CelticCaveGirls cephs - class 2 div 2 short face

[Tiny]

Without further ado, I present....my cephs.  Check out how tiny the ramus of the mandible is...   The upper incisors are retroclined  -  maxillary incisal angle is around 90 degrees,  in normal occlusion it is around 110.  This is common in Class 2 people who have had orthodontic correction







And, as I see things, my 2 surgical options -

Decompensate upper incisors, followed by BSSO




Rotational Le Fort 1 + BSSO

[sanddunes]

Hey Celtic Girl.  Has the Doctor told you which procedures he would recommend?  How many consults have you had so far?

[pekay]

is your implant secured in place with a screw?

[Tiny]

Hey Celtic Girl.  Has the Doctor told you which procedures he would recommend?  How many consults have you had so far?

1, I'm waiting for the full plan.   Either decomp + BSSO or bimax with CCW rotation of the maxilla. The latter will give a slightly better result but obviously a tougher recovery.  I am having at least 1 more consult.

is your implant secured in place with a screw?

 

Yes.  I should take it out and get a genio really but it depends on how much more that will cost

[Lazlo]

I think you should go for the option which will give you A LOT more length. And a fairly aggressive genio (yes have the implant removed), potentially with a lengthening genio as well. Look up pictures of the actress Ahna O'reilly --I think you should use her jawline as a model for the type of look you'd like to achieve. Part of it is that her jaw angles are wider than yours, but bringing the jaws forward will give you some additional width as well. I'm usually in favor of more aggressive transformational changes, so take my advice with a grain of salt, but if you were aiming for perfection, I'd certainly advise the more aggressive solution. You need a lot more mandible, chin projection in my opinion.

[Tiny]

I also favour a reasonably aggressive approach. The best way to lengthen would be to get a ramus BSSO but the problem with that is that the masseter muscle is so strong it pushes the jaw back up to original position

Ramus bsso -

[pekay]

you mean an inverted-L osteotomy?

[pekay]

IVRO also requires you to stay wired (~60 days for the bone to heal) since there isn't enough space for the plates or screws 

[Tiny]

you mean an inverted-L osteotomy?

No, I don't - that's usually used in extreme cases where congenital disorders are involved. I mean a bsso in the ramus of the mandible like this -




Or this, but it doesn't look as good for lengthening the ramus -

[Tiny]

Class II Division 2: The molar relationships are class II but the central are retroclined and the lateral teeth are seen overlapping the centrals.

Basically it's what you tend to get when you correct a deficient mandible with orthodontics rather than surgery

[x]

No, I don't - that's usually used in extreme cases where congenital disorders are involved. I mean a bsso in the ramus of the mandible like this -




Or this, but it doesn't look as good for lengthening the ramus -

a short-split ramus osteotomy is used to lengthen the ramus without stretching the muscles, but I highly doubt it would be indicated in your case

[Tiny]

a short-split ramus osteotomy is used to lengthen the ramus without stretching the muscles, but I highly doubt it would be indicated in your case

Why not, given how short my ramus is?

[x]

Why not, given how short my ramus is?

two reasons:

1.) a short split only cuts the ramus at the distal segment (to avoid stretching the pterygomandibular sling and pterygoid muscle), and is the rotated counterclockwise, so it's only indicated in open bites. given the current positioning of your maxilla you'd have to downgraft the posterior to create an open bite and then do the bsso. I doubt you'll find a surgeon willing to do it.

2.) I don't think it'd give you the aesthetic improvement you're looking for in a ramus-lengthening procedure


I too wish there was an effective ramus-lengthening procedure 

[Tiny]

two reasons:

1.) a short split only cuts the ramus at the distal segment (to avoid stretching the pterygomandibular sling and pterygoid muscle), and is the rotated counterclockwise, so it's only indicated in open bites. given the current positioning of your maxilla you'd have to downgraft the posterior to create an open bite and then do the bsso. I doubt you'll find a surgeon willing to do it.

This is what I've drawn in the pictures. CCW rotation of the maxilla to open the deep bite and then some kind of BSSO. It was suggested as a surgical options and I've seen other cases. It really lengthened the face signincantly.

In the future DO should be able to lengthen the ramus, all we can do now is get angle implants...

[x]

This is what I've drawn in the pictures. CCW rotation of the maxilla to open the deep bite and then some kind of BSSO. It was suggested as a surgical options and I've seen other cases. It really lengthened the face signincantly.

right, but the cuts are made along different parts of the ramus. It's not as cut and dry as the diagram you posted which as you said would likely lead to a high degree of relapse

In the future DO should be able to lengthen the ramus, all we can do now is get angle implants...

Yeah too little too late. as of now we're forced to make compensatory movements like cutting a normal maxilla up to rotate an underdeveloped mandible.

really unfortunate, so many occlusions could be solved so much more effectively via a ramus osteotomy. that's where the future of orthognathic surgery lies