BSSO vs. IVRO with Lefort 1

[chynee]

I'm about 4 months out from surgery (according to my surgeon and orthodontist), and my surgeon thinks I would have success with either BSSO or IVRO. He told me to research both online, so I could be fully educated. He said when it gets closer to surgery and he does manipulations of my CT scan on the computer, he'll have a better idea of which he'll think his best. He keeps mentioning that ultimately it's up to me as he is well versed in both surgeries.

I've done some research, but when I read about bone cuts too much I start getting a little faint. hah
Obviously, it seems the biggest risk in BSSO is the nerve. I'm not too concerned about it, but probably because I'm not living with any nerve issues now. My biggest concern with IVRO is being wired shut because I'm very thin naturally. I'm also nervous about potentially needing the bone shaved later. I'm a female who is almost 6' tall and has a very high metabolism. I literally don't have any weight to lose, and my surgeon has me already supplementing with protein shakes between meals to help me put on some weight before surgery.

edited to add: I have prognathism (underbite) which is why I'm have this surgery. Our last measurement was about 5 mm, but my bite has changed with the orthodontics.

Any BTDT advice?

[PloskoPlus]

I'm about 4 months out from surgery (according to my surgeon and orthodontist), and my surgeon thinks I would have success with either BSSO or IVRO. He told me to research both online, so I could be fully educated. He said when it gets closer to surgery and he does manipulations of my CT scan on the computer, he'll have a better idea of which he'll think his best. He keeps mentioning that ultimately it's up to me as he is well versed in both surgeries.

I've done some research, but when I read about bone cuts too much I start getting a little faint. hah
Obviously, it seems the biggest risk in BSSO is the nerve. I'm not too concerned about it, but probably because I'm not living with any nerve issues now. My biggest concern with IVRO is being wired shut because I'm very thin naturally. I'm also nervous about potentially needing the bone shaved later. I'm a female who is almost 6' tall and has a very high metabolism. I literally don't have any weight to lose, and my surgeon has me already supplementing with protein shakes between meals to help me put on some weight before surgery.

edited to add: I have prognathism (underbite) which is why I'm have this surgery. Our last measurement was about 5 mm, but my bite has changed with the orthodontics.

Any BTDT advice?

IVRO is hardly ever done these days. It does produce better looking jaw angles then BSSO, and because it's further from the nerve, there is technically less chance of damaging the nerve.  However, because there is no plate fixation, you may end up with total nerve loss.

This guy had IVRO and suffered badly:

http://jawsurgeryforums.com/index.php?topic=4023.msg28738#msg28738

With 5 mm, you could probably have a 7 mm Le Fort I advancement instead. Risk of any permanent numbness is much less than with lower jaw surgery (disclaimer: I ended up having permanent nerve damage after LF1, but t's just my s**t luck, because I've not found anyone else with the same problem).

[kjohnt]

IVRO is hardly ever done these days. It does produce better looking jaw angles then BSSO, and because it's further from the nerve, there is technically less chance of damaging the nerve.  However, because there is no plate fixation, you may end up with total nerve loss.

This guy had IVRO and suffered badly:

http://jawsurgeryforums.com/index.php?topic=4023.msg28738#msg28738

With 5 mm, you could probably have a 7 mm Le Fort I advancement instead. Risk of any permanent numbness is much less than with lower jaw surgery (disclaimer: I ended up having permanent nerve damage after LF1, but t's just my s**t luck, because I've not found anyone else with the same problem).

How is IVRO fixated?

OP - Did your surgeon mention just Lefort I advancement without touching your mandible?  I agree that it might be the way to go, but would need to see profile pictures.  It would be much easier and less risky, and may even look better.  I like the whole "ante face" thing though.

[PloskoPlus]

How is IVRO fixated?

It's not. The jaws are wired shut.

[chynee]

How is IVRO fixated?

OP - Did your surgeon mention just Lefort I advancement without touching your mandible?  I agree that it might be the way to go, but would need to see profile pictures.  It would be much easier and less risky, and may even look better.  I like the whole "ante face" thing though.

I don't know I think this chin needs to back up at least a little. I'll attach some photos of my jaw and profile and one of how I normally smile/look.

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[chynee]

IVRO is hardly ever done these days. It does produce better looking jaw angles then BSSO, and because it's further from the nerve, there is technically less chance of damaging the nerve.  However, because there is no plate fixation, you may end up with total nerve loss.

This guy had IVRO and suffered badly:

http://jawsurgeryforums.com/index.php?topic=4023.msg28738#msg28738

With 5 mm, you could probably have a 7 mm Le Fort I advancement instead. Risk of any permanent numbness is much less than with lower jaw surgery (disclaimer: I ended up having permanent nerve damage after LF1, but t's just my s**t luck, because I've not found anyone else with the same problem).

Thanks for the link! Not being stabilized with the screws and stuff does make me totally nervous. BSSO seems to be what I'm leaning towards but I want to make sure I fully understand both. It's so nervewracking researching all the risks. pun intended...

