Author Topic: Anatomy 101  (Read 2989 times)

beyondconfusedtbh

  • Full Member
  • ***
  • Posts: 153
  • Karma: 2
Anatomy 101
« on: July 23, 2018, 10:27:15 AM »
Been trying to brush up on anatomy while counting down the days till my SARPE & in doing so I stumbled upon the attached image.

For context: https://www.toportho.org/think-pieces

The page itself is interesting but my question is really only about the diagram.

Someone smarter than me, why is it only the region in blue that is affected when the palate is expanded? I'm posing this in the most literal sense ie. why is the rest of the skull (in green) not altered as a result? I can't get my head around it....

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: Anatomy 101
« Reply #1 on: July 23, 2018, 11:39:22 AM »
Been trying to brush up on anatomy while counting down the days till my SARPE & in doing so I stumbled upon the attached image.

For context: https://www.toportho.org/think-pieces

The page itself is interesting but my question is really only about the diagram.

Someone smarter than me, why is it only the region in blue that is affected when the palate is expanded? I'm posing this in the most literal sense ie. why is the rest of the skull (in green) not altered as a result? I can't get my head around it....

What are you expecting people here to do for ya..... go through the entire article to FIND the particular diagram you are talking about???
Please. No PMs for private advice. Board issues only.

beyondconfusedtbh

  • Full Member
  • ***
  • Posts: 153
  • Karma: 2
Re: Anatomy 101
« Reply #2 on: July 23, 2018, 12:30:48 PM »
attached image  ;)

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: Anatomy 101
« Reply #3 on: July 23, 2018, 02:19:00 PM »
Been trying to brush up on anatomy while counting down the days till my SARPE & in doing so I stumbled upon the attached image.

For context: https://www.toportho.org/think-pieces

The page itself is interesting but my question is really only about the diagram.

Someone smarter than me, why is it only the region in blue that is affected when the palate is expanded? I'm posing this in the most literal sense ie. why is the rest of the skull (in green) not altered as a result? I can't get my head around it....
So, your question 'translates' to:

'Why doesn't my WHOLE SKULL get expanded when the surgery I'm getting is aimed at expanding my maxilla?'?
Please. No PMs for private advice. Board issues only.

beyondconfusedtbh

  • Full Member
  • ***
  • Posts: 153
  • Karma: 2
Re: Anatomy 101
« Reply #4 on: July 23, 2018, 03:04:56 PM »
For example it marks the malar region as also being affected, so why then aren't the nasal bones also moved outwards? Maybe a better question would be 'where are the points of rotation & how can you figure them out?'

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: Anatomy 101
« Reply #5 on: July 24, 2018, 02:55:41 PM »
I'm disregarding your 'new' or 'better' question because I would like to know WHY it was not intuitively obvious to YOU (in the first place) that the WHOLE rest of the skull would not be separated apart via SARPE or why you didn't refine your question to only the nasal bones in the first place and instead asked about the WHOLE green area that included the REST of the skull.
Please. No PMs for private advice. Board issues only.

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: Anatomy 101
« Reply #6 on: July 24, 2018, 07:17:58 PM »
I'm disregarding your 'new' or 'better' question because I would like to know WHY it was not intuitively obvious to YOU (in the first place) that the WHOLE rest of the skull would not be separated apart via SARPE or why you didn't refine your question to only the nasal bones in the first place and instead asked about the WHOLE green area that included the REST of the skull.

ETA: ETA:

For now just focus on what the diagaram is telling you.

It's telling that the separate halves of the maxilla ('hemi maxillae') TILT outward and they TILT more outward 'above' than 'below' meaning they tilt more outward at the PALATE level which is above the SPACE between the 2 front teeth. 

It's telling you that the areas in GREEN are FIXED and will not be moving. So, it's telling you it won't give you the equivilent of say an orbital box osteotomy to increase your inter eye distance and it won't increase the distance between your ears. This is mentioned just in case you were hoping it would do such. (Sorry, but can't think of other reasons someone would not be able to wrap their head around WHY the SARPE did not increase the distance of the rest of the whole skull unless they harbored that as a hope.)

It's telling you EVERYTHING in BLUE (darker blue means more movement takes place than lighter blue areas) are the parts moving.

The anatomy is that the roof of the palate is the floor of the nose. So, in terms of 'nose bones' the nose bones at the floor of the nose are being separated so it will be the BASE of nose that will be WIDER. Other 'nose bones' one can FEEL at the SIDES of their MIDDLE nose. In term of ANATOMY those 'nose bones' are called the ASCENDING MAXILLA which flank the PERI-FORM aperture which is the pear shaped HOLE you see in the diagram.

