PMC5376922_01
Extraoral pictures of profile before treatment.
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Clinical examination showed a congenital bilateral complete palsy of facial nerve and dysfunction of lateral movements in both eyes, convex profile, reduced lower anterior facial height, open nasolabial angle, severe micrognathia, and incompetent lips with interlabial separation at rest of 13 mm (Figure 1).
Intraoral occlusion before treatment.
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Cephalometric analysis.
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The cephalometric analysis confirms the diagnosis of severe skeletal class II, retrognathic mandible, hypodivergent pattern and reduced lower facial height (Figure 3).
Palatal arch with extension arm.
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A button was positioned on the vestibular side of 2.7 and elastic ligation was tense from the button to the arm (Figure 4).
Extraction space before the closure.
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Segmented technique and intra-arch elastics to close extraction space.
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Ricketts' brackets with 0.018-inch slot were positioned on both dental arches; the use of segmented technique and intra-arch elastics have allowed the closure of extraction spaces (Figure 6).
Lateral occlusion before orthodontic treatment (a), at the end of presurgical orthodontics (b), and after surgery (c).
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Teleradiography in lateral projection before orthodontic treatment (a), at the end of presurgical orthodontics (b), and after orthognathic surgery (c).
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Upper lip incompetence that is typical in patients with MS has been corrected with lip augmentation through fat injections (Figure 8).
Profile after surgery.
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Outcome of the treatment was a significant improvement in the patient's smile and profile due to surgical normalization of skeletal pattern and smile surgery (Figure 9).
Occlusion after surgery.
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Molar and canine relationships were corrected to class I with appropriate overjet and overbite and midlines were achieved (Figure 10).