Abstract
Background: Craniofacial microsomia (CFM) is the second most common craniofacial anomaly with asymmetrical, congenital malformation. Treatment is challenging and requires interdisciplinary cooperation to restore function and facial esthetics. Objective: A CFM patient suffered from facial asymmetry, occlusal plane cant, malocclusion and severe obstructive sleep apnea, and a 3D surgical orthodontic treatment was planned. Case report: A 37-year-old male patient complained of small chin with deviation. Craniofacial microsomia grade IIa by Pruzansky system and S2A1T1 by SAT system was diagnosed. Clinical examination showed severe facial asymmetry, right microtia, chin deviation to right side 7.0 mm, occlusal plane cant, right Class II and left Class III molar, anterior crowding with upper left lateral incisor missing and lower right first molar buccal crossbite. Cephalometric analysis revealed severe skeletal Class II (ANB 9.0) with hyperdivergent facial type (SN-MP 43.0). Sleep study showed severe obstructive sleep apnea (OSA) with apnea-hypopnea index (AHI) 43.3/h. After general dental care, seven-month pre-surgical orthodontic treatment included leveling and alignment, arch coordination, lower right first molar extraction and initiating second and third molar protraction. 3D surgical plan included Le-Fort I-2 pieces osteotomy, bilateral sagittal split osteotomy (BSSO) and genioplasty. Bimaxillary advancement with counterclockwise rotation along with advanced genioplasty were designed to correct OSA. Post-surgical treatment continued for dental midline correction, upper left lateral incisor space adjustment, lower right molars protraction, finishing and detailing. After total 27-month treatment, significant improved OSA (AHI 0.9), normal overbite and overjet, Class I molar and canine, solid interdigitation and balanced facial symmetry and profile were achieved. Conclusion: 3D surgical orthodontics improves accuracy and efficacy in the treatment of adult craniofacial microsomia patients
Recommended Citation
Chiu, Hung-Wen; Lin, Cheng-Hui; and Chen, Yi-Hsuan Carol
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"Three-Dimensional Surgical Orthodontic Management of Pruzansky IIa Craniofacial Microsomia with Severe Facial Asymmetry and Obstructive Sleep Apnea,"
Taiwanese Journal of Orthodontics: Vol. 38:
Iss.
1, Article 5.
https://doi.org/10.38209/2708-2636.1396
Available at:
https://www.tjo.org.tw/tjo/vol38/iss1/5
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