Impaction

[Optimistic]

Just got my letter back from another surgeon who recommended impaction, so I suppose a lot of you were right in saying that it'd be unlikely I could fix an open bite with just a BSSO alone. In total everything that was suggested was:
- BSSO with rotation
- Orthodontic decompensation
- Sliding Genioplasty
- Impaction
--- Optional: Zygomatic Osteotomy

Is impaction just another word for a Lefort? I was ok with all the other stuff but idk about having my upper-jaw cut too. Something about it just freaks me out. Would it make any difference to my appearance at all given that it's clearly going to be minor? If some knowledgable people would be willing to pop in here and allow me to ask some questions would be really appreciated. I've looking it up on here a bit but I just have a few more questions.

I'll be speaking with another doctor tomorrow so hopefully I'll get some more answers.

[Lazlo]

Just got my letter back from another surgeon who recommended impaction, so I suppose a lot of you were right in saying that it'd be unlikely I could fix an open bite with just a BSSO alone. In total everything that was suggested was:
- BSSO with rotation
- Orthodontic decompensation
- Sliding Genioplasty
- Impaction
--- Optional: Zygomatic Osteotomy

Is impaction just another word for a Lefort? I was ok with all the other stuff but idk about having my upper-jaw cut too. Something about it just freaks me out. Would it make any difference to my appearance at all given that it's clearly going to be minor? If some knowledgable people would be willing to pop in here and allow me to ask some questions would be really appreciated. I've looking it up on here a bit but I just have a few more questions.

I'll be speaking with another doctor tomorrow so hopefully I'll get some more answers.

Is it Dr. Mommaerts? You should not feel worried about stating the surgeon as others may be looking for such procedures. Specifically the zygomatic osteotomy. Few surgeons perform this so we'd like to know who is offering it.

[x]

Is impaction just another word for a Lefort?

Lefort refers to the segmentation of the maxilla, impaction isn't always indicated. Because the Lefort can move the maxilla in all 3 planes, impaction describes only one of it's possible movements

Would it make any difference to my appearance at all given that it's clearly going to be minor?

It will shorten the length of your face. To what degree depends on the severity of your vertical deformity

[Optimistic]

Update for everyone: I just got done talking to Mommaerts on Skype so I have more info.

1. The impaction he's recommending is for the lower jaw, not upper. This is to deal with lip incompetence but will also change my facial thirds. Based on my simulations this would be a positive thing.

2. I asked for his opinion on IVRO and he stated that IVRO was an older procedure that wouldn't deal with the problem fully as those with jaws like mine have deficiencies in the posterior and anterior parts of the mandible, which wouldn't be solve by simply moving the entire thing forward. He also stated that it was more extreme and BSSO could provide a more controlled outcome.

3. I asked about lengthening of the ramus and altering the gonial angles. His opinion was that in most cases this is better left not done, or simply addressed through HA paste. He did however mention two other alternatives that he has done before: One was the use of customised titanium implants and the other was a BSSO of the ramus to change its angle to a more vertical position. Regarding the implants he said it was risky as they were incredibly expensive and if the patient wasn't happy with the outcome the only option was to get a new one. As for the sagittal split of the ramus I got the impression that this was a valid solution, however people doing it tend to want to go for more extreme angles and it could be "playing with nature" a bit too much.

That's all I can remember asking right now. I'm super tired so maybe I'll add more later. The BSSO of the ramus was interesting and is definitely I'd consider.

[x]

Could this be done as a method of dealing with my lip incompetence? Or would the chin/lower jaw need to come up to solve that? Thanks again btw.

Yeah in fact I'm not sure if a surgeon would do an impaction if zero lip incompetence was present. Think about it, if you impact but there's no lip gap suddenly the lips in their new position are going to be smashed up against each other and it would probably look bad. When the maxilla gets impacted, the chin/lower jaw automatically rotates up to fill the gap of the impaction.

Because MM wants to do it in the mandible, it likely means the posterior mandible has too much vertical length but the result should be the same in closing the lip gap and rotating the mandible up

[pekay]

this girl had her lip incompetence corrected with a bsso and genio only





http://littlewoodenshoes.blogspot.com

[Optimistic]

To be honest I feel like it's just a case of first picture's angling and focus on her big eyes, and the second one having that kind of "I just got arrested" look. Though having a weak chin does making one look younger. Fuark. I hope mine won't make me look too old now, though as a man that's ok I suppose.

[pumukka]

"I just got arrested" look.

loolol, I dont think she looks that older, is just is different poses hehe

[Modigliani]

Agree, she looks better and not a bit older.

I sometimes wonder what people are seeing here, or is it just a case of being negative for the sake of it.

[pekay]

I think she looks better too plus she was able to avoid all the s**t-storm that upper jaw surgery causes

[Optimistic]

What are you referring to? I'm having my maxilla brought forward.



"Jsf.com ruined all the confidence I had before jaw surgery"

Lovely quote / signature 

I don't know much about maxilla advancement as it's not something I need, although I believe some have questioned the effect it has on the S-shape at the 3/4 angle, hollowing under the orbital rim, and perhaps just generally being far more invasive than a standard BSSO/SG. In the right hands it should be nothing to worry about, imo. Just lurk around here some more and learn about the risks

[pekay]

pretty much what Weakjawbrah said PLUS the nose widening

[pumukka]

Some thoughts on this would be interesting as I've yet to find any articles, posts, or studies on impaction of the lower jaw before.

Could he have meant "impacting it" trough genioplasty? I believe there are 3 types of genioplasties that either length, shorten, or it just stays the same, so if its the one that is supposed to shortten it, your lower third/mandible+chin and even gonial angle would look shorter i think, maybe someone can correct me here

[Optimistic]

Could he have meant "impacting it" trough genioplasty? I believe there are 3 types of genioplasties that either length, shorten, or it just stays the same, so if its the one that is supposed to shortten it, your lower third/mandible+chin and even gonial angle would look shorter i think, maybe someone can correct me here

The thing is, I don't see how a genioplasty in that sense could help with the functional aspects associated with true impaction.