[PloskoPlus]

Thanks for the link! Not being stabilized with the screws and stuff does make me totally nervous. BSSO seems to be what I'm leaning towards but I want to make sure I fully understand both. It's so nervewracking researching all the risks. pun intended...

What kind of movements did your surgeon propose?  Who is your surgeon?

Your maxilla looks recessed, but I'd not go overboard with the LF1.  A chimp upper lip sucks.  I hate, hate, hate mine.

[kjohnt]

Damn IDK... I personally still question that you should touch your mandible at all.  I'm thinking maxillary advancement and slight impaction to offset the increases tooth/gum show (to keep it the same).  No BSSO or IRVO.  This would very mildly make your face shorter and give better projection in the mid-face.  It would also save you a lot of money and from the potential complications of altering the mandible.

Not that folks should compare their everyday pictures with magazine photos of celebrities, but just to compare profiles, look at this picture of Zoe Saldana.  I've always thought she looks nice from profile view.  I don't think her mandible is any less projected than yours.  But you can clearly see her maxilla sits more forward.



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[notrain]

edited to add: I have prognathism (underbite) which is why I'm have this surgery. Our last measurement was about 5 mm, but my bite has changed with the orthodontics.

Any BTDT advice?

Bear in mind that for a dental underbite of 5mm you would need a 7mm lefort 1 advancement to get a normal 2mm overjet after the surgery. 7mm lefort 1 would be too much for you, that would give you chimp mouth probably.

From your pics, your skeletal underbite looks larger than 5mm, I'd estimate you will end up with a dental underbite of 7-8mm pre op which would mean a lefort 1 advancement of 1cm if you'd left the lower jaw alone.

Personally, I wouldn't get IVRO for comfort reasons. I'd shoot for 5-6mm LF1 advancement which would nicely deemphasize your nose and 3-4mm BSSO Setback.

[chynee]

What kind of movements did your surgeon propose?  Who is your surgeon?

Your maxilla looks recessed, but I'd not go overboard with the LF1.  A chimp upper lip sucks.  I hate, hate, hate mine.

He has only told me that my bottom jaw should go back via BSSO or IVRO and LF1 on top. I'm not sure about up or down or other words (I'm still learning). I don't want to go overboard on the LF1 either. I'm really scared about showing too much gum or chimp lip because I do like how my upper teeth show know (I just need the dang bottom teeth to not cover my upper teeth.) I'm sorry your results weren't what you thought! My surgeon is Dr. Uday Mehta www.newjaw.com. After seeing several, he was my favorite and seemed the most experienced and understanding of my goals.

[chynee]

Imo you'd need mandibular setback with lf1 advancement to account for the discrepancy and achieve optimal aesthetics. Is this your surgeons plan?

Yep, that's exactly what he has planned!

[chynee]

Bear in mind that for a dental underbite of 5mm you would need a 7mm lefort 1 advancement to get a normal 2mm overjet after the surgery. 7mm lefort 1 would be too much for you, that would give you chimp mouth probably.

From your pics, your skeletal underbite looks larger than 5mm, I'd estimate you will end up with a dental underbite of 7-8mm pre op which would mean a lefort 1 advancement of 1cm if you'd left the lower jaw alone.

Personally, I wouldn't get IVRO for comfort reasons. I'd shoot for 5-6mm LF1 advancement which would nicely deemphasize your nose and 3-4mm BSSO Setback.

You have a good eye - it's definitely more than 5mm now. That measurement was taken in October when I had only been in braces for a few months. As my bottom teeth have straightened, the gap has only gotten bigger.

Can anyone here mention how hard it is to bite into EVERYTHING like this? Seriously, biting a piece off a sandwich or apple is impossible these days.

[PloskoPlus]

He has only told me that my bottom jaw should go back via BSSO or IVRO and LF1 on top. I'm not sure about up or down or other words (I'm still learning). I don't want to go overboard on the LF1 either. I'm really scared about showing too much gum or chimp lip because I do like how my upper teeth show know (I just need the dang bottom teeth to not cover my upper teeth.) I'm sorry your results weren't what you thought! My surgeon is Dr. Uday Mehta www.newjaw.com. After seeing several, he was my favorite and seemed the most experienced and understanding of my goals.

You may need impaction to go with the advancement. You really want to get this right the first time. Has he shown you any before and afters?

[notrain]

Can anyone here mention how hard it is to bite into EVERYTHING like this? Seriously, biting a piece off a sandwich or apple is impossible these days.

Tell me about it. Preop I had 13-14mm overjet (the opposite of what you have) and eating anything that I couldn't shove into my mouth with a spoon or fork was impossible.

[chynee]

You may need impaction to go with the advancement. You really want to get this right the first time. Has he shown you any before and afters?

I tried to google impaction, but I'm still not quite sure what that means.

I agree, I'd prefer one and done in the orthognathic surgery department. He did show me before and afters which all looked amazing. Would a surgeon show you bad before and afters though?