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Purpose: Temporomandibular joint ankylosis (TMJA) in children is associated with retrognathia, reduction in pharyngeal airway volume (PAV), and obstructive sleep apnea (OSA). Distraction-osteogenesis (DO) is the proven method in the management of OSA. There is paucity in literature about the effect of distraction vector on PAV. It can be expected that an oblique vector would improve PAV and relieve OSA. Thus, the study was designed to explore the feasibility, advantages, and disadvantages of this modified technique for managing TMJA and OSA simultaneously. Materials and method: The investigators designed a prospective study on patients of TMJA with retrognathia. Ethical approval was obtained (IECPG-547/14.11.2018). In all patients, simultaneous ankylosis release and mandibular distraction were performed. Primary outcome variables were improvement in 3-dimensional (3D) PAV and maximal interincisal opening (MIO). Secondary outcome variables were changed mandibular length, distraction relapse, and re-ankylosis. Paired t-test and multivariate ANOVA were used to assess all the parameters. Result: The study included 13 joints in 8 patients of TMJA with retrognathia (2 unilateral and 6 bilateral ankylosis) with mean age of 14.25 ± 7.37 years. Mean distraction performed was 19 ± 4.0 mm. There was a statistically significant improvement of PAV by 225% (p = 0.002), a reduction in Epworth's scale (p = 0.017), an increase in MIO (p = 0.001), and an increase in mandibular length. Three patients had re-ankylosis at the 25-month follow-up. Conclusion: The results of the present study conclude that modification of distraction vector improves 3D PAV and MIO in TMJA patients, with the added advantage of a reduction in overall treatment time and improved patient compliance. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Osseous genioplasty and chin augmentation with implants are the two main treatment options for retrognathia. This retrospective cohort study was performed to compare the prevalence of complications and patient satisfaction following osseous genioplasty and chin augmentation by implant. Eighty patients were included: 38 underwent advancement osseous genioplasty and 42 received chin implants (alloplastic, either Medpor or Silastic) intraorally or extraorally. The patients were assessed for complications 12 months after surgery, including neurosensory disturbances, infection or extrusion, wound dehiscence, and the need for reoperation. Patient satisfaction was evaluated using a visual analogue scale. The infection rate was significantly higher in the chin implant group than in the genioplasty group (P = 0.028). Moreover, dehiscence and the need for reoperation appeared to be more common following chin augmentation with implants. However, there was no significant difference in the prevalence of neurosensory disturbances between the two groups (P = 0.137). In the chin implants group, the extraoral approach resulted in a lower dehiscence rate than the intraoral approach. Patients in the genioplasty group had significantly higher satisfaction scores than those in the chin implant group (P = 0.001). Overall, the rates of the complications assessed were lower and patient satisfaction was higher after osseous genioplasty when compared to chin augmentation with implants. [ABSTRACT FROM AUTHOR]

Pierre Robin sequence (PRS) is frequently co‐occurring with other non‐PRS congenital anomalies. The types and the prevalence of anomalies co‐occurring with PRS vary in the reported studies. The aims of this report was to study the types and the prevalence of the anomalies co‐occurring with PRS in a well‐studied population northeastern France. The types and the prevalence of anomalies co‐occurring in cases with PRS were ascertained in all terminations of pregnancy, stillbirths and live births in 387,067 births occurring consecutively during the period 1979–2007 in the area covered by our registry of congenital anomalies which is population‐based, 89 cases of PRS were registered during the study period with a prevalence of 2.29 per 10,000 births, 69.7% of the cases had associated non‐PRS anomalies. Chromosomal abnormalities were present in 10 (11.2%) cases including three 22 q11.2 deletion. Non‐chromosomal recognizable conditions were diagnosed in 27 cases (30.3%) including 10 Stickler syndrome, 8 Treacher Collins syndrome, 3 cases with short stature and 6 other syndromes. Multiple congenital anomalies (MCA) were present in 25 cases (28.1%). The most frequent MCA were in the ear, face and neck (35 out of 98 anomalies, 35.7%), cardiovascular (18 anomalies, 18.4%), musculoskeletal (11 anomalies, 11.2%), central nervous (7 anomalies, 7.1%), urinary (6 anomalies, 6.1%), and eye (6 anomalies, 6.1%) system. The high prevalence of associated anomalies justifies a thorough screening for other congenital anomalies in cases with PRS. [ABSTRACT FROM AUTHOR]

