PMC6348796_01
(a), (b), and (c) Preoperative pictures with front and lateral views emphasizing anteroposterior deficiency of the jaw and chin, mouth opening limitation, and chin deviation to the right.
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In addition, it was possible to observe a chin deviation to the right, associated with anteroposterior deficiency of the jaw and chin (Figure 1).
(a), (b), and (c) Preoperative intraoral pictures emphasizing deep bite and teeth absence on the right side.
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The patient had a deep bite and teeth absence in the right posterior region of the mandible (Figure 2).
Preoperative panoramic radiography showing altered condylar morphology on the right side, mandibular asymmetry, and impaction of the teeth 47 and 48.
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Moreover, a chin deviation to the right and the impaction of the elements 47 and 48, in an unfavorable position and angulation, were observed (Figures 3 and 4).
(a) Coronal view of the CT scan emphasizing the bifid mandibular condyle in the laterolateral direction. (b) Axial view of the CT scan showing ankylosing mass.
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Moreover, a chin deviation to the right and the impaction of the elements 47 and 48, in an unfavorable position and angulation, were observed (Figures 3 and 4).
(a), (b), and (c) Transoperative pictures showing the endaural access and the exposure of the ankylosing mass.
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A dissection of the tissues and exposure of the intra-articular spaces were performed with condylectomy associated with the removal of the ankylosing mass with no interposition of tissue or material (Figure 5).
(a), (b), and (c) Surgical removal of the condylar process and bilateral coronoid process.
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This can be seen in the clinical picture (Figure 6(a)). The stable internal fixation of the chin was conducted with a chin plate of 10 mm and four 2.0 screws (Figures 6 and 7).
Stable internal fixation of the chin with a chin plate of 10 mm from the 2.0 mm system.
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The stable internal fixation of the chin was conducted with a chin plate of 10 mm and four 2.0 screws (Figures 6 and 7).
(a), (b), and (c) Transoperative pictures emphasizing the eminectomy on the left side.
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For that reason, besides the proposed treatment, an eminectomy on the left side in order to assist with the patient mouth opening was performed (Figure 8).
Mouth opening of 39 mm in the transoperative.
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After that, a 39 mm opening in the transoperative was achieved (Figure 9).
(a), (b), and (c) Postsurgery pictures after seven days emphasizing a more harmonic facial profile and improvement of the mouth opening and the mandibular deviation.
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The patient continued with the follow-ups, with a mouth opening of 22 mm, no pain, and a satisfactory aesthetic and functional result (Figures 10 and 11).
(a), (b), and (c) Intraoral pictures showing occlusion guided with elastic bands.
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The patient continued with the follow-ups, with a mouth opening of 22 mm, no pain, and a satisfactory aesthetic and functional result (Figures 10 and 11).
Panoramic radiography after seven days emphasizing the stable internal fixation of the chin and bone gap on the right side of the TMJ region.
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Seven days after the surgery, the patient performed a panoramic radiography, and the picture emphasized a good stability of the fixation and the bone gap on the right TMJ (Figures 12 and 13).
Profile teleradiograph after seven days showing a better facial profile with chin advancement.
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Seven days after the surgery, the patient performed a panoramic radiography, and the picture emphasized a good stability of the fixation and the bone gap on the right TMJ (Figures 12 and 13).
Physiotherapy with 15 wooden spatulas after 15 days of postsurgery.
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The patient was submitted to physiotherapy sessions with wooden spatulas, and after 30 days of postsurgery, he removed the orthodontic brackets, due to the stability of the occlusion (Figure 14).
(a), (b), and (c) Postsurgery pictures after two years emphasizing the improvement in the facial harmony, mouth opening, and chin deviation.
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Since then, the patient remained in clinical and radiographic follow-up of two years, having no complaints and with a mouth opening of 35 mm (Figures 15, 16, 17, 18, and 19).