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28 I I case report _ orthodontic _Selection of patients Combined orthodontic–surgical treatment requires not only strong and focused interdis- ciplinary collaboration, but also absolute ac- ceptance of the treatment plan by patients and parents. The treatment is time-consuming and post-operative corrections cannot be excluded. A detailed medical preoperative discussion should inform patients about the risks of com- bined treatment and the consequences of un- treated malocclusions. Malocclusions can cause numerous side-effects, such as back pain and chronic headaches (Figs. 3a & b). In markedly dolichofacial face types, malocclusions can lead to a pharyngeal constriction, which can mani- fest as obstructive sleep apnoea syndrome (Hochban et al. 1997). In adult patients, it is normally useful to de- termine the amount of malocclusion and force bite using a flat-plane bite splint. The splint is worn for six to eight weeks, and guarantees the identification of the physiological condylar po- sition. Pursuing orthodontic correction depends on the intended post-operative situation. There- fore, such correction is only dentoalveolar and does not transfer bite forces (Figs. 4a–c & 5a–e). The most favourable position of the maxilla and mandible is assessed on the basis of simulated cast surgery in which the amount of shift is determined. Using these casts, a splint can be fabricated and placed during surgery to fix the determined physiological condylar position pre- operatively (Figs. 6a–c). Teenagers with mandibular asymmetry that cannot be clearly classified should be treated with special care. Should clinical records be available only from the age of 16—whether as a result of erroneous dental records or simply owing to late initial assessment in a specialised practice—accurate early diagnosis of potential unilateral hyperplasia with further growth ten- dency is essential. According to the German Society of Oromax- illofacial Surgery guidelines, a nuclear medicine diagnostic is necessary—in addition to inspec- tion, palpation and radiography—to determine the risk of an abnormal growth in time. Through increased uptake in the affected region during scintigraphy, it is possible to draw conclusions about the growth’s behaviour. If the jaw con- tinues to change by abnormal bursts of growth, it is advisable to postpone surgical therapy until the cessation of growth. Figs. 5a–e_Pre-op clinical situation after orthodontic preparatory work. cosmeticdentistry 2_2012 Fig. 5e Fig. 5d Fig. 5c Fig. 5b Fig. 5a