Author Topic: Chin Wing after Bi-Max ??  (Read 12107 times)

Lazlo

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Re: Chin Wing after Bi-Max ??
« Reply #30 on: February 17, 2019, 07:15:55 PM »

So would it matter if you had your lower hardware removed? I didn't have a "high" bsso as far as I know. But then I had the hardware removed on both sides cause of different causes (on an infection and the other the surgeon just took it out while correcting some scar tissue).

So there shouldn't be any reason the side wing can't still be done.

I mean is Dr. Z at least willing to see you to consult with whether you can have the procedure done?

Lazlo

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Re: Chin Wing after Bi-Max ??
« Reply #31 on: February 17, 2019, 07:16:34 PM »
Most BSSO's are the modern ones which is the 3rd one .

okay and the third one does not disqualify you correct?

kavan

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Re: Chin Wing after Bi-Max ??
« Reply #32 on: February 17, 2019, 07:22:48 PM »
okay and the third one does not disqualify you correct?

No, the 3rd one that is MOST used in maxfax bi max is the one that can disqualify you (from chin wing). The 1rst is the 'high' BSSO that the chin wing docs like.

ETA: They don't want to cut through the SPLIT area of that (3rd) BSSO. The split area on the 1rst one is HIGHER so the chin wing cut doesn't go through the split area.

« Last Edit: February 17, 2019, 07:32:36 PM by kavan »
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ODog

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Re: Chin Wing after Bi-Max ??
« Reply #33 on: February 17, 2019, 09:20:36 PM »
No, the 3rd one that is MOST used in maxfax bi max is the one that can disqualify you (from chin wing). The 1rst is the 'high' BSSO that the chin wing docs like.

ETA: They don't want to cut through the SPLIT area of that (3rd) BSSO. The split area on the 1rst one is HIGHER so the chin wing cut doesn't go through the split area.

So this is what I’m wondering. The first diagram below you see a traditional chin wing where the ENTIRE lower border is cut and dropped/ advanced. This adds vertical length to the entire mandible, which is what the procedure was initially designed for, so the cut needs to be all the way down which traverses the most common BSSO (3rd) cut. Bad.

In the second diagram the cut is made at the back, but what if instead of mobilizing the entire border the cut is stopped somewhere near where I drew the red line, so that it doesn’t traverse the BSSO cut. I mean in a side wing you don’t even want to drop the whole border anyway as you only want dropdown at the back, so the question is, would you need to mobilize the entire border even in a side wing?

I’m thinking you probably have to because the drop down needs to be gradual. I’m not sure you can aggressively bend down the back where my red line is drawn without cutting further down to allow for a more gradual dropdown.

This is probably why Dr. Z said BSSOs are problematic for both SWs and CWs.

kavan

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Re: Chin Wing after Bi-Max ??
« Reply #34 on: February 17, 2019, 09:41:15 PM »
There is still a SPLIT where you drew your red line. Look at the diagrams I provided. The whole split is behind the GREEN part which is why it's called a SAGITTAL split. You're just looking at part where they move the mandible forward after they make the split.
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ODog

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Re: Chin Wing after Bi-Max ??
« Reply #35 on: February 18, 2019, 08:39:41 PM »
Oh now I get it. The entire border all the way up to the ramus is split, I wasn’t visualizing that. So Z was right. So he said it’s not always the case the border is destroyed, I wonder if he’s referring to how it heals, etc. Because it seems to me that all 3 cuts destroy the mandible border because there’s a split all the way up.

kavan

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Re: Chin Wing after Bi-Max ??
« Reply #36 on: February 18, 2019, 09:07:42 PM »
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ben from UK

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Re: Chin Wing after Bi-Max ??
« Reply #37 on: February 19, 2019, 06:07:20 PM »
Sidewing depends on 'elasticity' of the bone. Can't be done with everyone. In fact, there isn't a clear pic of anyone that has done a sidewing, despite SJ, and he also appearantly did fillers. I wanted a sidewing besides cw, surgeon promised that, I got more ruined golonial angles.  Maybe there are people with good sidewing results. But you almost never hear from people's experience unfortunately.

