Author Topic: Jaw Surgery Advice  (Read 2361 times)

Bwalano

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Jaw Surgery Advice
« on: December 01, 2018, 10:41:54 AM »
OP asked for deletion.
« Last Edit: January 02, 2019, 09:25:13 PM by GJ »

kavan

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Re: Jaw Surgery Advice
« Reply #1 on: December 01, 2018, 11:41:54 AM »
You could just get the BSSO because it does looks like a situation (the bite of your teeth) where they could move only the jaw. That is to say it doesn't look like a situation where they would 'have to' alter the upper jaw inorder to advance the lower one. So, I understand why single BSSO was offered. Your chin is not recessive so, no advancement needed there. His first suggestion was legit for the reasons given.

You THEN brought to the table you wanted midface changes such as changes to the nose, nose/lip angle. The doc is ACCOMMODATING those changes by offering you the Lefort 1 because he can justify moving forward for the nose/lip angle changes you want because he SEES you would have better TOOTH SHOW that way. Hence the drop down of the upper jaw as part of the package. It's also justified because you have a short midface area. That is to say your middle '1/3rd' is shorter than your lower '1/3rd'.

I usually don't opine on what people worry about. This post offered just to shed light on the most likely reason(s) the surgeon offered you what he offered.
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Bwalano

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Re: Jaw Surgery Advice
« Reply #2 on: December 01, 2018, 01:18:40 PM »
You could just get the BSSO because it does looks like a situation (the bite of your teeth) where they could move only the jaw. That is to say it doesn't look like a situation where they would 'have to' alter the upper jaw inorder to advance the lower one. So, I understand why single BSSO was offered. Your chin is not recessive so, no advancement needed there. His first suggestion was legit for the reasons given.

You THEN brought to the table you wanted midface changes such as changes to the nose, nose/lip angle. The doc is ACCOMMODATING those changes by offering you the Lefort 1 because he can justify moving forward for the nose/lip angle changes you want because he SEES you would have better TOOTH SHOW that way. Hence the drop down of the upper jaw as part of the package. It's also justified because you have a short midface area. That is to say your middle '1/3rd' is shorter than your lower '1/3rd'.

I usually don't opine on what people worry about. This post offered just to shed light on the most likely reason(s) the surgeon offered you what he offered.

Thanks for your input. Do you see any reason to have CCW or CW rotation done? My wish is for my profile to be stronger, and my midface to be more aesthtic i.e upturning of the nose tip and a less percieved length of the nose along with the other improvements I listed. My worries are that only impaction achieves this as opposed to a downgraft?
« Last Edit: December 01, 2018, 01:31:15 PM by kavan »

kavan

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Re: Jaw Surgery Advice
« Reply #3 on: December 01, 2018, 01:46:14 PM »
Well, you would not get (anterior) impaction for the CCW because that would shorten the anterior maxilla and make LESS tooth show where you need more tooth show. NOR would that be done for a shorter midface area which you have. You might get a modest posterior downgraft for the CCW rotation or just an 'even' uniform downgraft as you are not that much of a clear cut case for a rotation.

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Bwalano

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Re: Jaw Surgery Advice
« Reply #4 on: December 01, 2018, 03:40:30 PM »
Well, you would not get (anterior) impaction for the CCW because that would shorten the anterior maxilla and make LESS tooth show where you need more tooth show. NOR would that be done for a shorter midface area which you have. You might get a modest posterior downgraft for the CCW rotation or just an 'even' uniform downgraft as you are not that much of a clear cut case for a rotation.


Thanks again, so no CCW would be needed for my mandible? and the downgraft would still give me the positive midface effects I want? Is that more caused by forward movement as opposed to up or down?

kavan

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Re: Jaw Surgery Advice
« Reply #5 on: December 01, 2018, 05:26:59 PM »

Thanks again, so no CCW would be needed for my mandible? and the downgraft would still give me the positive midface effects I want? Is that more caused by forward movement as opposed to up or down?

No anterior impaction CCW would be needed (or even offered). CCW is to the MAXILLA. It's either anterior impaction or posterior downgraft. It's a rotation of the maxilla that results in the mandible 'auto rotating'.  I said, you MIGHT get a MODEST posterior down graft or just an even uniform downgraft. The doctors suggestion of getting a Lefort with forward movement and downward vertical movement ACCOMMODATES the REQUEST you made to him.

