Hey guys,
Hopefully you can help with my jaw on some issues (two parts: functional and aesthetic).
Some backstory: 28 yo western european male with a background in medicine, I (sadly) did not learn max-fac seriously enough…
First off, I had braces from 13 to 16, only on the upper teeth. All my wisdom teeth were removed as well. My molars have not had the room to come out and are still half-buried. My left TMJ would crack when I chew hard stuff (meat++) and rarely would I experience pain.
Since my teenage years, I have been snoring like crazy. My father took me to an ENT whom found nothing wrong with me (well I guess he stuck to ENT related stuff….). Since then, I have been experiencing nycturia, diurnal sleepiness, and would sometimes wake up during the night choking. All symptoms pointing toward sleep apnea, but no time to dig into this before long.
My BMI is 19, and no family history of sleep apnea.
My last semester was a rotation in a pulmonology service, and I asked for a basic sleep study (only oximeter, heart rate and airflow from the nose) that I could do at home. Keep in mind I do this on my own, no one is helping me.
Results: moderate sleep apnea: 16 AHI (undervalued by sympathetic activation, so could be more, but I don’t think it would reach toward severe).
I met an ENT with the results (nothing wrong in my nose, tonsils, tongue…), he only described my moderate retrognathia. He sent me to a pulmonologist in July, to program a complete sleep study (with the brain waves and stuff….).
I did not want to wait and do nothing until then, so on my own, I did a ceph, and some research. These are my conclusions:
- I obviously am skeletal class 2 [the (ugly) overbite]. This have been bothering me since my teenage years; I hate my profile and I have no jaw. But having functional consequences + aesthetic, I want to tackle this the hard way.
- I believe I have a prominant anterior nasal spine: this + the overbite make for a terrible combination aesthetically.
- My bite is fine (but cracks and pain on the left TMJ, not that fine I guess….)
- I reached the conclusions that bimax would make for a quick and efficient cure: no orthodontics needed, ANS shaved, and CCW to avoid the drop of the tip of the nose. Moving the two maxillas would give me the best projection aesthetically (adding a genioplasty), whereas BSSO would be limited by the upper maxilla.
I met a known maxfac yesterday, here are his conclusions:
Class II skeletal malocclusion: indication of BSSO after 12-18 months of orthodontics. He wouldn’t do bimax on me because the sleep apnea is not severe enough (I don’t understand this reasoning). Told me I would gain 5 mm of projection (but on the letter to the ortho, added that I would probably need a genio as well, I don't know if the 5mm included the genio or not).
He sent me to an ortho that will do the diagnosis (next month...).
I am not hyped by his program: two years of braces is expensive (but I would do it nonetheless if it’s necessary); BSSO only limit the projections, whereas I want to maximize aesthetics (without looking like a chimp: if I undergo surgery, I want to look the best I could). At least my sleep apnea would be solved…
I intend to go soo other maxfac.
What do you think?
Thanks !
ceph:
https://imgur.com/a/vFrualm