Author Topic: Genioplasty or BSSO  (Read 1516 times)

Blitz

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Genioplasty or BSSO
« on: September 26, 2020, 12:48:34 PM »
Hello

Would I be best suited with a genioplasty or bsso to increase both projection and face height? Ceph is provided below. Thank you

kavan

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Re: Genioplasty or BSSO
« Reply #1 on: September 26, 2020, 01:25:46 PM »
Lack of lower lip support in addition to short upper lip and downwardly rotated nose could suggest linear advancement (equal advancement of both jaws) in addition to sliding genio. It could also suggest CCW rotation via posterior downgraft which would allow for more advancement to the lower jaw than the upper, a sliding genio but less of one.
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Blitz

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Re: Genioplasty or BSSO
« Reply #2 on: September 26, 2020, 02:20:14 PM »
Lack of lower lip support in addition to short upper lip and downwardly rotated nose could suggest linear advancement (equal advancement of both jaws) in addition to sliding genio. It could also suggest CCW rotation via posterior downgraft which would allow for more advancement to the lower jaw than the upper, a sliding genio but less of one.

Thanks, I really appreciate the response.

Does posture affect the reading of the ceph? I have a spine injury which resulted in me having a forward and down head posture. When I went for the ceph they had me arch my head all the way forward, I'm not sure if I maintained proper posture.

I had two different recommendations from different surgeons.

The first surgeon was a general Max Fac, he wanted to preform extractions with a long mandibular advancement and small advancement of the maxilla. Similar to your reccomendation, however he didn't specifically mention CCW.

The craniofacial surgeon saw things diffently. He didn't use the ceph and would only work with a CT scan. He said that I had a very small chin and stressed the importance of a vertical advancement as well as horizontal to give me ideal facial thirds. He said this should also fix my everted lower lip which sticks out in front of the upper and provide proper lip seal, which is severely lacking.

How do you tell if it's a chin or mandible issue?

Is CCW normally used in those with a short posterior face height? Mine is rather long.
Thanks a lot

kavan

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Re: Genioplasty or BSSO
« Reply #3 on: September 26, 2020, 04:37:40 PM »
Thanks, I really appreciate the response.

Does posture affect the reading of the ceph? I have a spine injury which resulted in me having a forward and down head posture. When I went for the ceph they had me arch my head all the way forward, I'm not sure if I maintained proper posture.

I had two different recommendations from different surgeons.

The first surgeon was a general Max Fac, he wanted to preform extractions with a long mandibular advancement and small advancement of the maxilla. Similar to your reccomendation, however he didn't specifically mention CCW.

The craniofacial surgeon saw things diffently. He didn't use the ceph and would only work with a CT scan. He said that I had a very small chin and stressed the importance of a vertical advancement as well as horizontal to give me ideal facial thirds. He said this should also fix my everted lower lip which sticks out in front of the upper and provide proper lip seal, which is severely lacking.

How do you tell if it's a chin or mandible issue?

Is CCW normally used in those with a short posterior face height? Mine is rather long.
Thanks a lot

Cephs can be rotated in accordance to a surgeon selecting where he wants a vertical line to pass through certain land marks in the event it's not the same vertical as the ceph stat. CCW cases can involve doing so.

Linear advancement maintains one's bite with no extractions. Your ceph X ray is a little too fuzzy for me to see clearly as to whether your bite is right or not. But IF it is, I think you could have linear advancement along with a genioplasty. Your mandibular plane angle looks a little on the steep side. So, moving the both jaws 'forward' with linear advancement OR moving the lower jaw more than the upper would move the lower jaw in a diagonally downward direction where the chin would move in the same direction. IF it is your preference to move ONLY the chin, you would have that option with 'diagonally downward' genio which is one where the chin moves both vertically downward and horizontally outward which sounds like what the cranio is suggesting.

Extractions to the lower jaw are with the aim of pushing the front lower teeth backwards to create an overbite and allows for the lower jaw to be advanced more than the upper jaw. CCW (with posterior downgrafting) also allows for more lower jaw advancement than upper jaw, often with NO extractions involved. CCW decreases the mandibular plane angle. But it does not preclude having a diagonally downward genio along with it. If you had a 'long' posterior face height, your MPA would be on the LOW side which it isn't.

However, if you you wanted more 'face space' as in more soft tissue support than you have now bimax PLUS genio would do that whether it's linear advancement, advancement with lower jaw tooth extractions or CCW. All can be combined with genios. Isolated downward diagonal genio is an option if ONLY your chin area bothered you.

How do I tell as to which options? I look at the over all soft tissue support.

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Blitz

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Re: Genioplasty or BSSO
« Reply #4 on: September 26, 2020, 07:00:16 PM »
Cephs can be rotated in accordance to a surgeon selecting where he wants a vertical line to pass through certain land marks in the event it's not the same vertical as the ceph stat. CCW cases can involve doing so.

