Midline Mandibular Osteotomy in an Asymmetric Patient

This case report shows the possibility of the application of a mandibular osteotomy to resolve mandibular asymmetry with independent and discordant movements of both bony segments. The authors report the case of a 25-year-old woman referred for mandibular asymmetry, with a transverse excess of the right hemi mandible and vertical defect of the left one. The patient underwent a bilateral sagittal split osteotomy, midline osteotomy, and genioplasty, which corrected the mandibular asymmetry with contraction of the entire right hemi mandible. A slight left vertical increase was also obtained through the surgically created lateral open bite. In the follow-up assessment, the patient's face appeared symmetrical with normalization of the bizygomatic-bigonial relationships, and the facial shape corresponded to ideal anthropometric features. This technique resulted in resolution of mandibular asymmetry. In addition, mandibular osteotomy permits the esthetic management of the shape of the entire mandibular body in relation to the other third of the face. (Angle Orthod. 2009;79:1008-1014.)