Basically, the diagram shows you that that the base of the periform aperture, (roof of the palate and floor of the nose) and all areas in close vicinity to it are moving the most because the force is being transferred to those areas and also that areas have been CUT/released for such movement.

The diagram does NOT tell you that the maxilla has been cut in 2 directions: vertical and horizontal as in a Lefort 1 BUT the TEXT tells you that. It tells you that the CUTS they do in (modern SARPE surgery) free the maxilla halves to outwardly TILT.

The rest is MECHANICS. Some force is transferred to the 'cheek bones' directly connected to the CUT areas which are MOVING. They are allowed to move somewhat because the CUTS they make precludes them from RESISTING. The TEXT tells you that but in different words. The text tells you that cuts are made so the separated maxilla does not IMPINGE on the zygoma.


 But the outwardly rotational  movement or TILTING is around an APEX a FIXED point and that point is FURTHER fixed in place by the REST of the skull in green. That FIXED APEX point is/are the NASAL BONES (formally called that) directly below the glabella. From the text: [ and rotate outward from an apex somewhere in the upper nose ]

 The mechanics are that, rotation or even 'prying' something to separate via some kind of LEVERAGE happens around a FIXED point. The nasal bones are FIXED. The outward prying apart of the areas being actually moved would tend to cause some INWARD FORCE to the formal nasal bones so they STAY in PLACE. Not to mention that the formal nasal bones are connected to other FIXED areas.

So, in essence, the OUTWARD force exerted on the maxilla halves and cheek bones allowed to move via cuts to allow that is exerting an INWARD force to the nasal bones and NOT an outward force to separate them. The nasal bones are the APEX around where the maxilla halves rotate and hence considered a FIXED point where there is NO movement.

I hope I'm not at risk of confusing you more by giving as BASIC a mechanical explanation as I can.



Please. No PMs for private advice. Board issues only.

beyondconfusedtbh

  • Full Member
  • ***
  • Posts: 153
  • Karma: 2
Re: Anatomy 101
« Reply #7 on: July 25, 2018, 03:22:22 PM »
ahh makes sense, so in actuality its just saying that the expansion also causes the 'upper' bit of the maxilla to be pushed (projected?) outwards.

I think the source of my confusion came from looking at too many animated LF1 videos, I keep forgetting the maxilla encompasses much more than just the area that is cut.

Thanks, very coherent explanation

beyondconfusedtbh

  • Full Member
  • ***
  • Posts: 153
  • Karma: 2
Re: Anatomy 101
« Reply #8 on: July 25, 2018, 03:31:23 PM »
ps:

I was actually more curious about added width to zygomas/ projection of orbitals but you were probably aware of that since i've brought it up before. I have no concerns with distance between eyes etc I just wasn't sure about where the point of rotation was & thought it'd be the glabella or something since the nasal bones are so small (stupid in retrospect.)

I always considered SARPE 'minor' in comparison to bi-max since so many people talk about getting it as a first step, but honestly it's pretty involved...

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: Anatomy 101
« Reply #9 on: July 25, 2018, 06:43:31 PM »
It looks like the expansion takes place close to where the device is which is 'upper' because the device is at the roof of the mouth (palate) and floor of the nose where 'lower' would be between the front teeth. Clearly, 'upper' does not mean the skull where the rest of the head is.

The TEXT tells you it's NOT minor and that basically the modern SARPE includes the vertical split but also the horizontal aspect of the cut as would be like a Lefort 1.
Please. No PMs for private advice. Board issues only.

beyondconfusedtbh

  • Full Member
  • ***
  • Posts: 153
  • Karma: 2
Re: Anatomy 101
« Reply #10 on: July 26, 2018, 03:00:43 AM »
Okay, so just to clarify that I do actually understand now, the red line on [attached pic] is referred to as the 'upper' maxilla & is the region that will be expanded the most. The region ABOVE this red line is not the upper, but the 'ascending' maxilla.

The apex is somewhere around the glabella/ nasal bones and the distraction device is fitted more or less in line with the roof of the mouth/ base of nose. Thus, the bones are tilted outwards MORE at the red line than above and below it, with the ascending maxilla being affected the least.

The cut is made so that the region directly above the red line does not impinge on the zygomas as it too will expand slightly.

Final grade?

