Cases reported "Facial Asymmetry"

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11/30. A European Board of orthodontics case report. Case category: severe skeletal discrepancy.

    OBJECTIVES: this 18.1 year-old girl presented with a chief complaint of progressive worsening of facial and dental esthetics, crowding, headache and facial pain. MATERIALS AND methods: clinically, she was at the end of her growth and exhibited a severe facial asymmetry, but with normal sagittal and vertical cranial relationships. Clicking in the right TMJ was evident. This was accompanied by a deviation upon opening, and pain in the joint. The pain she experienced during jaw movement, and upon palpation, was significant. There was a shift to the right from centric relation to intercuspal position. Intraorally, the tissues were normal, with mild tetracycline staining, still present primary canines, impacted third molars and upper permanent canines. Her first molars had fillings. Orthodontically, her occlusion was a severe Class III subdivision left, with a severe right-side crossbite, lower midline deviation to the right 6 mm, and a 1 mm lateral shift in intercuspal position. She also exhibited severe crowding and asymmetry in both arches. The sequence of her treatment was as follows: (a) extraction of primary canines and impacted third molars, surgical exposure of impacted canines, (b) lower occlusal splint for TMJ dysfunction and an upper arch fixed appliance for ideal alignment and leveling, (c) upper occlusal splint for the maintenance of TMJ function and lower arch fixed appliance for ideal alignment and leveling, (d) surgical skeletal correction, (e) post-surgical orthodontic finishing, (f) post-treatment retention.
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ranking = 1
keywords = vertical
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12/30. Utilization of third molars in the orthodontic treatment of skeletal class III subjects with severe lateral deviation: case report.

    AIM: This clinical report discusses the importance and use of third molars in the adult patient by presenting a case in which their use during orthodontic treatment allowed occlusal improvement. SUBJECT AND TREATMENT PLAN: The patient was a Japanese adolescent boy who had a skeletal Class III malocclusion with severe lateral deviation of the mandible, significant loss of posterior occlusal vertical dimension, due to premature loss of the maxillary and mandibular left first molars, and furthermore, both first molars had advanced carious lesions that had resulted in reduced crown heights and bilateral chewing surfaces. The mandible had shifted to the left, with a bilateral chewing pattern and a lack of posterior vertical alveolar height, which in turn had produced an abnormal occlusal plane and curve of Spee. The maxillary arch was expanded, the maxilla was moved downward and forward, and the mandible was moved slightly backward and rotated open to increase posterior vertical alveolar and crown height. The reconstruction of a functional occlusal plane was achieved by uprighting the posterior teeth to correct asymmetric posterior vertical alveolar and crown height, using a full multibracket system incorporating four third molars and closing the space from the missing first molars and extraction of the questionable first molars. RESULTS: A normal overbite and overjet and adequate posterior support and anterior guidance were established, achieving a better intercuspation of the posterior teeth. A favorable perioral environment was created, with widened tongue space to produce an adequate airway. A well-balanced lip profile and almost symmetric face were achieved using the four wisdom teeth without extraction of the four premolars. Subsequent mandibular growth, with development of posterior vertical alveolar height and temporomandibular joint adaptation, has resulted in an almost symmetric posterior vertical height and joint structure between right and left sides. These factors have contributed to the occlusal stability maintained for more than 5 years. CONCLUSION: In the growing patient, with missing and/or early advanced caries of the first molars, it may be more beneficial to plan occlusal improvement through extraction of the questionable first molar rather than premolar extraction. This method of treatment can equalize posterior vertical dimension and does not restrict tongue space. In addition, this treatment method addresses the clinician's concern about postorthopedic relapse due to tongue habits and eruption of the third molars.
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ranking = 7
keywords = vertical
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13/30. Features and treatment of skeletal class III malocclusion with severe lateral mandibular shift and asymmetric vertical dimension.

    AIM: To highlight the effectiveness of orthodontic treatment and bilateral equalization of the vertical occlusal dimension, along with the correction of asymmetric cervical and masticatory muscle activities in patients with Class III malocclusion with lateral deviation of the mandible and severely asymmetric condyle and ramus. methods: Two normally growing and one nongrowing Japanese patients with severe lateral deviation of the mandible, asymmetric vertical occlusal dimension, and severely asymmetric temporomandibular joints are discussed. In addition to orthodontic treatment, all patients received physiotherapy of the cervical muscles and gum-chewing training for elimination of the masticatory muscular imbalance. patients also had postural training during treatment. All patients were treated with a bite plate to equalize the bilateral posterior vertical dimension, followed by full multi-bracketed treatment to establish a stable form of occlusion and to improve facial esthetics. RESULTS: This interdisciplinary treatment approach resulted in normalization of stomatognathic function, elimination of temporomandibular joint dysfunction symptoms, and improvement of facial appearance and posture. In growing patients, the significant response of the fossa, condyle, and ramus on the affected side during and after occlusal correction contributed to the improvement of cervical muscle activity. In contrast, less improvement was observed in the growing patient who did not receive physiotherapy of the neck muscles, postural training, or masticatory habit training during the posttreatment period. The nongrowing patient showed little morphologic improvement of the cervical spine, condyle, and fossa during treatment and after retention, even with physiotherapy of the neck muscles and attention to posture and masticatory habits. CONCLUSION: Based on these results, early occlusal improvement, combined with physiotherapy to achieve muscular balance of the neck and masticatory muscles, was found to be effective. It is important to assess the morphology and function of the neck muscles and cervical spine prior to occlusal therapy in patients with an asymmetric vertical dimension, lateral deviation of the mandible, and asymmetric temporomandibular joint structures. Therapy should correlate orthopedic and surgical patient management as needed.
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ranking = 8
keywords = vertical
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14/30. Use of orthopedic finger distractor for facial asymmetry correction.

