Listen, I mentioned three times so far that my knowledge on this subject is scarce. You keep saying that my face is severely retruded but it is not - my maxilla and my mandible are BOTH PROGNATHIC with my SNA being 88 and my SNB 81. I've been reading your post for three days and I think I finally managed to understand it fully because at the time I was writing my first post I had no idea what a CW/CCW rotation even means. Where I'm coming from they would put me in a mental institution just to hear me utter the words tooth show. So, I need to be fully prepared before my consultation which I plan on doing locally one more time because I am pretty sure they will tell me I shouldn't do bimax because the numbers are not adding up. As they already (I guess) did.
Thank you for being so thorough, it helped. I'm forcing the bsso because I am also looking at my analysis and my profile and I am wondering how much my proghnatic maxilla contributes to my profile looking like that.
In a normal profile the base of the nose should be aligned with the nasion (otherwise, you would get a monkey;). There's no such a thing in my profile because my maxilla+philtrum are indeed huge and much further away from my forehead so I just think that any type of horizontal and vertical advancement of my maxilla could possibly look weird. I am still missing that part of information on whether my maxilla is indeed vertically deficient and I can sense you are hesitant about confirming that in your post - because if the only criteria for confirmation is lack of tooth show - I am thinking what will happen if with a bimax I reveal my PROGNATHIC MAXILLA and TEETH. And I am aware of the fact that I should not be bringing it back because I need forward projection of the mandible.
Thanks for the psychological evaluation, I didn't know you can get that one here as well.
Also, I would like to know why my articular angle is so high (158, should be 140). And does it change with mandibular advancement. Thank you.
Whoa! You get on here 'Looking for Advice'. But when you get advice that doesn't conform to YOUR OWN advice for yourself, the advice giver is then obliged to 'prove' their advice via ceph angle analysis with tutorial or otherwise disprove your doctor's advice by same?
I don't even know IF you realize you are expecting that or entitling yourself to that. But let me just say that if you are expecting to know everything about your angles and would need a TUTORIAL as to how they relate so you can better understand things more, I'm not volunteering to do all that in any contingency for your wanting to know all that via JSF. It's TEDIOUS to measure out someones angles by hand and it's WORK to to cater a tutorial for them based on all the GAPS they have. It EXCEEDS what I'm willing to do on JSF for $0/hour.
It sounds like I would need me to draft up a document showing how you differed from the patients who were successfully treated via the 3 point landing procedure in the links you found in order for you to understand that I didn't need to mention anything about your SNA and SNB angles when I conveyed to you that your retrusion of the mandible (relative to your maxilla) EXCEEDED the relative retrusion that the patients who had successful outcomes from that 3 point (no cut to the maxilla) surgery. I'm not volunteering to do that for $0/hour here. Nor am I even offering privatized for pay tutorials on JSF. Just saying, for people who would need that to 'prove' to them why my advice was in CONFLICT to their 'understanding', it's not something I volunteer to do.
Furthermore, I find it STRANGE that you just happen to know all the measurements of all those angles in the ABSENCE of having a ceph TRACING that included read outs of the angles. Could it be that your doc gave you such a ceph tracing where the angles were drawn from the appropriate points and lines drawn from there to measure the angles. BUT instead of putting that up here, you elected to WITHHOLD it in favor of putting up a ceph with no tracings on it?
How is that you know exactly what those angles are? Did you get a ceph tracing from the doctor with the read outs. If so, why are you asking me to 'look at your angles' which is something that requires me to chart out the points, connect them and then measure with a protractor and to do so because you elected to WITHOLD a ceph tracing?...OR is this something you can do by yourself to do your own ceph tracing. Which one is it?
Yes. You do have GAPS of understanding and realize you do. But another thing you do which really doesn't sit well with me is despite your being aware that you have GAPS of understanding, you contend that your SNA and SNB angles ALONE 'mean your maxilla and mandible are BOTH PROGNATHIC'. Again, I volunteered NO information about your angles. Others did. What I told you was that your mandible and chin were MORE retrusive than the patients I looked at who had successful treatment for short face and also your mandible/chin was MORE RETRUSIVE than the patients in the link where they had successful 3 point landing rotation of mandible only.
