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Banja: Asymmetric face, Upper jaw small and narrow, smile distractor

Facial diagnosis

  • Protruding lower jaw
  • Receding upper jaw
  • Asymmetric face

Dental diagnosis

  • Class III

Treatment jaw surgery

  • Advancement upper jaw (Le Fort I)
  • Rotation lower jaw
  • Upper jaws merely impacted posteriorly

Treatment aesthetic surgery

  • Cheek augmentation


About this case

Banja is 18 years. She is a lovely young girl, but a bit sad that her jaws show some asymmetry.  Her face is lacking some depth and there was a lack of tooth show. She went to the orthodontist who chose to put lingual brackets. Obviously the upper jaw did not fit the lower arch in width, so first we needed to widen the upper jaw with a smile distractor. Meanwhile the orthodontist continued with the treatment. During the orthognatic surgery we needed to place some screws through the gums to enable us to manage the occlusion during, but also some days after the surgery( the time to settle the occlusion). The surgery was well prepared on our CBCT (3D RX). Clinically we found that most importantly the face had to be clockwise opened. So Dr Defrancq did a Le Fort I with slight anterior advancement and extrusion, but mostly a posterior impaction in the molar region. The lower jaw was adapted to this occlusion in a class I position. We knew from the CBCT that the genioplasty would not be necessary. On the other hand we enhanced the high cheekbone region with HA on the bone, applied with tisseel® (see my website). The outcome was really rewarding for Banja. She is looking forward to finish the surgeries with a nose job later this year.