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wanja: Facial asymmetry, massive condylar overgrowth.

Facial diagnosis

  • Asymmetric face
  • Open bite

Dental diagnosis

  • Open bite

Treatment jaw surgery

  • Rotation upper jaw
  • Shortening upper jaw (intrusion upper jaw - Le Fort I)
  • Rotation lower jaw
  • Widening upper jaw (Smile distractor)

About this case

Wanja is a most lovely and nice lady, approaching her late forties. For many years she had an ongoing problem of asymmetric outgrow of the right ascending ramus of the jaw, including a massive and uncontrolled overgrowth of the right condyle. She developed a most disturbing facial asymmetry with a functional disturbance with a massive open bite on one side of almost 15mm. Her mouth opening at that time was reasonable. She visited some maxillofacial surgeons and was told that a total joint replacement would be necessary. I agreed with them and told her it was surely on the toplist of therapies. But Wanja was very reluctant for this major and not frequently performed surgery and was afraid of more problems down the road, including the possibility of mouth opening restriction, facial nerve problems, and persisting asymmetries. So we had a long and serious tolk, discussing the pro’s and cons, and the "what if’s with plan B’s". Finally we went along with the more familiar approach of purely more conventional orthognatic surgery to correct her facial asymmetry. Before the surgery we insisted that Wanja had braces placed, so that we would be able to better handle the stability of the bite,. We included also the agreement that the orthodontist would be willing to follow her bite further on. We agreed not to consider her condylar malformation at first hand. During the surgery we reshaved extensively the jaw line - inferior border- in the light of gaining  even more symmetry.  So merely we performed the classic "trimax" :upper - lower - jaw osteotomies with a genioplasty and inferior border reshaping. Due to the lack of transversal width in the upper jaw we added a smile distractor on the program to widen the upper jaw during the Lefort I. The outcome was most rewarding. She kept the smile distractor a year in place, and  she continued to work softly but insistently at her mouth opening. An absolutely astonishing result. The mouth opening  one year later got easely 33 mm. She is totally pain free. A most rewarding result for a nice and lovely laidy.