Case Studies

Orthognathic Surgery:
Johnny's Quest For that Perfect Profile

Dr Firdaus Hanapiah
BDS(Otago) MSc(Lon.) FDSRCS(Eng.)

Introduction

Young Johnny is a normal 21 year old who grew up in a Kuala Lumpur's suburb. He is a healthy young man who went to high school like so many of his cohorts and led a normal life. He was a smart kid as well and qualified to do a degree in a famous London University.

However , Johnny always had a disadvantage which he shared with no other of his siblings although the trait existed in his family's lineage. He had an overpoweringly elongated lower jaw. This was however not a physical disability as such, but it did give problems with his biting and mastication of food and he stands out from the crowd.

At the age of 18 , he sought help from dental professionals and was referred to us for this condition. Upon examination we found him to be a pleasant young man with a disproportionately long lower jaw and short upper jaw.

Fig 1 : Frontal view. Fig 2 : Side view

Fig 3 : View from the top of the head showing a reverse overjet in which the lower jaw is 12 mm in front of the upper jaw.

Fig 4 : A three dimensional CT Scan shows the mandibular discrepancies.
Fig 5 : Various cuts made during orthognathic surgery

Fig 6 : Six weeks after Operation, A totally new smile.

Fig 7 : Six weeks post operative profile photo, note that there is now no overjet , and the cheekbone is now more pronounced.

He was then recommended to undertake orthodontic ( Braces ) treatments to get his teeth in alignment. After which, it was decided that the best line of treatment would be to do a bi-maxillary orthognathic surgery with the objectives of; to shorten his lower jaw and to bring forward his upper jaw. (Fig 4. Fig 5)

The surgery was done uneventfully and within three days he was out of the hospital. He had some bruising and swelling of his face as well as numbness of his lips, but this was a temporary transition to recovery.

After six weeks, he had some adjustments made to his orthodontic brackets and was ready to go back to school in London. (Fig 6, Fig 7). However, for obvious reasons, he had to redo his passport before he went back!

Conclusion

There are many options that can be taken for this case and cases similar to this. However ,orthodontics treatment alone cannot repair the extensive discrepancies of the jaws. The option of orthognathic surgery is a realistic option as it is a predictable, safe and pleasing outcome to this case and those similar to this.