case/orthognathic/rt/31 1

Case presentation orthognathic

surgery

PRESENTED BYDr. RAHUL TIWARI

2ND YEAR MDS - PG StudentDEPT. OF ORAL & MAXILLOFACIAL SURGERY

SIBAR INSTITUTE OF DENTAL SCIENCES

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Patient name : P Chetan saiOngole B Tech 3rd yr.

Age / Sex : 19yrs/Male

Chief complaint : Complains of unaesthetic apperarence of his face

HOPICONTACT NO 9010480298

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Case HistoryPMH, PDH, DRUG, FAMILYPre-natal history Informer : Mother

Condition of mother : Normal during pregnancy Delivery : Full term Type : Normal

Post-natal history: Feeding : Breast fed till

1 yrMilestones of development : Normal

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Childhood History:Habits : No deleterious habits

Injuries : No relevant history

Mental Development : Normal

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General History :

Reasons for taking treatment

- Esthetic

Attitude of patient to treatment - +ve

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Extra oral photographsPRE TREATEMENT

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Extra oral photographsPRE SURGICAL

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Clinical examinationGeneral examinationHeight : 5 feet 10 inches”

Weight : 68kgs

Gait & Posture : Normal

Body type : Mesomorphic

VITALS , PICKLE

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Extraoral examination

Head shape: Mesocephalic

Facial type: Mesoprosopic

Facial symmetry: No gross asymmetry detected

Clinical examination contd..

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Inter canthal - 38.29mm Inter pupillary - 74.43mm Alar base width- 30.74mm Nose dorsum length- 38.20mm Upper 1/3rd - 58 mm Middle 1/3rd – 57 mm Lower 1/3rd -- 62 mm

Clinical examination contd..

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Stomium line to nose: 22mm

Stomium line to chin : 43mm Lips : competent Interlabial gap : 0mm

Clinical examination contd..

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Incisor exposure during smile: full crown exposure

Clinical examination contd..

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Facial profile : Convex

Facial divergence : Posterior divergent

Profile view

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Nose : Normal

Nasolabial angle : Average

Mentolabial sulcus : Deep

Throat angle : Obtuse

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SOFT TISSUE EXAMINATION

Oral hygiene status : Satisfactory

Gingiva : NAD

Oral Mucosa : NAD

Tongue : Normal

Intraoral examination

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HARD TISSUE EXAMINATION

Teeth present :

87 6 5 4 3 2 1 1 2 3 4 5 6 78

1 2 3 4 5 6 77 6 5 4 3 2 1

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Skeletal mid line : Dental mid line

Upper – coincides coincides

Lower – coincides coincides

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Upper arch : U –SHAPE Lower arch : U –SHAPE

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Molar relation –Class II Canine relation – Class

II Overjet - 6mmOverbite – 4mmCurve of spee 3mm on both

sides

Molar relation – Class II

Canine relation – Class II

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Freeway space : 3mm TMJ Exam : NAD Respiration : Nasal

Mandibular movements:

Maximum mouth opening : 40 mm

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Radiographs

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OPG

3rd molars are seen in MAXILLARY quadrant

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Lateral cephalogram

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Burstone analysis- soft and hard tissue.

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MCNAMARA

ANALYSIS

Parameter Normal range Measured value

Inference

Nasolabial angle 102°±8 95° AveragePoint A to N 0±2mm 3mm Increased.Maxillary length 91mmMandibular length

115-118mm 118mm Normal mand. length

Maxillomandibular differential

20-23 ( small25-27 (medium)30-33 (large)

27 mm Medium

Low. ant. facial height

60-63 mm 70mm Increased

MPA 22°±4 22° Normodivergent Facial axis angle 90.0±3.5° 93 ° NormalPog to N -1.8± 4.5mm -5mm Retrognathic Mandible

Maxi. incisor to pt A

4 mm 3 mm Normally up.incisors

Mand. incisor to A-Pog

1-2 mm -3 mm Backwardly placed mand.incisors

Skeletal class II, Normodivergent with backwardly placed l ower incisors

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BJORK’S ANALYS I S

Parameter Normal range

Measured value

Inference

Saddle angle 123 ± 5° 135° Retro postisioned condylar fossa

Articular angle 143 ± 6° 135° Prognathic changesGonial angle 130 ± 7° 117° Anticlockwise rotation of

mand.Total post angle

396° 388° Horizantal growth

Ant cranial base

71 ± 3 mm

71mm Normal

Post cranial base

32 ± 3 mm

33 mm Normal

Ramus height 44 ± 5 mm

57 mm Increased

Mand body length

71 ± 5 mm

79 mm Increased

SN – MP 36° 28 ° Hypodivergent L1to MP 90 ± 3° 99 ° Proclined lower incisors U1to SN 102 + 2° 102 ° Normal upper incisorsPFH(S-Go) 84AFH(N-Me) 120PFH/AFH % 64 ±2% 70% Horizantal growth

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Skeletal A postpubertal 19yrs male patient with

skeletal class II bases, hypodivergent growth pattern and retrognathic mandible.

Dental Angles class II DivI malocclusion with mild

crowded and Proclined lower anteriors.Soft tissue Mesoprosopic face with convex facial

profile, soft tissues matching skeletal base

DIAGNOSIS

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Problem list

1. Skeletal and dental class II2. Backwardly placed mand.incisors3. Retrognathic mandible4. Mild lower anterior proclination5. Convex profile

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Treatment objectives1. Correction of skeletal and dental Class II

relationship2. Correction of proclined Lower incisors. 3. Attaining ideal overjet and overbite4. Attaining pleasing facial profile

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TREATMENT PLAN

As the patient growth is completed and patient having skeletal class II bases because of retrognathic mandible.

• BSSO should be carried out and bring mandibular advancement

of 4 mm.

• If required reduction genioplasty should be done.

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Thank you