Interdisciplinary Management of Bilateral Maxillary Facial Exostoses Associated With Esthetic and Psychosocial Concerns Using Osteoplasty and Gingivoplasty: A Case Report

Résumé fourni par la source

Maxillary facial exostoses are uncommon benign bony enlargements that are typically asymptomatic but may become clinically significant when they compromise facial esthetics or negatively affect a patient's psychological well-being. Surgical intervention is generally reserved for patients with functional limitations or esthetic concerns. This report describes the interdisciplinary management of bilateral maxillary facial exostoses in a young adult using psychological assessment, osteoplasty, and gingivoplasty to restore harmonious maxillary contours and improve patient confidence. A 26-year-old healthy female (American Society of Anesthesiologists (ASA) Physical Status Classification I) presented with bilateral facial maxillary exostoses that produced a prominent anterior maxillary contour. The patient reported significant esthetic dissatisfaction and psychosocial distress that adversely affected her confidence while performing her professional responsibilities as a school counselor. After comprehensive clinical evaluation and psychological assessment confirming appropriate expectations for treatment, the patient elected surgical management rather than prolonged orthodontic therapy. A full-thickness mucoperiosteal flap was elevated, followed by conservative osteoplasty to recontour the excessive facial alveolar bone and gingivoplasty to establish physiologic gingival architecture. The surgical site was closed with 4-0 nylon sutures. Postoperative healing was uneventful, with suture removal at 17 days demonstrating favorable soft tissue healing and substantial reduction of the bony prominence. At six weeks, complete healing and marked improvement in facial esthetics were observed. The patient reported a significant increase in self-confidence and satisfaction with the treatment outcome. This case demonstrates that interdisciplinary management combining psychological evaluation with conservative periodontal surgery can successfully address esthetic and psychosocial concerns associated with bilateral maxillary facial exostoses. Osteoplasty combined with gingivoplasty represents a predictable treatment option for carefully selected patients seeking immediate esthetic improvement while avoiding prolonged orthodontic treatment.

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