PMC7433974_01
(a) Lateral view showing short mandibular length and bad proportion in soft tissue in the mandibular area. (b) Three-fourth view with inadequately relation in the chin position and zygoma position. (c) Facial asymmetry, chin deviation 12 mm to the left
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F1
In consultation, the patient had significant facial asymmetry, with a chin deviation of 12 mm from the midline, associated with pain on palpation and restricted mouth opening [Figure 1]; initially, the treatment was conservative with local techniques, physiotherapy, and oral splint with poor results.
(a) Presurgical frontal view related to skeletal condition. (b and c) Show great deviation in the normal position of the mandible with a complex position in the mandibular angle
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F2
In the study with CT [Figure 2], a difference was noted in the morphology of the mandibular region, particularly at the level of the mandibular angle, where the right angle-ramus complex was convex and continuous with the mandibular shape, whereas the left angle-ramus complex presented an area of extensive concavity.
(a) Planning of the bimaxillary orthognathic surgery together with the design of the left temporomandibular joint prosthesis. (b) Constructed prosthesis maintaining the posterior mandibular contour in the internal area of the prosthesis. (c) Fit of the prosthesis in posterior area of mandibular ramus, maintaining contour and shape of the mandibular ramus and angle
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F3
The case was planned out on software with the responsible engineer (V.B.) [Figure 3]. The surgical treatment consisted of surgery starting at the mandible, performing a sagittal osteotomy of the mandibular ramus on the right side with a regression of 2.2 mm, and joint replacement of the TMJ on the left side where advancement of 9 mm was estimated, incorporating a condilectomy (with no coronoidectomy), and the augmentation of the lateral volume of the mandibular angle and the height of the gonion position based on the mirror image on the right side.
(a) Lateral view observing better position in the mandible length and good relation between the mandible and neck. (b) Chin position in relation with zygoma area and (c) Frontal view showing a correct position in the midline with symmetry between the left and right side mandible contour
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F4
The patient follow-up for 12 months showed total stability of the surgery [Figure 4], maintaining the prosthetic system without complications; recovery of the facial symmetry was achieved and is maintained with a mouth opening >35 mm, and no pain is present [Figure 5].
(a) Facial condition after 12 months, observing total facial symmetry and positioning of midline of the chin. (b and c) Showing stability of installed prosthesis, with no alterations of position or loss of screws in the area
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F5
The patient follow-up for 12 months showed total stability of the surgery [Figure 4], maintaining the prosthetic system without complications; recovery of the facial symmetry was achieved and is maintained with a mouth opening >35 mm, and no pain is present [Figure 5].
Dental condition and occlusion evolution from the (a) first condition in the initial stage, (b) presurgical dental relation with midline deviation of approximately 5 mm and left crossbite and (c) Stable occlusion, maintaining canine guide and sagittal relation
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F6
Dental occlusion was stable, and normal midline was observed [Figure 6] with no complications.