Author Topic: I need some help with my DJS result  (Read 2464 times)

dailydave

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I need some help with my DJS result
« on: April 19, 2023, 05:17:48 PM »
My main issue is that it looks like I didn’t get CCW rotation on my lower jaw, only on the upper one. What do you think? I attached before/after CT images.


Before: https://ibb.co/N2yxy9r
After: https://ibb.co/7rmTnVy

Tomasjohn

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Re: I need some help with my DJS result
« Reply #1 on: April 20, 2023, 06:21:26 AM »
Do you now have an open bite?

dailydave

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Re: I need some help with my DJS result
« Reply #2 on: April 20, 2023, 07:13:12 AM »
Do you now have an open bite?

I had right after surgery (never had before) but ortho later closed it with elastics.

kavan

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Re: I need some help with my DJS result
« Reply #3 on: April 20, 2023, 12:16:03 PM »
Correct. Most likely because your surgeon elected to maintain your MPA and so maintain it as to give you a streamline mandibular border which is a good thing.

Your MPA angle is well within the norm; approx 26 deg. in both before and after. So, it doesn't look like your MPA angle decreased with the CCW-r to the maxilla. However what the CCW-r, based on the rotation of a triangle, does is allow for the BSSO aspect of the surgery to the mandible to go out further than it otherwise would go if not for the CCW-r. Now, IF your surgeon felt that it was needed to REDUCE your MPA (mandibular plane angle), which is done by kind of twisting the BSSO segment CCW-r, that could have been done too. Thing is that when they elect to do a CCW-r 'twist' directly to the mandible, it leaves part of it sticking out below and between the posterior and anterior mandible. In your case, it looks like you got a 'streamline' lower border of the mandible. Like no extra part sticking out lower between the posterior and anterior mandible. So, that is a GOOD thing in your case because your MPA was within the norm and didn't need to be reduced. The anterior open bite that arose from the posterior downgraft to the maxilla could be closed later down the line with devices to do that.
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dailydave

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Re: I need some help with my DJS result
« Reply #4 on: April 20, 2023, 05:49:11 PM »
Correct. Most likely because your surgeon elected to maintain your MPA and so maintain it as to give you a streamline mandibular border which is a good thing.

Your MPA angle is well within the norm; approx 26 deg. in both before and after. So, it doesn't look like your MPA angle decreased with the CCW-r to the maxilla. However what the CCW-r, based on the rotation of a triangle, does is allow for the BSSO aspect of the surgery to the mandible to go out further than it otherwise would go if not for the CCW-r. Now, IF your surgeon felt that it was needed to REDUCE your MPA (mandibular plane angle), which is done by kind of twisting the BSSO segment CCW-r, that could have been done too. Thing is that when they elect to do a CCW-r 'twist' directly to the mandible, it leaves part of it sticking out below and between the posterior and anterior mandible. In your case, it looks like you got a 'streamline' lower border of the mandible. Like no extra part sticking out lower between the posterior and anterior mandible. So, that is a GOOD thing in your case because your MPA was within the norm and didn't need to be reduced. The anterior open bite that arose from the posterior downgraft to the maxilla could be closed later down the line with devices to do that.

Thank you very much for the detailed answer! You see, my problem is that in my opinion now my face looks really downward grown and weird because of the lack of mandibular rotation. My lips also look a bit strange to mee. I attched how I look now:

Profile: https://ibb.co/gd31yJF

Original plan: https://ibb.co/J3sd6R0

Is there any way to improve the aesthetics of my profile? I will get a revision genio soon where they will move my chin a bit up (so also forward as my chin will be moved diagonally) to make my face less long and more forward. Do you think that this would improve my case and make my mandible to appear less steep? I would be also happy if it would stretch the skin more, especially under my neck.

kavan

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Re: I need some help with my DJS result
« Reply #5 on: April 20, 2023, 07:59:32 PM »
Thank you very much for the detailed answer! You see, my problem is that in my opinion now my face looks really downward grown and weird because of the lack of mandibular rotation. My lips also look a bit strange to mee. I attched how I look now:

Profile: https://ibb.co/gd31yJF

Original plan: https://ibb.co/J3sd6R0

Is there any way to improve the aesthetics of my profile? I will get a revision genio soon where they will move my chin a bit up (so also forward as my chin will be moved diagonally) to make my face less long and more forward. Do you think that this would improve my case and make my mandible to appear less steep? I would be also happy if it would stretch the skin more, especially under my neck.

