Orthopedic-orthodontic treatment of facial asymmetry developed after condylar fracture in a growing patient.

D. Pizzoni
Hellenic Orthodontic Review 1999;2:43-58.

The case presented is a 10.6-year old boy whose chief complaint was progressive facial asymmetry. The patient’s medical history reveals a facial trauma at age 2.6 years without further diagnosis and treatment. The clinical examination shows the patient’s growth at the start of the spurt, significant facial asymmetry, signs of a previous left TMJ fracture with pain, deviation and limitation in mandibular movements, mandibular asymmetry, a malocclusion characterized by Class I first molar and canine relationships on the right side and Class II first molar and canine relationships on the left side, 5 mm lower midline deviation to the left, and increased overjet and overbite.
The treatment carried out included (a) the use of a repositioning splint placed on the maxillary dental arch worn 24 hours/day in order to increase left condylar growth and improve the reduced mandibular mobility and (b) subsequent orthodontic treatment by means of fixed appliances for tooth alignment and final dental interarch coordination. Very good patient’s motivation and compliance as well as biological response during the pubertal growth spurt allowed to obtain good skeletal, dental and functional correction, with remodelling of the left condyle.

Request for reprints:Dr. Dario Pizzoni, Via Visconti di Modrone 38, I-20122 Milan, ITALY