Second-trimester 2D ultrasound (US) assessment of the fetal anatomy, as proposed by worldwide guidelines, allows detecting the majority of fetal malformation. However, the detection rates of fetal facial anomalies seem to still be low, mostly in cases of isolated facial malformation. The purpose of this research was to assess and analyze the concordance between the antenatal imaging findings from second-trimester US screening and the results of fetal postmortem autopsy. Between January 2010 and January 2020, there were 43 cases where fetuses with prenatal ultrasound diagnosis of a face abnormality, associated or not with a genetic syndrome or chromosomal disorder, following intrauterine death (IUD) or termination of pregnancy (TOP) after the 13 weeks of pregnancy, underwent autopsy in the Pathological Anatomy section of Bari Polyclinic specializing in feto-placental autopsies. The diagnosis of the fetal facial defects at ultrasound was compared with the findings at autopsy in all cases. A very high level of agreement between prenatal ultrasound and autopsy findings was found for facial abnormalities associated with genetic syndromes or numerical abnormality of chromosomes. A lower level of concordance was instead found in isolated facial defects or those associated with other organ anomalies, but not associated with genetic syndrome or numerical chromosome anomaly. A detailed examination of aborted fetuses led to successful quality control of early-second-trimester ultrasound detection of facial anomalies; however, it was less accurate for the isolated ones. It is, thus, reasonable to propose a systematic early-second-trimester prenatal ultrasound screening for facial anatomy by operators specialized in fetal medicine field, using 2D, 3D, and 4D techniques (two-, three-, and four-dimensional ultrasound). [ABSTRACT FROM AUTHOR]

Objective: Intermaxillary elastics, anchored skeletally, represent a promising concept for treatment in adolescent patients with skeletal Class III anomalies. A challenge in existing concepts is the survival rate of the miniscrews in the mandible or the invasiveness of the bone anchors. A novel concept, the mandibular interradicular anchor (MIRA) appliance, for improving skeletal anchorage in the mandible, will be presented and discussed. Clinical case: In a ten-year-old female patient with a moderate skeletal Class III, the novel MIRA concept, combined with maxillary protraction, was applied. This involved the use of a CAD/CAM-fabricated indirect skeletal anchorage appliance in the mandible, with interradicularly placed miniscrews distal to each canine (MIRA appliance), and a hybrid hyrax in the maxilla with paramedian placed miniscrews. The modified alt-RAMEC protocol involved an intermittent weekly activation for five weeks. Class III elastics were worn for a period of seven months. This was followed by alignment with a multi-bracket appliance. Discussion: The cephalometric analysis before and after therapy shows an improvement of the Wits value (+3.8 mm), SNA (+5°), and ANB (+3°). Dentally, a transversal postdevelopment in the maxilla (+4 mm) and a labial tip of the maxillary (+3.4°) and mandibular anterior teeth (+4.7°) with gap formation is observed. Conclusion: The MIRA appliance represents a less invasive and esthetic alternative to the existing concepts, especially with two miniscrews in the mandible per side. In addition, MIRA can be selected for complex orthodontic tasks, such as molar uprighting and mesialization. [ABSTRACT FROM AUTHOR]

