Early orthognathic approach combined with SABG for congenital dentofacial deformity-A rare case report

Patients with dentofacial deformities form an important part of the society and present with physical and psychological issues due to their appearance. The rehabilitation of such patients requires a surgical intervention which can be tremendously volatile due to several factors amongst which residual growth is considered to be the most imperative. In this report, a case of a 14 year old male patient with a class III skeletal base and cleft lip and palate is presented. Growth Treatment Response Vector (GTRV) cephalometric analysis is used to predict the mandibular growth vector thereby giving an insight into whether an early orthognathic surgical intervention for the early rehabilitation of this patient can be considered and whether future surgeries post growth can be eliminated. Pre-surgical orthodontics involved levelling and aligning followed by SABG in the cleft region which allowed the normal eruption of impacted canine. Surgically maxillary advancement of 6mm with an anterior pitch down of 4mm, and advancement genioplasty of 6mm was done to achieve an orthognathic profile. Postsurgical settling was done, and the case was finished in skeletal Class I, functional molar and canine relationship with ideal overjet and over bite.