 BOTH the forward and downward movements of the Lefort are needed to accommodate your request which is a legit request BECAUSE you also would need the downward movement for better teeth show. It's not a pick only one but not the other movement thing.

I've given ample info as to HOW your requests FIT into your doctor's suggestions to you.

I have NO IDEA what is in your minds eye as to what you want to look like and have shed plenty of light on how your requests fit into the doctors suggestions. If you have a clear cut visual image in your mind's eye of what you want to look like (or what you don't want to look like), DRAW IT or produce a visual of it and hash that out with your doctor. It's not my task to 'know' what is in your mind's eye as to tell you how the doctors suggestions fit it and I don't want to keep repeating that his suggestions FIT into your VERBAL requests to him.


End of question and answer session.

Others are invited to chime in
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Bwalano

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Re: Jaw Surgery Advice
« Reply #6 on: December 05, 2018, 09:05:13 PM »
I have come back to this thread as I have some new questions.

1. As I have quite a bit of nasal tip projection sometimes my midface looks long, will the downgraft lengthen the midface / middle 1/3rd as I do not want this.

2. Would it be silly to ask for more of a posterior downgraft than anterior, and will a uniform downgraft have any changes in the occlusal plane.

3. If the anterior is downgrafted more than the posterior will that result in a steeper occlusap plane?

4. Does impaction result in more changes to the nose as opposed to downgrafting or is it all due to forwards movements. The way I am visualising it in my head is that impacting and moving forward will come into more contact with the nasal base tissue resulting in the upturning/shortening etc, whilst downgrafting will mean the lower maxilla is pressing lower?

kavan

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Re: Jaw Surgery Advice
« Reply #7 on: December 06, 2018, 09:00:35 PM »
I have come back to this thread as I have some new questions.

1. As I have quite a bit of nasal tip projection sometimes my midface looks long, will the downgraft lengthen the midface / middle 1/3rd as I do not want this.

2. Would it be silly to ask for more of a posterior downgraft than anterior, and will a uniform downgraft have any changes in the occlusal plane.

3. If the anterior is downgrafted more than the posterior will that result in a steeper occlusap plane?

4. Does impaction result in more changes to the nose as opposed to downgrafting or is it all due to forwards movements. The way I am visualising it in my head is that impacting and moving forward will come into more contact with the nasal base tissue resulting in the upturning/shortening etc, whilst downgrafting will mean the lower maxilla is pressing lower?

Hi,
I would hesitate to address these questions, which DO appear to suggest they arise because you think you have a long midface, in the absence of knowing what your BASIS (of understanding) is for asking them. I would not want any info I provided to be used to 'micro-manage' a surgeon. I would also like to get an idea of what your BASE understanding about the proportions of your face actually is. This is because answering/explaining these types of relationships is CONTINGENT on whether or not the person asking them has a grasp about the most SIMPLE relationships about their own face.

 IF indeed these questions arise BECAUSE you THINK you have a 'long' midface or a 'long' 'middle 1/3rd', I would like you to DEMONSTRATE how your 'middle 1/3' is longer than your lower '1/3rd'.

That said, please SHOW on your ceph X ray the 'division of the 1/3rds' as to SHOW your middle '1/3rd' is longer than your lower '1/3rd'. Do that by passing the appropriate horizontals needed to divide the middle '1/3rd' from the lower '1/3rd'.

If you get it right, we can build on that

Again, I need to establish what your basis is for asking the questions is before I  answer them.

If you get it right, then there is a BASIS to build on. If not, there is no basis of fundamental understanding to build on and I won't answer your questions.  But of course, OTHERS may.
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Bwalano

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Re: Jaw Surgery Advice
« Reply #8 on: December 07, 2018, 12:07:26 AM »
Thanks for the response Kavan.

