Abstract
We report a case of Apert syndrome improved by surgical orthodontic treatment combined with Le Fort II maxillary distraction, and its long-term management. A 14-year 2-month-old male patient with the chief complaint of anterior crossbite and crowding was referred from the plastic surgery department. He had a concave lateral profile due to hypoplastic midface and protruded lower jaw. The upper dental arch width was narrow with deep palate. Overjet and overbite were －6.0mm and ＋3.0mm, respectively. Cephalometric analysis showed SNA of 77.3°, SNB of 85.0° and ANB of －7.7°, indicating maxillary growth deficiency and forward overgrowth of the mandible. The patient was diagnosed a skeletal Class III case with crowding and hypoplastic midface. After extraction of the upper second premolars, presurgical orthodontic treatment including maxillary expansion was performed for 18 months. Then, at the age of 15 years and 8 months, a bone distraction device was placed immediately after Le Fort II osteotomy. Due to little changes in dimension and less horizontal growth, the characteristic of the cranial base in this syndrome was determined using a profilogram with minor corrections. After 15mm of distraction, the device was placed for 6 months for retention and then removed. Subsequently, at 21 months postoperation (17 years 5 months old), retention was begun. The treatment results showed that the mid-facial deficiency was improved and good occlusion was achieved. During the retention period, occlusion was stable and no relapse of tooth alignment was observed. The occlusal conditions obtained have been maintained even 14 years after treatment.
