Micrognathia (Lower Jaw Hypoplasia) Bilateral Sagittal Split Osteotomy

Patient with a disproportionately small lower jaw

The patient is a 21-year-old male from Bhopal in Madhya Pradesh, India. His lower jaw has been very small ever since he can remember. He said that he has always had trouble with speech and eating. Snoring has also been a chronic problem for him. He stated that this had made his facial profile appear concave and he hated it.

The patient had faced significant bullying at school and in college. This had caused him to become socially withdrawn and he had few friends. He had the tendency to avoid all social gatherings and led a rather lonely life. This had greatly worried his parents and they had approached a local oral surgeon who examined the patient. Realizing the degree of deformity, the surgeon had referred them to our hospital for corrective jaw surgery.

Specialty center for Oral and Maxillofacial Surgery

Our hospital is a referral center for complicated cases requiring oral and maxillofacial surgery. All the protocols laid down by the American Association of Oral and Maxillofacial Surgeons are rigorously followed by us. We are renowned for orthognathic surgery and facial cosmetic surgery. Surgery costs are also economical when compared with developed Western countries. Open bite correction is a routine part of orthognathic surgery.

Follow up of cases is done long term after surgery with excellent results. Documentation of cases helps in the process of long term follow up of cases. The latest technology is used for the maintenance of up to date patient records.

The patient had always wished to have a masculine appearing prominent lower jaw. He felt that surgical correction of his jaw along with the resultant profile correction would solve all his problems. Our hospital is a premier center for jaw deformity surgery in India. We perform all jaw surgeries ranging from cosmetic jaw surgery to jaw surgery for pathological conditions such as cysts, tumors, etc.

What is micrognathia?

Micrognathia is a condition where the jaw is undersized. It is also sometimes called “mandibular hypoplasia”. This condition is common during infancy. It however is usually self correcting during growth with a gradual increase in the size of the mandible to normal size. Since the jaw size discrepancy will be pronounced during infancy, it can lead to abnormal alignment of teeth. When this is severe, it can even lead to disruption in the feeding patterns of the infant.

A surgical implication of micrognathia in both children and adults is that it can made intubation difficult. Anesthesia is induced through awake bronchoscopic intubation in the presence of micrognathia. Micrognathism, which is true hypoplasia of the mandible is different from retrognathism, which is a backwardly positioned mandible.

Initial presentation at our hospital for management of his problem

Dr SM Balaji, jaw deformity surgeon, examined the patient and obtained a detailed history. Comprehensive imaging studies were obtained for the patient. The patient had an anterior deep bite with class II malocclusion. His lower jaw was retruded and his face had a concave profile. Treatment planning was performed for the patient and he was advised to undergo lower jaw advancement surgery by about 10 mm. It was also explained to him that he would need postsurgical orthodontic treatment for correction of his dental malocclusion. The patient and his parents were in agreement with the jaw osteotomy and consented to surgery. All incisions will be made intraorally to avoid external scarring.

Successful correction of the patient’s micrognathia

Under general anesthesia, incisions were made in mandibular retromolar region bilaterally. Following this, flaps were elevated and bone cuts were made in the mandible. Bilateral sagittal split osteotomy was performed using Obwegeser’s technique. Extreme care was taken to protect the inferior alveolar nerve throughout mobilization of the proximal and distal segments of the mandible. The distal segment of the mandible was advanced by about 10mm. Occlusion was checked, bone was stabilized and fixed using titanium plates and screws. Closure was then done using resorbable sutures.

Complete patient satisfaction at the outcome of the surgery

The patient and his parents were very happy with the surgical outcome as the cosmetic improvement was immediate. His occlusion had become normal and he now had a prominent jaw line and masculine facial profile. He also said that his speech had improved to a great extent following the surgery.

The patient was instructed to return in a few months time for fixed orthodontic treatment. This would help in correction of his malaligned teeth. It was explained that completion of orthodontic treatment would complete rehabilitation of his dentofacial problems.

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