Is this possible with double Jaw surgery with CCW?

[Tom199358]

Hi,

I have a follow up appointment with a maxofacial surgeon this month to go over options regarding jaw surgery. The surgeon looked at my scans and smile and determined it is possible for me to have double jaw surgery to improve my facial balance. Due to my mid face growth and gummy smile, he believes counter clockwise rotation will benefit me.

I had braces when I was a kid and a plate to correct my overbite. In addition, I have a sliding genioplasty to help with the recessed jaw. I believe this did not really correct the issue. I have attached a photo of my scan with a rough edit I made in photoshop. Is something like this possible with the suggested surgery? The surgeon also said it may be worth adding verticle height to my chin with another sliding genioplasty. My bite is fine and I experience a bit of tmd and clicking in my left side, but besides that, everything is functional. I also dont have sleep apena. Thanks

https://imgur.com/a/fVNv9M5

[GJ]

That seems realistic, but how did he say CCW would help with a gummy smile?
Is he doing impaction as well?

[Post bimax]

That seems realistic, but how did he say CCW would help with a gummy smile?
Is he doing impaction as well?

I'm guessing the CCW rotation is from anterior impaction.

[GJ]

I'm guessing the CCW rotation is from anterior impaction.

Ah, gotcha. That will be pretty minimal, then, and the morph might not be realistic.

[Tom199358]

He measured my smile and made comment regarding excessive mid face growth. The appointment was fairly short and he said he'll go into more detail in my next appointment. I'm assuming he'll perform impaction as well with the rotation.

Are there any questions I should ask in my appointment to get the best results? Thank you

[Post bimax]

He measured my smile and made comment regarding excessive mid face growth. The appointment was fairly short and he said he'll go into more detail in my next appointment. I'm assuming he'll perform impaction as well with the rotation.

Are there any questions I should ask in my appointment to get the best results? Thank you

You need to ask exactly what movements he's proposing.  The CCW rotation he's talking about is probably just a result of the anterior impaction since you have a gummy smile.  It's unlikely you'll be getting the posterior downgraft version of CCW surgery since your occlusal plane already looks pretty flat.  Ask him how many millimeters he's planning on advancing each jaw and how many millimeters he's impacting you.

Both anterior impaction and maxillary advancement can cause changes to the nose and subnasal area.  In particular, nostril flare, tip upturning, and a more convex philtrum.  Larger movements are more prone to this issue.  I would ask about management of these side effects.

[Tom199358]

You need to ask exactly what movements he's proposing.  The CCW rotation he's talking about is probably just a result of the anterior impaction since you have a gummy smile.  It's unlikely you'll be getting the posterior downgraft version of CCW surgery since your occlusal plane already looks pretty flat.  Ask him how many millimeters he's planning on advancing each jaw and how many millimeters he's impacting you.

Both anterior impaction and maxillary advancement can cause changes to the nose and subnasal area.  In particular, nostril flare, tip upturning, and a more convex philtrum.  Larger movements are more prone to this issue.  I would ask about management of these side effects.

Thanks for the detailed reply, I'm learning so much and it will definitely help me with my appointment. Just a couple more questions. Sorry in advance!

1. Could the angle of the x-ray impact the occlusal plane? I recall feeling like I was looking slightly upwards when I had them done

2. In the edit next to my x-ray, I did not bring the maxillary forward. I removed a portion of the maxillary and angled it upwards in a counter clockwise rotation. Afterwards, I moved the lower jaw forward to accommodate for the change. In the edit, this has changed the occlusal plane, but I feel as if it is within an acceptable level? Do you have any comments regarding my thought process?

Thank you again

[Post bimax]

Thanks for the detailed reply, I'm learning so much and it will definitely help me with my appointment. Just a couple more questions. Sorry in advance!

1. Could the angle of the x-ray impact the occlusal plane? I recall feeling like I was looking slightly upwards when I had them done

2. In the edit next to my x-ray, I did not bring the maxillary forward. I removed a portion of the maxillary and angled it upwards in a counter clockwise rotation. Afterwards, I moved the lower jaw forward to accommodate for the change. In the edit, this has changed the occlusal plane, but I feel as if it is within an acceptable level? Do you have any comments regarding my thought process?

Thank you again

1.  This is still a contested question.  The general consensus here is that no, looking up or down will not change your surgeon's reading of the occlusal plane because surgeons use various methods to normalize the CEPH.  However, it will change my visual perception of your occlusal plane just eyeballing it.  So it's possible your OP is steeper than I suggested.  Your surgeon will know.

2.  I think you've captured the gist of what a CCW movement does here.  I would show your morph to your surgeon and ask if it's reasonable.  The degree of CCW rotation you'll get will depend on how much your maxilla is impacted, which in turn will depend on how gummy your smile is.  Keep in mind that an over-impacted maxilla will result in zero or negative gum show, which is actually worse than a gummy smile because it's very aging.  Optimally you'll want about 1-2mm of gum show when smiling.  Your upper lip lengthens as you age.