Early orthognathic surgery in response to bullying due to malocclusion

Urifavourable dental and facial features can have a psychological impact on patients. Orthodontic treatment can have a positive impact on the psychosocial well-being of patients who are bullied about dentofacial features. The use of orthognathic surgery in growing patients to correct dentofacial deformity is a controversial topic. This case report describes the treatment performed for a 13-year-old girl who presented complaining of a "different bite and prominent chin", which was attracting insults at school. Insults regarding her teeth and jaw caused symptoms such as anxiety and stomach pains prior to school in the morning. As a result of the negative psychological effects of the serious bullying, it was decided to proceed with early orthognathic surgery for psychological reasons. As orthognathic surgery is usually timed in the late teens, or early twenties when growth is near completion, the risks of further growth and relapse were discussed at length with the patient and her parents, especially when informed consent was being obtained. Treatment included orthodontic alignment of the arches, early orthognathic bimaxillary surgery and post-surgical orthodontics to detail the occlusion. There was a dramatic improvement in the patient's self-esteem, with return to school and extra school activities only weeks after the surgery. This case demonstrates that early intervention may be appropriate for some orthognathic patients in exceptional circumstances. The patient and her parents were very happy with the outcome but post-treatment growth was unfavourable as expected.