closed views; Presurgical intraoral photography. (m) Right, (n) Left, and (o) Frontal views of the occlusion.
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F1
Incisor show was 1 mm at rest and 6 mm at smile [Figure 1a-l]. The dental relationship was Class III (Cl III) bilaterally both in molar and canine region with approximately 10 mm reverse overjet [Figure 1m-o]. Severe retrogenia was noted in both clinical and cephalometric evaluation [Table 1 and figures 1a-l and 2c].
Radiographic evaluation(a) preoperative PA cephalometric evaluation, (b) postoperative PA cephalometric evaluation, and(c) preoperative lateral cephalometric evaluation, (d) postoperative lateral cephalometric evaluation, (e) preoperative panoramic view, (f) postoperative panoramic view. Note that the copper beaten skull appearance is obvious in lateral and anteroposterior cephalometric evaluation because of the raised intracranial pressure.
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F2
Preoperative radiographic evaluation showed no asymmetry in the posteroanterior view and no root resorption in the panoramic view [Figure 2a and e]. Severe retrogenia was noted in both clinical and cephalometric evaluation [Table 1 and figures 1a-l and 2c]. The postoperative phase of orthodontic treatment was finalized aiming to achieve maximum interdigitation and optimum occlusion [Figure 2b,d, and f]. Facial height proportions were improved to ideal ranges and severely deficient chin was resolved mostly by advancement genioplasty and slightly by forwarding rotation of the mandible which is significant in both radiographic and clinical examination [Figures 2, 4 and 5].
Modified Le-Fort III osteotomy(a) Osteotomy lines, (b) Subtarsal incision, (c and d) Priauricular osteotomies, (e and f) vestibular incision and initial stabilization with intermediate surgical splint and intermaxillary fixation, (g and h) profile and inferior views immediately after initial fixation, and (i) rigid fixation of the bone graft.
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F3
Then, the separated segment was stabilized using an intermediate surgical splint and intermaxillary fixation and a mono-cortical bone graft harvested from the iliac crest was used to fill the gap in zygomatic area, and finally, rigid fixation was done using mini plates [Figure 3].
Postoperative photography(a) Inferior view, (b and c) Right frontal lip closed and smile views, (d) Superior view, (e and f) Right oblique lip closed and smile views, (g and h) Left oblique smile and lip closed views, (i and j) Right profile lip closed and smile views, (k and l) Left profile smile and lip closed views; Postsurgical intraoral photography. (m) Right, (n) Left, and(o) Frontal views of the occlusion.
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F4
There was a decrease in the scleral show and Proper chin projection was obtained [Figure 4a-l]. Class I occlusal relationship with 1 mm vertical overlap and 0.5 mm overjet was obtained [Figure 4m-o]. Facial height proportions were improved to ideal ranges and severely deficient chin was resolved mostly by advancement genioplasty and slightly by forwarding rotation of the mandible which is significant in both radiographic and clinical examination [Figures 2, 4 and 5].
Cephalometric tracing superimposition on skull base showing obvious improvement in the occlusal relationship and skeletal discrepancy as well as soft-tissue parameters. (white lines for preoperative tracing and red lines for postoperative one). Slight mandibular forward rotation is noted in condylar and dental areas.
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F5
Facial height proportions were improved to ideal ranges and severely deficient chin was resolved mostly by advancement genioplasty and slightly by forwarding rotation of the mandible which is significant in both radiographic and clinical examination [Figures 2, 4 and 5].