Author Topic: In need of advice, recessed jaw and chin  (Read 2382 times)

amj

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In need of advice, recessed jaw and chin
« on: July 12, 2019, 08:26:14 AM »
My jaw is underdeveloped and I was diagnosed with sleep apnea as a child, nothing was said regarding my jaw (had my tonsils and adenoids taken out). I am on an orthodontics waiting list and wanting to gain something from this (pointers to surgeries etc). and I have attached a few photos with my jaw in my natural position. As you can see my chin is completely recessed.

I have read a bit about retrognathia (which I assume is what I have) and regarding surgeons, as I live in the UK only surgeons in Europe are available to me. I only want surgery for aesthetics as it has knocked my confidence a bit after noticing it myself. Nobody has ever mentioned it to me and dentists have never said about it except for crowded lower teeth. As far as I know I need both my upper and lower jaw moving forward meaning I'd need bimax. Any help would be appreciated.

Lefortitude

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Re: In need of advice, recessed jaw and chin
« Reply #1 on: July 12, 2019, 08:49:35 AM »
Class 3. Probably cant fix it with ortho alone. You'l probably be looking at jaw surgery with braces for a few years.

amj

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Re: In need of advice, recessed jaw and chin
« Reply #2 on: July 12, 2019, 09:38:32 AM »
Class 3. Probably cant fix it with ortho alone. You'l probably be looking at jaw surgery with braces for a few years.
Class 3 bite? I wouldn’t expect to get it fixed with ortho but what would they be able to do, like what sorts of braces? And what surgery am I looking at? Bimax?

kavan

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Re: In need of advice, recessed jaw and chin
« Reply #3 on: July 12, 2019, 11:03:49 AM »
From the photos (and thanx for posting your photos), it looks like it could be anterior open bite with bi-max recession of BOTH jaws. The upper jaw being behind the lower as seen by upper lip being behind lower lip would be deemed as 'class 3'. Maxilla (lefort 1 area) is clearly recessed evidenced by the conCAVE area right beside the nose. The chin is recessed and casts LONG in the frontal photo due to the 'hanging' soft tissue below. So, your chin bone might not be long but the lack of bone support to lower whole mandible area including chin results in what you see as what I call a 'sub-mental HANG' or GULLET formation where it's the BASE (bottom) of this 'sub-mental hang CURVE' you see from the FRONT which gives look of very long chin. The mandible recession is evidenced by the extremely short chin to neck distance.


The extreme aesthetic deviation from the norm, in NO WAY, justifies just 'fixing' the class 3 via ortho alone. On the contrary, the skeletal formation justifies BI-MAX surgery.

The facial appearance being one of extreme LACK of soft tissue support, to my eye, is indicative of bimax RETRUSION (retrusion of BOTH jaw bones). The class 3 look of it is from the maxilla being more retruded than the mandible BUT BOTH have significant retrusion.

Although you don't give a diagnosis of 'anterior open bite', (nor can I confirm one from here), the sub-mental HANG or 'GULLET' formation under chin is a common soft tissue contour associated with anterior open bite.

That said, my guess would be your surgery would POSSIBLY be posterior impaction; wedge shaped removal of back part of maxilla. Something where excess growth to BACK of maxilla (posterior maxilla) can thrust the lower jaw downward and back and contribute to that gullet formation. Removal of posterior excess helps relieve the downward thrust it causes to the mandible and also helps 'level out' the maxilla. From there, the maxilla is displaced forward and also the mandible and chin.

If you have SLEEP APNEA, and ALSO IF insurance is paying for the surgery, 'push' for surgical correction on THOSE grounds ALONE and don't tell them you are interested 'only in aesthetics'. Push for CONSULTS with maxfax surgeons for sleep apnea and for multiple consults.  Once you get in for a consult, at THAT POINT, discuss aesthetic maximization possibilities with the surgery.
I don't know much about the NHS in the UK other than that they CAN and do FINANCE some maxfax surgeries. But when ever you are dealing with insurance BUREAUCRATS in any insurance or government system, there's always the chance (sometimes high probability) of getting an OFFICIOUS bureaucrat with whom the mention of 'aesthetic alone' motivation can TRIGGER them to SPIN THEIR GEARS to deny surgery on those grounds even if it's justified which I feel that it IS in your case.

IF insurance is NOT paying for the surgery and if it's SELF PAY, then perfectly appropriate to disclose from the get go that aesthetic improvement is your main focus and they will KNOW aesthetic improvement will ALSO come with correction to open up the airway.
 