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Introduction An orthodontist's primary objective is to diagnose and describe the characteristics of any particular malocclusion. It has been reported that when the anteroposterior dimension of the maxilla is either reduced or increased, the measured dentoalveolar and skeletal parameters gets affected in other dimensions also. Aim This study aims to assess and compare the dentofacial characteristics in individuals with different skeletal morphology (normal, retrognathic, and prognathic maxilla). Materials and Methods A total of 194 individuals in the age group of 18 to 32 years were grouped as group I (34 males, 33 females) with normal maxilla, group II (30 males, 32 females) with retrognathic maxilla, and group III (34 males, 31 females) with prognathic maxilla. The measurements of N-A and anterior nasal spine to posterior nasal spine were the basis for selecting the individuals. The dentoalveolar characteristics were assessed using 17 lateral cephalometric and 08 posteroanterior (P-A) cephalometric parameters. Results The data of the study when analyzed statistically using sample "t" test (p < 0.05), revealed significant differences between the genders within the groups. All 08 characteristics measured in the P-A cephalogram showed had significant differences. Pairwise comparison between the groups was performed using the Tukey post hoc test (p < 0.05) and significant differences in various dentoalveolar characteristics were observed between the groups. Conclusion Dentoalveolar and facial parameters showed a significant degree of sexual dimorphism associated with maxillary morphology in all three groups of individuals. The majority of the parameters showed male dominance, and the differences were statistically significant. Statistically significant differences were observed in dentofacial characteristics in individuals with different skeletal morphologies [ABSTRACT FROM AUTHOR]

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Difficult laryngoscopy (DL) was established as the most accurate determinant of difficult intubation. Here, we sought to assess the diagnostic value of various bedside tests for predicting DL. We also aimed to create a regression model in this context. Methods: 137 patients were included in the study. Demographic features and eight diagnostic variables were evaluated for DL predictivity. These were retrognathia, presence of buck teeth, modified Mallampati test (MMT), upper lip bite test (ULBT), sternomental distance, interincisor distance (IID), thyromental distance, and neck circumference. DL was identified by Grade III-IV view during laryngoscopy according to the Cormack-Lehane classification. Results: The frequency of DL was 27% (n=37) in our sample population. Among predictive tests, IID was lower in patients with DL, while mean MMT score, frequency of retrognathia, and that of Grade 3 in ULBT were significantly higher. According to the results of logistic regression analyses IID (Odds Ratio [OR]: 0.504, Confidence intervals [CI] 95% [0.260-0.978], p=0.043), MMT score (OR: 2.001, CI 95% [1.159-3.454], p=0.013), and presence of retrognathia (OR: 0.108, CI 95% [0.019-0.613], p=0.012) were determined as independent predictors of DL. Our predictive model (two out of three factors: IID =4 cm, MMT score=3, and retrognathia) anticipated DL with a sensitivity of 35.1%, a specificity of 91%, a negative predictive value of 79.1%, and an accuracy of 75.9%. Discussion and Conclusion: None of the bedside tests or their dual combinations had considerable success for predicting DL in our study. Considering this fact and variation of the predictive performance of bedside tests for DL among different ethnicities, we composed a distinctive regression model. This model anticipated DL with reasonable specificity and accuracy rates. [ABSTRACT FROM AUTHOR]

When Pierre Robin sequence is associated with many congenital abnormalities, prompt diagnosis and treatment are essential. As Pierre robin sequence can cause significant upper respiratory tract obstruction and aspiration pneumonia it needs detailed evaluation and early correction. Here we report a two years-old girl child with patent ductus arteriosus associated with cleft palate and tongue tie (Pierre Robbin sequence) who was promptly treated. This type of presentation is rare and important. A girl child with a Pierre robin sequence, associated with PDA was under follow-up since birth. The baby was mildly tachypnoeic & was started on diuretics at one month of age. Early closure of PDA with a device was done at 11 months of age. At the age of two years, corrective surgery was done for cleft palate, and tongue tie (Pierre Robin sequence). Pierre Robin sequence may be associated with congenital heart disease, like ventricular septal defect, patent ductus arteriosus, and atrial septal defect in 20 percent of patients. If not treated, the airway obstruction can produce cardiac or respiratory failure, pulmonary hypertension, etc. Early diagnosis and timely intervention helps to alleviate the difficulties. Antenatal screening in high-risk mothers and early identification of the congenital anomaly are the only methods to detect and treat such congenital anomalies.

