26. d srinu facial asymmetry dr. rahul vc tiwari, sibar institute of dental sciences, guntur, andhra...

CASE PRESENTATIONORTHOGNATHIC SURGERY

PRESENTED BY

Dr. RAHUL TIWARI

3RD YEAR MDS - PG Student

DEPT. OF ORAL & MAXILLOFACIAL SURGERY

SIBAR INSTITUTE OF DENTAL SCIENCES

1

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

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PATIENT CHIEF COMPLAINT

UNAESTHETIC APPEARENCE

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HISTORY OF PRESENT ILLNESS

2002- CONDYLECTOMY – 10 YRS AGE- CHENNAI

07/12/2015- SIDS- LE FORT 1, UNI. SAG RT. , IVRO LT. SIDE

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HISTORY

Past Medical History – NRH

Past Dental History – ORTHOGNATHIC SURGERY

Family History – NRH

Personal History – NRH

Drug History - NRH

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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

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EXTRA ORAL EXAMINATION 7

EXTRA ORAL EXAMINATION 8

OCCLUSION9

R.S- 26

OTHER FINDINGS 10

OVERJET & OVERBITE

INTRA ORAL EXAMINATION 11

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

ANALYSIS13

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

INVESTIGATIONS- RADIOLOGICAL 14

INVESTIGATIONS- RADIOLOGICAL 15

INVESTIGATIONS- RADIOLOGICAL16

INVESTIGATIONS- RADIOLOGICAL 17

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PRE OPERATIVE POST OPERATIVE

19

PRE-OPERATIVE

ANALYSIS20

POST -OPERATIVE

RO

CK

Y M

OU

NTA

IN A

NA

LYSIS

21

11.5 mm

10.8 mm

0 mm

0.7 mm

85.8 mm 72.1 mm66.2 mm 65.2 mm

85.8-66.2 =19.6

72.1-65.2 = 6.719.6-6.9 = 12.7

(1.27 cm.)

VTO22

INVESTIGATIONS-HEAMATOLOGICAL

CBP

GRBS

VIRAL MARKERS

OTHERS - PAC

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PROBLEM LIST

ASYMMETRIC FACE

ASYMMETRIC CHIN

TEETH SHOWN DURING REST

ANTERIOR PROCLAINED TEETH

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DIAGNOSIS

FACIAL ASYMMETRY

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PREVIOUS SURGERIES

CONDYLECTOMY ON LEFT SIDE

LE FORT 1 OSTEOTOMY

UNILATERAL SSRO ON RIGHT SIDE

IVRO ON LEFT SIDE OF MANDIBLE

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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

ILEAC GRAFT HARVESTING28

PROPELLER GENIOPLASTY29

ANTERIOR MAXILLARY OSTEOTOMY30

THANK YOU

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