The reason, I volunteered NO information about your angles (and let others volunteer) was because I had reason to suspect you already had a ceph tracing that you were WITHHOLDING. That was due to the angle measures being correct. Quite frankly, I detected somewhat of a passive aggressive 'challenge' of 'Let's withhold the ceph tracing to see if Kavan will do one, get it right, if I withhold it'. Also, to see if you keep asking ME about angles despite OTHERS telling you about your angles but not asking them directly.
Here's what I'll volunteer about your angles: SNA, SNB, ANB and SArGo are consistent with the angle measures you mentioned. Given that it's tedious for me to hold up a hand held protractor to cross reference all of them, I'm just confirming those 4. So, I would assume that all the other ones you have measures of are probably correct. However, given that the angles I measured are consistent with those you ALREADY HAVE info about, I would conclude that you also have a CEPH TRACING with read outs of what those angles are BUT elected to withhold putting that up in favor of putting up an un marked out (un charted out) ceph instead.
Am I right or wrong on that OR is this something where you can find all those points yourself, and construct the lines needed to measure the angles? Another thing I'll confirm here is what Lefortitude told you which is that 'measurements relative to the cranial base in general have fallen out of favor among maxfac surgeons (in the US atleast).' However, to his statement, I would add the qualifier of 'GOOD' surgeons in the US. So, SNA and SNB (ANB is just angle SNA-SNB) are angle measures relative to the cranial base. A good surgeon who is in capacity to kick up a nice aesthetic change doesn't necessarily rely on those. For example, Gunson and the doctors April mentioned, all of whom are TOP doctors, would most likely NOT tell you that BOTH of your jaws are 'prognathic' or advise you to forego surgery to the maxilla for that reason. They would be MORE LIKELY to include surgery to the maxilla that included a ROTATION of it via a DOWNGRAFT. Doesn't matter if it's CW or CCW, it would still be a downgraft with a ROTATION (surgery to the maxilla).
Angle measures RELATIVE to the cranial base just convey the relationship between the maxilla and the mandible and whether someone is class 1 relationship or Class 2 or 3. They don't preclude someone who has a maxilla relatively MORE forward than the mandible from having a rotation to it if such a rotation would allow the mandible to come more forward for a better 'line up of the lips' in a circumstance where someone's lower lip is found more behind the upper lip.
I'll also confirm what April told you which is that CW/CCW are rotations and not advancements.
Rotations are separate and different displacements from TRANSLATIONS. For example a CCW rotation of the maxilla eg. an overall downgraft that's more in the posterior direction than anterior can be done WITHOUT moving the maxilla 'forward'. Moving either one of the jaws along a 'path' is a translation. When ever you move along a path where the line of that path has an angle of inclination relative to a horizont, the movement is a translation. The ROTATION is when they CHANGE the angle of inclination of the path (relative to a horizont) they are wanting to do the translational displacements over. For example if they feel they could kick up a good aesthetic result with a BSSO that say the mandibular plane doesn't have a 'good enough' angle of inclination to it so that the translation they do brings it out to the 'right' place, they can set the path over which to do the translation to a more favorable angle of inclination by ROTATING the maxilla. So a rotation of the maxilla is DIFFERENT from moving it along a linear path which is a 'translation'.
As to another one of Aprils questions to you she asked:
Did you do those angles yourself or do you already have a ceph analysis? If you already have an analysis, why not post it?
You didn't answer it. Same question I have. Why are you asking people to look at your angles if you actually HAVE a ceph tracing with them all listed on it OR do you know how to measure them yourself via charting out the exact points on your ceph?
Maybe I gave too much info for you to digest despite it being very generous of me to offer that much. However, on the grounds of my having some reason to believe that you withheld posting a ceph TRACING (when you had one already) and not answering April's question whether or not you had such when you asked people to 'look at your angles', this marks the END of the information I'm going to volunteer to you.
Enclosed, my measures of the same angles you somehow already know in the absence of answering April's question to you whether or not you actually had a ceph tracing that measured those angles (or in the presence of avoiding a DIRECT answer to the question.)