DJS Or Just Genio Based on These Plans?

[Captain_Jack2001]

So, I recently had a consultation with a surgeon and he has proposed two options for me - one of which is DJS + Genio and one is Genio only. He doesn’t necessarily believe I need a full DJS and a Genio would be a much more cost effective option for very similar results. I have SFS, and so the two plans are as followed:

Option 1 - Genio Only:

- 5mm advancement

- 5mm downgraft

Option 2 - DJS:

- 4 degrees of clockwise rotation alongside a 4mm chin downgrafting

- Would result in linear advancement of the upper jaw of 0.8mm and setback of my mandible by 0.7mm.

Based on the simulations, do I opt solely for the genio, or do you think a DJS is necessary?

[Captain_Jack2001]

Final DJS Attachment

[GJ]

Based on these images, I can't tell. The DJS plan is at a 3/4 angle, which isn't super useful to compare. If that is your actual face and jaw in the images, I'd probably go with the genio only, as the jaw looks normal.

[Captain_Jack2001]

Based on these images, I can't tell. The DJS plan is at a 3/4 angle, which isn't super useful to compare. If that is your actual face and jaw in the images, I'd probably go with the genio only, as the jaw looks normal.

Is the side profile of both not sufficient? You can see the skull structure for both before and after of each suggestion.

[GJ]

Is the side profile of both not sufficient? You can see the skull structure for both before and after of each suggestion.

I didn't realize you put the DJS profile in the genio post. It looks like the only difference in the images is really where the lower lip is sitting. What would be best is if you posted an x-ray or scan of your current jaw.

[kavan]

The surgeon gave you sufficient visual comparison proposals with the expectation that you could decide which one looked better to YOU. The displacement measures/numbers are incorporated within the VISUAL proposals. OK. The surgeon is expecting you to observe such things as the lower lip is less behind the upper lip because it's advanced further in the double jaw surgery. Even if you're not in the capacity to pin point the subtle differences in the DJS, your still expected to tell which one looks better to YOU.  So, with that, he's assuming you are in the capacity to evaluate whether it's 'worth it' to YOU to go through what ever extra pain and expense for the change to be observed, especially in the profile comparison, to have the DJS. That said, if you can't determine which one looks better to YOU, then get the one that is the least surgery.

[Captain_Jack2001]

I didn't realize you put the DJS profile in the genio post. It looks like the only difference in the images is really where the lower lip is sitting. What would be best is if you posted an x-ray or scan of your current jaw.

[GJ]

I would probably avoid DJS and try a genio with some grafting to fill in the LM fold. But, it is really your call. You could always have DJS later in that scenario. Ask the surgeon if the genio would prevent DJS due to chin position (probably not).

[Captain_Jack2001]

I would probably avoid DJS and try a genio with some grafting to fill in the LM fold. But, it is really your call. You could always have DJS later in that scenario. Ask the surgeon if the genio would prevent DJS due to chin position (probably not).

I was told that if I got genio it would not prevent any future DJS on consult. Out of interest, why would you avoid DJS?

[GJ]

why would you avoid DJS?

You look pretty good as is if that's you in the scans. Your x-ray is also not bad. I personally don't think it's worth the trade offs and the risks.

[Captain_Jack2001]

You look pretty good as is if that's you in the scans. Your x-ray is also not bad. I personally don't think it's worth the trade offs and the risks.

Thank you. Yes it is me in the scans and X-ray, I had them a few weeks ago. I’m going to consult other surgeons and see if they agree, but yeah, I was told that bimax would not be worth the extra cost and recovery for me and that genio would be very sufficient. I didnt ask but I assume that’s because my maxilla isn’t recessed and therefore bimax would likely overadvance me if done to any meaningful movements.

I think he said the bimax would only be useful to correct my lip seal, but as you said, it’s a lot more money, plus ortho to fix something that is very insignificant.

Thanks for your help!

[GJ]

Thank you. Yes it is me in the scans and X-ray, I had them a few weeks ago. I’m going to consult other surgeons and see if they agree, but yeah, I was told that bimax would not be worth the extra cost and recovery for me and that genio would be very sufficient. I didnt ask but I assume that’s because my maxilla isn’t recessed and therefore bimax would likely overadvance me if done to any meaningful movements.

I think he said the bimax would only be useful to correct my lip seal, but as you said, it’s a lot more money, plus ortho to fix something that is very insignificant.

Thanks for your help!

NP. That surgeon sounds correct/ethical to me based on what I'm looking at in these images.