Does anyone wish their jaws were advanced more for functional reasons

[jawsaw]

This is sort of a repost, I think my previous post wasn't clear or concise enough.

I Think I could use more advancement. If my jaws were advanced another 5 mm or so I think that would leave me more room to breathe while standing up straight. I think I still have forward head posture to compensate for a constricted airway.

The issue isn't the ability to stand up straight. I can stand straight, but when I do my airway still feels constricted albeit less.

Can anyone relate? Has anyone had multiple surgeries to deal with this? Were they covered by insurance?

Im feeling a little bummed.

[jawsaw]

Okay I have done some thinking and I think I have a grasp on what I am not satisfied with. Bear with me here.

I had a flat occlusal plane and a steep mandibular plane.

It would be routine to rotate my jaws counter clockwise IF my occlusal plane was also steep.

Because my occlusal plane is flat if they were to rotate my jaws counter clockwise I would have a weird reverse smile (my smile arc would have been curved in the opposite direction of my lower lip. And that would look odd

My jaws were advanced with a SLIGHT clockwise rotation to improve my smile arc (which it did)

But my mandibular plane is still steep.

Let me remind you that my concern is not aesthetic. I am concerned with feeling like there is ample space between my chin and my neck. When I stand up straight, although my jaws were advanced, I still feel a constriction in my airway at an unacceptable level.

If i look up, giving myself a flat mandibular plane THEN it finally feels like there is enough space.

It is my steep mandibular plane that is f**king this whole thing up.

OKAY TIME TO TAKE A TRIP BACK TO GRADE SCHOOL PYTHAGOREAN TRIANGLES

Remember the 3 4 5 right triangle? to make a larger but congruent triangle you have to keep the ratio of the sides the same.
Lets make it a 6 8 10 triangle. The units are millimeters. Now lets hypothetically superimpose this triangle onto my jaw. The 10mm hypotenuse is on my mandibular plane.

         6
  -----------------
  -                  -
  -              -
8-          -  10 
  -     -
  -

This is a crude representation of me looking to the left. When My mandible was advanced it was done so along the mandibular plane. The hypotenuse. The 10mm portion of the triangle. SO IF MY JAW WAS ADVANCED 10MM ALONG MY STEEP ASS MANDIBULAR PLANE, THEN THE RESULTING PROJECTION WAS ONLY 6MM.

Right? I mean this is simple math.

What the hell is the solution at this point? Im not giving up. MY mandibular plane strongly indicates ccw but my occlusal plane does not. The occlusal plane would be a casualty when fixing my mandibular plane.

ALL I WANT IS TO STAND TALL AND NOT FEEL LIKE MY FACE IS CHOKING ME.

Is this too much to ask?

[terry947]

So basically what you're saying is that your oclussional plane is flat but you're mandibular plane is steep?

Tbh the only way to improve this would be a straight advancement. Rotations would f**k up the balance.

[Lazlo]

dude you need to provide real pics i have no idea what you're talking about.

[jawsaw]

I'm not going to post pics. Sorry Lazlo.

I guess I'm just trying to say that when the mandible is advanced, it is advanced at whatever angle your mandible is. So a straight advancement on a steep mandibular plane isn't really straight forward, its straight along the diagonal line of the mandible. so its advanced forward and down. So if my mandibular plane was flat I would have gotten a much larger FORWARD advancement because it would have been advanced only forward, as opposed to forward and down along an angled mandibular plane.

Seeing as I can't rotate counterclockwise to flatten my mandibular plane, my only option to create more space between my chin and my neck would be to advance my mandible more along its steep plane, resulting in some inevitable elongation of my face, with a straight advancement of my maxilla to meet the mandible.

from what I understand my maxilla was advanced 4mm and the mandible was advanced 9mm or so, with a 7mm genio.

I still look somewhat deficient in the chin region, but that is only a bi-product of my actual concern; having the ability to stand straight without my chin/steep mandibular plane constricting my airway.

I respect my surgeon a lot, but I am pretty sure I need more advancement or some other option that I don't know about.

During my consult with Posnick I was told that he would advance my maxilla at least 10mm with a bone graft, and then advance the mandible 15mm or so to meet the maxilla. This amount of movement frightened me because I didn't want to risk the "chimp" look. Now I am wondering if a more drastic advancement like this would have resulted in a superior outcome.

hmmmmm

[ditterbo]

Dr. Posnick supposedly does great cosmetic jaw surgery... and he wanted to move my jaws in that 15-20mm range as well.

[jawsaw]

2 effing centimeters? wow. That is the largest ive heard of.

Only tangentially related. Does anyone know the maximum genio advancement? without taking aesthetics into consideration. Like, lets push the limits Frankenstein far. 10mm? more?

The reason I ask is mine was 7, and it honestly looks like I could use another 7. I wonder if a genio advancement could suffice to provide me with the space I want between my neck and chin.

Im certain bimax is the superior way to go though

[kjohnt]

Jawsaw-

It doesn't make sense to me that you would have been advanced along the mandibular plane - it would have to follow the occlusal plane.  But if the occlusal plane was made to be slightly steeper, then the mandibular advancement was that much (whatever it was) downward.  The teeth have to stay together and an advancement following a steep mandibular plane would require a huge downgrafted maxilla.  That didn't happen.

