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Main Instructor Jen-Bang Lo
Tung-Yiu Wang
Jia-Kuang Liu1
Department / Institution Department of Stomatology, National Cheng Kung University Hospital, Tainan, Taiwan
Classification Case report
Objective: We observed the mandibular growth in a skeletal class III patient with facial asymmetry for 10 years. Different treatment was shown depending on different age, malocclusion and growth problem. Use of optimal symmetry plane(OSP)method to identify facial asymmetry in final stage of treatment was also presented.
Case: A little girl was brought to our hospital at age 8 with chief complaints of posterior crossbite and anterior edge to edge occlusion. Cephalometric analysis showed skeletal class III with mandibular prognathism, hyperdivergent facial pattern with lower midline shift only to R’t 1 mm. Her malocclusion was corrected by RPE and 2 by 4 appliance with chin cup used. After phase I treatment, we kept regular follow up for mandibular growth. Occlusal plane canting and lower midline shift to R’t 6.5 mm was noted during f/u. Serial cephalometric films showed no further mandibular growth at age 18. Thus, orthodontic treatment combined with 2-jaw orthognathic surgery was planned with 3D navigation system. Facial asymmetry, midline deviation and profile had improved after treatment.
Discussion and summary: It is challenging for orthodontists to treat skeletal class III patients with overdeveloped mandible and asymmetry due to unpredictable mandibular growth. With CT-based OSP analysis, we can quantify the misalignment between midface and mandible. Also, more precision in planning surgical schemes in correcting facial asymmetry can be achieved with 3D navigation system.
10 Year Follow Up and Treatment for A Skeletal Class III Asymmetric Growing Patient