Hi,
Alongside my lack of projection in both the lower and upper jaw, I also lack width. This is something that is most commonly corrected with implants -- either custom-designed silicone gonial implants or full wrap-around implants that also augment the chin. I've also seen people get a combination of gonial implants and a widening genioplasty.
Something I've recently been looking into, however, is MSDO [Mandibular Symphyseal Distraction Osteogenisis]. I'm sure most of you have heard of this procedure and know that it entails dividing the mandible from the midline and widening laterally, but I'll be willing to bet that non of you have had it. If you know about the procedure, I assume you also acknowledge the lack of documented cases online.
What I was considering is whether or not this procedure -- in combination with an upper pallet widening procedure and then DJS later -- would make my chin and mandible look
wider. If it could, it may negate the need for something like a chin implant or widening genioplasty, and, in combination with the effects of BSSO, may reduce the need for gonial widening implants. So, I had a look at what the literature says to see if I could form a conclusion as to whether this would be beneficial. TL;DR -- it doesn't seem particularly useful to those ends.
Disclaimer: I'm only just beginning to learn about the ins and outs of these different procedures and the topic of orthodontic science in general, so I'd greatly appreciate any corrections to holes in my knowledge below. I'm jotting things down here to learn from those more experienced, ultimately.
What the literature saysThe literature is pretty clear on the benefits for combatting overcrowding -- You can read about how the procedure works in this study:
https://www.jdao-journal.org/articles/odfen/pdf/2016/03/odfen180110.pdf which has also been posted on the forum before.
One of the most commonly cited dangers of the procedure is excessive stress on the condyles. This is usually stated as the number one reason not to do it on forums and on Reddit, but the aforementioned paper -- as well as this review on that exact topic:
https://core.ac.uk/download/pdf/51289723.pdf -- claims the fear to be mostly unfounded.
I'd also noticed some discussion online about it having the ability to improve sleep apnea when combined with other upper jaw procedures, although Dr. Kasey Li most recently concluded the effect is relatively weak:
https://pubmed.ncbi.nlm.nih.gov/36704954/But what about where aesthetics are concerned?
I could only find one paper that showed a person's facial profile before and after MSDO:
https://www.researchgate.net/publication/24273147_Midsymphyseal_distraction_osteogenesis_A_new_alternative_for_the_treatment_of_dental_crowding
He also underwent expansion of the upper arch, and his cephalometric analysis showed favorable forward growth changes as well; I assume, being an adolescent, his face then grew into a better shape because of his treatment.
As such, looking at the pictures doesn't really tell us much. He obviously looks better, but how much of this can be
acutely attributed to the MSDO is unclear, and improvements wouldn't necessarily scale to an adult face anyway.
I then looked for papers that referenced any potential jaw-widening effects directly and found two papers that showed the contrary: that bigonial width either stayed essentially the same or
decreased after the procedure:
https://academic.oup.com/ejo/article/27/5/512/473595.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225601/From what I can tell, the only real suggested benefit aesthetically would be those involved with the smile [less bucal corridors] and a wider chin. It doesn't seem to increase the bigonial width and may even reduce it depending on the extent of the extraction, which makes sense if you try to visualize it.
I guess it could technically make the face look wider by virtue of the extra chin width, but it doesn't look like it would do anything to correct the inward rotation of the gonions on a small jaw, which makes sense, as that would require an actual rotation on both sides [something I assume is impossible]. I wonder now what the effects on the chin would be compared to something like a widening genioplasty.
Anyway, just thought I'd organize my thoughts here. Would be interested to hear yours and if I'm on the right track with what I've found out. Thanks!
