Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2021) – 132.50
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI (2021) – 0.5
Average rejection rate (2022) – 79.69%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download original text (EN)

Dental and Medical Problems

2020, vol. 57, nr 1, January-March, p. 103–109

doi: 10.17219/dmp/112574

Publication type: clinical case

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

Complex orthodontic and surgical management of an adult patient with transverse maxillary deficiency and skeletal class III malocclusion: A case report

Kompleksowe leczenie ortodontyczno-chirurgiczne pacjentki dorosłej z niedorozwojem poprzecznym szczęki i III klasą szkieletową – opis przypadku

Rafał Nowak1,A,B,C,D,E,F, Małgorzata Rzepecka-Skupień2,B,C,D, Ewa Zawiślak2,C,D,E

1 Department of Maxillofacial Surgery, Wroclaw Medical University, Poland

2 Department of Maxillofacial Orthopedics and Orthodontics, Wroclaw Medical University, Poland


Skeletal deformities constitute a relatively common structural and functional craniofacial abnormality. The chief complaints reported by patients include a lack of satisfaction with facial appearance, difficulty with breathing or eating, and altered speech. The management of skeletal malocclusion requires a complex orthodontic and surgical approach. The paper presents the case of a 28-year-old woman with maxillary constriction and skeletal class III malocclusion. Transpalatal distraction (TPD), based on the distraction osteogenesis phenomenon, was used for correcting transverse maxillary deficiency by increasing the maxillary bone base, and therefore the transverse maxillary dimension. The next stage was orthodontic treatment, involving dentoalveolar decompensation, as part of preparation for bimaxillary osteotomy (BIMAX). The last stage of the complex treatment was BIMAX, which ultimately eliminated skeletal defects in both the sagittal and frontal planes. This complex multidisciplinary management significantly improved facial harmony, increased nasal volume, caused a shift from mouth breathing to nasal breathing, and restored normal occlusal relationships.

Key words

orthognathic surgery, orthodontics, skeletal maxillary constriction, skeletal deformities

Słowa kluczowe

chirurgia ortognatyczna, ortodoncja, zwężenie szczęki, wady gnatyczne

References (16)

  1. Converse JM, Shapiro HH. Treatment of developmental malformations of the jaw. Plast Reconstr Surg (1946). 1952;10(6):473–510.
  2. Panula K. Correction of dentofacial deformities with orthognatic surgery. Outcome of treatment with special reference to costs, benefits and risks. Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu, Finland, 2003 (PhD thesis).
  3. Proffit WR, Turvey TA, Phillips C. Orthognathic surgery: A hierarchy of stability. Int J Adult Orthodon Orthognath Surg. 1996;11(3):191–204.
  4. Champy M, Lodde JP. Mandibular osteosyntheses: Localization of osteosyntheses depending on the mandibular stresses [in French]. Rev Stomatol Chir Maxillofac. 1976;77(8):871–876.
  5. Robinson RC, Holm RL. Orthognathic surgery for patients with maxillofacial deformities. AORN J. 2010;92(1):28–49;quiz 50–52.
  6. Agnihotry A, Fedorowicz Z, Nasser M, Gill KS. Resorbable versus titanium plates for orthognathic surgery. Cochrane Database Syst Rev. 2017;10:CD006204.
  7. Kulewicz M. Distraction osteogenesis in orthognathic surgery [in Polish]. Acta Clin. 2001;1(2):117–128.
  8. Laptook T. Conductive hearing loss and rapid maxillary expansion. Am J Orthod. 1981;80(3):325–331.
  9. Chrcanovic BR, Custódio AL. Orthodontic or surgically assisted rapid maxillary expansion. Oral Maxillofac Surg. 2009;13(3):123–137.
  10. Mommaerts MY. Transpalatal distraction as a method of maxillary expansion. Br J Oral Maxillofac Surg.1999;37(4):268–272.
  11. Matteini C, Mommaerts MY. Posterior transpalatal distraction with pterygoid disjunction: A short-term model study. Am J Orthod Dentofacial Orthop. 2001;120(5):498–502.
  12. Bell RB. A history of orthognathic surgery in North America. J Oral Maxillofac Surg. 2018;76(12):2466–2481.
  13. Obwegeser HL. Some innovative evolutions in surgery of the cranio-maxillofacial skeleton. J Craniomaxillofac Surg. 2017;45(9):1361–1377.
  14. Obwegeser HL. Orthognathic surgery and a tale of how three procedures came to be: A letter to the next generations of surgeons. Clin Plastic Surg. 2003;34(3):331–355.
  15. Nocini PF, Chiarini L, Bertossi D. Cosmetic procedures in orthognathic surgery. J Oral Maxillofac Surg. 2011;69(3):716–723.
  16. Steinhäuser EW. Historical development of orthognathic surgery. J Craniomaxillofac Surg. 1996;24(4):195–204.