Why do teeth always seem like they're to the right of the nose?

[molestrip]

I've seen it in pictures around the internet. I don't mean to pick on this surgeon - he might be good and I'm a terrible judge - but just as an example in every one of the pictures below, the incisors seem to be to the right of the nose:

Link to pictures

Is it just the angle the pictures are being taken from? What do you all think of these cases btw? Do they look good? I'm a terrible judge.

[nrelax11]

My teeth are like this because my nose is slightly crooked

[Cmonster]

I went through the pictures, very interesting. Some of them still have asymmetry post op- it could be due to lip positioning, the negative or black spaces in the mouth are uneven, and other facial features that dont line up like eyes, chin, jaw angles, nose etc. Asymmetry is very hard to correct from what I understand, and I see it strongest in case #2 and 3.
The girl in case #7 ended up with a beautiful result, slightly gummy, even if the teeth are somewhat uneven size wise she still looks like herself!

[nrelax11]

I like girl number 7 results too..she looks really cute after Although her expression in the first pic wasn't that flattering lol

[Alue]

Odd, my teeth (midline) are a bit to the right of the nose too.  I have condylar hypoplasia and I believe one of the condyles (sp) is longer than the other. 
Surgeon wants to do a aerthroplasty in addition to bimax.  I'm not sure if proper alignment of the TMJ joint would fix the asymmetry, though.   It definitely wouldn't fix the midline, but I don't really care much about midline. 

[Alue]

On a side note, it kind of depresses me.  After viewing a LOT of before and after pictures, the ones that have the most dramatic results typically have one and only one defect (ie. recessed maxilla with mandible in orthgnathic position or vice versa) and younger people typically have a much more dramatic change than older people. 

I could have gotten away with lower jaw advancement alone had I gone that route when I was a teen, but because of a orthodontic workaround I will need bi-max, and even then, I doubt it will put me where I could have been had I gotten jaw surgery when I was younger. 
Like that guy towards the bottom, his front improved a little (although hes smiling in the after and not in the before shot), but his side profile didn't improve at all despite bi-max advancement.  I'm sure he's happy to be pain free, though. 

[ForeverDet]

This doctor just sucks at anticipating the maxillary position relatively to the mandible so you have the nearly universal post-op cant/asymmetry. To be fair it is difficult to make it "perfect" after surgery but these results are outside the acceptable zone even though patients look good mostly and he's adequately corrected their other issues.

[molestrip]

So it's not just me? Oh man now that I'm looking at this stuff, I see all kinds of problems here. This would drive me nuts! Yes the mid-line of the maxilla isn't lined up with the midline of the mandible in about half the photos. Some of them aren't even level! A lot of them look pretty bad pre-op though. Is that perhaps the limitation? A few were also TMJ cases so there may have been some condylar resorption responsible. My case looks pretty close the first guy's and his result looks decent. Only difference is that I'll be going forward 10mm on bottom and 5mm w/3-way+CCW on top too.

[ticktickatick]

Many of them had cants pre-op. Moving things forward or back won't fix a cant. Since he didn't mention leveling out the jaws in any of the descriptions I would assume he just didn't correct that particular problem.

From what I understand, the main problem with canted jaws is that one side of the jaw has grown longer than the other. You can kind of even out the upper jaw, but there isn't a good way to do this for the lower jaw (at least in a typical two jaw surgery). So if you fix the upper jaw it makes the lower jaw look worse than if you had just left the cant alone.

[Alue]

Many of them had cants pre-op. Moving things forward or back won't fix a cant. Since he didn't mention leveling out the jaws in any of the descriptions I would assume he just didn't correct that particular problem.

From what I understand, the main problem with canted jaws is that one side of the jaw has grown longer than the other. You can kind of even out the upper jaw, but there isn't a good way to do this for the lower jaw (at least in a typical two jaw surgery). So if you fix the upper jaw it makes the lower jaw look worse than if you had just left the cant alone.

Yes one of the condyles can grow longer than the other.  Or you can have condular reabsorbtion /hypoplasia in the TMJ.

[molestrip]

That's a concern of mine as well. My bite opened up in my late teens. I then shifted slightly to the left over the next decade. CBCT and MRI or the joint look great though so it's a bit of a puzzle. Either a slow remodel of the bone (they do continue to change, albeit slowly) or uneven wear of teeth. I have no visible asymmetry right now and my mid-line is perfect so I'm hoping to keep it that way. Is that an unrealistic expectation?

Also, my plan doesn't change my nose much however it does cause my teeth to drop and protrude somewhat into my upper lip, which is flat now. Is that going to be awkward? I'm curious to know how people adjust to such changes. I expect that the muscles figure it out over time but it seems strange.

[Alue]

That's a concern of mine as well. My bite opened up in my late teens. I then shifted slightly to the left over the next decade. CBCT and MRI or the joint look great though so it's a bit of a puzzle. Either a slow remodel of the bone (they do continue to change, albeit slowly) or uneven wear of teeth. I have no visible asymmetry right now and my mid-line is perfect so I'm hoping to keep it that way. Is that an unrealistic expectation?

Also, my plan doesn't change my nose much however it does cause my teeth to drop and protrude somewhat into my upper lip, which is flat now. Is that going to be awkward? I'm curious to know how people adjust to such changes. I expect that the muscles figure it out over time but it seems strange.

Do one of the sides bulg out more than the other when you open your jaw?  Like if you put your hands over your tmj and open slowly can you feel it shifting in one direction or bulging more on one side than the other?

[molestrip]

Nope. Surgeons seem to check for that a lot though. They put their hands on top of the TMJ and ask me to open/close. So far no one has commented on it. The asymmetry is really small, only 2mm I think so below a perceptible threshold. It's possible my bruxism has simply intruded my teeth unevenly even, possibly to adjustments by dentists to my mouthguard over the years even. One surgeon I consulted mentioned I shouldn't wear a night guard anymore after surgery if I can avoid it.