PDF: Orthodontic treatment of a patient with Duchenne muscular dystrophy and macroglossia: How informed consent was critical to success

This article describes the complex orthodontic treatment of a 22-year-old patient with Duchenne muscular dystrophy and macroglossia.

His orthodontic treatment hinged on providing proper informed consent and management of the malocclusion with glossectomy, extractions, fixed appliances, and elastics.

Challenges to traditional treatment are outlined, and compromises to both process and outcome are discussed from an informed consent point of view because of the serious risks involved.

The treatment objectives were met, and the outcome was considered a success. 

The treatment goals in prioritized order were to (1) extract all third molars and the supernumerary paramolar, (2) reduce his massive tongue volume, (3) establish a functional occlusion, (4) close his anterior and posterior open bites and generalized spacing, and (5) increase his incisor display on smile.

Although numerous glossectomy techniques have been described, the keyhole technique with anterior wedge reduction is the most common. 

To establish a functional occlusion and close his bite, we intended to add simple crown tipping and lingual crown torque in a generalized fashion in both arches.

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