Confused more than ever about my case

[Luka2020]

First of all I want to say thanks to everyone on this forum who has offered me their advice regarding my case. I am still researching and thinking about all the possible solutions and the more I research, the more confused I get on what are the correct moves to make.

In short: I don't like how my chin looks from the side. It looks recessed. After examining my x rays and CBCT it seems like my actual chin is normal sized, but I have protruding teeth and mouth making the chin look smaller from the side. This has been an aesthetic issue except for the lip incompetence. I was contemplating between genioplasty and braces with premolar extractions. Both would make the profile look more balanced.

However, Looking at the CBCT I noticed an issue that is not aesthetic – a narrow airway. I am not an expert but the narrowest part is in color red, and 127mm2 is also very small based on the info from the Internet.
This raises many questions in my head.

-   Should I be concerend about the possibillity of sleep apnea in the future? I do have daytime sleepiness and tiredness quite often. I sometimes snore but not very often according to my gf. I am 25.

-   Should I completely rule out the possibility of extractions + braces retraction because of the possibility of pushing the tongue further back into the airway or does it not have that effect if the whole jaw is not being moved (like in BSSO)?

-   Theoretically, If I would consider Maxillomandibular advancement after premolar extractions, would I be again on the starting point regarding the airway size? I wonder if bony movements produce different effects on the airway when compared to dentoalveolar movements?

-   And finally, does horizontal sliding genioplasty ALWAYS move the genioglossus muscle or does it have to be a special kind of genioplasty which aims directly at helping with airway size like the genioglossus muscle advancement?


p.s. The ceph was taken before my orthodontic treatment which was without extractions, and CBCT was taken after. I am amazed how different and less protruded my soft tissue looks on the virtual ceph taken from CBCT after the braces. Are virtual cephs like this one accurate?

Any input on my case is highly appreciated. I live in such a country that there are very few experts regarding jaws (max. facs, orthos, etc..) and let alone ones who have knowledge about airways. That is why the knowledge from members on this forum is so valuable to me.

Pictures on the link: removed

Have a nice day!
Luka

[kavan]

This looks like an 'aesthetic case' where the aesthetics look pretty good and that includes the side profile.

The type of genioplasty they use (I think) with the sleep apnea cases is the sliding one; slides UP and OUT along a diagonal. That would also shorten you chin and I wouldn't advise that.

Red part for the airway is basically color coding where the narrowest part is red and wider parts are other colors. I don't have data at hand as to volume measures that mean 'too narrow'.

All in all, I think you look GOOD and I'm hard pressed to suggest surgery.

[Sergio-OMS]

First of all I want to say thanks to everyone on this forum who has offered me their advice regarding my case. I am still researching and thinking about all the possible solutions and the more I research, the more confused I get on what are the correct moves to make.

In short: I don't like how my chin looks from the side. It looks recessed. After examining my x rays and CBCT it seems like my actual chin is normal sized, but I have protruding teeth and mouth making the chin look smaller from the side. This has been an aesthetic issue except for the lip incompetence. I was contemplating between genioplasty and braces with premolar extractions. Both would make the profile look more balanced.

However, Looking at the CBCT I noticed an issue that is not aesthetic – a narrow airway. I am not an expert but the narrowest part is in color red, and 127mm2 is also very small based on the info from the Internet.
This raises many questions in my head.

-   Should I be concerend about the possibillity of sleep apnea in the future? I do have daytime sleepiness and tiredness quite often. I sometimes snore but not very often according to my gf. I am 25.

-   Should I completely rule out the possibility of extractions + braces retraction because of the possibility of pushing the tongue further back into the airway or does it not have that effect if the whole jaw is not being moved (like in BSSO)?

-   Theoretically, If I would consider Maxillomandibular advancement after premolar extractions, would I be again on the starting point regarding the airway size? I wonder if bony movements produce different effects on the airway when compared to dentoalveolar movements?

-   And finally, does horizontal sliding genioplasty ALWAYS move the genioglossus muscle or does it have to be a special kind of genioplasty which aims directly at helping with airway size like the genioglossus muscle advancement?


p.s. The ceph was taken before my orthodontic treatment which was without extractions, and CBCT was taken after. I am amazed how different and less protruded my soft tissue looks on the virtual ceph taken from CBCT after the braces. Are virtual cephs like this one accurate?