ODog

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Re: Chin Wing after Bi-Max ??
« Reply #38 on: February 19, 2019, 08:45:09 PM »
Sidewing depends on 'elasticity' of the bone. Can't be done with everyone. In fact, there isn't a clear pic of anyone that has done a sidewing, despite SJ, and he also appearantly did fillers. I wanted a sidewing besides cw, surgeon promised that, I got more ruined golonial angles.  Maybe there are people with good sidewing results. But you almost never hear from people's experience unfortunately.

You got ruined goinal angles because the surgeon segmented the wrong section of your mandible. Hard to believe, but he messed up. CW is going to blunt your angels but a side wing should not. How could it ?

There is a user here, Optimistic, that apparently had great results with a side wing. Obviously we will never see the results. The thing is, you can always get an implant later if it truly is a worthless procedure.

ODog

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Re: Chin Wing after Bi-Max ??
« Reply #39 on: February 19, 2019, 08:46:52 PM »
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Thanks Kavan your pics weren’t loading for me the other day so I was going off memory.

ODog

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Re: Chin Wing after Bi-Max ??
« Reply #40 on: February 20, 2019, 02:14:18 PM »
This was Dr. Z’s explanation.....

“if the distance after conventional BSSO from the lower border to the nerve is too small Side Wing or Chin Wing are not possible anymore. And: Small segment (makes for ?) difficult fixation, higher risk of resorption, possible step in Jaw Line.”

The latter part I think was in response to me asking if he could segment only a small part of the back jaw for the side wing. So it seems the real issue is the distance from lower border to nerve? But isn’t that the case even if you don’t get a BSSO? I’m confused.
« Last Edit: February 20, 2019, 03:49:33 PM by ODog »

PloskoPlus

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Re: Chin Wing after Bi-Max ??
« Reply #41 on: February 20, 2019, 02:43:55 PM »
This was Dr. Z’s explanation.....

“if the distance after conventional BSSO from the lower border to the nerve is too small Side Wing or Chin Wing are not possible anymore. And: Small segment (makes for ?) difficult fixation, higher risk of resorption, possible step in Jaw Line.”

The latter part I think was in response to segmenting on a small part of the back jaw for the side wing. So it seems the real issue is the distance from lower border to nerve? But isn’t that the case even if you don’t get a BSSO? I’m confused.
It is. But a standard bsso can make that issue worse. Save your money and find a surgeon who will do a proper CCW surgery on you.

ODog

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Re: Chin Wing after Bi-Max ??
« Reply #42 on: February 20, 2019, 03:58:56 PM »
It is. But a standard bsso can make that issue worse. Save your money and find a surgeon who will do a proper CCW surgery on you.

My surgery is March 18 and most of it is covered by insurance so I’m going forward with it. I’m also getting bi-max advancement which would be more than 30k + in the US. Besides, I have no tooth show so wouldn’t CCW make that worse? No surgeon has been able to satisfactorily explain if I’m a CCW case or not.

PloskoPlus

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Re: Chin Wing after Bi-Max ??
« Reply #43 on: February 20, 2019, 04:13:47 PM »
My surgery is March 18 and most of it is covered by insurance so I’m going forward with it. I’m also getting bi-max advancement which would be more than 30k + in the US. Besides, I have no tooth show so wouldn’t CCW make that worse? No surgeon has been able to satisfactorily explain if I’m a CCW case or not.
No tooth show could be due to a long upper lip or vertical maxillary deficiency. In the first case, you get a lip lift and then surgery. In the other case you can still have CCW if your occlusal plane is steep - downgraft both at the front and the back of the maxilla, but more at the back to produce ccw rotation.

Lazlo

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Re: Chin Wing after Bi-Max ??
« Reply #44 on: February 20, 2019, 04:49:39 PM »
I feel like improving tooth show is completely doable for CCW in the right hands.

Dr. Arnett in my previous consultation a long time ago when he was still practicing indicated the need for greater tooth show and that he would address that even though he was doing a massive CCW rotation. He also said support for the upper lip would be better.