Orthodontic treatment and tongue surgery in a class III open-bite malocclusion. A case report.

Cases such as this are a real challenge to clinical orthodontists. They require patience as well as proper diagnosis and treatment planning. The orthodontist must also help the patient psychologically by treating the teeth and surrounding structures and by treating the patient as an individual. It is the feeling of both the Author and the Plastic surgeon in this case, Dr. Fernando Ortiz Monasterio, that this type of surgery would be successful in most non-pathological macroglossia cases. It appears that the sutured areas might be said to develop more dense epithelial tissue, not allowing the tongue to expand and readapt so readily to the position of the teeth in the mandibular arch. This is indicated in the present case, as is demonstrated by the decrease in width of the mandibular arch from the first molar area to the anterior part of the mouth. It should be noted that orthognathic surgery was not as widely used at the time that this patient was studied and treated as it is today. If this case had presented for the first time this year, it is likely that the treatment plan of most orthodontists would have combined orthognathic and tongue surgery, with orthodontics to lessen trauma to the supporting structures of the teeth from the extreme and complicated mechanics which would have to be used in treatment. The psychological aspects of this case were of tremendous importance; the treatment results have undoubtedly changed his life completely (Fig. 10). Once unable to speak clearly with his oversize tongue, he has since gone on to complete his education and is now a successful orthodontist.