Orthodontics First in Hemimandibular Hyperplasia. “Mind the Gap”

Abstract

A 32-year-old man was referred to the Division of Orthodontics of the University of Naples “Federico II”, with a 15-year history of gradually increasing right-sided facial asymmetry. Clinical and radiological examinations was consistent to hemimandibular hyperplasia, a rare developmental asymmetry characterized by three-dimensional enlargement of one-half of the mandible. The standard surgical-orthodontic management was proposed to the patient. However, he refused to undergo bimaxillary orthognatic surgery. Therefore, a different treatment was proposed based on the orthodontic technique of pre-surgical decompensation and post-surgical refinement used in bimaxillary orthognatic surgery planning, and surgical intervention with a condylectomy. The dental arches were evenly levelled out with a multi-bracket treatment and then the condylectomy was performed. Orthodontic treatment continued with a levelling and torque control by 0.19 × 0.25 SS arch and physiotherapy. At the three-month follow-up, the patient showed anterior and posterior bite rebalancing, arch intercuspation recovery, and anterior open bite closure due to muscular self-rebalancing. The two-year follow-up showed regular mandibular dynamic, orthodontic appliances were removed, and the patient was instructed to wear retainer for the following months. The final result was aesthetically reasonable for the patient, although slight asymmetry of the chin persisted.

What Features on Routine Panoramic Radiographs Could Help Orthodontists to Estimate the Occurrence of Condylar Hyperplasia from Other Mandibular Asymmetries—Retrospective Analysis Study

“…Occurrence of skeletal class III is most common. Quite often, skeletal and dental features include asymmetrical angle skeletal class III malocclusion, which corresponds with other studies such as that by López et al or Vernucci et al [8,14,16]. Clinically, a one-sided shifting chin is followed by overgrowth of the mandibular basis on the affected side, which also includes soft tissue changes in disproportion and asymmetry in mouth angle position and lip visualization.…”

“…If radiological features of asymmetry are troublesome in full evaluation, a SPECT-CT evaluation of pathological bone growth is sensitive enough (86%) to confirm the diagnosis, which correlates with the study of Nolte et al and others [11,13,14]. SPECT-CT could have also a great amount of false positive results, which should be taken into consideration, and the study itself should be repeated in time [8,13,15]. When pathological growth is present, a condylectomy procedure is scheduled.…”

“…Alyamani and Abuzinada described 18 cases, where 15 were females [4]. On the other hand, other authors also indicate slight female predominance [5][6][7][8][9][10][11][12][13]. Etiological factors remain unknown, but many are taken into consideration, especially endocrinal and trauma followed by other factors such as genetic, hereditary, or perhaps even iatrogenic once in the close proximity of the joint [5][6][7][8].…”

“…On the other hand, other authors also indicate slight female predominance [5][6][7][8][9][10][11][12][13]. Etiological factors remain unknown, but many are taken into consideration, especially endocrinal and trauma followed by other factors such as genetic, hereditary, or perhaps even iatrogenic once in the close proximity of the joint [5][6][7][8]. Perhaps, other factors might be related to geographical regions and other possible individually driven factors.…”

Novel Unilateral Dental Expander Appliance (UDEX): A Compound Innovative Materials

“…Otherwise, a mandibular lingual arch must be inserted to avoid lingual tipping and constriction of the mandibular arch. Like removable appliances, elastics require patient compliance and might extrude the involved teeth with the force's vertical component [22,23]. This extrusion effect is undesirable in vertical growers and patients with little overbite.…”