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: Anatomy 101
« Reply #11 on: July 26, 2018, 08:44:40 PM »
What you first need to understand is WHY you asked your first question the way you did. Like why wasn't it intuitively obvious to you (in the first place) that the WHOLE rest of the skull would not be separated apart via a SARPE or why you didn't refine your question to only the nasal bones in the first place and instead asked about the WHOLE green area that included the REST of the skull.


TBH, it was unfathomable to me that someone would ask that question because the question reflected too much of an absence of background fundamentals that I would need someone to have to 'digest' my answer and/or giving one would only confuse you more.

I don't mean to chide you here but I really think you need to be more introspective as to WHY you didn't understand the WHOLE (rest of the) skull would not be pryed apart in this process. It's quite possible that you lack background in basic mechanical principles (or inability to include them in your thinking process) and would have to revisit those things or study up on those things to increase your capacity to undertand material that involves them. Otherwise it's beyond the scope here for me to give a 'tutorial' on all the basic concepts one would need to have to process an explanation. It's HARD for me to explain things when there doesn't seem to be much backdrop understanding of much at all on the part of the other person for me to 'grab onto'.

Your questions involve me observing/processing FOR YOU what you didn't or could not observe yourself that were there to observe. For example:

a: You later asked about 'rotation' points and 'how to figure those out'. Rotation points refer to FIXED points/areas that don't move, or that something else moves relative to. So, with reference to the diagram, how does one 'figure' out what the FIXED areas in the diagram which don't move??? The diagram SHOWS you what the FIXED areas are that DON'T move by coloring them GREEN.

b: The TEXT mentioned that the APEX where the outward tilting/ rotation could be related to as far as the facial bones were concerned was at the nasal bones. So observing what the TEXT says also helps.

c: I already gave explanation as to WHICH area is expanded the most which is near the base of the periform aperture and this can be considered the 'floor' of the nose and the 'roof' of the palate. I also told you that 'more above than below' referred to at the base of the nose vs. between the front teeth. So, more (TRANSVERSE) expansion above the front teeth than between them. As to your red line, it's not a matter of most of the expansion being 'above' or 'superior' to your red line. The matter is the expansion is more AT the line or in the vicinity of your red line. The red line cuts through the POSTERIOR part of the aveolar processs of the tooth bearing upper jaw. So, you would need to LOOK at the original diagram with REFERENCE to your red line to OBSERVE that the Posterior aspect of the upper jaw is being EXPANDED transversely and those areas are in DARK blue meaning they are being expanded more than the areas in light blue. TRANSVERSE expansion to the POSTERIOR part of the upper jaw is a salient goal of SARPE surgery that makes the tooth bearing upper jaw WIDER where it is too narrow.

d: The Lefort 1 type cut is made so that the outward transverse expansion of the (narrow) posterior tooth bearing upper jaw can take place without the zygoma areas impinging on the desired movement.

That's about it as to all I'm going to explain here.
Please. No PMs for private advice. Board issues only.

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: Anatomy 101
« Reply #12 on: July 27, 2018, 08:56:29 PM »
What you first need to understand is WHY you asked your first question the way you did. Like why wasn't it intuitively obvious to you (in the first place) that the WHOLE rest of the skull would not be separated apart via a SARPE or why you didn't refine your question to only the nasal bones in the first place and instead asked about the WHOLE green area that included the REST of the skull.


TBH, it was unfathomable to me that someone would ask that question because the question reflected too much of an absence of background fundamentals that I would need someone to have to 'digest' my answer and/or giving one would only confuse you more.

I don't mean to chide you here but I really think you need to be more introspective as to WHY you didn't understand the WHOLE (rest of the) skull would not be pryed apart in this process. It's quite possible that you lack background in basic mechanical principles (or inability to include them in your thinking process) and would have to revisit those things or study up on those things to increase your capacity to undertand material that involves them. Otherwise it's beyond the scope here for me to give a 'tutorial' on all the basic concepts one would need to have to process an explanation. It's HARD for me to explain things when there doesn't seem to be much backdrop understanding of much at all on the part of the other person for me to 'grab onto'.

