Free Online Library: Hiperplasia condilar, diagnostico y manejo clinico a proposito de un caso clinico.(CASO CLINICO, Ensayo) by “Revista Facultad de. Case report. Facial asymmetry secondary to mandibular condylar hyperplasia. A case report. Alberto Wintergerst Fisch,* Carlos Iturralde Espinosa,§ Santiago. Title: Tratamento da assimetria facial causada por hiperplasia condilar: série de casos. (Portuguese); Alternate Title: Treatment of facial asymmetry caused by.
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The case of a 20 year old man with severe class III maloclussion due to mandibular prognathism and maxillary retrusion who also presents severe laterognathia with condylar hyperplasia and deficient zygomatic projection with dental crowding caused by a collapsed maxilla is hereby presented. The treatment objectives were: Treatment consisted in 3 phases: The maxilla was advanced 5 mm and intruded 3 mm in the posterior region with a Le Fort I osteotomy.
A vertical osteotomy with an extraoral approach was performed in the mandible for the correction of the laterognathia. Intermaxillar fixation was used after surgery. Los objetivos del tratamiento fueron: Along with overcrowding it is among the main reasons for seeking an orthodontic consult. The age at which the patient arrives for consultation is crucial in the decision for the kind of treatment: Some patients have problems adapting to significant changes in their facial appearance.
This tends to be a bit more problematic for older patients. Generally patients who are candidates for orthognathic surgery present a natural compensation hoperplasia their malocclusion which is why it is of great importance to let the patient know at the time when orthodontic decompensation happens, that the asymmetry and the maxillofacial discrepancy will be more noticeable.
In cases of prognathism and maxillary collapse a transverse compensation of both arches may exist so it is also important to match the size of the dental arches transversally in order to provide a correct oclusion. Male patient of 20 years of age presents to the Clinic of Orthodontics with the following chief complaint: Cephalometrically, a skeletal class III by prognathism and maxillary hypoplasia was observed, a laterognathia with severe unilateral condylar hyperplasia hiperplazia present and also a zygomatic-malar depression Figures 1 and 2.
Initial panoramic and lateral radiographs. CAT that shows the degree of discrepancy and maxillomandibular asymmetry.
HIPERPLASIA CONDILAR: CARACTERÍSTICAS, MANIFESTACIONES, DIAGNÓSTICO Y TRATAMIENTO. REVISIÓN DE TEMA
The treatment consisted of three phases: A 5 mm maxillary advancement with a posterior intrusion of 3 mm was performed as well as vertical osteotomies of the mandibular ramus with extraoral access.
The fixation was intermaxillary. A gammagraphy was requested with the purpose of ruling out active condylar growth Figure 3. Frontal tomographic slice hiperplaxia shows the maxillomandibular discrepancy.
Gammagraphy that shows the end of metabolism and active cell proliferation in the mandible. Intraorally, there is a collapsed maxillary dentition with severe crowding in the upper arch and moderate crowding in the lower Figure 4. On the facial analysis, a considerable asymmetry and a depression hiperplasua the middle third is observed Figure 5.
Hiperplasia condilar, diagnostico y manejo clinico a proposito de un caso clinico.
Due to the collapsed maxilla, the posterior crossbite and age of the patient at the initial time of treatment, the treatment options were: Faced with the refusal of the patient for a second surgical intervention a second treatment plan is designed: After consulting with the patient, the following treatment plan is chosen: Extractions of the dental organs 15 and 24 were performed and fixed orthodontic appliances.
With that procedure, the pre-surgical jiperplasia begins. By correctting the compensation with dental retroclination oftheupperincisorsandproclinationofthelower teeth, they are aligned into their bony bases and ready for surgery. The patient is subjected to a Cone Beam CT scan to be sure that there was no damage to the external cortical of the maxilla.
