Opinion on BSSO + Genioplasty plan

[thorkis]

Hello. In september I will begin my pre-jaw surgery orthodontic treatment with a surgeon in Antwerp, Belgium. I was a mouthbreather growing up due to enlarged tonsils, and I have sleep apnea (which has improved from severe to moderate in the last few years because I received myofunctional therapy specifically to treat it). Because there are other treatment options for apnea, my main interest in seeing a maxfac was for the potential aesthetic benefits. However, to my surprise he told me that the surgery is required functionally, and so is covered by insurance  At the consultation he took one look at my x-rays and told me that my airway should be at least three times bigger, and that lower jaw surgery of 10-12mm in addition to a genioplasty (I didn't ask how many mm) would correct this as well as the aesthetic imblanace.

While I am pretty confident that I am in good hands, I am interested in the opinions of those on this board - in your estimation could there be potential aesthetic downsides to my face of a bsso + genioplasty? I asked the doctor if he thought it would add more vertical height to my face and he said no. Additionally, he thinks that my upper jaw is in a fine position as it is, but I am unsure of this. Finally, I am aware that I have a slightly asymmetrical face which doesn't really bother me now, but I wonder if the surgery will accentuate it.

Thank you very much for taking the time to read this and offering your opinion

Photos: https://imgur.com/a/wYebqgA

Note: my bite is good because I received a compensation treatment of braces when I was a teenager to correct my overbite. Now for a year from september I will need braces again in order to undo the work of the previous braces and put the teeth in the correct pre-surgical position. I imagine this will be difficult as my insecurities surrounding my appearance will have to worsen before getting better.

[Dopesaint]

I would get another opinion. Your xrays look like you need double jaw surgery with counter clockwise rotation.

[ArtVandelay]

Agree with above you need double jaw surgery. I'm struggling to see how a BSSO alone is possible. Are you extracting premolars?

[kavan]

From what I can see, the upper jaw area is very GOOD. You probably could get away with BSSO only plus genio which would most likely require the 'sacrifice' of a premolar (extraction). You'd get about 5mm out of that and more could be added from the genio.  However, I don't see how he's going to get 10-12mm JUST out of the BSSO unless he does CCW posterior downgraft.

Your upper jaw IS fine as it is. However, to get the amount he said from the BSSO and NOT change how your upper jaw looks from the front (not advance it), he'd probably need to do a Lefort 1, posterior downgraft CCW to achieve his goals for the BSSO.

I think you should go back and ask him if you're getting double jaw surgery or single.

[thorkis]

Thanks for the replies. He did not mention anything about extracting molars, nor the orthodontist. He also said that my wisdom teeth were fine to stay. As far as I understand, the braces will slide my lower teeth back and my upper teeth forward, thus creating a very accentuated overbite, which I would have anyway if I hadn't had braces when I was younger (apologies if I'm explaining obvious info). He said that by september next year this should move my teeth enough to create the 10-12 mm space to slide the lower jaw forwards, but that IF there wasn't enough distance created he would have to move the upper jaw as well. I will ask him about CCW the next time I meet him.

I had two other consultations booked with maxfacs in Brussels where I live. The first one was last week, and he couldn't tell me anything definitive except that I would need more tests done so he can have my xrays in 3d etc. His private clinic didn't give me a lot of confidence.

Here is my surgeon's website with before and afters if you are interested: http://nassernadjmi.com/en-GB/content/images/81/

 

[kavan]

Given that your upper jaw is already in good position, a Lefort 1 via CCW posterior downgraft would come into play as a way to get the 'extra more' out of the BSSO but without moving the upper jaw forward to do it, thus preserving the relationship you see at the base of the nose and upper lip area. The upper jaw is 'moved'. But the movement is a downward rotation of the posterior maxilla. So the CCW in question would be the posterior downgraft type.

Your description of the pre-surgical brace preparation sounds right (decompensation process). It would be great IF that much overlap could be created for single jaw surgery without any pre-molar extraction to facilitate achieving the desired overlap. Sounds like you'll be in good hands whether it's single jaw or bimax surgery.