A 72‑year‑old female with symptomatic cholelithiasis was posted for laparoscopic cholecystectomy. She had been previously posted for the same surgery at a different center, but the surgery was not performed due to failed intubation. On airway examination, reduced thyromental distance, prominent incisors, and retrognathia were observed. We planned and executed rapid sequence intubation under videolaryngoscope guidance using The Anaesthetist Society Scope, and the surgery proceeded uneventfully. At the end of the surgery, she was extubated over a bougie, observed, and shifted out without complications. [ABSTRACT FROM AUTHOR]

Objectives: Patients with high mandibular plane facial morphology are the most dominant facial type who experience TMJ abnormalities with resultant condylar resorption, affecting the orthodontic and orthognathic treatment outcomes. The study aimed to quantitatively assess the three-dimensional condylar remodeling during the presurgical orthodontics and after orthognathic surgery of the retrognathic mandible with a high mandibular plane angle. The study also investigated the correlation between the resultant remodeling based on the hypothesis that condylar resorption following orthognathic surgery is a part of a progressive presurgical resorption process. Materials and methods: The study included adults with mandibular retrognathism and high mandibular plane angle who have computed tomography scans (CT) obtained before any treatment (T0), after completion of presurgical treatment before surgery (T1), and at long-term follow-up after surgery (T2). DICOM of CT scan was gathered and processed using ITK-SNAP and 3D Slicer software. The interval between T0 and T1 was represented as a presurgical phase, while between T1 and T2 was defined as a postsurgical phase (T1-T2). Results: Twenty-five patients (50 condyles) were included with a mean age of 23 ± 3.2 years. The mean of the follow-up during the presurgical phase was 19.8 ± 7.1 months and 15.5 ± 5.5 months during the postsurgical phase. The condylar volume during the presurgical phase (T0-T1) was relatively stable (− 3.3 ± 37.2mm3). However, during the postsurgical phase (T1-T2), the volume was significantly reduced − 113.8 ± 98.3mm3 (P < 0.001). Localized condylar surface resorption during the postsurgical phase was significantly higher than during the presurgical phase (P < 0.05). No correlation was found between the localized condylar surface remodeling during the presurgical and postsurgical phases. However, a negative statistically significant correlation existed between the overall condylar volume changes during the presurgical and postsurgical phases (r = 0.502, P < 0.001). Conclusion: Significant condylar resorption following orthognathic surgery of the retrognathic mandible with a high mandibular plane angle might occur regardless of the presurgical status of the condyle. Clinical relevance: The study provided an evidence to be discussed with the patients and considered throughout the treatment of mandibular retrognathia with high mandibular plane angle. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Pierre Robin Sequence is a rare craniofacial malformation that invariably combines retrognathism, glossoptosis, and upper airway obstruction, with a prevalence ranging from 1 in 8000 to 1 in 14,000 newborns. Although formally described by the French physician Pierre Robin in 1923, older and even ancient as far back as the Babylonian times, descriptions have been identified. Dr Pierre Robin's perspicacity lay in putting up a treatment for the patients presenting those symptoms. That is why his successors honored his work by naming this disease after him., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Treacher Collins syndrome, also known as mandibulofacial dysostosis, is a rare congenital disorder affecting craniofacial development. It is caused by an autosomal dominant mutation, primarily in the TCOF1 gene, which impacts the development of the first and second branchial arches. We present the case of a 12-year-old male with bilateral conductive hearing loss and deformed ears, whose clinical and imaging findings were consistent with Treacher Collins syndrome. Imaging revealed microtia, atresia of the external auditory canals, and hypoplastic middle ear structures. Additionally, facial abnormalities such as retrognathia, hypoplastic zygomatic bones, and a cleft palate were identified. This case underscores the crucial role of imaging in diagnosing Treacher Collins syndrome and guiding multidisciplinary management strategies., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

