Unilateral condylar hyperplasia treated with simultaneous 2-jaw orthognathic surgery and posterior segmental osteotomy.

A 25-year-old woman presented with left condylar hyperplasia, canting-type facial asymmetry, mandibular prognathism, and arch width discrepancy. Bone scintigraphy confirmed the inactive status of the condyle, and the temporomandibular joint functioned within the normal range; thus, orthognathic surgery without condylectomy was performed. To correct facial asymmetry successfully through orthognathic surgery, sufficient dentoalveolar decompensation must be achieved in the presurgical orthodontic phase. In cases of canting-type facial asymmetry, teeth on the nondeviated side are extruded as dentoalveolar compensation. Therefore, vertical decompensation is required for intrusion of the extruded teeth. A miniscrew and resin build-ups were used for the intrusion of teeth, and posterior segmental osteotomy was simultaneously performed with orthognathic surgery for further intrusion. The canting-type facial asymmetry was notably corrected through successful vertical decompensation and close cooperation between orthodontists and maxillofacial surgeons. After 2 years of retention, the treatment results remained stable.

Camouflage treatment of posterior bite collapse in a patient with skeletal asymmetry by using posterior maxillary segmental osteotomy.

Orthodontic treatment of posterior bite collapse due to early loss of molars and the consequent drift of adjacent teeth is complicated. When the posterior bite collapse occurs in patients with facial asymmetry, both transverse and vertical compensation are necessary for camouflage orthodontic treatment. In such cases, posterior maxillary segmental osteotomy (PMSO) can be an effective alternative procedure that simplifies the orthodontic treatment and shows long-term stability through dental compensation within the alveolar bone housing. This case report aimed to describe the orthodontic treatment of maxillary occlusal plane canting caused by severely extruded maxillary teeth in a patient with skeletal facial asymmetry that was corrected with PMSO along with protraction of the lower second molar to replace the space of the extracted first molar. The treatment duration was 18 months, and stable results were obtained after 2 years of retention.