At the age of 20 years, twin A underwent surgical correction of the traumatic deformity according to the facial template phenotype of the unaffected twin sister. The orthognathic surgery procedure included a high Le Fort I osteotomy with maxillary advancement and impaction and with bilateral mandibular sagittal split osteotomy with setback associated genioplasty.
The present case demonstrates long-term follow-up of the influence of the facial trauma consisting of Le Fort II and III fractures. The comparison of the facial growth and development between twin A and twin B suggested that the cartilaginous septum and facial sutures plays an important role in the development of the nasomaxillary complex. Superimposition of the cephalometric radiographs before orthognathic surgery of the twin sisters (Fig. 2) revealed severely forward mandibular growth inhibition that resulted in significant posterior rotation of the nasal and maxillary bones and a vertical pattern of jaw growth. Because we compared two genetically identical twins, the disturbed nose and facial growth must be linked to the traumatized cartilaginous septum and facial sutures.
According to our observations in the patient presented here, it is suggested that trauma is most likely the cause of the developmental deformity of twin A. The unaffected twin sister (twin B) may serve as the genetic facial phenotype for the surgical orthognathic reconstruction intervention in twin A.
Dror Aizenbud, D.M.D., M.Sc.
Larry R. Morrill, D.D.S.
Stephen A. Schendel, M.D., D.D.S.
1. Meeuwis J, Verwoerd-Verhoef HL, Verwoerd CD. Normal and abnormal nasal growth after partial submucous resection of the cartilaginous septum. Acta Otolaryngol
2. Verwoerd-Verhoef HL, Verwoerd CD. Surgery of the lateral nasal wall and ethmoid: Effects on sinonasal growth. An experimental study in rabbits. Int J Pediatr Otorhinolaryngol
3. Grymer LF, Pallisgaard C, Melsen B. The nasal septum in relation to the development of the nasomaxillary complex: A study in identical twins. Laryngoscope
4. Grymer LF, Bosch C. The nasal septum and the development of the midface: A longitudinal study of a pair of monozygotic twins. Rhinology
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