Chin wings, Mandibular nerves & Gonial Angles

[beyondconfusedtbh]

So i had a consult this week in Germany. It went well, but I found out after my CT that my mandibular nerve is too low to have a chin wing (despite the Dr. saying I'd benefit greatly from one.)

Damn.

So what other options are there for me? IMPLANTS ARE A NO. I know many people on here share my stance on them. I was inspired by this ancient thread http://jawsurgeryforums.com/index.php?topic=963.0

The majority of the time it seems some of the users on here like to say what isn't possible, so i'll remind everyone that this is can all be considered HYPOTHETICAL. 

For those of us with a very low mandibular nerve, are chin wings completely out of the question? And more imporantly, has no one ever reduced an obtuse gonial angle? I'll be honest, I find it hard to believe that other than implants there is no solution considering some of the feats that surgery allows for. Remember I'm not talking obtuse to exactly 90 degrees, rather just a difference that is noticeable. Put simply it'd be nice to be able to see where the ramus ends and lower mandible starts.

Anyway feel free to share thoughts and opinions, I'm going to upload my cephs as soon as they're emailed to me. If anyone is interested in helping me further then I'm willing to PM pictures of my face as well.

[beyondconfusedtbh]

PS i understand that surgeons are my best bet in understanding this, but application of that logic defeats the point of a forum. lets all try to remember that )

[kavan]

PS i understand that surgeons are my best bet in understanding this, but application of that logic defeats the point of a forum. lets all try to remember that )

To the best of my knowledge, I've posted a few times as of recent (and before that too) about chin wings not working for people with:

a: STEEP mandibular plane angles
b: not enough 'space' between the tooth roots and the border of the mandible where the CUT for a chin wing has to be made which happens to be where the mandibular NERVE (that can get damaged) is.

Maybe some of these chin wing doctors are reading my posts and are no longer taking on patients with that type of morphology given that prior patients having that type of morphology riding in  on the 'wave' of chin wings have had problems with it due to their morphology and if not pain/nerve problems, the procedure for that type of morphology just turns out to be a glorified genio.

[beyondconfusedtbh]

If it wasn't clear, I can't have the surgery due to the position of my mandibular never. thats nothing new at all lol. there's posts on here from years ago saying the same thing. though i understand your stance and why you've take it, after seeing some B/A's I can pretty confidently tell you that the chin wing does, at the very least, fulfil my criteria of making the angle slightly smaller/ better/ more obvious in most cases.

I've attached an (incredibly poor) illustration to explain/ clarify. Lets say an individual has A, surely B & C are achievable through some other surgery. I'm currently thinking ILO would be most effective/ realistic. Perhaps when coupled with some sort of distraction to expand the mandible as was talked about in the thread I linked before. I must ask kavan, in the time that you've been on here have you seen any ILO B/A's (other than the one we assumed was one)?

Even if it is possible, the next problem is finding a surgeon that carries out ILO's in the first place.

[boyo]

I had chin wing surgery where the gonial angle was dropped 1 cm down. Worked fine. The problem is that it did very little in increasing the width of the gonials, which i also needed.

And what you're asking for is realistically only achievable with jaw implants.

[beyondconfusedtbh]

By width you mean the actual angle right lol?

Apologies for the illustration, it's probably just caused confusion.

https://www.sciencedirect.com/science/article/pii/S221454191600002X

Fig. 1 VS Fig. 17

[beyondconfusedtbh]

maybe ILO is the only 'solution' here. I'm still waiting on cephs, I understand its probably hard to give advice currently.

[kavan]

If it wasn't clear, I can't have the surgery due to the position of my mandibular never. thats nothing new at all lol. there's posts on here from years ago saying the same thing. though i understand your stance and why you've take it, after seeing some B/A's I can pretty confidently tell you that the chin wing does, at the very least, fulfil my criteria of making the angle slightly smaller/ better/ more obvious in most cases.

I've attached an (incredibly poor) illustration to explain/ clarify. Lets say an individual has A, surely B & C are achievable through some other surgery. I'm currently thinking ILO would be most effective/ realistic. Perhaps when coupled with some sort of distraction to expand the mandible as was talked about in the thread I linked before. I must ask kavan, in the time that you've been on here have you seen any ILO B/A's (other than the one we assumed was one)?

Even if it is possible, the next problem is finding a surgeon that carries out ILO's in the first place.

The position of your and most other people's mandibular nerve is between the roots of teeth and border of the mandible. You probably don't have enough 'space' between the nerve and the border of the mandible or high plane angle for them to either safely navigate the cut or for you to get much out of the surgery. The first 2 contours of you illustration don't do well with chin wings.

In your other thread about DISTRACTION Osteogenisis where you cited an article, I SHOWED a photo of the 'halo' distraction device the author uses for DO.

[beyondconfusedtbh]

That was a slightly different matter, about how DO on a LFI level can also result in changes to the midface.

I'm currently thinking ILO would be most effective/ realistic. Perhaps when coupled with some sort of distraction to expand the mandible as was talked about in the thread I linked before.

I was inspired by optimistics post (http://jawsurgeryforums.com/index.php?topic=963.0)

Regardless it seems that this route is pointless at this point. Perhaps I let the whole gonial angle hype get to me too much LOL.