Clubfoot and dentofacial deformity in a young patient during dynamic phase of growth

Aim Young patient G.F., a 12 years old female, came to visit at Unit of Orthodontics in Dental Clinic - Policlinico of Milano for an orthodontic evaluation and for a postural evaluation. The patient suffering from congenital left clubfoot was affected by a severe second class malocclusion and by an evident asymmetry of the left hemimandible. During anamnestic recording the parents reported falls at 3-5 years of age. The aim of this work is to demonstrate that the role of the orthodontist is crucial to detect the consequences of traumatic injuries in early childhood. Methods The young patient affected by congenital left clubfoot showed a dismetric left legs and a severe second class malocclusion. The malocclusion consisted of insufficient transversal development of the maxilla, mandibular retrusion and left condyle hypoplasia. A traumatic event could have damaged the regular development of left condyle. The patient underwent to panoramic radiography , cephalometric radiography, CBCT, photographs and dental casts; cephalometric analysis and treatment plan were carried out. The treatment plan consisted of a first phase for orthopedical expansion of maxilla by means of rapid palatal expander for increasing the transverse dimension, achieving an adequate morphology of the palatine vault and to correct the proclination of upper incisors; during this phase the patient underwent also to logopedical rehabilitation to obtain an adequate function and posture of the tongue; in the second phase the patient underwent to multibracket appliance for recovering the upper impacted canine, for alignment and leveling of dental elements and at last for correction of sagittal and vertical discrepancy. Results The orthopedic-orthodontic treatment by means of rapid palatal expander and multibracket orthodontic appliance proved to be an adequate therapeutic strategy to reduce transversal, sagittal and vertical discrepancies in growing patient. It also is important to early detect the consequences of traumatic injuries in order to minimize condylar growth defects. Conclusions The Orthodontist plays a fundamental role in the multidisciplinary team during stomatognathic and postural rehabilitation of the patient affected by congenital disorder. Infect a careful analysis of the radiographic examination and an accurate clinical examination of the growing patient can lead to the detection of mandibular asymmetries resulting from a traumatic event.