Abstract
Background: Conventional orthognathic surgery can become challenging when multiple goals such as correction of transverse and anteroposterior discrepancies of the dental arches are aimed. Thus, additional procedures such as midline mandible osteotomy for mandibular constriction and tongue reduction due to true macroglossia may be alternatives to a more functional and aesthetical outcome. Case Report: A treatment of a 35-year-old female patient with Class III sagittal skeletal pattern marked by an increased angle facial profile, maxillary retrusion, vertical maxillary deficiency, and mandibular protrusion, a Class III malocclusion associated to an edentulous maxilla, partially dentate mandible, transverse mandibular excess and true macroglossia. With an Index of Orthognathic Functional Treatment Need (IOFTN) grade 5, the patient underwent bimaxillary orthognathic surgery, mandible constriction and partial glossectomy. After about a year of follow-up, the patient demonstrated skeletal stability for the orthognathic procedures as well preservation of tongue function. Conclusion: The combination of the techniques performed was effective in the treatment of the multifaceted deformities, providing satisfactory function, harmonious facial aspect and enabling effective prosthetic rehabilitation to the patient.
Highlights
Orthognathic surgery has the objective of correcting skeletal deformities of congenital or acquired congenital origin, repositioning the bony bases that support the upper and lower teeth, seeking facial harmony, functional occlusion, the health of orofacial structures, aesthetics and stability [1]
Medial mandibular osteotomies used to be performed in a linear vertical fashion, which sometimes resulted in periodontal defect or poor bone healing due to poor bone contact
Clayman and Adams described the technique of medial step osteotomy, which provides a greater area of bone contact, more stability, and less chance of resulting in periodontal defects as it does not cause a long sagittal or vertical defect in the mandibular symphysis [3, 4]
Summary
The combination of the techniques performed was effective in the treatment of the multifaceted deformities, providing satisfactory function, harmonious facial aspect and enabling effective prosthetic rehabilitation to the patient.
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