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Treating patients with prognathic maxillae is a multifaceted process, especially when dealing with thalassaemia complications. This case study addresses the issue of severe maxillary protrusion in a woman living with β-thalassaemia major who had presented with pronounced maxillary protrusion, lip incompetence and an everted upper lip. Following initial alignment and levelling using the 0.018inch standard edgewise system, the patient underwent a Le Fort I osteotomy procedure. Segmental osteotomy was ruled out owing to the heightened risk of excessive bleeding. The outcomes demonstrated successful management of the thalassaemic patient through presurgical orthodontics, LeFort I osteotomy, and subsequent post-surgical orthodontics and periodontics. The patient exhibited improved facial aesthetics after an active treatment period of 4 years.
CPD/Clinical Relevance:
Orthodontic treatment for patients with β-thalassaemia major and skeletal Class II malocclusion with prognathic maxillae requires a multidisciplinary approach, including Le Fort I osteotomy and careful management of elevated bleeding risks
Article
Thalassaemia is a family of hereditary genetic conditions that are common worldwide. They can be categorized into two primary divisions: α- and β-thalassaemia.1 β-thalassaemia, alternatively referred to as Cooly's anaemia, is an inherited blood disorder marked by an abnormality in skull formation, resulting in a distinctive appearance in the affected individual.2
Clinically, β-thalassaemias can be categorized as thalassaemia trait, minima, minor, intermediate and major, indicating the level of anaemia present. This disorder primarily affects regions around the Mediterranean Sea, a significant portion of Central Africa, the Middle East, the Indian subcontinent, and southeast Asia, encompassing Indonesia, with occurrence rates ranging from 5% to 20%.1 These haematological challenges contribute significantly to orthodontic complications, because the disorder is associated with extensive craniofacial changes as a result of bone marrow hyperplasia and altered bone metabolism, complicating standard orthodontic treatments.3 Thalassaemia may be linked to skeletal facial deformities.4
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