Orthognathic Surgery for Maxillary Asymmetry
Clinical Findings Supporting Medical Necessity
- The patient presents with class 3 malocclusion with significant dental midline discrepancy (6-7mm total discrepancy between maxillary and mandibular midlines), indicating severe asymmetry that exceeds the 3mm threshold for medical necessity 1, 2
- Posterior crossbite is present, suggesting a transverse discrepancy between the maxilla and mandible 1
- Dental midline discrepancy of 6-7mm total between maxilla and mandible exceeds the threshold of "asymmetries greater than 3mm with concomitant occlusal asymmetry" required for medical necessity 1, 2
- The upper dental midline is left of mid-sagittal plane and lower dental midline is right of mid-sagittal plane by approximately 3-4mm 1
Surgical Plan and Considerations
- The proposed LeFort I advancement procedure is appropriate for correction of the maxillary asymmetry and class 3 malocclusion 3, 4
- LeFort I osteotomy allows for correction of transverse, vertical, and anteroposterior dimensions of the maxilla 4, 5
- Mandibular reconstruction (21196) will address the mandibular component of the asymmetry and help establish proper occlusion 4, 5
Important Considerations
- Removal of third molars at least six months prior to orthognathic surgery is necessary to allow for proper bony healing 6
- Detailed imaging studies, including CT maxillofacial scans, are crucial for surgical planning to accurately assess the skeletal discrepancies 6, 7