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PloskoPlus

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Re: In need of advice, recessed jaw and chin
« Reply #4 on: July 12, 2019, 11:37:28 AM »
Your case is not simple. AFAIK, UK surgeons are mediocre. See Alfaro in Spain.

amj

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Re: In need of advice, recessed jaw and chin
« Reply #5 on: July 16, 2019, 01:00:13 PM »
From the photos (and thanx for posting your photos), it looks like it could be anterior open bite with bi-max recession of BOTH jaws. The upper jaw being behind the lower as seen by upper lip being behind lower lip would be deemed as 'class 3'. Maxilla (lefort 1 area) is clearly recessed evidenced by the conCAVE area right beside the nose. The chin is recessed and casts LONG in the frontal photo due to the 'hanging' soft tissue below. So, your chin bone might not be long but the lack of bone support to lower whole mandible area including chin results in what you see as what I call a 'sub-mental HANG' or GULLET formation where it's the BASE (bottom) of this 'sub-mental hang CURVE' you see from the FRONT which gives look of very long chin. The mandible recession is evidenced by the extremely short chin to neck distance.


The extreme aesthetic deviation from the norm, in NO WAY, justifies just 'fixing' the class 3 via ortho alone. On the contrary, the skeletal formation justifies BI-MAX surgery.

The facial appearance being one of extreme LACK of soft tissue support, to my eye, is indicative of bimax RETRUSION (retrusion of BOTH jaw bones). The class 3 look of it is from the maxilla being more retruded than the mandible BUT BOTH have significant retrusion.

Although you don't give a diagnosis of 'anterior open bite', (nor can I confirm one from here), the sub-mental HANG or 'GULLET' formation under chin is a common soft tissue contour associated with anterior open bite.

That said, my guess would be your surgery would POSSIBLY be posterior impaction; wedge shaped removal of back part of maxilla. Something where excess growth to BACK of maxilla (posterior maxilla) can thrust the lower jaw downward and back and contribute to that gullet formation. Removal of posterior excess helps relieve the downward thrust it causes to the mandible and also helps 'level out' the maxilla. From there, the maxilla is displaced forward and also the mandible and chin.

If you have SLEEP APNEA, and ALSO IF insurance is paying for the surgery, 'push' for surgical correction on THOSE grounds ALONE and don't tell them you are interested 'only in aesthetics'. Push for CONSULTS with maxfax surgeons for sleep apnea and for multiple consults.  Once you get in for a consult, at THAT POINT, discuss aesthetic maximization possibilities with the surgery.
I don't know much about the NHS in the UK other than that they CAN and do FINANCE some maxfax surgeries. But when ever you are dealing with insurance BUREAUCRATS in any insurance or government system, there's always the chance (sometimes high probability) of getting an OFFICIOUS bureaucrat with whom the mention of 'aesthetic alone' motivation can TRIGGER them to SPIN THEIR GEARS to deny surgery on those grounds even if it's justified which I feel that it IS in your case.

IF insurance is NOT paying for the surgery and if it's SELF PAY, then perfectly appropriate to disclose from the get go that aesthetic improvement is your main focus and they will KNOW aesthetic improvement will ALSO come with correction to open up the airway.

I appreciate your reply as it was more in-depth as I expected. I am completely new to this so I have lots of questions. I get why my chin and jaw look that way in the mirror/in photos. The only thing that I do not understand is what you mean by sub-mental hang CURVE and gullet formation, I assume you mean that the soft tissue protrudes more than my chin bone? Would this be more to do with the lack of chin bone support so soft tissue augmentation would not be viable?
I would like to do more research on this but cannot seem to find much information online easily. I guess I would be able to talk to my orthodontist about this whenever I get an appointment (hopefully soon).

Unfortunately I do not have health insurance as it is not required in UK like it is in america and do not know many that do. I feel as if I could get something done with the NHS due to sleep apnea. I suppose what I want now is recommendations for orthodontics or surgeons so I'll start research.

Regarding posterior impaction, where you mention excess growth do you mean that posterior impaction encourages growth? I have looked it up and it appears as this example is the most similar to mine even with the lower teeth on the before photo looking slightly similar to my own. Do you think this surgery would help crowded teeth?


I take it this is a type of bimax surgery and I couldn't have multiple surgeries for this?
Again thanks for the reply.

Post bimax

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Re: In need of advice, recessed jaw and chin
« Reply #6 on: July 16, 2019, 01:42:26 PM »
That is the largest AOB I have ever witnessed

kavan

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Re: In need of advice, recessed jaw and chin
« Reply #7 on: July 16, 2019, 06:37:27 PM »
When I say 'gullet' or 'submental HANG curve', with reference to the photo of the person you posted, which I'm ASSUMING is NOT YOU (because the person in photo already had surgery), the gullet is the FLUB under the chin. Person in recent photo has anterior open bite and the UNDER CHIN contour associated with it which is why I think YOU hava AOB.

No idea if person in photo had multi surgeries or just corrected in one. But obviously he got corrected as shown in photos. He probably got posterior impaction to correct his AOB.

Crowded teeth is taken care of ahead of time by being in braces. Sometimes extractions are needed.  I can just tell by your CHIN CONTOUR formation that you probably have AOB.

Plosko, on this string, gave you a suggestion for a (self pay) surgeon.
Please. No PMs for private advice. Board issues only.