The orthodontic surgical prediction was sent to the Department of Maxillofacial Surgery. Along with the surgery of models, it was arrived to a hiperlasia surgical treatment plan Figure 6. Surgical prediction from the Department of Orthodontics. Prior to surgery routine laboratory analysis are carried out and additionally, a bone scan SPECT bone of the skull and facial massif with MDP-Tcm was requested to make hiperplzsia that there was no active cell proliferation at the level of the condyle which could cause a relapse in the asymmetry and the laterognathia caused by the condylar hyperplasia on the right side.
The surgery was in charge of the maxillofacial surgeon Juan Carlos Lopez Noriega and the fourth-year resident Carlos Acosta Behrends from the department of maxillofacial surgery. In a surgery that lasted four and a half hours under general anesthesia the following was performed: Posterior intrusion 3 mm. A high Le Fort I was performed to correct the zygomatic deficiency. Vertical osteotomies of the mandibular ramus with extraoral access were performed to correct the asymmetry and check the verticality of the patient.
An intermaxillary fixation was placed and the patient had his mouth closed for four weeks Condilaf 7. Thus, it was necessary to keep the jaw in a stable position to avoid postsurgical relapse. During surgery and the post-surgery weeks several brackets debonded so it was to order a panoramic radiograph to reposition and replace the lost appliances. Prior to the withdrawal of the appliances, a braided. After debonding the appliances, final models are taken for the confection of the retainers.
In condilsr lower arch, 3 to 3 fixed retention was placed with twisted wire. In the upper arch, a circumferential retainer was placed.
The extra and intraoral photographs show positive results. The facial asymmetry was corrected, the midface depression and the zygomatic- malar deficiency improved. The profile changed significantly due to the maxillary advancement and the mandibular retrusion. Cephalometrically, the dental compensation was corrected and the verticality of the patient decreased due to the maxillary intrusion and mandibular auto rotation Figure 8. Comparison between pre and cnodilar radiographs. Oclussally, the bilateral posterior crossbite was corrected.
Canine class I and an adequate posterior intercusp relationship in functional molar class II were obtained as well as a correct overbite and overjet and canine guidance as a disoclussion system. The facial and dental aesthetics improved Figure 9. A high Le Fort I osteotomy is favorable for the correction of maxillary deficiencies and lack of zygomatic projection.
At the same time, the choice of vertical osteotomies in the mandible along with the posterior maxillary intrusion allowed the redirection of the mandible by counter-clockwise rotation Figure Comparison of the pre and post-surgical CAT scans.
Facial changes during treatment.
A correct diagnosis as well as the correct interdisciplinary planning is essential for a successful treatment. We must take into consideration the limitations that a treatment may have when it is performed only by orthodontic camouflage, as well as the anatomical limitations that orthognathic surgery has in severe discrepancies such as the present case.
It is important to psychologically dondilar the patient to accept the major changes that occur during and after the surgical-orthodontic treatment Figure Inicio Revista Mexicana de Ortodoncia Severe prognathism and laterognathia, condilar hyperplasia with considerable fac Under a Creative Commons license. Along with hipfrplasia it is among the main reasons for seeking an orthodontic consult.
This tends to be a bit more problematic for older patients. Initial panoramic and lateral radiographs. CAT that shows the degree of discrepancy and maxillomandibular asymmetry. Gammagraphy condikar shows the end of metabolism and active cell proliferation in the mandible. Surgical prediction from the Department of Orthodontics. Comparison between pre and post-treatment radiographs. Comparison of the pre and post-surgical CAT scans.
Facial changes during treatment. Elimination of transverse dental compensation is critical hiperplasiw treatment of patients with severe facial asymmetry.
Asimetría facial secundaria a hiperplasia condilar mandibular: Reporte de un caso
Am J Orthod Dentofacial Orthop. Class III malocclusion with complex problems of lateral open bite and severe crowding successfully treated with miniscrew anchorage and lingual orthodontic hiperlasia. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty I. Surgical procedures to correct mandibular prognathism and reshaping of the chin. Contemporary treatment of dentofacial deformity.
Prognatismo y laterognasia severos, hiperplasia condilar Skeletal class III with laterognathia and lower facial Revistas Revista Mexicana de Ortodoncia. Si continua navegando, consideramos que acepta su uso.
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