See on the ceph it it probably more objective to say that the lower 1/3rd is longer than the middle. However as I mentioned due to tip projection from an angle that is not perfectly straight I appear IRL to have a longer middle 1/3rd, and that is my reason for raising these questions.

kavan

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Re: Jaw Surgery Advice
« Reply #9 on: December 07, 2018, 08:04:00 PM »
There is no 'probably' here as in 'probably more objective to say the middle 1/3rd is shorter than the lower 1/3rd'. You didn't show what I asked you to demonstrate (division of the 1/3rds on your ceph). So, the only 'probably' conveyed to me is you either lack the basis to do that or don't want to process information objectively. So, no basis demonstrated to be built on by addressing other questions. There needs to be some demonstration of basic understanding for me to build on if I am to answer questions lest the person process the information incorrectly through a FEAR FILTER and then go about trying to micro-manage the displacements the surgeon does and with no basis to understand what they're asking for.

If your doc is a good guy, he WON'T be performing anterior impaction to someone with a short maxilla and little tooth show. So, question #4 is a MOOT one to even ponder. Crossed of the list to address.

'dammit daniel' in another thread told you the drop down to the maxilla is a distance increase in the facial height that is seen at the lower 1/3rd. Yet you ask the SAME question again as to whether the downgraft will lengthen the midface. Was already addressed. So crossed off the list to address again.

As to questions #2 and #3, it would be silly to make any requests in the absence of demonstrating you can produce a diagram where lines are drawn through the right places for the division of '1/3s'. Again some basis for understanding is needed to be built on. However, the relationships would be SELF EVIDENT to someone who knew where to draw one set of lines because not too much of jump to find the line of the occlusal plane, measure the angle relative to a horizont, determine if it's 'steep' or 'low angle' and then determine which rotation increases the steepness and which one decreases it. As to whether or not a uniform graft changes the occlusal plane, it's the same as asking if putting a uniformly even block of something on any plane would change the angle of inclination of the plane your putting it on. 6th grade geometry. Moral of story...if those relationships aren't self evident to you the answers to those questions (given to you by someone else) aren't grounds enough to make requests based on solely the answers to the questions.

So, all 4 questions can be disregarded. But no preclusion for someone else to answer them.

Your ceph reveals you are a low angle patient (low occlusal and mandibular plane) with a SHORT face. Your doctor told you your overall aesthetics (including the nose and nose to lip angle) would improve with BOTH the forward and downward displacements. He most likely SEES on your ceph your face is short due to not enough downward growth of maxilla.

All you've demonstrated here is a belief that your midface is long and a fear it will look longer to you in the mirror. Ultimately what you really want to know is whether or not you will like what you see in the mirror; whether or not you will look like how you want to look in your mind's eye. THAT question can't be answered here. If your fear is that your midface will look longer to YOU via the aesthetic IMPROVEMENTS your doc is willing to perform or you need an answer as to whether or not you will like what you see in the mirror, have your doc tackle that fear. If he has any reason to believe you would be UNHAPPY with an outcome aimed at improving your overall aesthetic, he might  elect to limit to the single BSSO or he might have some other way of tackling the question 'Will I like what I see in the mirror?'

In the meantime, here's a link to SHORT FACE GROWTH PATTERNS where you can look at patients who have somewhat similar growth pattern to maxilla you have and see if their midfaces look longer to you.

https://pocketdentistry.com/23-short-face-growth-patterns-maxillomandibular-deficiency/





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Bwalano

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Re: Jaw Surgery Advice
« Reply #10 on: December 07, 2018, 11:17:23 PM »
Thank you for the link to the short faces Kavan. I can see now that I have not been objective in asessing my own midface. I also agree that I think I should simply follow the protocols the doc has listed as these are probably for the best as you have commented. Thank you for the enlightenment and I will return if I have any relevant questions. Thanks again for taking the time to respond, I have truly learnt alot.

kavan

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Re: Jaw Surgery Advice
« Reply #11 on: December 08, 2018, 10:04:10 AM »
Thank you for the link to the short faces Kavan. I can see now that I have not been objective in asessing my own midface. I also agree that I think I should simply follow the protocols the doc has listed as these are probably for the best as you have commented. Thank you for the enlightenment and I will return if I have any relevant questions. Thanks again for taking the time to respond, I have truly learnt alot.

Glad all this helped. If you still have the FEAR of 'long midface' after looking at things objectively, you would need to bring that to the table with your surgeon.
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Bwalano

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Re: Jaw Surgery Advice
« Reply #12 on: December 09, 2018, 06:41:10 PM »
Hi there,

Following the profile shots, can you advice me on why this is occuring if on the ceph it doesnt seem the case and can anything be done about this?