Orthognathic correction of a craniofacial deformity in a patient with a mutilated dentition: a case report

Orthognathic surgery is routinely performed for patients with dentofacial deformity and has been conducted for more than 100 years (1). Orthognathic Surgery is a functional and esthetic surgery that affects patients self perception. Patients have noted an improvement in their facial appearance after orthognathic surgery that was associated with improvement in psychosocial adjustments (2). When the decision to move both the maxilla and the mandible is made, there are numerous variables to be considered. Among these variables are the stability of double jaw surgery, improving the masticatory function of the patient and lastly, the esthetic result. Past studies have also looked at patient concerns including temporomandibular joint symptoms, speech difficulties and problems with mastication. In one study by Rivera and colleagues who studied 143 patients pre-operatively found 71 pecent with esthetic concerns (3), 47 percent had functional concerns and 28 percent had temporomandibular joint concerns. Traditional treatment planning for two-jaw surgery uses the condyle as the point of rotation with the mandibular occlusal plane being used as a template for setting the maxillary teeth (4). This approach, which allows clockwise and counterclockwise rotation of the mandible gives stable skeletal results. Recent studies appear to indicate that long term stability is achieved mainly when rigid fixation is employed. Orthognathic surgery is only one part of the process to correct a dentofacial deformity. The process starts with the initial diagnosis, followed by a treatment plan and then patient consent. Treatment generally begins with a dental assessment to correct decay, followed by orthodontic decompensation in preparation for surgical intervention. Orthognathic surgery is followed by postoperative orthodontia to maximize the occlusal relationship. This process underscores the skill and detailed communication between orthodontist and oral surgeon, and emphasizes the crucial aspect of team approach in such complex surgical cases. We present here a report on a patient who had a mutilated dentition both in the maxilla and mandible along with a craniofacial deformity.