Combined Therapy for Mandibular Prognathism: Sagittal Split Osteotomy with Excision of Tongue

Abstract

In the evaluation of the beauty and functional integrity of the lower face, the oral cavity, teeth, mandible, maxilla, and the size and position of the tongue are important. The tongue locates forward and is larger than normal in prognathism, in which the jaw protrudes from the skull. It is not clear whether an enlarged tongue causes the open bite, protrusion or dental arch misalignment, or is a result of them. Here, we report two patients with mandibular prognathism and relative macroglossia, which were treated by mandibular setback surgery using a bilateral sagittal split osteotomy (BSSO) and excision of the tongue. This procedure achieved aesthetic improvement of the face and dentition.

A Case Report on Surgical–Orthodontic Correction of Skeletal Class III Malocclusion with Severe Prognathic Mandible and Retrognathic Maxilla

“…[ 15 ] The tongue locates forward and is larger than normal in mandibular prognathism. [ 16 ] The force exerted by the enlarged tongue on the lingual surfaces of the maxillary teeth may cause proclination of the maxillary incisors. The dental changes may also be due to the natural tendency of the body to attain normal occlusion.…”

Inborn errors of metabolism and their impact in paediatric dentistry

“…4 Clinically, this is of importance to dentists due to its correlation with an increased incidence of anterior open bite (AOB), bimaxillary proclination and a skeletal III base (mandibular prognathism in relation to the maxilla, or cranial base, or maxillary hypoplasia in relation to the cranial base). 20 Such prognathism, which can also be seen in the Alpha mannosidosis and Pompe disease (GSD type II) 5 (in the absence of macroglossia) can cause functional, masticatory, speech, and aesthetic challenges. 14,21 In MPS, the macroglossia can be attributed to glycosaminoglycan accumulation in the head and neck region, with hypertrophy of the adenotonsillar region and upper and lower airway being commonly observed.…”

“…Macroglossia can be found in mucopolysaccharidoses, mucolipidosis II, glycogen storage disorder type II and multiple sulfatase deficiency 4 . Clinically, this is of importance to dentists due to its correlation with an increased incidence of anterior open bite (AOB), bimaxillary proclination and a skeletal III base (mandibular prognathism in relation to the maxilla, or cranial base, or maxillary hypoplasia in relation to the cranial base) 20 . Such prognathism, which can also be seen in the Alpha mannosidosis and Pompe disease (GSD type II) 5 (in the absence of macroglossia) can cause functional, masticatory, speech, and aesthetic challenges 14,21 …”

Overview on the Anatomical and Clinical Aspects of Mandibular Prognathism

“…Pseudo macroglossia, or relative macroglossia, is defined as the tongue being normal in size, but appearing large due to its anatomical reciprocation. The tongue locates forward and is larger than normal in prognathism, and this macroglossia may cause problems such as Class III malocclusion and an open bite (32) .…”