Orthognathic Treatment of the Facial Asymmetry Due to the Hemimandibular Hyperplasia

Case Report

J Dent & Oral Disord. 2017; 3(1): 1054.

Orthognathic Treatment of the Facial Asymmetry Due to the Hemimandibular Hyperplasia

Gülsen A*, Findikçioglu K and Sibar S

Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, University of Gazi, Turkey

*Corresponding author: Gulsen A, Department of Plastic Reconstructive and Aesthetic Surgery, University of Gazi. Besevler, Ankara, Turkey

Received: February 16, 2017; Accepted: March 15, 2017; Published: March 22, 2017


Our aim is to present orthognathic treatment of facial asymmetry patients due to hemimandibular hyperplasia who was a 45-year-old. She had no posterior teeth except one molar tooth bilaterally in the upper jaw and had only canines and incisors in the lower jaw. In treating facial asymmetry due to the hemimandibular hyperplasia, the condylar head was preserved and bilateral sagittal split osteotomy and angular ostectomy on the hyperplastic side were used to correct the asymmetry. Because of loss posterior buccal teeth, maxillary surgery was not planned. 3D model were used for diagnosis and surgical set-up in the patient. The simulation of the surgery was tested first in the 3D model. Following the surgery, an aesthetically pleasant facial symmetry was obtained in the case. Orthognathic treatment of hemimandibular hyperplasia.

Keywords: Hemimandibular hyperplasia; Orthognathic surgery; 3D model


Hemimandibular Hyperplasia (HH) is a unilateral developmental deformity of the mandible characterized by a three dimensional enlargement of the condylar head, condylar neck, ramus and body on the effected side. It stops in the midline symphysis on the effected side by constructing a rotated facial appearance and prominence of the mandibular angle and also it causes crossbite malocclusion, facial asymmetry. The first case report was presented in 1836 [1]. Excessive growth of mandible can be appearing as unilateral Condylar Hyperplasia (CH), Hemimandibular Elongation (HE), or Hemimandibular Hyperplasia (HH) [2-4]. CH is consisted of condylar overgrowth with facial asymmetry but normal mandibular shape; HE is elongation of mandibular corpus without vertical increment; and HH is increment of mandibular, ramus and corpus height with condyle or rarely without condyle [5]. The underlying causes of this anomaly are not clearly determined. Local circulatory problems, traumatic lesions, hormonaldistrubances, etc are considered to be etiologic factors [6,7]. This anomaly normally begin to occur in teenage years and may continue to the thirties. Diagnosis of the HH is made with clinical, radiological (panaographic and posteroanteriorcephalomertricradiogaraphs) and CT imaging’s [8,9]. 3D models may also be useful for diagnosis and surgical treatment plan.

The treatment options of HH are designed according to the severity of the problem and also depends on presence of active condylar growth. Condylectomy, lower mandibular margin ostectomy with angular ostectomy, bimaxillary surgery to re-level occlusal cant or all of the mare used [4,10,11]. If the condylar activity had stopped, condylectomy may not be preferred to avoid TMJ disturbances. Condylectomy has particularly become performed to remove growth site in active condylar growth cases [12-13].

The aim of this study is to present the result of the orthognathic surgery treatment of one case with severe facial asymmetry due to the hemimandibular hyperplasia.

Cephalometric points and measurements used for the patients were shown (Figure 1,2).