Linear advancement maintains one's bite with no extractions. Your ceph X ray is a little too fuzzy for me to see clearly as to whether your bite is right or not. But IF it is, I think you could have linear advancement along with a genioplasty. Your mandibular plane angle looks a little on the steep side. So, moving the both jaws 'forward' with linear advancement OR moving the lower jaw more than the upper would move the lower jaw in a diagonally downward direction where the chin would move in the same direction. IF it is your preference to move ONLY the chin, you would have that option with 'diagonally downward' genio which is one where the chin moves both vertically downward and horizontally outward which sounds like what the cranio is suggesting.

Extractions to the lower jaw are with the aim of pushing the front lower teeth backwards to create an overbite and allows for the lower jaw to be advanced more than the upper jaw. CCW (with posterior downgrafting) also allows for more lower jaw advancement than upper jaw, often with NO extractions involved. CCW decreases the mandibular plane angle. But it does not preclude having a diagonally downward genio along with it. If you had a 'long' posterior face height, your MPA would be on the LOW side which it isn't.

However, if you you wanted more 'face space' as in more soft tissue support than you have now bimax PLUS genio would do that whether it's linear advancement, advancement with lower jaw tooth extractions or CCW. All can be combined with genios. Isolated downward diagonal genio is an option if ONLY your chin area bothered you.

How do I tell as to which options? I look at the over all soft tissue support.
Thanks a lot. I'll probably avoid bimax as I really like the look of my upper jaw. I'll be looking into ccw.

How do you determine how much to move the mandible and the chin? As in 7mm bsso and 3 mm genio or 5 mm each.

How do you tell if the deformity is due to a recessed mandible or chin?

This result got me excited about the diagonally placed  genioplasty since my profile looks similar. I'm not sure if an isolated genioplasty would be an ideal fix or a camouflage. I was told my occlusion is good.


kavan

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Re: Genioplasty or BSSO
« Reply #5 on: September 26, 2020, 08:59:52 PM »
Thanks a lot. I'll probably avoid bimax as I really like the look of my upper jaw. I'll be looking into ccw.

How do you determine how much to move the mandible and the chin? As in 7mm bsso and 3 mm genio or 5 mm each.

How do you tell if the deformity is due to a recessed mandible or chin?

This result got me excited about the diagonally placed  genioplasty since my profile looks similar. I'm not sure if an isolated genioplasty would be an ideal fix or a camouflage. I was told my occlusion is good.

Everything starts with having good capacity for understanding basic geometrical relationships.
That's the foundation needed to relate to what's going on in maxfax or at least the one I use to understand things myself. I'm going to provide one last entry here as to BIMAX advancement with genio.

With linear advancement, (in an aesthetics case) you only do it as MUCH as the maxilla can be moved out to give better support to the upper lip and base of the nose area. But you don't move out the maxilla AS MUCH as the mandible COULD be moved forward which could result in the maxilla being too forward to look good.

The illustration is one where the horizontal red line is parallel to your maxillary plane (ANS-PNS) and where the diagonal green line is parallel to the mandibular plane. (The mandibular plane angle is the angle the green line makes with the horizontal.) The point here is that with linear advancement, one is just moving along the lines that define the maxillary plane and the mandibular plane. There are no rotations.

So, let's say things could look better with the mandible moved further out than the maxilla. In that case, extractions to the lower jaw pre-molars could be used to push the front lower teeth backwards to create more of an overbite which will allow for more lower jaw advancement. In that case, the mandible still pretty much moves along the diagonal line AND the chin moves in the same direction.

But STILL, in BOTH scenarios, it's BIMAX surgery. As to the chin, it's going to be moving along the same downward diagonal line as the mandible. Hence, there is chin advancement WITH the bimax. The chin goes along with the 'ride' and on the SAME PATH the mandible is moved 'forward and it's moving 'forward' on a diagonally downward path. A genio can be ADDED to that.

Personally, I think you would benefit more from BIMAX surgery WITH a genio that can be adjusted to the mandibular displacements than you would with genio alone. It would tend to yield more over all soft tissue support than genio alone. In fact, when the cranio guy suggests a genio alone and tells you it will vertically elongate and horizontally advance the chin, that's basically the same/similar diagonally downward direction that advancement of the lower jaw would yield in a BIMAX scenario where where both jaws were moved linearly the same amount and/or a scenario where the lower jaw was advanced MORE linearly than the upper jaw.

If your occlusion is good, then you could have bimax EQUAL linear advancement but ONLY to the extent where it would improve the soft tissue support to the base of the nose and upper lip. To that the the diagonally downward genio could be added. But LESS so given the mandibular advancement will move out the chin point in the the same/similar direction that a diagonally downward genio would.

ETA: diagram included with this post.



« Last Edit: September 26, 2020, 09:13:22 PM by kavan »
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