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Case Reports
. 2020 Sep 28;17(19):7087.
doi: 10.3390/ijerph17197087.

Orthodontics First in Hemimandibular Hyperplasia. "Mind the Gap"

Stefania Perrotta  1 , Giorgio Lo Giudice  2 , Tecla Bocchino  1 , Luigi Califano  2 , Rosa Valletta  1
Affiliations
Case Reports

Orthodontics First in Hemimandibular Hyperplasia. "Mind the Gap"

Stefania Perrotta et al. Int J Environ Res Public Health. .

Abstract

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.

Keywords: CAD/CAM; condylar hyperplasia; hemimandibular hyperplasia; mandibular asymmetry; orthognatic surgery; skeletal asymmetry.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Extraoral view T0 (A); three-month post-surgical follow-up (B); two-year follow-up (C).
Figure 2
Figure 2
Intraoral view T0 (A); Pre-surgical (B); three-month post-surgical follow-up (C); two-year follow-up (D).
Figure 3
Figure 3
Radiographical analysis: T0 Orthopantomography (A); T0 Temporomandibular Joint (TMJ) Computed tomography scans of left TMJ in coronal (B) and sagittal view (C) and right TMJ in coronal (D) and sagittal view (E). Orthopantomography, three-week post-surgical follow-up (F). Orthopantomography, two-year follow-up (G).
Figure 4
Figure 4
T0 skull radiography posteroanterior view (A); two-year follow up skull radiography laterolateral view (B).
Figure 5
Figure 5
Total body scintigraphy showing no sites of pathological accumulation.
Figure 6
Figure 6
Intra-operatory view: Al-Kayat and Bramley preauricolar approach and TMJ exposure (A); condyle removal (B); Penrose drain positioning (C); and wound closure with running interlocking suture (D).
Figure 7
Figure 7
Maxillary occlusal cant correction from T0 (left) to two-year follow-up (right).
See this image and copyright information in PMC

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