This case report describes the successful long-term management of a 19-year-old female patient presenting with a skeletal Class II pattern, mild anterior open bite, and mandibular retrognathia. The orthodontic treatment approach involved the distal movement of the maxillary and mandibular dentitions through the extraction of the maxillary second molars and mandibular third molars, combined with the use of extra-alveolar infrazygomatic crest (IZC) and buccal shelf (BS) miniscrews for anchorage. The treatment outcome achieved a stable, well-aligned dentition with ideal intercuspation and an improved facial profile. The 7-year post-treatment records demonstrated a stable occlusion and satisfactory facial aesthetics, confirming the long-term stability of this treatment approach. This case report supports that en-masse distalization of the entire dentition by extracting the upper second molars and lower third molars, coupled with bone miniscrew anchorages, can be a favourable alternative to the conventional premolar extraction approach for the correction of borderline Class II malocclusions., (Copyright © 2024 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background: Skeletal Class II malocclusion due to a retrognathic mandible produces a backwardly positioned tongue and soft palate, emanating compromised upper airway dimensions and breathing difficulties. Aims: The present review aims to explore and concise the findings of the existing studies assessing the effects of fixed functional appliances on pharyngeal airway dimensions by advancing the mandible. Design: A literature search was carried out on MEDLINE/PubMed, Cochrane Library, Science direct, Semantic Scholar and Google Scholar databases for studies up to December 2020, resulting in 1037 studies. Specified inclusion/exclusion criteria guided the selection of 18 relevant articles. The sample size, type of the appliance, method of assessment and outcomes of these articles were assessed in detail and tabulated. Results: Out of 18 studies included, 12 were retrospective longitudinal and the remaining were clinical trials. Majority of the studies (72%) reported a positive influence of the fixed functional appliances on the dimensions of the oropharyngeal and hypopharyngeal airways with minimal effects on nasopharyngeal airway. Conclusion: Thus, it can be concluded that fixed functional appliances have a beneficial effect on the middle and lower pharyngeal airway dimensions by advancing the mandible.

Aims: The current manuscript explores the viability of reverse sagittal split osteotomy technique for correction of ankylotic cases with post gap arthroplasty mandibular retrognathia to achieve socially acceptable esthetic results. Method: Reverse sagittal split osteotomy which was introduced by Collins et al in 1983 was performed with certain modifications on two cases to correct mandibular hypoplasia in post gap arthroplasty cases. The paper also highlights intraoral as well as extraoral approach for performing the osteotomy along with better management of bad split under direct vision Result: It was observed that the reverse sagittal split technique for advancement of mandible in cases of tmj ankylosis-induced dentofacial deformity provided better proximal control, reduced chances of bad split, greater range of advancement (11–14 mm) with esthetically acceptable results. The osteotomy cuts on lateral surface of mandible make the procedure effectively easier and quicker with better control over proximal segment and management under direct vision. Conclusion: When Distraction Osteogenesis and conventional orthognathic is not a choice in management of dentofacial deformity of post-release ankylosis cases due to the poor proximal control and concern over bad split, reverse sagittal split can be an appropriate choice to manage these deformities without any donor site morbidity. [ABSTRACT FROM AUTHOR]

The aim of this study was to clarify the clinical significance of bone metabolism in the mandibular condyles in determining condylar resorptive changes. Twelve condyles of patients with idiopathic condylar resorption and degenerative joint disease were analysed using 99mTc HMDP SPECT/CT at baseline and subsequent computed tomography during the follow-up period. Twenty-two healthy condyles were enrolled as controls. After generating three-dimensional SPECT/CT images, two independent observers scored the degree of condylar uptake and measured the morphological changes in the condylar height and condylar volume. In the group with positive condylar uptake, the follow-up computed tomography showed significant decreases in condylar height (−1.69 ± 0.93 mm) and condylar volume (−12.51 ± 10.30%) when compared to healthy controls (condylar height, 0.09 ± 0.54 mm; condylar volume, −0.29 ± 4.22%) (P < 0.001). Moreover, the degree of uptake correlated with the changes in condylar height (observer 1, P = 0.012; observer 2, P = 0.039) and condylar volume (observer 1, P = 0.005; observer 2, P = 0.037). These results suggest that condylar bone metabolism is closely related to the resorptive activity. Thus, SPECT/CT would be useful in the prognostic evaluation or determination of treatment strategies for idiopathic condylar resorption and degenerative joint disease. [ABSTRACT FROM AUTHOR]

