Orthodontic-Surgical Correction of a Skeletal Class III With Severe Facial Asymmetry - Case Report

Sep 30, 2026

A 17-year-old female with complete skeletal growth presented with severe facial asymmetry and skeletal Class III malocclusion, including left-sided mandibular prognathism, chin height discrepancy and leftward chin deviation, plus paranasal depression and a cant of the maxillary occlusal plane higher on the right. Dental asymmetry comprised a 7 mm Class III molar relationship, right-sided canine Class III pattern, left end-on Class II molar pattern, and a left posterior crossbite. After oral and maxillofacial evaluation, bimaxillary orthognathic surgery with chin border reduction was performed using Le Fort I advancement, asymmetric intrusion, and mandibular ramus osteotomies, with final occlusal and facial alignment verified pre-fixation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages20

Reading Time50 min

AccessFree to download

Abstract

Treatment approach

Surgical procedures

Introduction

Diagnostic and planning challenges

Prevalence and etiologies of facial asymmetry

Soft tissue asymmetry and residual deformity

Review began 10/29/2025 Review ended 11/27/2025 Published 12/10/2025 © Copyright 2025 Martínez-Suárez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98899 Open Access Case Report Orthodontic-Surgical Correction of a Skeletal Class III With Severe Facial Asymmetry Treated With Double Jaw Surgery and Mandibular Shaving: A Case Report Gerardo Martínez-Suárez 1, Luis Pablo Cruz-Hervert 2, Martha Elizabeth Tovar-Martínez 1 , Angelica Julián-Castrejón 3, José Rubén Gómez-Garibo 4, Juan Antonio Maldonado-Moreno 5 1. Dentistry, Clínica Odontológica Aragón, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónomade México, Tlalnepantla de Baz, MEX 2. Medicine, División de Estudios de Posgrado e Investigación (DEPeI) en Odontología, Universidad Nacional Autónoma de México, Ciudad de México, MEX 3. Dentistry, El Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI), Ixtapaluca, MEX 4. Nuclear Medicine, Hospital Regional de Alta Especialidadde Ixtapaluca, Ixtapaluca, MEX 5. Orthodontics, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, MEX Corresponding author: Juan Antonio Maldonado-Moreno, [grupoolinka@hotmail.com](grupoolinka@hotmail.com) Abstract A 17-year-old female with severe facial asymmetry and skeletal Class III malocclusion, whose skeletal growth was already complete, presented with left-sided mandibular prognathism, a 5 mm chin height discrepancy (higher on the right side), and a 7.6 mm chin deviation to the left, together with paranasal depression and a 4 mm cant of the maxillary occlusal plane, positioned higher on the right side. The patient exhibited significant dental asymmetry, including a Class III molar relationship (7 mm) and canine relationship on the right side and a Class II molar relationship (end-on) on the left, along with a left posterior crossbite. After evaluation by the oral and maxillofacial surgery team, it was determined that she required bimaxillary orthognathic surgery combined with chin border reduction. The treatment consisted ofbimaxillary surgery and inferior chin border shaving, including a Le Fort Iosteotomy for 5.5 mm of maxillary advancement, asymmetric intrusion (2 mm right-sided downward repositioning and 2 mm left-sided intrusion), and bilateral mandibular ramus osteotomies to achieve a 5.5° rotation to the right and counterclockwise mandibular rotation. The final positioning was adjusted according to the preoperative surgical plan, with careful verification of occlusal alignment, overjet, overbite, facial symmetry, and lip commissure level before rigid fixation was performed. Categories: Quality Improvement, Dentistry, Oral Medicine Keywords: bimaxillary surgery, digital planning, facial asymmetry,“orthognathic surgery”, skeletal class iii deformities Introduction Due to the complexity of diagnosis and treatment planning, patients with facial asymmetry-particularly those with skeletal Class III malocclusion-present a significant therapeutic challenge. Class III malocclusion combined with facial asymmetry is a multifactorial dentofacial deformity that results in both functional limitations and aesthetic concerns. In adult patients, where orthopedic growth modification is no longer an option, this condition typically requires a comprehensive treatment approach. The integration of orthodontic treatment with orthognathic surgery has proven to be effective and is widely accepted for achieving harmony between the skeletal, dental, and soft tissue components of the face [1-3]. The prevalence of facial asymmetry varies widely across populations and facial regions, with global estimates ranging from 21% to 85%[4] . The lower third of the face is most commonly affected, showing asymmetry in approxim

FAQs

What condition did the 17-year-old patient have at presentation?

She had severe facial asymmetry with skeletal Class III malocclusion, including left mandibular prognathism, chin height discrepancy, and chin deviation to the left, along with maxillary occlusal plane cant and paranasal depression.

What treatment was selected after evaluation by the oral and maxillofacial surgery team?

Bimaxillary orthognathic surgery combined with chin border reduction was planned to address both skeletal and facial asymmetry.

Which major surgical steps were performed in the case report?

The treatment included Le Fort I osteotomy for maxillary advancement, asymmetric intrusion, and bilateral mandibular ramus osteotomies with postoperative positioning adjusted to the surgical plan, followed by careful verification before rigid fixation.

Sep 30, 2026

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