Your questions involve me observing/processing FOR YOU what you didn't or could not observe yourself that were there to observe. For example:

a: You later asked about 'rotation' points and 'how to figure those out'. Rotation points refer to FIXED points/areas that don't move, or that something else moves relative to. So, with reference to the diagram, how does one 'figure' out what the FIXED areas in the diagram which don't move??? The diagram SHOWS you what the FIXED areas are that DON'T move by coloring them GREEN.

b: The TEXT mentioned that the APEX where the outward tilting/ rotation could be related to as far as the facial bones were concerned was at the nasal bones. So observing what the TEXT says also helps.

c: I already gave explanation as to WHICH area is expanded the most which is near the base of the periform aperture and this can be considered the 'floor' of the nose and the 'roof' of the palate. I also told you that 'more above than below' referred to at the base of the nose vs. between the front teeth. So, more (TRANSVERSE) expansion above the front teeth than between them. As to your red line, it's not a matter of most of the expansion being 'above' or 'superior' to your red line. The matter is the expansion is more AT the line or in the vicinity of your red line. The red line cuts through the POSTERIOR part of the aveolar processs of the tooth bearing upper jaw. So, you would need to LOOK at the original diagram with REFERENCE to your red line to OBSERVE that the Posterior aspect of the upper jaw is being EXPANDED transversely and those areas are in DARK blue meaning they are being expanded more than the areas in light blue. TRANSVERSE expansion to the POSTERIOR part of the upper jaw is a salient goal of SARPE surgery that makes the tooth bearing upper jaw WIDER where it is too narrow.

d: The Lefort 1 type cut is made so that the outward transverse expansion of the (narrow) posterior tooth bearing upper jaw can take place without the zygoma areas impinging on the desired movement.

That's about it as to all I'm going to explain here.

ETA: If med articles (such as this one) are difficult for you to understand, then stick to the things that are easier to understand. Med articles presume or presuppose the reader has the background to understand what they are conveying and are not written for lay people.

Don't get me wrong, I 'understand' how and why it might be hard for many people to understand material AIMED at medical professionals.

Even though they are out there for anyone to read, the presentation, format, text, illustrations etc. PRESUPPOSES the reader has enough background TO understand what is being conveyed whether or not they are actually a med professional in the venue of maxfax surgery.

One presupposition regarding capacity to understand what is being conveyed in such an article would be IF the reader could answer 'YES' to the following question:


'Do I score high on tests that measure aptitude in science topics, eg. math, physics and also on tests that measure reasoning/information processing abilities?'

If the answer is 'NO', then best NOT to pursue med articles in the absence of any grounding needed to process the information they convey. This also holds true even if someone with a science background gives an explanation.

If this article and it's contents are difficult to understand, in addition to attempted explanations then take heart because you are NOT 'expected' to understand med articles in order to have surgery. Your surgeon won't be holding contingent you pass a quiz based on the contents of the article in order to have SARPE surgery. Yes, that's right. You can have surgery without having to go to medical school to understand how it's done. Happens all the time.

All you need to know (in the absence of ANY science background that would apply to digesting material in this med article) is:

a: The objective of the surgery is to WIDEN the BACK PART of the tooth bearing upper jaw as to make an area WIDER where it is presently TOO NARROW.

b: In order for the area they want to move and make wider and be FREE to do so without RESISTANCE from a 'neighboring' area is to make (type of) cuts that goes through the BACK of the tooth bearing upper jaw. (Like a Lefort 1 cut but with some alterations where cut is wider in places where it needs to be wider.) If not, the neighboring areas will remain as FIXED areas and hence RESIST or otherwise 'impinge' on the DESIRED movement/objective of the SARPE expansion.

c: The neighboring areas that do move somewhat in the direction of the specific area needed to be transversely expanded (back of the tooth bearing upper jaw to become wider) are shown on the original diagram in LIGHT blue. They move 'somewhat' but NOT 'as much' as the specific area/s (dark blue) being widened MORE via the SARPE. The neighboring areas in light blue move somewhat but not as much as the areas in dark blue because they are UNFIXED (via types of cuts) needed for them to move somewhat so they 'get out of the way' (or don't impinge or otherwise interfere with) of the desired SARPE expansion. They move somewhat because they are UNFIXED in some places (via cuts) yet remain FIXED in other places. All areas on the original diagram that are GREEN are FIXED areas (that don't move). Areas that move somewhat (light blue) are UNFIXED where they NEIGHBOR areas to be expanded the most but will RESIST the same extent of expansion that the dark blue areas have because the light blue areas are also 'connected to' FIXED areas in green.

d: If you need to know WHY an area DEFINED as a FIXED area doesn't move, for example the areas on the original diagram DEFINED by the color GREEN as areas that do not move, the simple answer is because they are FIXED in place. If you need to know WHY an area is fixed in place and not subject to movement/displacement by forces exerted on other areas, then you will need to study up on basic mechanical principles usually taught in high school.

Please. No PMs for private advice. Board issues only.