Maxillary protraction with a face mask is an effective treatment for class III children with maxillary hypoplasia. However, in late adolescence, orthopedic approaches are not very effective for treatment of maxillary deficiency. The aim of this study was to report a minimally invasive technique to orthopedically treat a 16-year-old female adolescent with mild to moderate maxillary deficiency, before the cessation of growth. A circumvestibular corticotomy technique was performed followed by a regimen of rapid maxillary expansion and application of heavy extra-oral forces. After termination of the orthopedic and orthodontic phases, the patient was monitored for ten years. The dental and skeletal results immediately after treatment were compared with the results ten years after termination of treatment. A noticeable anterior displacement of “A” point was observed after the orthopedic phase and this remained unchanged for ten years.

Objective: Intermaxillary elastics, anchored skeletally, represent a promising concept for treatment in adolescent patients with skeletal Class III anomalies. A challenge in existing concepts is the survival rate of the miniscrews in the mandible or the invasiveness of the bone anchors. A novel concept, the mandibular interradicular anchor (MIRA) appliance, for improving skeletal anchorage in the mandible, will be presented and discussed. Clinical case: In a ten-year-old female patient with a moderate skeletal Class III, the novel MIRA concept, combined with maxillary protraction, was applied. This involved the use of a CAD/CAM-fabricated indirect skeletal anchorage appliance in the mandible, with interradicularly placed miniscrews distal to each canine (MIRA appliance), and a hybrid hyrax in the maxilla with paramedian placed miniscrews. The modified alt-RAMEC protocol involved an intermittent weekly activation for five weeks. Class III elastics were worn for a period of seven months. This was followed by alignment with a multi-bracket appliance. Discussion: The cephalometric analysis before and after therapy shows an improvement of the Wits value (+3.8 mm), SNA (+5°), and ANB (+3°). Dentally, a transversal postdevelopment in the maxilla (+4 mm) and a labial tip of the maxillary (+3.4°) and mandibular anterior teeth (+4.7°) with gap formation is observed. Conclusion: The MIRA appliance represents a less invasive and esthetic alternative to the existing concepts, especially with two miniscrews in the mandible per side. In addition, MIRA can be selected for complex orthodontic tasks, such as molar uprighting and mesialization.

Dynamic muscle discord (DMD) is a fundamental concept in facial soft tissue augmentation with dermal fillers, particularly in perioral rejuvenation and lip enhancement. It is frequently observed in patients with facial skeletal and soft tissue deficiencies. The lack of adequate structural support may result in compensatory muscle hypertonicity or confer a mechanical advantage in certain muscle groups over their antagonistic counterparts. This discord in activity between the various muscle groups can affect the posture and profile of mobile facial features both at rest and during facial expression. Unfortunately, despite being a condition that commonly presents to varying degrees in patients seeking lip enhancement, DMD is often poorly diagnosed and undertreated. The author describes the causes, consequences and treatment of this condition in relation to the perioral region, as illustrated by a case study discussion. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Maxillary protraction with a face mask is an effective treatment for class III children with maxillary hypoplasia. However, in late adolescence, orthopedic approaches are not very effective for treatment of maxillary deficiency. The aim of this study was to report a minimally invasive technique to orthopedically treat a 16-year-old female adolescent with mild to moderate maxillary deficiency, before the cessation of growth. A circumvestibular corticotomy technique was performed followed by a regimen of rapid maxillary expansion and application of heavy extra-oral forces. After termination of the orthopedic and orthodontic phases, the patient was monitored for ten years. The dental and skeletal results immediately after treatment were compared with the results ten years after termination of treatment. A noticeable anterior displacement of "A" point was observed after the orthopedic phase and this remained unchanged for ten years. [ABSTRACT FROM AUTHOR]