Orthognathic Surgery for Mandibular Prognathism: A Case Study with 3D Surgical Planning and Post-operative Analysis
- Dr. Park
- Oct 23, 2024
- 2 min read
This case study presents the comprehensive treatment journey of a patient with mandibular prognathism (protruding lower jaw) who underwent orthognathic surgery. The process, from pre-operative planning to 7-week post-operative review, is documented with a focus on 3D surgical planning and post-operative skeletal changes.
Pre-operative Evaluation and Planning:
Comprehensive Data Acquisition: Dental impressions, intraoral scans, and cone-beam computed tomography (CBCT) scans were obtained to capture the patient's dentofacial anatomy. Cephalometric analysis revealed a significant mandibular protrusion with the pogonion positioned 20mm anterior to the nasion..
Virtual Surgical Planning (VSP): Advanced CAD software facilitated precise simulation of surgical movements for optimal facial aesthetics and functional occlusion. This approach allowed for accurate correction of the patient's asymmetry.
Patient-Specific Implants (PSIs): Custom-designed surgical guides and plates were fabricated to ensure precise execution of the planned osteotomies and jaw movements.
Surgical Procedure and Immediate Post-operative Period:
Orthognathic Surgery: The patient underwent bimaxillary surgery involving Le Fort I osteotomy for maxillary repositioning and bilateral sagittal split osteotomy (BSSO) for mandibular setback. A substantial mandibular setback of 21.71mm was achieved.
Post-operative Day 2 CBCT comparison confirmed the accuracy of the surgical movements.
Post-operative Follow-up and Analysis:
Week 5: CBCT analysis after occlusal splint removal revealed:
Skeletal Changes: Superimposition of CBCT images highlighted subtle upward movement of the pogonion and initial occlusal contact in the molar region.
Mandibular Autorotation: The mandible exhibited autorotation, leading to antero-superior rotation of the chin and a reduction in horizontal overjet from 5.77mm to 4.66mm.
Week 7: Clinical examination demonstrated excellent healing with minimal swelling and good interincisal opening.
Discussion:
This case highlights the transformative potential of orthognathic surgery in correcting dentofacial deformities. The utilization of 3D virtual planning and patient-specific implants ensures predictable and accurate surgical outcomes. Post-operative autorotation of the mandible played a significant role in achieving the desired occlusal relationship. Further refinement will be achieved through post-surgical orthodontics.
Conclusion:
Orthognathic surgery is a powerful tool for achieving facial harmony and functional occlusion. This case demonstrates the importance of meticulous planning, precise surgical execution, and comprehensive post-operative monitoring for optimal results.
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