Any input on my case is highly appreciated. I live in such a country that there are very few experts regarding jaws (max. facs, orthos, etc..) and let alone ones who have knowledge about airways. That is why the knowledge from members on this forum is so valuable to me.

Pictures on the link: removed

Have a nice day!
Luka

Don't do extractions.
Get a home sleep test, a WatchPAT preferably, to get some extra information (a functional one) about your breathing.
Not every genioplasty advances the tongue muscles.

[Luka2020]

This looks like an 'aesthetic case' where the aesthetics look pretty good and that includes the side profile.

The type of genioplasty they use (I think) with the sleep apnea cases is the sliding one; slides UP and OUT along a diagonal. That would also shorten you chin and I wouldn't advise that.

Red part for the airway is basically color coding where the narrowest part is red and wider parts are other colors. I don't have data at hand as to volume measures that mean 'too narrow'.

All in all, I think you look GOOD and I'm hard pressed to suggest surgery.

Thank you very much for your assessment, Kavan. Please take a look at this one more photo of my side profile where the beard doesn't interfere so much: removed
My chin is very far behind my lower lip (partly due to the protrusion). but in the Ceph my actual chin bone doesn't seem small.
I am not even sure if a genioplasty of lets say 7mm would be enough. Bigger than that and it becomes hard to find a good surgeon and the risks of numbness are bigger I think.
Anyway, your assessment of the new picture of my side profile would be extremely appreciated.
Cheers!

[Luka2020]

Don't do extractions.
Get a home sleep test, a WatchPAT preferably, to get some extra information (a functional one) about your breathing.
Not every genioplasty advances the tongue muscles.

Thank you for your advice. I will look into getting a home sleep test.

[InvisalignOnly]

You look good, I would do nothing. Get braces to straighten your teeth and call it a day.

[GJ]

The most I'd do is genio.

[kavan]

Thank you very much for your assessment, Kavan. Please take a look at this one more photo of my side profile where the beard doesn't interfere so much:removed
My chin is very far behind my lower lip (partly due to the protrusion). but in the Ceph my actual chin bone doesn't seem small.
I am not even sure if a genioplasty of lets say 7mm would be enough. Bigger than that and it becomes hard to find a good surgeon and the risks of numbness are bigger I think.
Anyway, your assessment of the new picture of my side profile would be extremely appreciated.
Cheers!

The issue here is that it's quite a tall order to un-confuse all the confusion you generate in the process of being dissatisfied with your chin projection such as the need to discuss specific airway volumetric measures, pre-emptive surgery for potential sleep issues, pre molar extractions against possible bimax etc. So, here we have an 'aeshtetics only' that's tied into all these other mechanizations that go into generating confusion.

Now you add to the mix, a different profile shot with an OVERLY ACUTE labial mental angle that differs significantly from the that seen in the ceph where you pose in front of a visually confusing background. Evaluation of that photo DENIED other to show what's CONFUSING about it; a beard that comes out at a sharp point below your lip. Never seen anything like that before.

Sorry, I'm a loss for a surgical solution based on this 'other' photo you presented.

If you want people to focus on your CHIN in photos of you, consider posing against a plain background with a SHAVED face and hold off on all of the extraneous mechanizations where you spin your gears generating confusion about getting teeth pulled, pre-emptive apnea surgery etc.

[kavan]

Subsequent to a (private) request from the OP for me to remove an illustration I made on a photo he alerted my attention to, yet finding that he did not remove the original photo from his links, I have removed all the links to his photos in addition to my illustration.

Note to Luka (the OP):

When you post photos asking for help, and IN PARTICULAR, when I am asked to view ANOTHER photo that you seek an opinion on, it is IMPLICIT, permission is given for me to ILLUSTRATE something on the photo. In the event this implicit permission has been retracted, requests to remove an ILLUSTRATED photo, specifically, one I illustrate to convey feedback and more specifically, a photo a poster directs my attention to must demonstrate that the poster himself has removed the (original) photo. This was not done at the time I was PMed to remove my illustration as to what I observed on the photo requested of me to observe.

For that reason, I've removed all links to your photos. You may re-enter your link AFTER you remove the photo you alerted my attention to. I shall not be rendering any further/future advice based on your photos and queries thereof.