A sliding genio that slides up and outward along a diagonal cut will make your MPA less steep and address the excess length to the face you don't like (and wish the BSSO via CCW did). It would also tend to tighten the under chin/neck area somewhat. So, you could have that to address what the BSSO didn't do.
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dailydave

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Re: I need some help with my DJS result
« Reply #6 on: April 21, 2023, 11:19:10 AM »
A sliding genio that slides up and outward along a diagonal cut will make your MPA less steep and address the excess length to the face you don't like (and wish the BSSO via CCW did). It would also tend to tighten the under chin/neck area somewhat. So, you could have that to address what the BSSO didn't do.

Thank you! Do you think that it would also help with my lips? The lower one is more behind and just rolled out.

kavan

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Re: I need some help with my DJS result
« Reply #7 on: April 21, 2023, 01:06:05 PM »
hard to predict but i think it might help give more support to lower lip
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Tomasjohn

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Re: I need some help with my DJS result
« Reply #8 on: April 21, 2023, 01:16:15 PM »
Thank you! Do you think that it would also help with my lips? The lower one is more behind and just rolled out.

As kavan said, it could give more support.
It will probably not bring the lower lip forward (red point).

If you fill out the yellow area in the picture I think it could indirectly help mask the discrepancy of upper/lower lip.

https://imgur.com/a/QgoxmkX

Because of the (then reduced) difference in projection between area above upper lip and below under lip (yellow)

kavan

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Re: I need some help with my DJS result
« Reply #9 on: April 21, 2023, 03:09:22 PM »
As kavan said, it could give more support.
It will probably not bring the lower lip forward (red point).

If you fill out the yellow area in the picture I think it could indirectly help mask the discrepancy of upper/lower lip.

https://imgur.com/a/QgoxmkX

Because of the (then reduced) difference in projection between area above upper lip and below under lip (yellow)
nice suggestion
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dailydave

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Re: I need some help with my DJS result
« Reply #10 on: April 21, 2023, 03:51:41 PM »
As kavan said, it could give more support.
It will probably not bring the lower lip forward (red point).

If you fill out the yellow area in the picture I think it could indirectly help mask the discrepancy of upper/lower lip.

https://imgur.com/a/QgoxmkX

Because of the (then reduced) difference in projection between area above upper lip and below under lip (yellow)

nice suggestion

Thank you for the asnwers! What’s the best way to fill that area other than grafting?

kavan

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Re: I need some help with my DJS result
« Reply #11 on: April 21, 2023, 04:32:48 PM »
fillers (injected). consider that after the genio.
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Tomasjohn

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Re: I need some help with my DJS result
« Reply #12 on: April 22, 2023, 10:08:33 AM »
I just wanted you to be aware of this detail. Not sure if it's important or not.

dailydave

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Re: I need some help with my DJS result
« Reply #13 on: May 12, 2023, 11:18:19 AM »
As kavan said, it could give more support.
It will probably not bring the lower lip forward (red point).

If you fill out the yellow area in the picture I think it could indirectly help mask the discrepancy of upper/lower lip.

https://imgur.com/a/QgoxmkX

Because of the (then reduced) difference in projection between area above upper lip and below under lip (yellow)

hard to predict but i think it might help give more support to lower lip

I eventually got the genio revision.

Before: https://ibb.co/xYPzSyX
After: https://ibb.co/BTvwvCn
 
There’s still significant swelling but I can already see the step off more and more on the soft tissue. Isn’t it too big based on the xray? What do you guys think overall of the result?

kavan

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Re: I need some help with my DJS result
« Reply #14 on: May 13, 2023, 02:59:07 PM »
 More of a sliding genio would result in more of a step off and the revision conformed to your request of more projection of the chin point and less length to the chin area.
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