Comprehensive treatment for mandibular micrognathia: Integrative approaches in orthognathic surgery, distraction osteogenesis, and periodontal management

Abstract

Mandibular micrognathia not only disrupts the 3-dimensional orientation of the jaw but also induces secondary functional alterations in adjacent soft and hard tissues, as well as the stomatognathic system, significantly impairing the patient's quality of life. This case report documents the comprehensive treatment of a patient with severe micrognathia with obstructive sleep apnea-hypopnea syndrome. The treatment commenced with bilateral mandibular distraction osteogenesis to increase the height and length of the mandible, which also facilitated upper airway patency by stretching the soft tissues. After a 6-month retention period, the distraction devices were removed, and the maxillary arch was surgically expanded to align with the mandibular arch width. Presurgical orthodontic treatment was initiated after complete periodontal therapy. After 18 months, orthognathic surgery was conducted to establish proper occlusal alignment and enhance facial esthetics. Overall, the treatment outcomes were highly satisfactory, emphasizing the importance of an integrated approach for clinicians. This case report highlights that treatment objectives should extend beyond airway clearance and esthetic restoration to include occlusion, periodontal health, and joint stability, necessitating comprehensive diagnosis and multidisciplinary collaboration to achieve functional, esthetic, and long-term results.