Lower jaw advancement needed along with Lefort?

[ODog]

Hi everyone,

I am in braces preparing for jaw surgery next year. I've only had one initial consult with the surgeon, and since then he's only been in contact with my orthodontist. So until I meet with the surgeon again, I was looking for advice or even clarification if Im misunderstanding something.

So... I've been diagnosed with a small, narrow, retrognathic maxilla, underbite, and cross bite. In addition to fixing these issues, I stated my desire to shorten the face a little if possible as I feel it's long and narrow, more dramatically the lower third (mandible). Keep in mind this post is mainly about aesthetic concerns and not functional.

To correct these issues, they decided on the following tentative plan: Maxilla advancement maybe 4 or 5 mm, maxilla expansion 4-5 mm, CCW with impaction to swing steep mandibular plane upward and shorten midface (I think?).

Now this involves only upper jaw work. At our initial consult the surgeon said double-jaw surgery is possible if he needs to set the mandible back a little to align the bite. My aesthetic concern with both is that my mandible too seems rather underdeveloped; it is definitely narrow as he told me, which gives me a narrow pointy chin, but it also looks short and close to my neck in my profile shots:

https://imgur.com/gallery/jTrbg

So lower setback seems out of the question to me. In fact I thunk it even looks too short to do nothing. Could I benefit aesthetically from lower advancement As well? What sorts of problems would this pose, etc.

Looking for opinions.... thanks!!!

[kavan]

Hi everyone,

I am in braces preparing for jaw surgery next year. I've only had one initial consult with the surgeon, and since then he's only been in contact with my orthodontist. So until I meet with the surgeon again, I was looking for advice or even clarification if Im misunderstanding something.

So... I've been diagnosed with a small, narrow, retrognathic maxilla, underbite, and cross bite. In addition to fixing these issues, I stated my desire to shorten the face a little if possible as I feel it's long and narrow, more dramatically the lower third (mandible). Keep in mind this post is mainly about aesthetic concerns and not functional.

To correct these issues, they decided on the following tentative plan: Maxilla advancement maybe 4 or 5 mm, maxilla expansion 4-5 mm, CCW with impaction to swing steep mandibular plane upward and shorten midface (I think?).

Now this involves only upper jaw work. At our initial consult the surgeon said double-jaw surgery is possible if he needs to set the mandible back a little to align the bite. My aesthetic concern with both is that my mandible too seems rather underdeveloped; it is definitely narrow as he told me, which gives me a narrow pointy chin, but it also looks short and close to my neck in my profile shots:

https://imgur.com/gallery/jTrbg

So lower setback seems out of the question to me. In fact I thunk it even looks too short to do nothing. Could I benefit aesthetically from lower advancement As well? What sorts of problems would this pose, etc.

Looking for opinions.... thanks!!!

When the upper jaw is rotated CCW which it sounds like part of plan, the lower jaw swings up, takes on more of a horizontal alignment which brings it more forward.

[ODog]

Thanks. I don't know if that will be enough movement though. For example, I'm trying to correct my forward head posture but when I pull my neck in to where it's supposed to be my jaw sinks into my neck, which obviously looks very awkward and is uncomfortable. I have no choice but to adopt a forward head just to get by but I now have arthritis in my neck and it'll only get worse. I'd like to be able to breathe and talk normally with my head in its natural position.

[kavan]

Thanks. I don't know if that will be enough movement though. For example, I'm trying to correct my forward head posture but when I pull my neck in to where it's supposed to be my jaw sinks into my neck, which obviously looks very awkward and is uncomfortable. I have no choice but to adopt a forward head just to get by but I now have arthritis in my neck and it'll only get worse. I'd like to be able to breathe and talk normally with my head in its natural position.

That could have to do with it having a downward orientation. CCW will oriented more outward. Think of the big hand on 6 and then CCWed to 3 oclock. The hand will be pointing outward.