First, we wish to express our appreciation to Drs. Yuanyuan Jiang, Qiaoling Ma, and Huang Li for their insightful comments. We hope that their comments and our reply will remind readers to consider the best treatment option for each particular patient in the future.
As pointed out, the patient had a skeletal Class I relationship, not Class III. However, the primary treatment goals for this patient were to “reposition the premaxilla by osteotomy to reduce the size of the alveolar defects and improve the retroclined maxillary incisors” and “reconstruct alveolar defects by bone grafting.”
In this case report, the minimal expansion of the posterior segments and the surgical repositioning of the premaxilla enabled us to minimize the alveolar defects, and we observed a sufficient alveolar bone ridge.
If we did not perform 2-jaw surgery, including retraction of the mandible, theoretically, the combination of the alternative treatments would require simultaneous expansion of the collapsed posterior segment, repositioning of the retroclined premaxilla, and improvement of the canted occlusal plane. However, these multisegmented osteotomies were associated with a risk of poor blood supply postoperatively. Thus, after a full consultation with the patient, we selected a step-by-step approach, including 2-jaw surgery.
We believe that this method of treatment was good in terms of stability of grafted bone, reduction of the surgical risk of the maxilla, stability of the occlusion, and improved facial asymmetry.
As shown in Figure 5, C and D , the asymmetry of the mandible was not improved. Also, the molar relationships on both sides were Class I. However, this was because the mesiodistal positions of the maxillary left and right molars were different. Therefore, the amounts of mandibular setback in the 2-jaw surgery were 3.0 mm on the right side and 7.0 mm on the left side.
The main point of this case report was to introduce the approach for the maxilla. Therefore, we omitted some descriptions of facial asymmetry. Before treatment, the posteroanterior cephalometric analysis showed that the mandibular deviation toward the right was approximately 8.0 mm at the mental spine. In the posttreatment posteroanterior cephalometric analysis, the mandibular deviation was changed to 4.0 mm. Although the mandibular deviation was not eliminated perfectly, we think that there was an improvement.