Lower Jaw Surgery or Sliding Genio? [Pics]

[Ezra]

I've looked at your cephs. The near 'flat' occlusal and mandibular plane angles are not in the direction of addressing via CCW. On the contrary---in direction of clockwise rotation. However, I still think you could get away WITHOUT bi-max, especially so if you are wanting to avoid any 'surprises' to your nose orientation..

The displacement I made is a drop down to the chin with minor advancement. Something where the gaps would need to be filled in with a 'bone buttress'. The chin drop with modest advancement, increases the angle of inclination of the mandibular plane with reference to the points used to assess the angle and of course, directly targets the the shortness of the chin relative to the rest of the mandibular body.

So with this edit, it looks like a sliding genio alone would possibly be sufficient? According to one surgeon I consulted with, it is possible to fill in gaps using bovine cartilage grafts. Any thoughts on this?

[Ezra]

Here is example of why my advice was so. The spaces suggest the chin drop. Fill them in visually and it's pretty close to what he's doing when he juts. Not exactly but close enough. Keep in mind when he juts his jaw forward, he's dropping his chin in the process. He's NOT advancing his maxilla and displacing the orientation of his nose.

I notice in this picture you edited, I could possibly see a "witches chin" look. I'm wondering if is true with sliding genios? The surgeon told me it actually moves the soft tissue forward enough and the "chin indent" (forgive me for not remembering the actual term) moves forward with it.

[kavan]

I notice in these picture you edited, I could possible see a "witches chin" look. I'm wondering if is true with sliding genios? The surgeon told me it actually moves the soft tissue forward enough and the "chin indent" (forgive me for not remembering the actual term) moves forward with it.

I'm not talking about a 'sliding' genio, I'm referring to a drop down with a buttress between the cuts. I'm talking about something aimed at increasing the angle of the mandibular plane and also making the chin look longer in frontal.

[Ezra]

I'm not talking about a 'sliding' genio, I'm referring to a drop down with a buttress between the cuts. I'm talking about something aimed at increasing the angle of the mandibular plane and also making the chin look longer in frontal.

I'm trying to understand what the difference is. Isn't that just a type of sliding genio procedure?

Edit: It's called a drop down genio. I get it now.

[mommabear]

Someone else mentioned a deep bite resulting in a short lower face.

How does it look when you test a "spacer" like a pencil eraser between the top and bottom molars for more height?

[kavan]

I'm trying to understand what the difference is. Isn't that just a type of sliding genio procedure?

A slide is usually an angled cut where the bone is slid onto itself and some bone contact remains. There is some shortening of the chin with a 'forward' slide to project outwards. There is some elongation to the chin with backward slide BUT with loss of forward projection.

Although one can still make an angled cut to DROP DOWN the chin, as to not actually slide it BACKWARDS a spacer block or graft needs to be buttressed between where it was cut. Buttress materials can vary, eg. bone from spine of pelvis, calcium hydroxy appatite blocks, sometimes porex...something where the cut and SEPARATED bone segments have contact with something else.

However, some docs might elect to do the sliding (backwards) genio to elongate and then compensate with lost forward projection with a chin implant overlay.

[Ezra]

Someone else mentioned a deep bite resulting in a short lower face.

How does it look when you test a "spacer" like a pencil eraser between the top and bottom molars for more height?

I just tried it. My face was slightly longer, but my chin was still badly recessed, bad lip posture.

[JigJaw_:/]

I think you'd be fine with the chin osteotomy alone, plus the lip lift...if you are really hankering for more tooth show. You seem to have pretty good bone structure, really just the chin that needs a little push. Definitely don't want to keep having to mess with your nose, cause that will change with bimax. I need some of my upper lift knocked off as well, but you show more teeth than I do.

[JigJaw_:/]

kavan, is there a more preferred "buttress" for drop-down as far as stability?

[kavan]

kavan, is there a more preferred "buttress" for drop-down as far as stability?

It can be hydroxy appetite, harvest bone from pelvic spine, maybe porex block or other materials.

[JigJaw_:/]

So if I want to stay away from an implant overlay with drop-down, they will definitely be making an angled cut? If I'm understanding correctly, the only way to get the desired forward projection... How does the stabilization differ in a drop-down slide forward than a drop down? Please feel free to cyber smack me if I'm asking dumb questions.

[kavan]

So if I want to stay away from an implant overlay with drop-down, they will definitely be making an angled cut? If I'm understanding correctly, the only way to get the desired forward projection... How does the stabilization differ in a drop-down slide forward than a drop down? Please feel free to cyber smack me if I'm asking dumb questions.

This is someone else's thread where the info I gave was meant to apply to them.

[Lazlo]

yo dude, your rhino looks amazing. i love the new nose. frankl really is that good huh?

can i see a pic of the scar on your columnella? I want to see what it looks like when its healed.