Patient with a Hereditary Tendency for a Large Lower Jaw Running Through his Family

The patient is a 24-year-old male from Ludhiana in Punjab, India. He has always had a large lower jaw. This caused an unattractive facial structure. The scientific term for this is mandibular prognathism. Many members of his family also have a large lower jaw.

Functional and Esthetic Difficulties Caused by Mandibular Prognathism

This has caused him to have problems with eating and speech. He has also felt very self-conscious because of the cosmetic compromise from the large jaw. Desiring to get this corrected, he and his parents made inquiries with many surgeons including dentists and oral surgeons. They had been referred to our hospital for surgical correction.

Certain syndromes have been associated with a large lower jaw. Acromegaly, which is a condition caused by excess growth hormone in adults results in mandibular prognathism. A percentage of these patients also have gum disease due to chronic mouth breathing.

Specialty Procedures performed in our hospital

A common term for a very large lower jaw is lantern jaw. The chin is extremely prominent and forwardly positioned. Mastication and speech are rendered very difficult in these cases. Patients undergoing facial feminization also undergo jaw reduction procedures.

Our hospital is a specialty center for jaw reconstruction surgery. Le Fort I surgery is performed for retrusion or advancement of the upper jaw. Distraction osteogenesis is also used for the advancement of the retruded maxillaLower Jaw Protrusion – Bilateral Sagittal Split Osteotomy Reduction and retrognathic mandible.

Jaw reduction surgery is routinely performed in our hospital. All these surgeries are performed under general anesthesia in our state of art operating theatres.

Initial Consultation and Examination at our Hospital

Dr. SM Balaji, Specialist in Jaw Surgery, examined the patient. A detailed history was also obtained. He then ordered imaging studies including a 3D CT scan. These are mandatory for patients undergoing jaw surgery.

This showed that the patient had a skeletal overbite of 12 mm. There was also a horizontally impacted right third molar. He had bilateral impacted wisdom teeth. These were also indicated for removal.

Treatment Planning Explained in Detail to Patient and his Parents

Treatment planning was modified as the patient wanted to undergo both procedures at the same time. The mandibular setback is usually performed six months after wisdom tooth extraction, but an exception was allowed in this patient.

The patient will first undergo presurgical fixed orthodontics to decompensate the arch. This would be followed by surgery and postsurgical orthodontics. The last stage of orthodontics would be fine-tuning his dental occlusion. They then consented to surgery.

Wisdom Tooth Surgery Followed by Mandibular Setback

Under general anesthesia, both impacted third molars were extracted. Sectioning of the left third molar was performed to enable easy wisdom tooth extraction. Attention was turned to the bilateral sagittal split osteotomy (BSSO) following wisdom teeth extraction. The bilateral sagittal split osteotomy would enable backward positioning of the lower jaw to achieve good alignment with the upper jaw.

Preservation of Inferior Alveolar Nerve throughout Surgery

Bilateral sagittal split osteotomies were made. The inferior alveolar nerve was mobilized with the proximal segment. This allowed for mobilization of the distal segment. A slice of bone 14 mm was removed from the site of the osteotomy.

The mandible was then set back and occlusion was checked. Stabilization of the mandibular segments was performed with plates and screws. Care was taken to ensure that the inferior alveolar nerve remained safe throughout the procedure.

Complete Patient Satisfaction with Results of Surgery

There was a tremendous immediate improvement in facial esthetics. The patient and his family were very happy with the results of the surgery. They expressed their satisfaction before their final discharge from the hospital.

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Common Jaw Pathologies that require Resection and Reconstruction

Cysts and tumors of the jaws are amongst the most common jaw pathologies. Treatment of these conditions includes jaw resection and reconstruction. The most common cysts of the jaws include dentigerous cysts and odontogenic keratocysts. Dentigerous cysts are always associated with an impacted tooth.

Importance of Jaws towards Overall Human Health

The importance of the jaws towards maintaining optimal physical and mental health cannot be understated. Proper mastication of food is very important in obtaining the nutrition that the body needs to maintain good health. Jaws also play an important role facilitating overall human health.

