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Abstract

A 17-year-old girl who was diagnosed as Pruzansky Grade III hemifacial microsomia (HFM) at right side, came with chief complaint of face asymmetry and occlusal deviation. The patient was regularly followed up in the Chang Gung Craniofacial Center. She had her affected right side ramus and condyle reconstructed with costochondral graft (CCG) around 6 years of age. The extraoral examinations indicated severe facial asymmetry with longer right face and prominent left face; the lower jaw was severely deviated to the left side due to overgrowth of the CCG at right mandible; besides, the right reconstructed condyle was ankylosed. The presurgical orthodontics involved initial leveling and alignment and expansion of upper dental arch. The right ankylosed condyle was released before orthognathic surgery (OGS). The OGS included 2-pieces LeFort I osteotomy to align the maxillary arch form, and bilateral sagittal split osteotomies to correct the severely displaced mandible. The treatment outcome showed improvement of face symmetry and profile. Stable dental occlusion and alignment was achieved then further retained with both fixed and removable retainers. We illustrated the decision of treatment modalities, process of orthognathic and orthodontic treatment, special consideration of surgical design and complications for this case.

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