Division of Orthodontics, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", 80138 Naples, Italy.
Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", 80138 Naples, Italy.
Int J Environ Res Public Health. 2020 Sep 28;17(19):7087. doi: 10.3390/ijerph17197087.
A 32-year-old man was referred to the Division of Orthodontics of the University of Naples "Federico II", with a 15-year history of gradually increasing right-sided facial asymmetry. Clinical and radiological examinations was consistent to hemimandibular hyperplasia, a rare developmental asymmetry characterized by three-dimensional enlargement of one-half of the mandible. The standard surgical-orthodontic management was proposed to the patient. However, he refused to undergo bimaxillary orthognatic surgery. Therefore, a different treatment was proposed based on the orthodontic technique of pre-surgical decompensation and post-surgical refinement used in bimaxillary orthognatic surgery planning, and surgical intervention with a condylectomy. The dental arches were evenly levelled out with a multi-bracket treatment and then the condylectomy was performed. Orthodontic treatment continued with a levelling and torque control by 0.19 × 0.25 SS arch and physiotherapy. At the three-month follow-up, the patient showed anterior and posterior bite rebalancing, arch intercuspation recovery, and anterior open bite closure due to muscular self-rebalancing. The two-year follow-up showed regular mandibular dynamic, orthodontic appliances were removed, and the patient was instructed to wear retainer for the following months. The final result was aesthetically reasonable for the patient, although slight asymmetry of the chin persisted.
一位 32 岁男性因逐渐加重的右侧面部不对称 15 年就诊于那不勒斯“费德里科二世”大学正畸科。临床和影像学检查符合单侧下颌骨肥大，这是一种罕见的发育性不对称，表现为下颌骨的三维增大。向患者提出了标准的手术-正畸治疗方案。但是，他拒绝接受双颌正颌手术。因此，基于双颌正颌手术规划中的术前补偿和术后精细调整的正畸技术，提出了一种不同的治疗方案，包括下颌角切除术。通过多托槽治疗均匀整平牙弓，然后进行下颌角切除术。通过 0.19×0.25 SS 弓和物理治疗继续进行正畸治疗，以进行水平和转矩控制。在三个月的随访中，由于肌肉的自我平衡，患者表现出前后面部咬合重新平衡、尖牙交错恢复和前牙开颌闭合。两年的随访显示下颌骨动态正常，拆除了正畸矫治器，并指导患者在接下来的几个月佩戴保持器。尽管下巴仍有轻微的不对称，但最终结果对患者来说是合理美观的。
