Author Topic: My surgical plan. Thoughts?  (Read 2996 times)

Class2

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Re: My surgical plan. Thoughts?
« Reply #15 on: June 18, 2023, 10:21:08 PM »
This is the plan so far:

https://drive.google.com/drive/folders/1hTzotSZPTu-4srZfAdOLd3Pii2Id35Vw?usp=drive_link

He didn't mention the AOB at all during planning. He just said that the teeth were placed in proper occlusion and rough jaw movements would be the focus. OP going from 12.5 to 9.5 from a  mostly anterior differential, only a tiny bit in the posterior and that could be just from the lefort 1? I'm a little bit uncomfortable with the amount of maxillary advancement, so that's my main concern right now. Mandibular advancement seems adequate for OSA. Genio is 4mm, but will be a 6mm so +2 pog to these numbers.

What is everyone's thoughts?

GJ

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Re: My surgical plan. Thoughts?
« Reply #16 on: June 19, 2023, 06:59:56 AM »
In those images it looks like it's moving both forward and CCW. Is that what's happening?

Usually with CCW you'd just get rotation, not advancement. I think this is how you get the "anti-face" look that some love, some hate. But, I could be misreading the records so don't freak out. Let some others chime in.
Millimeters are miles on the face.

Class2

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Re: My surgical plan. Thoughts?
« Reply #17 on: June 19, 2023, 08:46:00 AM »
In those images it looks like it's moving both forward and CCW. Is that what's happening?

Usually with CCW you'd just get rotation, not advancement. I think this is how you get the "anti-face" look that some love, some hate. But, I could be misreading the records so don't freak out. Let some others chime in.

Yes both are being done. the ccw is minor; 3 degrees from the anterior impaction.

What's anti-face?

kavan

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Re: My surgical plan. Thoughts?
« Reply #18 on: June 19, 2023, 06:05:41 PM »
In those images it looks like it's moving both forward and CCW. Is that what's happening?

Usually with CCW you'd just get rotation, not advancement. I think this is how you get the "anti-face" look that some love, some hate. But, I could be misreading the records so don't freak out. Let some others chime in.

Yes and that can be interpreted via the displacement read out.

CCW is a rotation at the maxilla to change its angle of orientation to a more favorable one. It doesn't preclude the maxilla from also being advanced.In fact maxillary advancement is best done WHEN the maxilla is rotated to a more favorable orientation. In this case the CCW is a NET rotation of combined anterior and posterior impaction where the anterior impaction is more than the posterior.
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kavan

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Re: My surgical plan. Thoughts?
« Reply #19 on: June 19, 2023, 06:13:10 PM »
This is the plan so far:

https://drive.google.com/drive/folders/1hTzotSZPTu-4srZfAdOLd3Pii2Id35Vw?usp=drive_link

He didn't mention the AOB at all during planning. He just said that the teeth were placed in proper occlusion and rough jaw movements would be the focus. OP going from 12.5 to 9.5 from a  mostly anterior differential, only a tiny bit in the posterior and that could be just from the lefort 1? I'm a little bit uncomfortable with the amount of maxillary advancement, so that's my main concern right now. Mandibular advancement seems adequate for OSA. Genio is 4mm, but will be a 6mm so +2 pog to these numbers.

What is everyone's thoughts?

If you didn't get the 4.7 maxillary advancement along with the 14.4 mm advancement at the pog point, then your teeth would not mesh/line up for the correct bite and you would look like you had maxillary retrusion via relative comparison with the mandibular advancement.
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Class2

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Re: My surgical plan. Thoughts?
« Reply #20 on: June 19, 2023, 06:44:09 PM »
If you didn't get the 4.7 maxillary advancement along with the 14.4 mm advancement at the pog point, then your teeth would not mesh/line up for the correct bite and you would look like you had maxillary retrusion via relative comparison with the mandibular advancement.

The software automatically adjusts so the bite is correct. When we had the maxilla advanced only 3mm, the pog was updated accordingly to match the bite. He felt a larger maxillary advancement was more appropriate based off of something he saw from the top view after we did the 3 degree rotation. Something I should get clarified.

What do you think of the plan overall? I was considering less of a maxillary advancement but another 2 degree of ccw. Something I could talk to him about as he seems quite open about it all. I like the idea of a 7.5 OP more than 9.5, and with the extra ccw the b point should be similar to the current plan. Also, this way there will be less widening of the nose. He did say he didn't like cutting into the ans much more than with the current impaction though. I know you don't opine on specific movements but perhaps the general idea of it? ;)

kavan

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Re: My surgical plan. Thoughts?
« Reply #21 on: June 20, 2023, 03:32:19 PM »
The software automatically adjusts so the bite is correct. When we had the maxilla advanced only 3mm, the pog was updated accordingly to match the bite. He felt a larger maxillary advancement was more appropriate based off of something he saw from the top view after we did the 3 degree rotation. Something I should get
clarified.

As I mentioned in reply #13 of this string:
Exact meanings in terms of mm measures are found on surgery proposal plans generated by sophisticated software.


Indeed, a sophisticated software program is used in the planning process which is one of a complex multi-factorial equation where all of the many movements are balanced with each other. The program can be used to take a look at altering 1 displacement and will generate a visual and displacement readout of how all OTHER things change when one thing is altered. Likewise, it will do similar if more than 1 movement is altered.  So, you must have witnessed the changes generated by the sophisticated software generated for a 3mm advancement when he was showing it to you.

I was considering less of a maxillary advancement but another 2 degree of ccw. Something I could talk to him about as he seems quite open about it all. I like the idea of a 7.5 OP more than 9.5, and with the extra ccw the b point should be similar to the
current plan. Also, this way there will be less widening of the nose. He did say he didn't like cutting into the ans much more than with the current impaction though. I know you don't opine on specific movements but perhaps the general idea of it? ;)

Millimeter changes and rotational changes are more than just 'ideas' for me to engage in. They are specific changes that would require use of the sophisticated software which is WHY I refrain from engaging is specific displacement ponderings. So if you want to posit such things as the b point would remain constant with MORE
rotation and less advancement and your nose would look better, you can cross reference all your ideas of specific mm and rotational displacements with your doctor who has the software program to show you a visual and a displacement readout of how other things change along with it.

Instead of pondering and positing the (mathematical) outcomes of specific mm or rotational changes, try considering some general relationship principles instead from information already conveyed to you such as:

1: Relationship of CCW-r via anterior impaction to the maxilla to the B point: You were given general info that the lower jaw can swing upward with a maxillary impaction. The displacement read out confirms an upward displacement of the B point. So, if the B point swings upward as a function of net CCW-r impaction, you
posit that MORE anterior impaction will have little to no effect on the positional displacement of the B point. (I'm just re-phrasing what you are positing but suggest you ponder more on what you are positing.)

2: You posit MORE of a CCW-r impaction will mitigate widening of the nose because it allows for less advancement but what about nose support?. Consider pondering the relationship that MORE impaction in exchange for less advancement would have to the support at tha base of the nose.

What do you think of the plan overall?

I think the overall VISUAL plan reflects a favorable change to the bone structure; a great profile improvement and it's a given that all the mm displacements on the displacement readout are associated with the visual changes shown on the visual.


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