Effects of Jaw Pathology on Speech and Facial Esthetics

The effects of jaw pathology on speech and facial esthetics can result in a compromise in the overall quality of life. Speech therapy is often required after radical resection of jaws and jaw reconstruction surgery. Maxillofacial surgeons receive specialized training for jaw cyst surgery.

Importance of Jaw Reconstruction Surgery for Returning to Normal Life

Patients who have undergone resection of extensive jaw pathologies are often left with residual facial deformities. Patients thus affected require jaw reconstruction surgery for returning to normal life.

Cystic conditions like dentigerous cysts and odontogenic keratocysts often cause the destruction of the jawbone. Mastery over jaw reconstruction surgery takes many years to attain and is technique sensitive.

Preferred Sites for Harvesting Bone Grafts for Jaw Reconstruction Surgery

Bone grafts for jaw reconstruction surgery are harvested from three preferred sites. The preferred sites for harvesting bone grafts among different surgeons include the long bones of the legs, hips and ribs.

Harvesting sufficient bone from the hips leads to a deformity in the region. An unsightly scar is usually the result of harvesting sufficient quantities of bone from the tibia.

Ideal Site for Harvesting Bone for Jaw Reconstruction Surgery

The ideal site for harvesting bone for jaw reconstruction surgery is from the rib region. There is complete regeneration of the bone when the periosteal continuity is not compromised following surgery. Scarring is also minimal as multiple grafts can be harvested through a single incision.

Leading Center for Jaw Reconstruction Surgery and Facial Plastic Surgery

Our hospital is a leading center for jaw reconstruction surgery following resection of jaw pathologies. Results from facial plastic surgery have won us many international accolades. We have over 30 years of experience in successfully reconstructing a wide variety of jaw defects.

Types of jaw surgery performed here include orthognathic surgery and surgery for receded lower jaws. Other procedures performed include removal of odontogenic cysts and mandibular osteotomy. Corrective jaw surgery is performed through intraoral small incisions.

We also address radicular cysts, nevoid basal cell carcinoma syndrome, giant cell lesions and fibrous dysplasia.

Patient Referred to our Hospital for Management of the Jaw Pathology

The patient is an 18-year-old female from Cuttack in Odisha, India. She had developed pain and swelling in the right side of her mandible approximately one year ago. The swelling was gradually progressive and greatly alarmed them.

They presented at a local hospital where imaging studies demonstrated a radiolucent lesion enclosing an impacted third molar. The lesion extended from the body into the ramus of the mandible. A diagnosis of dentigerous cyst was made.

She had subsequently undergone enucleation of the cyst. The teeth associated with the cyst were also extracted. Jaw reconstruction had however not been performed. The patient and her parents were very unsatisfied with the treatment.

Unfortunately, the swelling and pain returned approximately four months ago. They had visited another local hospital where imaging studies had been obtained. Diagnosed with a recurrent dentigerous cyst, they were referred to our hospital for management of her recurrent dentigerous cyst.

Initial Presentation at our Hospital for Redo Dentigerous Cyst Surgery

The patient and her parents made their initial presentation at our hospital for her redo dentigerous cyst surgery. Our hospital exclusively uses bone grafts harvested from the ribs. We have successfully performed redo dentigerous cyst surgery for many patients with failed iliac and femoral grafts.

Jaw Reconstruction Surgery followed by Dental Implant Surgery

Treatment planning was explained to the patient and her parents. They consented to the redo dentigerous cyst surgery. She first underwent the redo dentigerous cyst surgery. This was followed by jaw reconstruction surgery using titanium reconstruction plate and rib grafts.

A second procedure was performed four months later. This was dental implant surgery in the reconstructed jaw bone. The time period was to allow for consolidation of the bone grafts with surrounding alveolar bone. The patient and her parents were very happy with the results of the surgery.

Patient Instructed to Return in Four Months for Ceramic Crowns

The patient and her parents were instructed to return in four months for ceramic crowns. This interim period would allow for complete osseointegration of the dental implants to the surrounding bone.

The patient and her patents expressed understanding of the instructions. They were very happy with the level of care given to them at our hospital.

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