Help with deciphering surgeon plan- potential changes to alar base (widening)?

[Ember22]

 One of my concerns with having surgery (lefort 1) is the potential for the negative aesthetic changes to my nose.  I don't want the wide, turned up pig nose some people seem to end up with.  I already have a rather wide and round/somewhat bulbous nose.   I expressed this concern to Dr. Gunson.  He said that with a standard lefort 1- no CCW, I would have greater potential for change to my nose.  Due to my steep occlusal plane, the movement would need to be larger.  I don't quite remember this part, but I believe he said that with CCW, the issue of the steep occlusal plane would be addressed.  This movement would somehow provide greater support to the base of my nose and the advancement would be smaller, due to the occlusal plane becoming (less steep?) and alar base widening wouldn't be an issue.

Can anyone clarify this?  I am also attaching the proposed movements. How can I tell exactly how many mm I'm going to be advanced?

[kavan]

For the Maxilla:

A-P means anterior-posterior direction. So a + sign means HORIZONTAL forward movement.

The VERTICAL movement for each part listed , a + sign means that part is going DOWN and a - sign means that part is going UP.

For the mandible:

A-P. A + sign means horizontally forward
The VERTICAL movement for each part listed, a - sign means downward and a + sign means upward.

[PloskoPlus]

For the Maxilla:

A-P means anterior-posterior direction. So a + sign means HORIZONTAL forward movement.

The VERTICAL movement for each part listed , a + sign means that part is going DOWN and a - sign means that part is going UP.

For the mandible:

A-P. A + sign means horizontally forward
The VERTICAL movement for each part listed, a - sign means downward and a + sign means upward.

I think you have the vertical signs mixed up.

[kavan]

I think you have the vertical signs mixed up.

Which ones did I mix up?

Maxilla

Vertical POSITIVE for the PNS means DOWN. So a NEGATIVE would mean UP.

Mandible

Vertical POSITIVE for anything to the mandible means UP. So a vertical NEGATIVE would mean down.


ETA:  To the OP. Please show your ceph displacement diagram so we can cross reference the proposed displacements to what I told you.

[Ember22]

Which ones did I mix up?

Maxilla

Vertical POSITIVE for the PNS means DOWN. So a NEGATIVE would mean UP.

Mandible

Vertical POSITIVE for anything to the mandible means UP. So a vertical NEGATIVE would mean down.


ETA:  To the OP. Please show your ceph displacement diagram so we can cross reference the proposed displacements to what I told you.

[PloskoPlus]

Which ones did I mix up?

Maxilla

Vertical POSITIVE for the PNS means DOWN. So a NEGATIVE would mean UP.

Mandible

Vertical POSITIVE for anything to the mandible means UP. So a vertical NEGATIVE would mean down.


ETA:  To the OP. Please show your ceph displacement diagram so we can cross reference the proposed displacements to what I told you.

Sorry, you're right.

[Post bimax]

Your horizontal movements are relatively small so changes to your nose should be minimal.

[beautyislife]

did dr.gunson's staff mention anything about timelines for when you could get surgery?

[Ember22]

did dr.gunson's staff mention anything about timelines for when you could get surgery?

What do you mean by timelines?  Are you referring to how long it would be until I was ready for surgery, orthodontically speaking?
My orthodontist said to expect 1.5-2 yrs of braces before getting surgery. 

[Ember22]

Your horizontal movements are relatively small so changes to your nose should be minimal.

I was sort of under that impression, however after more research, I can see that the nose can still widen with small advancement.  I guess I don't fully understand why CCW supposedly helps with this issue.

[kavan]

Sorry, you're right.

Actually, the mandible movements in the OP's case, with reference to his/her actual displacement diagram is OPPOSITE (as in inconsistent) with what they are in other people's cases where a positive for the vertical means up and a negative for the vertical means down.

Not sure what happened here with the mandible other than having to refer to someone elses Gunson diagram with readings where a positive for the vertical showed something going up and a negative for the vertical was down.

I also cross referenced that with an Alfaro read out along with the diagrams of movements. Same thing for the mandible. A negative vertical showed something going down.

However, with reference to the OP's displacement diagrams the movements for the mandible suggest the opposite where negative for the vertical is up.

So, my bad for not asking the OP to show the displacement diagram in the first place. But somewhat baffling that read out for negative verticals DON'T mean down but mean up in the OP's case when referring to the displacement diagram.

[beautyislife]

What do you mean by timelines?  Are you referring to how long it would be until I was ready for surgery, orthodontically speaking?
My orthodontist said to expect 1.5-2 yrs of braces before getting surgery.

When I went, his staff mentioned they were booked until a few months out for surgery already. I was just curious if they mentioned that to you, but since it's 2 years out, that clears things up. thanks.

[Post bimax]

I was sort of under that impression, however after more research, I can see that the nose can still widen with small advancement.  I guess I don't fully understand why CCW supposedly helps with this issue.

CCW allows for a smaller movement of the maxilla relative to the mandible because the occlusal plane is rotated counter-clockwise. This helps mitigate side effects that usually accompany maxillary advancement because the maxilla doesn’t need to be moved horizontally as much. You can still have some nostril widening/tip upturning even with CCW, but it’s less than if you got a larger straight advancement.

[kavan]

Well, CCW via anterior impaction (where ANS is moving UP) will certainly help make less what looks like a long anterior maxilla (where it looks like you have excess upper tooth show and/or too much gum show) and it will help auto rotate lower jaw in CCW to make less the steep mandibular plane angle and also make less the OP which all together clearly kick up a profile improvement.  Also, CCW is done to mitigate--make less--unfavorable changes to the nose base. But it doesn't guarantee to PRECLUDE any unfavorable nose base change just because it's CCW.

Ultimately, you would need to SEE that the contour changes of the profile (shown in the displacement diagram) are WORTH IT improvements for you and weigh the profile improvements with a possibility of having base of the nose change--from the front-- you might not like.

[PloskoPlus]

Actually, the mandible movements in the OP's case, with reference to his/her actual displacement diagram is OPPOSITE (as in inconsistent) with what they are in other people's cases where a positive for the vertical means up and a negative for the vertical means down.

Not sure what happened here with the mandible other than having to refer to someone elses Gunson diagram with readings where a positive for the vertical showed something going up and a negative for the vertical was down.

I also cross referenced that with an Alfaro read out along with the diagrams of movements. Same thing for the mandible. A negative vertical showed something going down.

However, with reference to the OP's displacement diagrams the movements for the mandible suggest the opposite where negative for the vertical is up.

So, my bad for not asking the OP to show the displacement diagram in the first place. But somewhat baffling that read out for negative verticals DON'T mean down but mean up in the OP's case when referring to the displacement diagram.

Hmm, I thought whatever the cephalometric landmark, horizontal + means forward and - means back.  Vertical + means down, - means up. It sort of makes sense + for downgrafting, advancement, - for impaction, setback.