Functional treatment of an asymmetry case having left side paralysis: a case report

Abstract

This case report presents the results of functional and myofunctional treatment of a 9-year, 5-month-old male patient with laterognathy, facial asymmetry and dentofacial deformity. The patient had a history of herpes encephalitis at age 8.5 months and palsy on the left side in early childhood, and his left side remained paralyzed as a sequela. The patient had dentoalveolar asymmetry with a Class I right and Class III left canine relation, a 1.5 mm midline deviation, anterior cross-bite, an overjet of -3 mm and an overbite of 3 mm. The dentoalveolar and facial asymmetries were corrected using a modified removable appliance, with an acrylic vestibular shield inserted on the right side to guide the mandible in the upper arch and an acrylic plate with artificial teeth in the lower arch. The patient was instructed to practice myofunctional exercises regularly. In total, treatment, including observation, was completed in a period of 2 years and 10 months, at which time, a marked correction in facial asymmetry and profile and improvement in smile esthetics could be observed.

Keywords: Facial asymmetry; Functional treatment; Laterognathy; Myofunctional exercises.

Figure 1.

Pre-treatment extraoral photographs

Figure 2.

Pre-treatment intraoral photographs

Figure 3.

Pre-treatment hand-wrist radiograph.

Figure 4.

Removable appliances inserted in the mandibular and maxillary arches.

Figure 5.

Post-treatment extraoral and intraoral photographs.

Figure 6.

Post-treatment hand-wrist radiograph.

Figure 7.

Postero-anterior cephalometric measurements and superimpositions using Björk’s structural technique.

Figure 8.

Two years follow-up extraoral and intraoral photographs.