But I think you're realizing the real issue from your follow up posts in that you simply weren't advanced enough because you were afraid of the aesthetic implications or the surgeon you chose hasn't the aesthetics of Posnick.

Also, I saw a girl on Facebook who was advanced 2cm... and TBH she could have used another at the chin.

[PloskoPlus]

But I think you're realizing the real issue from your follow up posts in that you simply weren't advanced enough because you were afraid of the aesthetic implications or the surgeon you chose hasn't the aesthetics of Posnick.

Skill more like it.  90% of surgeons consider a class I bite to be the only thing that matters, irregardless of how you look afterwards.  I learned this the hard way.

[Tezcatli]

2 effing centimeters? wow. That is the largest ive heard of.

Only tangentially related. Does anyone know the maximum genio advancement? without taking aesthetics into consideration. Like, lets push the limits Frankenstein far. 10mm? more?

The reason I ask is mine was 7, and it honestly looks like I could use another 7. I wonder if a genio advancement could suffice to provide me with the space I want between my neck and chin.

Im certain bimax is the superior way to go though

I think 10mm is a reasonable goal for a genioplasty. 14mm seems like a lot but there are two step genios.

I see many surgeons are conservative with genioplasties, which is fine when you are dealing with women but men could have more advancement in most of the cases. Even Posnick, I have his book and his results are great in general but more so with females, many of the guys still have a so-so chin, I think 2-3mm would have made a lot of difference in many cases(3mm is like a small chin implant).

[jawsaw]

Kjohnt,

Yea you are right. It would have required a huge downgraft of the maxilla if it was advanced along the mandibular plane. It is so hard to visualize how the movements were made.

[jawsaw]

Plosko,

What are you talking about?

you are class 1 but not satisfied with results? how so?

[jawsaw]

I would also like to add why i think my case was a little tricky for the surgeon.

Forward head posture. I think my forward head posture, which causes a lot of back, neck and shoulder problems really masks how recessed my jaws were. Also the facial hair I had does a great job of masking it.

It is psychologically distressing to have forward head posture. It takes so much pressure off of my body when I stand up straight. Pre-surgery I could stand up straight but my airway would be extremely constricted. Like I was breathing through a pin hole. I would sit up straight if I was on a long car drive with no passengers, because sitting up straight not only made me look weird, but I didnt have the ability to talk, but it felt relieving on my neck and shoulders.

It is like my jaw surgery had been planned assuming that my forward head posture would remain.

Now post surgery, I stand up more straight, and doing so gives me the same constricted sensation that I had before surgery in forward head posture.

Get it? space was created. I could either enjoy the larger airway in forward head posture, or stand up straight and constrict the airway to where it was before surgery.

Very frustrating.

Even with this issue I am having I want to remind everyone that I am in good spirits. My quality of life has definitely improved. These Issues are important to me personally, and I am going to push forward to have them resolved.

This surgery is basically black magic. I am no luddite, But come on guys, it is basically science fiction that procedures like this exist and are done routinely. Of course not every case will end up picture perfect. Human biodiversity wouldn't allow that. Imagine that you are an auto mechanic but every single engine is different than the last, and requires unique treatment to be restored. Its all about perspective .

[Lazlo]

I'm not going to post pics. Sorry Lazlo.

I guess I'm just trying to say that when the mandible is advanced, it is advanced at whatever angle your mandible is. So a straight advancement on a steep mandibular plane isn't really straight forward, its straight along the diagonal line of the mandible. so its advanced forward and down. So if my mandibular plane was flat I would have gotten a much larger FORWARD advancement because it would have been advanced only forward, as opposed to forward and down along an angled mandibular plane.

Seeing as I can't rotate counterclockwise to flatten my mandibular plane, my only option to create more space between my chin and my neck would be to advance my mandible more along its steep plane, resulting in some inevitable elongation of my face, with a straight advancement of my maxilla to meet the mandible.

from what I understand my maxilla was advanced 4mm and the mandible was advanced 9mm or so, with a 7mm genio.

I still look somewhat deficient in the chin region, but that is only a bi-product of my actual concern; having the ability to stand straight without my chin/steep mandibular plane constricting my airway.

I respect my surgeon a lot, but I am pretty sure I need more advancement or some other option that I don't know about.

During my consult with Posnick I was told that he would advance my maxilla at least 10mm with a bone graft, and then advance the mandible 15mm or so to meet the maxilla. This amount of movement frightened me because I didn't want to risk the "chimp" look. Now I am wondering if a more drastic advancement like this would have resulted in a superior outcome.

hmmmmm

I get it. You needed a bit of CCW or more of a genioplasty which could have been tilted up a bit and pulled along much of the soft tissue. I get what you're saying but some people also just have short mandibular bones so they can only be advanced so much.

[jawsaw]

Lazlo,

Yes, I think.

I probably have a short mandibular bone. Short but long. I really hope there is room for more advancement, somewhere, anywhere.