A surgical mandibular advancement performed under local anesthesia and intravenous sedation for a severe skeletal...

A skeletal Class II case is described that was treated orthodontically combined with a simplified technique of surgical mandibular advancement which is associated with low morbidity. The patient was a 14 year, 5 month old boy who presented with a skeletal Class II malocclusion, a large retrusion of the chin, an increased nasolabial angle, maxillary and mandibular asymmetry. There was a Class II dental relationship, a need for space in the mandibular arch of about 10 mm and a deep bite. The maxillary incisors were lingually inclined and the mandibular incisors were labially displaced. Orthodontic treatment alone of this patient was thought inadequate since extractions in the mandibular arch because of the need for space would require extractions in the maxillary arch as well, resulting in a worsening of the profile. A surgicalorthodontic treatment with both maxillary and mandibular advancement was therefore proposed, but the patient refused it because he did not want the general anaesthesia and hospitalization. A compromise treatment was ultimately proposed and accepted by the patient, with the extraction of 2 mandibular premolars and a mandibular advancement with local anaesthesia and intravenous sedation in a 1 day hospital setting. A good occlusal and functional result was obtained together with a satisfying aesthetic improvement and this result was stable at the 4 year control. The surgical procedure of mandibular advancement performed on this patient is an excellent opportunity for the orthodontist to treat Class II malocclusions with a mandibular deficiency.