Dr. RAHUL VC TIWARI, SIBAR INSTITUTE OF DENTAL SCIENCES, GUNTUR, ANDHRA PRADESH, INDIA.FACIAL ASYMMETRY CASE PRESENTATION

1. CASE PRESENTATION
ORTHOGNATHIC SURGERY
PRESENTED BY
Dr. RAHUL TIWARI
3RD YEAR MDS - PG Student
DEPT. OF ORAL & MAXILLOFACIAL SURGERY
SIBAR INSTITUTE OF DENTAL SCIENCES
1

2. PRELIMNARY DATA
 Patient name – D SRINU Date – 23/07/2016
 Age / sex – 22/M O.P.No. – 730541
 Occupation – STUDENT Religion – HINDU
 Marital status – UNMARRIED Blood group – O +VE
 Date of birth – 20/6/1992 Socioeconomic status – GOOD
 Address – CHIRALA GUNTUR Contact no. – 0961887515
2

3. PATIENT CHIEF COMPLAINT
 UNAESTHETIC APPEARENCE
3

4. HISTORY OF PRESENT ILLNESS
 2002- CONDYLECTOMY – 10 YRS AGE- CHENNAI
 07/12/2015- SIDS- LE FORT 1, UNI. SAG RT. , IVRO LT. SIDE
4

5. HISTORY
 Past Medical History – NRH
 Past Dental History – ORTHOGNATHIC SURGERY
 Family History – NRH
 Personal History – NRH
 Drug History - NRH
5

6. GENERAL PHYSICAL EXAMINATION
 Height – 5’9” Weight – 68KG
 Gait – NAD Built – AVERAGE
 Nourishment – FAIR Signs of Clubbing – NO
 Pulse – 78 Resp. Rate – 22
 Blood Pressure- 130/84 Temperature – AFEBRILE
 P.I.C.K.L.E. - NO
6

7. EXTRA ORAL EXAMINATION 7

8. EXTRA ORAL EXAMINATION 8

9. OCCLUSION
9
R.S- 26

10. OTHER FINDINGS 10
OVERJET & OVERBITE

11. INTRA ORAL EXAMINATION 11

12. ANALYSIS 12
 ASYMMETRIC FACE
 INNER INTER CANTHAL- 32MM
 INTER PUPILARY – 67MM
 ALAR BASE WIDTH- 31MM
 NOSE DORSUM LENGTH- 43MM
 COLLUMELLA HEIGHT0- 10 MM
 MOUTH WIDTH- 48MM
 MOUTH OPENING – 52MM
 UPPER FACE- 55MM
 MIDDLE FACE- 49MM
 LOWER FACE – 73MM
 FACAIL FIFTHS – DISSIMMILAR
 C CURVE – ONE BREAK
 NASAL CONTOUR – CONVEX
 NASOLABIAL ANGLE- ACUTE
 UPPER LIP – 17MM
 LOWER LIP – 46MM
 LIP POSTURE- INCOMPITENT
 LIP CONTOUR- EVERTED
 LIP TEXTURE – FISSURED

13. ANALYSIS 13
 INCISAL SHOW AT SMILE – 4MM
 INCISAL SHOW AT REST- 2MM
 GINGIVAL EXPOSURE – 0MM
 CHIN FORM – RECESSIVE
 MENTOLABIAL SULCUS- SHALLOW
 MENTALIS ACTIVITY – ABSENT
 CHI THROAT ANGLE- OBTUSE
 DENTAL MIDLINE – 2MM DEVIATED RT. SIDE
 OVERJET – 11MM
 OVERBITE- 10 MM
 MOLAR RELATION- ABSENT
 CANNINE REALTION- CLASS I
 BRACHYCEPHALIC HEAD
 LEPTOPROSCOPIC FACE

14. INVESTIGATIONS- RADIOLOGICAL 14

15. INVESTIGATIONS- RADIOLOGICAL 15

16. INVESTIGATIONS- RADIOLOGICAL
16

17. INVESTIGATIONS- RADIOLOGICAL 17

18. 18
PRE OPERATIVE POST OPERATIVE

19. 19
P
R
E
-
O
P
E
R
A
TI
V
E

20. ANALYSIS
20
P
O
S
T
-
O
P
E
R
A
T
I
V
E

21. ROCKYMOUNTAINANALYSIS
21
11.5 mm
10.8 mm
0 mm
0.7 mm
85.8 mm 72.1 mm
66.2 mm 65.2 mm
85.8-66.2 =19.6
72.1-65.2 = 6.7
19.6-6.9 = 12.7
(1.27 cm.)

22. VTO
22

23. INVESTIGATIONS-HEAMATOLOGICAL
 CBP
 GRBS
 VIRAL MARKERS
 OTHERS - PAC
23

24. PROBLEM LIST
 ASYMMETRIC FACE
 ASYMMETRIC CHIN
 TEETH SHOWN DURING REST
 ANTERIOR PROCLAINED TEETH
24

25. DIAGNOSIS
 FACIAL ASYMMETRY
25

26. PREVIOUS SURGERIES
 CONDYLECTOMY ON LEFT SIDE
 LE FORT 1 OSTEOTOMY
 UNILATERAL SSRO ON RIGHT SIDE
 IVRO ON LEFT SIDE OF MANDIBLE
26

27. TREATEMENT PLAN
 ILEAC CREST GRAFTING FROM ANGLE TO BODY ON RIGHT SIDE
 PROPELLAR GENIOPLASTY ON THE ANTERIOR MANDIBLE
 ANTERIOR MAXILLARY OSTEOTOMY OF SETBACK OF 4MM
27

28. ILEAC GRAFT HARVESTING
28

29. PROPELLER GENIOPLASTY
29

30. ANTERIOR MAXILLARY OSTEOTOMY
30

31. THANK YOU
31