Preparation for DJS, advice needed

[kavan]

IMO CW does result in an angle that would result in more bony recession, which is why I said linear. I'm not sure if Kavan sees something else or has a different opinion on that.

Correct. Yes it does result in more bony recession because CW moves the chin point back to reduce the prominence it has with it's present angle orientation. So, the 'something else' that Kavan sees is the relationship CW has to moving the chin point backwards in a case where a prominent chin would become TOO prominent (too far forward) with linear advancement and prominent enough that you would have to LOP part of it OFF to compensate for the linear advancement.

Ultimately, I suggest that people inquiring about rotations familiarize themselves with the ROTATIONS OF A TRIANGLE and how rotations of a triangle relate to the triangle formed by points; ANS, PNS and POG can be drawn of one's own ceph. I've put up a link to that here: https://jawsurgeryforums.com/index.php/topic,7883.msg72313.html#msg72313
Yet, frequently I find that my diagrams have been removed (no file found for them) and I've gotta put them back up again. (No idea why the diagrams I put up there 'go away'.)

[kavan]

I agree with that...at first I didn't think he was recessed.

The second set of photos seem to show he is recessed "in the flesh", but now it's a question of which is accurate. Ceph and first set of photos look like Morgan Dollar profile, which isn't necessarily recessive just a bit more feminine than some like.

I've marked out his approximate S, N, A and B points. SNA and SNB measures don't kick up recession. SNA is higher than norm. SNB a little higher than norm. SNA is more higher than the norm than is SNB. So, I really can't confirm bimax recession based on that.

I've also marked out his triangle (ANS, PNS,POG); the GREEN one and rotated it CW (around ANS as fixed point ) to displace it to ANS',PNS', POG'; the RED triangle to show how the prominence at the POG point moves backwards with that.

Personally, it's easier for me to look at the surgeon's displacement proposal plan rather than what the person says they have. In his case, I encourage him to get a displacement proposal from the surgeon that shows him a proposed contour change from it that correspond to the proposed displacements.

[kubabuk]

Thanks for the answers. I will adress the issues now.

2: CW-r which will rotate the chin point (Pog) down and back and thereby reduce the chin prominence and without a separate surgery to the chin to reduce prominence.

But it seems like CW-r will increase the effect of "merging" of the mandible and neck that I would like to avoid. Is my intuition here correct?

The other part of the matter is that when I look at other angles of the face, such as SNA and SNB, the SNA (associated with maxilla orientation) is a little above the norm and SNB (associated with mandible orientation) is also a little above the norm. SNA is more above the norm than is SNB. So now, I'm not that convinced the maxilla is recessive and I'm now questioning if the mandible is recessive. I disclose I didn't CROSS REFERENCE your SNA and SNB angles with your self assessments of recession to BOTH JAWS."

As I (and all my orthodontists/dentists) said I do have micrognathia. In the past few weeks I learned (from my ortho and denstist) that I have maxilla recession too. So it's not merely my own self assesment, but of course it still could be wrong.

Although your initial entry was 'easy to follow' for GJ, it wasn't for me. For example, you were preparing for DOUBLE JAW surgery but with ONLY option of the Lefort 1 (single upper jaw surgery). Also, you wanted to know if you 'should try to convince' your surgeon to do something. To me, that type of question conveys you want to be a 'back seat driver' telling your surgeon what he/she needs to do. But don't know the directions yourself. Although you're not expected to know HOW to DIRECT your surgeon, another 'back seat' driver from here (even if it's me) can't be expected to proxy to direct him/her for you to convince of those directions.

You are right, I might have a wrong attitude towards the whole thing. The thing I'm worried about is that my surgeon will not take aesthetics into consideration, leaving me with a functional, but not aesthetically satisfying result. It is an insurance covered operation after all.
As I said I'm still new to the topic, so my post might not be perfect. I'm sorry if it's 'hard to follow', maybe you could give me some hints where I could write something more clearly (I'm being honest and not trying to be argumentative here; it's in my best interest to make my post 'easy to follow' and maybe I lack some knowlege in the topic of jaw surgery etc.) ?
The lower jaw operation will probably be BSSO, but I will know for sure only after my first appointment with the surgeon.

What would be easier for me to follow would be a displacement PLAN from your surgeon.

Unfortunatelly I don't have that yet. I will probably make another post in the future with that kind of info though.

I will post some more photos showing the issues I have with my face more clearly.

[kubabuk]

Now some more photos, some of which are the already posted and just grouped differently:

short mandible (micrognathia) clearly visible when I open my mouth wide:
https://imgur.com/a/CwW43RS

photos showing how far behind my upper jaw is in relation to my nose (I'm holding my upper lip close to the upper incisors, because at rest there seems to be a lot of space between my upper incisors and my upper lip giving the false impression of maxilla not being recessed):
https://imgur.com/a/KMQlfd8

here you can see how far behind my upper incisors are relatively to my nose (even though my upper lip seems to be forward enough):
https://imgur.com/a/2DZcXmi

and finally the poor tooth show at rest (you can't see my upper teeth at all), which could suggest maxilla recession:
https://imgur.com/a/fbfWqng

I also attached some ceph calculations done by my ortho.

Here are some photos showing a worringly sagging mouth area; could it be caused by recessed jaws?:
https://imgur.com/a/Z96ZYZG

[kubabuk]

One more thing: could the SNA/SNB angle be unreliable diagnostic tools in some cases? Could it be that the jaws are recessed despite the angles showing otherwise?

[kubabuk]

Thanks for your help. I will probably make a new post after talking with some surgeons in a few months.

[kavan]

I've removed my entry for 2 reasons.

1. It may not have been helpful.

2. On the premise that when people want aesthetic improvement, they are referring to the soft tissue contour profile. So, I've done a morph that is in venue of improving soft tissue contour profile. Morphs don't predict surgical outcomes but you can use this to ASK your surgeon IF his bone displacements can kick up something like it OR if he has a very different aesthetic in mind.
In the event this aesthetic is not to your liking, you may also use it to ask if your surgeon will avoid an outcome like it.

In that way, it will be up to your maxfax to tell you if your preparation for DJS is toward a similar aim or a different one. Also, in that way, you don't have to try to communicate with him via stuff like, rotations, displacements, angles...etc.

Diagram/photo included with this entry.

Thanks for your help. I will probably make a new post after talking with some surgeons in a few months.

[kubabuk]

Thank you very much, I belive the morph you made will be very useful to me. This is pretty much the effect I would like to achieve.
One more question popped into my mind while looking at the morph - am I at high risk of having a "chimp lip" with these sorts of movements of the jaws? How could I minimize this risk?

[kavan]

Thank you very much, I belive the morph you made will be very useful to me. This is pretty much the effect I would like to achieve.
One more question popped into my mind while looking at the morph - am I at high risk of having a "chimp lip" with these sorts of movements of the jaws? How could I minimize this risk?

The morph should allow you to ask those types of questions to your surgeon.

ETA: That is because it provides enough visual information for a surgeon to cross reference it with your ceph and the measures you have as to address questions about risks vs trade-offs highly specific to you.