symmetry S S Case Report Surgical-Orthodontic Diagnosis and Treatment Planning in an Asymmetric Skeletal Class III Patient—A Case Report Francisco Vale 1, * , Catarina Nunes 1 , Adriana Guimarães 1 , Anabela Baptista Paula 1,2,3,4,5 and Inês Francisco 1   Citation: Vale, F.; Nunes, C.; Guimarães, A.; Paula, A.B.; Francisco, I. Surgical-Orthodontic Diagnosis and Treatment Planning in an Asymmetric Skeletal Class III Patient—A Case Report. Symmetry 2021, 13, 1150. https://doi.org/10.3390/sym13071150 Academic Editor: Chiarella Sforza Received: 8 June 2021 Accepted: 24 June 2021 Published: 27 June 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Faculty of Medicine, Institute of Orthodontics, University of Coimbra, Área de Medicina Dentária—Av. Bissaya Barreto, Bloco de Celas, 3000-075 Coimbra, Portugal; uc2019185767@student.uc.pt (C.N.); uc45131@uc.pt (A.G.); anabelabppaula@sapo.pt (A.B.P.); uc43891@uc.pt (I.F.) 2 Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, 3000-075 Coimbra, Portugal 3 Faculty of Medicine, Area of Environment Genetics and Oncobiology (CIMAGO), Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, 3000-075 Coimbra, Portugal 4 Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal 5 Clinical Academic Center of Coimbra (CACC), 3000-075 Coimbra, Portugal * Correspondence: fvale@fmed.uc.pt Abstract: The skeletal Class III pattern is characterized by a sagittal intermaxillary mesial discrep- ancy. This discrepancy may have an unfavorable impact on function and aesthetics, which can be aggravated by the presence of facial asymmetries. This case report describes the diagnosis and treatment planning of a 19-year-old male patient with a skeletal Class III, maxillary hypoplasia, anterior crossbite, and mandibular asymmetry. When the patient reached skeletal maturity at the end of puberty, the definitive diagnosis was skeletal Class III with hyperdivergent profile and mandibular asymmetry, and a surgical-orthodontic treatment was proposed. At the end of the treatment, bimaxil- lary surgical correction allowed a skeletal Class I with mandibular symmetry, improving the function of the stomatognathic system and facial aesthetics. Keywords: aesthetics; asymmetry; dentistry; case report; orthodontics; orthognathic surgery; skeletal class III 1. Introduction Nowadays, dentofacial aesthetics of the smile and face symmetry are two factors considered in social comparisons [1], i.e., a symmetrical smile is considered more attrac- tive [2]. Additionally, orthodontic treatment has been demonstrated to increase oral health parameters [3]. Facial asymmetry can manifest as a part of disharmony of the craniofacial complex, altering the proportions between the facial thirds [4], having skeletal, dental, and soft tissue involvement [5]. According to Thiesen et al., the prevalence of facial asymmetry varied from 11 to 37% [6], being 61% more prevalent in skeletal Class III patients [7] than skeletal Class II [4]. The assessment of facial asymmetry is usually performed by comparing the distance between gnation or ment points and the facial midline [4]. The etiology is not entirely known, but several genetic and environmental risk factors are identified [4,5]. Most cases of facial asymmetry have a mandibular origin, resulting in a deviation of the lower third of the face [6]. Additionally, the mandible has a longer growth period, which increases the probability of being more affected than other structures. Haraguchi et al. reported that the longer growth and the mobility of the mandible promotes a more asymmetrical growth than the maxilla, which is connected to the adjacent skeletal structures [8]. Moreover, Severt and Proffit reported a prevalence of 85% of lateral excursion to the left in patients with dentofacial deformities with mandibular deviation [9]. Symmetry 2021, 13, 1150. https://doi.org/10.3390/sym13071150 https://www.mdpi.com/journal/symmetry