Treacher Collins syndrome: Orthodontic treatment with mandibular distraction osteogenesis and orthognathic surgery

Abstract

Interdisciplinary treatment for patients with Treacher Collins syndrome is challenging because of the rarity of the condition and the wide variety of phenotypic expression. A 23-year-old male was diagnosed with Treacher Collins syndrome with a history of severe obstructive sleep apnea. He presented with a Pruzansky-Kaban classification grade I mandible, skeletal type II pattern with a hyperdivergent mandibular plane, severe convex profile, and Class II malocclusion with a missing mandibular incisor. Improvement of facial esthetics was achieved by a combination of orthodontics, mandibular distraction osteogenesis, and 2-jaw maxillomandibular advancement surgery. Presurgical orthodontic treatment involved permanent tooth extraction to relieve severe crowding, and Class III mechanics were employed to increase overjet. Correction of mandibular hypoplasia by increasing ramal height and the mandibular length was done by intraoral mandibular distraction osteogenesis. Counterclockwise rotation of the mandibular plane angle and a Class III occlusion with negative overjet were achieved after mandibular distraction osteogenesis. A postdistraction posterior open bite was maintained with a biteplane during the consolidation period. Subsequently, 2-jaw orthognathic surgery was performed. LeFort I osteotomy was done for maxillary advancement to correct an anterior crossbite, eliminate canting, and reestablish occlusal contact at the mandibular occlusal plane. Bilateral sagittal split ramus osteotomy was done to correct the residual mandibular deviation. A genioplasty was also performed to improve chin projection. Postoperatively, the oropharyngeal airway was enlarged. The patient's facial profile and obstructive sleep apnea problem were improved as a result of advancement and counterclockwise rotation of the maxillomandibular complex.