Therapeutic management of patients with class III skeletal malocclusion. Mandibular prognathism, maxillary retrognathism – a case report

Abstract

Mandibular prognathism (progenism, underbite) is a type of malocclusion characterised by an abnormally anterior position of the mandible or the underdevelopment of the maxilla. The profile of an individual with the pathology is significantly prolonged in the sagittal plane, which distorts facial aesthetics. Underbite also negatively affects the entire masticatory function and may cause numerous ailments. Patients with prognathism struggle not only with aesthetic problems, but with functional issues as well. What is more, it can lead to difficulties in the psychosocial area of life by causing lower self-esteem and distorted self-image. Mandibular prognathism is treated with the use of orthodontic camouflage or combined orthodontic-surgical treatment, the latter method, despite its invasiveness, being the more popular one. An important element in the process of patient rehabilitation during treatment is the physiotherapist, who selects the right rehabilitation procedures aiming at the stomatognathic system. Even before the surgery itself, proper therapy begins whose task is preparing the craniofacial area for surgical invasion. After surgery, on the other hand, the physiotherapeutic procedures aim at the reduction of swelling, activating temporomandibular joints (TMJ), myofascial therapy, and special exercises (myokinesthetic therapy) which are aimed at supporting the adaptation of the body to a new morphological structure. This dissertation presents the case of a 19-year-old female patient with mandibular prognathism who underwent combined orhodontic-surgical treatment. The treatment consisted of Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO). The overall results of treatment were evaluated as very good.