Non-Syndromal Facial Asymmetry.

On extra-oral examination, an obvious facial asymmetry of the mandibular third with deviation of chin to right with a convex profile and excessive exposure of lower lip was noticeable. Bilateral temporomandibular joint and condylar movements were within normal limits without any clicking or grating noise. The mentolabial sulcus and the nasolabial sulcus were flattened. Intra-oral examination revealed an adequate inter-incisal mouth opening of 35mm. There was an anterior open-bite deformity of 4mm, with deviation of mandibular midline to the right by 7mm. There was a Angle's class I relation of molars on the right with a class III relation on the left and cross bite of right maxillary premolars and anterior teeth. Cephalometric analysis was done in both lateral and postero-anterior views, which revealed SNA: 84o,SNB : 82o,ANB:2o and there was asymmetry in the lower third of the face. Study models were obtained from impressions and articulated after rotating the mandibular cast arbitrarily in a transverse plane to achieve maximum intercuspation, thereby correcting the deviated midline and the left side class III relation to Class I. Surgical splint was fabricated over the occlusal surfaces of maxillary and mandibular teeth in the new corrected occlusal relation. The patient was operated under general anaesthesia with intra oral bilateral sagittal split osteotomy, transverse rotation and reposition. Rigid internal fixation was done using titanium plates and screws. Haemostasis was achieved and wound was sutured with absorbable vicryl after placing an extra-oral drain bilaterally.