Severe prognathism and laterognathia, condilar hyperplasia with considerable facial asymmetry

Resumo

The case of a 20 year old man with severe class III maloclussion due to mandibular prognathism and maxillary retrusion who also presents severe laterognathia with condylar hyperplasia and de- fi cient zygomatic projection with dental crowding caused by a collapsed maxilla is hereby presented. The treatment objectives were: to establish a correct overbite and overjet, to provide an stable occlusion and correct the sagittal and transversal problems as well as to improve function in order to promote a better quality of life. Treatment consisted in 3 phases: presurgical orthodontics, the surgical procedure and a postsurgical orthodontic phase. The maxilla was advanced 5 mm and intruded 3 mm in the posterior region with a Le Fort I osteotomy. A vertical osteotomy with an extraoral approach was performed in the mandible for the correction of the laterognathia. Intermaxillar fi xation was used after surgery. Treatment results exceeded the expectations for the clinicians and for the patient himself by achieving a correct function and improving signifi - cantly the patient’s aesthetics.

Key words: Asymmetry, laterognathia, maxillary collapse, gammagraphy.