Correction of Facial Asymmetry Using Patient-Specific Implants: A Case Report

Abstract

Dentofacial deformities can have a profound impact on patients’ function and facial aesthetics. Traditionally, dentofacial deformities and malocclusion have been managed with growth modification, orthodontic therapy, and orthognathic surgery, or a combination of these modalities. The aim of this article is to discuss the use of patient-specific alloplastic implants as an adjunct or alternative to orthognathic surgery in patients with dentofacial deformities. A 40-year-old man who previously underwent surgically assisted rapid palatal expansion followed by LeFort I osteotomy advancement, intraoral vertical ramus osteotomy setback (IVRO), rhinoplasty, and fat transfer to the malar region presented with a chief complaint of dissatisfaction due to significant facial asymmetry. Tear trough deformity, concave nasal dorsum with nasal tip deviation to the left, submalar fullness, chin deviation to the right, and a poorly defined mandibular border outline were all noted on physical examination. The patient was treated with lower lid blepharoplasty with fat repositioning, buccal fat pad reduction (bichectomy), and patient-specific malar and mandibular border implants. In a patient who has a moderate-to-severe malocclusion and dentofacial deformity, traditional treatment includes orthodontic correction and orthognathic surgery. Patients undergoing primary orthognathic surgery can benefit from alloplastic implants. For patients who have residual maxillary or mandibular asymmetry after orthognathic surgery, the treatment options are secondary orthognathic procedures or facial implants. These patients can benefit from treatment with alloplastic facial implants as an adjunct or alternative to orthognathic surgery to normalize skeletal contours and improve facial aesthetics. Patient-specific alloplastic implants can be used as a powerful adjunct or alternative to orthognathic surgery. Patients with mild occlusal and skeletal deformities who have traditionally been treated with orthodontic therapy alone can benefit from evaluation of alloplastic implants. Patients with residual asymmetries after orthognathic surgery can benefit from alloplastic implants as an adjunct with secondary osteotomies or as an alternative altogether.