Midface hypoplasia

[stupidjaws]

http://topnews.in/files/bastian-schweinsteiger.jpg bastian

http://www.fifa.com/mm/photo/worldfootball/clubfootball/01/68/61/91/1686191_full-lnd.jpg vlado

[stupidjaws]

guys i'd say this: let's see how things turn out.

if we really look funny we'll get additionall surgery.

[Alue]

alright found a bunch of before/afters that showcase mid-face deficiencies (everyone had a Le Fort 1 + some form of grafting)

These two scare me, how come the maxilla and mid face appear to have moved forward but the mandible/chin seems to have stayed behind in both cases?   Were they advanced the same? 

[Dempah]

Did some morphing, would something like this have been possible to achieve for this guy?

[Alue]

Did that guy have a slight underbite before surgery? 

[Heavyweight]

These two scare me, how come the maxilla and mid face appear to have moved forward but the mandible/chin seems to have stayed behind in both cases?   Were they advanced the same?  

I think his maxilla was advanced too much. He started with a strong bone structure, but the maxillary advancement seemed to wash it out. The change in his 3/4 view is what bothered me the most -- he had originally had some concavity under his cheekbones, which is desirable in men, but advancing the maxilla caused it to become convex. This is what he should have looked like imo.



It's actually quite similar to his starting point, which is why I don't think he needed surgery at all.

[Dempah]

your changes look much better. What did  you do?

Just did a very fast morphing while watching soccer. 

But I gave him a softer lower third by shaving off the square jaw and chin. CCW to bring the lower jaw and chin forward while improving the nasolabial angle. No restrictions with photoshop!
Is this possible to achieve? No idea!   

[Alue]

I think his maxilla was advanced too much. He started with a strong bone structure, but the maxillary advancement seemed to wash it out. The change in his 3/4 view is what bothered me the most -- he had originally had some concavity under his cheekbones, which is desirable in men, but advancing the maxilla caused it to become convex. This is what he should have looked like imo.

How is concavity under cheekbones (which aren't really prominent) different from mid-face hypoplasia?  I guess midface hypoplasia is more characterized by lack of cheek bones etc.?  It almost looks like the grafting (I'm assuming there was grafting) was done too low. 
I agree it looks like his maxilla was advanced too much.  I guess it is possible he still had swelling in that picture. 

[CK]

How is concavity under cheekbones (which aren't really prominent) different from mid-face hypoplasia?  I guess midface hypoplasia is more characterized by lack of cheek bones etc.?  It almost looks like the grafting (I'm assuming there was grafting) was done too low. 
I agree it looks like his maxilla was advanced too much.  I guess it is possible he still had swelling in that picture. 

personally im skeptical about what "could" have been done. we dont have access to his ceph, we dont know anything about his actual bone structure. his pre-op status might have had several mitigating factors that prevented what *we* think should have happened.

every face is different, and the upper jaws development varies from person to person. photoshop showing soft tissue changes are often reasonable, but full-scale bone warps aren't realistic.

[Lazlo]

personally im skeptical about what "could" have been done. we dont have access to his ceph, we dont know anything about his actual bone structure. his pre-op status might have had several mitigating factors that prevented what *we* think should have happened.

every face is different, and the upper jaws development varies from person to person. photoshop showing soft tissue changes are often reasonable, but full-scale bone warps aren't realistic.

or his surgeon could have been a s**thead

[Modigliani]

 

[PloskoPlus]

I have the paper.  This guy had a 13 mm (!!) maxillary advancement at the LeForte 1 level!

Overall:


Case 2: retromaxillism, narrow maxilla,
mandibular retroalveolism
Clinical characteristics
Frontal view showing narrow facies with poor
gonial angle contour (Fig. 2A)
Concave profile
Flat midface: maxilla and malar
??Edentulous?? facial expression
The chin prominent but in normal position
Lack of dental support to the upper and lower lip
Prominence of nasolabial folds and crease
Narrow alar base
Class I molar and canine relation
Crowding in the maxillary and mandibular
dental arches
Incongruent curves of Spee
Protrusive maxillary incisors

Treatment plan
The treatment plan is a combined surgical and
orthodontic approach. The two-stage surgical
approach (Figs. 2B?D) is
1. Anterior mandibular alveolar segment distrac-
tion osteogenesis [4,5] and surgically assisted
rapid palatal expansion (see Fig. 2B).
2. Orthodontic alignment of two dental arches,
including full decompensation of the existing
skeletal anomalies. Now it becomes clear that
this case is a class III case (retro-/micromaxil-
lism). The occlusion before the second surgical
procedure shows class III molar relation and
a negative overjet. The opened space behind
the canines will be managed by dental implants
at the end of the treatment.
3. Bimaxillary surgery: 13 mm of maxillary
advancement at the LeFort I level, mild mandib-
ular set back through BSSO [6], and clockwise
rotation of both jaws. In addition, vertical chin
augmentation and, again, mandibular segmen-
tal osteotomy for widening of the mandible
(see Fig. 2D).
Outcome
The outcome shows improved facial aesthetics with
good lip support, balanced skeletal relation, and
widened maxilla and mandible (Fig. 2E). From
the frontal view, the face has harmonized, with
normal mandibular width and gonial angles. The
occlusion shows a normal overbite and overjet.
The creation of a gap behind the canines allows
class II molar relation. The bone and gingiva gener-
ated there through distraction is excellent and ready
for dental implants.


What I put in bold may be of interest to those with narrow faces.

[pekay]

That guy looks weird post-op (not better just different)

[Gregor Samsa]

That guy looks weird post-op (not better just different)

His face is still a bit long but otherwise I think it's a huge improvement. It looks like his upper jaw was advanced slightly too much though. I don't see any mention of HA grafts so I don't understand how they managed to advance his entire midface so much though since most surgeons told me that couldn't be done in my case.

[PloskoPlus]

His face is still a bit long but otherwise I think it's a huge improvement. It looks like his upper jaw was advanced slightly too much though. I don't see any mention of HA grafts so I don't understand how they managed to advance his entire midface so much though since most surgeons told me that couldn't be done in my case.

They widened his mandible.  I thought it was impossible.

Sigh... And the Le Fort III girl looks outstanding.  Like a completely different person.