Revision Maxillary Downgrafts

[ghiggson90]

Hey y'all. I had a LeFort/BSSO/Genio in June, where they moved my maxilla up 8 mm, my jaw slightly back, and then a genioplasty. I am pleased with the genioplasty, but definitely not the LeFort.T

1) To what exent would it be possible to undo the impaction? I now have zero tooth show at rest which makes me look very old. I would be willing to accept my old somewhat gummy smile if it means recuperating incisor display.

2) What grafting materials would be used? I see Wolford uses PBHA. Does anyone know what Gunson uses?

3) How long should one wait before revision? Some surgeons say 6 months, some say 12.

Much appreciated.

[CCW]

Hey y'all. I had a LeFort/BSSO/Genio in June, where they moved my maxilla up 8 mm, my jaw slightly back, and then a genioplasty. I am pleased with the genioplasty, but definitely not the LeFort.T

1) To what exent would it be possible to undo the impaction? I now have zero tooth show at rest which makes me look very old. I would be willing to accept my old somewhat gummy smile if it means recuperating incisor display.

In my opinion it doesn't make sense to restore your old gummy smile, but it can be corrected to normal. It sounds as though you require a full revision.

2) What grafting materials would be used? I see Wolford uses PBHA. Does anyone know what Gunson uses?

Same stuff.

3) How long should one wait before revision? Some surgeons say 6 months, some say 12.

Hard to say, depends on the surgeon.

[PloskoPlus]

AFAIK, if the required down graft is small, Gunson will use just bone scraps from the osteotomy. Different surgeons use different materials.

[ghiggson90]

Before.

[ghiggson90]

After. Think I need to come down at least 4mm. Will possible push for full reversion. Comments appreciated.

[PloskoPlus]

After. Think I need to come down at least 4mm. Will possible push for full reversion. Comments appreciated.

How long is your upper lip? Can you close your lips without effort?

[ghiggson90]

How long is your upper lip? Can you close your lips without effort?

I haven't measured my lip, but I can close my lips entirely without effort.

[ghiggson90]

How long is your upper lip? Can you close your lips without effort?

22 mm.

Also, just to update my situation, a surgeon has already agreed to downgraft me 4 mm with rigid fixation and autologous bone graft. Have another consult on the 29th.

[ghiggson90]

22 mm.

Also, just to update my situation, a surgeon has already agreed to downgraft me 4 mm with rigid fixation and autologous bone graft. Have another consult on the 29th.

One of the leading surgeons has offered me the following plan:

+ 5 mm anterior downgraft (based on 0 to -1 mm tooth show at rest)
+ 6.5 mm posterior downgraft
+ 2 mm maxillary advancement
+ 4 mm reduction genioplasty

Any feedback or thoughts would be appreciated.