This study evaluated the prediction of facial profile in patients with skeletal mandibular prognathism at each stage of facial treatment. Specifically, the accuracy of manual prediction using tracing paper （following MP） and digital prediction using Dolphin Imaging software （version 11.0；GC Ortholy, Tokyo） （following IS） were compared. Fifteen patients （4 males and 11 females, mean age 23.6 years） underwent sagittal splitting ramus osteotomy for correction of skeletal mandibular prognathism, and the temporal changes of hard and soft tissues from the initial examination （T0） and just before orthognathic surgery （T1） to within 1 month from the end of postoperative orthodontic treatment （T2）, respectively were evaluated. The MP and IS values were calculated by predicting the change in soft tissue over time from the change in hard tissue over time and compared with the measured values （AC values）. Four measurement points on the hard tissue and five points on the soft tissue of a standard lateral X-ray photograph were used for comparison, and Bland–Altman analysis was used. The results showed that there was a fixed error in prediction at T2, with MP values predicting the upper and lower lips excessively upward and the soft tissue Pog excessively posterior. In addition, the IS values showed a fixation error that predicted the upper lip excessively upward, the lower lip excessively posterior, and the soft tissue Me excessively posterior. Thus, the results suggest that the prediction of lateral morphology after preoperative orthodontic and dynamic orthodontic treatment for patients with skeletal mandibular prognathism may lead to excessive patient expectations.
This report describes a case of surgical orthodontic treatment for facial asymmetry caused by mandibular condylar fracture in infancy. A 14-year-old female was referred to our clinic for surgical orthodontic treatment with a chief complaint of facial asymmetry. She had experienced a right mandibular condylar fracture at 4 years of age, and had undergone open reduction and internal fixation. Subsequently, the growth of the mandible was disturbed, resulting in mandibular deviation and horizontal inclination of the occlusal plane. After preoperative orthodontic treatment, facial asymmetry and malocclusion were corrected by bimaxillary orthognathic surgery at age 16. The facial morphology and occlusion at 24 months postoperatively were satisfactory.