Surgical Correction of Mandibular Prognathism in an Aviator

Mandibular prognathism is a term coined in case of the mandible over-riding the maxilla with a cross bite of the dental occlusion element also termed as Skeletal Class III relation and Dental Class III Malocclusion. A 24 year old serving apparently healthy Air force MIG 21 fighter pilot in A1G1 medical fitness reported to AFIDS while on planned annual leave with chief complaints of difficulty in chewing and abnormally protruding lower jaw leading to unsightly aesthetics, difficulty in mastication, altered speech and low morale. Aeromedical issues revolved around altered concave facial profile with accentuated negative nasionmenton angle compromising face mask fit as also speech alteration for effective communication. Asper norms for ideal dental fitness for armed forces, he was unfit since none of his anterior teeth came to approximation and posterior teeth were in complete cross bite. After obtaining written consent, he was operated under general anaesthesia for bilateral intra oral sagittal split osteotomy and posterior setback with rigid internal fixation. Post operative profile improved drastically, phonation improved especially the linguo- palatal sounds and the total mandibular Class III cross bite was corrected to normalcy with Class I harmonious occlusal scheme both dental and skeletal. The subject was placed out of flying category for three months for satisfactory healing of surgical bony wound subsequent to which he was evaluated and since bone healing was adequate, masticatory and phonetic functions had improved he was reverted back to his flying category.