Results of orthodontic treatment of a child with asymmetrical micrognathia and the congenital mandibular condylar hyperplasia

Abstract

Aim. To analyze the results of orthodontic treatment of a child with asymmetrical micrognathia and mandiblar condylar hyperplasia. Methods. The configuration of a face in the photos was evaluated and diagnostic models of the jaws were analyzed by using the Pont’s and Korkhaus methods in treatment dynamics. The physiological status of bone tissue, temporomandibular joints and teeth was studied by using orthopantomography and computed tomography. Functional disorders were detected by using special tests, including Eschler–Bittner's test and Ilyina-Markosyan’s test. Orthodontic treatment and stimulation of mandibular growth in the mixed dentition stage were undertaken with the single jaw removable appliances and the appliance improved by us for correction of the distal occlusion. The Damon Q bra­cket system with archwires was used in permanent dentition period. Results. The child's convex facial profile was typical for distal occlusion and micrognathia. The facial asymmetry, increasing with mouth opening, and a decrease in mandibular range of motion indicated lesion of the right temporomandibular joint. The right condyle was enlarged on the orthopantomogram. The computed tomography showed that it was asymmetrically enlarged and had a cellular structure. There was detected asymmetric micrognathia. The comprehensive rehabilitation plan included orthodontic treatment, myotherapy, speech therapy, mechanotherapy. The use of removable orthodontic appliances led to the normal size of the dentition and their relation, significantly reduced functional disorders and improved facial aesthetics. Five years after completion of orthodontic treatment, the physiological occlusion and amplitude of the mandibular movements remained, but the right mandibular angle was flattened. Conclusion. The comprehensive rehabilitation of a child with asymmetrical micrognathia and mandibular condylar hyperplasia started in mixed dentition stage provided conditions for the formation of normal permanent dentition and the improvement of functional disorders and facial aesthetics; our results allow us to suggest the positive effect of our tactics for treatment of the patient.