    facial asymmetry after unilateral ankylosis results due to the loss of the condylar growth center on the ankylosed side. This results in the skeletal midline deviating to the affected side, a lack of vertical growth on the same side produces a cant of the occlusal plane and mandibular retrognathism is seen as a result of the hypoplasia. The lower border of the mandibular corpus and angle on the contra lateral side is usually flattened. We report a case of facial asymmetry following unilateral ankylosis, which was treated by a combined approach with distraction osteogenesis and orthodontics. Inexpensive orthopedic finger distractors were used. The facial changes were analyzed using the Grummons facial asymmetry analysis.
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ranking = 1
keywords = vertical
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15/30. Italian Board of orthodontics: case N. 2 adult malocclusion.

    OBJECTIVES: this 20,2 year-old girl presented with a class III malocclusion with severe crowding. MATERIALS AND methods: she was at the end of her growth with a severe skeletal and dental class III malocclusion with lower midline deviation and severe crowding. A concave profile, due to chin's prominence, was present. Lower vertical third of the face increased. No signs or symptoms of TMJ problems were present: lingual position of 12 and 22 is a potential problem for TMJ's health. The state of oral mucosa and gingiva was good. But oral hygiene was not good. Lower midline deviated 3 mm to the left side; canine and molar class I on the right side and class III on the left side. The sequence of her treatment was as follows: a) extraction of 15, 25, 35, 44; b) upper and lower arch fixed appliance for alignment, leveling, correction of lower midline and occlusal relationship; c) post-treatment retention.
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ranking = 1
keywords = vertical
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16/30. A new protocol of Tweed-Merrifield directional force technology with microimplant anchorage.

    Tweed-Merrifield directional force technology with microimplant anchorage is a useful treatment approach for a patient with a Class I or Class II dentoalveolar-protrusion malocclusion. It can create a favorable counterclockwise skeletal change and a balanced face without patient compliance. In contrast, headgear force with high-pull J-hook can obtain similar results but depends on patient cooperation. This case report presents the treatment of a patient with Class I canine and molar relationships, a convex profile with retrognathic mandible and marked lip protrusion, and excessive lower anterior facial height. Good facial balance was obtained by Tweed-Merrifield directional force technology with microimplant anchorage, which provided horizontal and vertical anchorage control in the maxillary and mandibular posterior teeth, and intrusion and torque control in the maxillary anterior teeth, resulting in a favorable counterclockwise mandibular response.
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ranking = 1
keywords = vertical
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17/30. Case report MM. Surgical-orthodontic correction of bilateral buccal crossbite (Brodie syndrome)

    A surgical approach to treatment was required for this 35-year-old patient to correct a malocclusion characterized by a bilateral buccal crossbite. Surgical procedures included a LeFort 1 osteotomy to reduce maxillary width and correct the vertical asymmetry. The mandible was lengthened with a bilateral sagittal split osteotomy. Treatment options for the nongrowing patient are limited in the correction of severe skeletal disharmonies.
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ranking = 1
keywords = vertical
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18/30. An autosomal dominantly inherited syndrome of facial asymmetry, esotropia, amblyopia, and submucous cleft palate (Bencze syndrome).

    This is the second report of a dominantly inherited syndrome of facial asymmetry, esotropia, and amblyopia (Bencze syndrome). The phenotypic spectrum is expanded to include submucous cleft palate. The observation for the first time of male-to-male transmission seems to confirm an autosomal dominant mode of inheritance. The facial asymmetry in this family was mild and did not require surgical intervention. With the exception of one patient who had other abnormalities, intelligence was normal.
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ranking = 0.0091761724269098
keywords = transmission
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19/30. Hemihypoplasia of the mandible combined with lateral open bite corrected by sandwich technique. A case report.

    A hemihypoplasia of the body of the mandible and the ascending ramus on the left side, combined with a lateral open bite on the right side is described. Operative reconstruction on the left side was performed by sandwich technique. The correction of the lateral open bite involved the following: vertical ramus osteotomy on the right side, paramedian vertical body osteotomy on the left side, moving the body of the mandible upwards into the predetermined position.
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ranking = 2
keywords = vertical
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20/30. Familial facial asymmetry (autosomal dominant hemihypertrophy?).

    A family in which several members were affected with facial hemihypertrophy is reported. Mandibular asymmetry and maxillary hypoplasia were common to all affected persons in this family. An autosomal dominant mode of inheritance appears to be the pattern of transmission of such a condition.
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ranking = 0.0091761724269098
keywords = transmission
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