My complex cases ceph tracing. what do they mean?

[Lefortitude]

Im thinking since my maxilla isnt too recessed, double jaw surgery may not be ideal.

the ortho who did the tracing says i need to get teeth extracted and a jaw surgery to fix the problem or a genio with bone graft can cover the cosmetic issue. 

what do you all make of this? 

http://imgur.com/a/leDp4

[ditterbo]

Since chin wing isn't an option, have you considered a wrap around jaw implant? IMO you probably want heft as much as or more than you need advancement.

[CCW]

Bimax with CCW, no extractions, if you want to look as good as possible.

[Lefortitude]

Since chin wing isn't an option, have you considered a wrap around jaw implant? IMO you probably want heft as much as or more than you need advancement.

Ive certainly considered it, but i feel at my young age, im pretty prone to getting hit in the face, the osteotomy is the best route for me.

@CCW since my maxilla is not super recessed (i.e sna angle) i feel a chin wing would be the ideal solution, IF i can find a surgeon who preforms it regularly, and can confirm that it can be preformed safely (i.e without significant bone resorption or damage to the mental nerve)  since my mandible is also quite hypoplastic. 

[CCW]

Your ortho wants to extract teeth so that your mandible can be advanced any meaningful amount. With CCW it can be advanced more, and you get to keep all your teeth. Gunson and Wolford do big CCW rotations all the time where the maxillary incisor tip barely moves at all.

A chin wing would be a camouflage treatment, and it wouldn't improve your airway.

http://www.drlarrywolford.com/galleries/photos-maxillofacial-surgery/

[ditterbo]

Hey CCW, does CCW rotation help correct sleep apnea or is it all in the jaw advancement?  Reason being Gunson will go bersek on the CCW, with a bigger posterior downgraft than even the jaw advancement, so I end up with like 9mm of a mandibular cut. I thought sleep apnea types need almost double that for real treatment.

[Lefortitude]

Your ortho wants to extract teeth so that your mandible can be advanced any meaningful amount. With CCW it can be advanced more, and you get to keep all your teeth. Gunson and Wolford do big CCW rotations all the time where the maxillary incisor tip barely moves at all.

A chin wing would be a camouflage treatment, and it wouldn't improve your airway.

http://www.drlarrywolford.com/galleries/photos-maxillofacial-surgery/

thank you kindly CCW! i hope dr gunson considers taking my case.

[CCW]

Hey CCW, does CCW rotation help correct sleep apnea or is it all in the jaw advancement?  Reason being Gunson will go bersek on the CCW, with a bigger posterior downgraft than even the jaw advancement, so I end up with like 9mm of a mandibular cut. I thought sleep apnea types need almost double that for real treatment.

It helps in the sense it allows for a bigger movement that wouldn't be possible without CCW rotation if it's indicated. The actual forward movement of the pog and the base of the tongue is what matters, and if the OP is very steep, there won't be a lot of actual forward movement since most of it will go downwards because the advancement has to follow the plane of the mandible. In Gunson's plan (saw it in your thread), you'll have a 17.6mm advancement which is massive and wouldn't be possible without CCW rotation.