Idea for complete jaw improvement (angle, occlusion, advancement)

[Lazlo]

Euphoria posted it...it's in here somewhere.  Insanely steep occlusional angle and open bite (I think)  They guy had trimax

If you elongate the ramus in the vertical dimension then you will move the teeth apart, vertically.  Rotating the mandible will move the back teeth down even more.  However you look at it it will be tricky. 

No matter what you do, even if you get DO + BSSO, you will still need paste to smooth things over.  There is a Dr Y case where someone got implants because their jawline wasn't smooth after jaw surgery

I think it's all going to depend on the actual shape of the gonial angle and the the occlusional plane

Consider this schematic



In the first row, you have the 'ideal' jaw shape and the 'downward growth' shape where everything is very steep, but not short.  The guy who got the trimax with IVRO was like this.

In the 2nd row, the pic on the right has short ramus and mandible, obtuse gonial angle.  Even if you do this DO + BSSO thing, the gonial angle is still the same shape and there is going to be a discrepancy after rotation that you will need paste or an implant to cover.  That's why you might be better doing the cut in the angle itself, and fill it with a graft

In the 3rd row, the plane and angle are good, but the ramus and the mandible is short.  In this case you would get a good improvement

The 4th case, which I didnt draw, would be were the angle is OK, but the upper and lower planes are steep.  In this case you could do a lefort with rotation and rotational, lengthening SSRO (it it was stable)

YOU DREW THESE!? Oh my god celticcavegirl, please become a surgeon, you'd be amazing and so empathetic. SERIOUSLY, it would be no hands down contest I'd go with you!

[Optimistic]

On this topic still, can someone please explain BSSO vs IVRO? The more I look at this the more it seems as though an IVRO is ideal for me. It would reduce the gonial angle and create a better jawline by all accounts. Moreover, would it not be possible to lengthen the ramus if cut a certain way?

I don't know HOW it could be done, but surely the right osteotomy, drop the ramus down even just a bit, rotate it ccw, with some mandibular advancement to fix the occlusion and improve jaw angle. Done. No?

[Lazlo]

Word up.

weakjawbrah i'm gonna suggest you bypass this optimism phase and move straight to the realistic acceptance phase. Many of us went through this about 6 months, looking for that magic cure and all of us came to the disappointing realization that you by and large can't change the hand you were dealt. Better to embrace it. Also I think you overestimate the malleability of the face, specifically in an area that deals with heavy loading much throughout the day


some b/a's of DO on the ramus. I think you'll find that t D.O. is marketed less as cosmetic and more functional in nature for a reason

the first guy's results look amazing --see when i see stuff like that i wonder why is this not available from the surgeons we've all consulted with, Euphoria, what's your guess?

[Lurker25]

For future reference in case anyone would fall into the same search pattern, with no answers, that I fell into.

Here is a "lengthening" of the ramus and angle change (gonial angle) via bimax surgery. "Bilateral stepwise body osteotomies and bilateral sagittal split osteotomies (Obwegeser)" on the mandible.

https://www2.aofoundation.org/wps/portal/!ut/p/a1/jY9LD4IwEIR_DVd2gUSNtx6U-AoHfEAvpsRSSLDblCKJv17kjI-57WS-zQxwyIBr8aiVcDVp0bxvPruGCWK8SXGXJMcAWboK4vMaEQ_REMi_BNj8Px4_iOEvfgtcNVSMVXOmi2ihgFtZSiut39nBrpwz7dJDD_u-D31BJXX6Ng70yarBNq2HhqybflJR6yCbZMHcT9lzLy8vkhZ3ng!!/dl5/d5/L2dJQSEvUUt3QS80SmlFL1o2XzJPMDBHSVMwS09PVDEwQVNFMUdWRjAwME0z/?approach=&bone=CMF&classification=95b-Special%20considerations&contentUrl=srg%2F95b%2F05-RedFix%2FP410-2JawSurg%2F02_Introduction.enl.jsp&implantstype=hidden&method=Special%20considerations&redfix_url=1340701672038&segment=Orthognathic&showPage=redfix&soloState=lb&step=1&subStep=11&treatment=











EDIT: You just need to find the right surgeon who is willing to perform the procedure. The following two images are of an extreme case of course:





https://www2.aofoundation.org/wps/portal/!ut/p/a1/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKN_A0M3D2DDbz9_UMMDRyDXQ3dw9wMDAx8jYEKIvEocDQnTr8BDuBoQEi_l35Uek5-EtipkY55ScYW6fpRRalpqUWpRXqlRUDhjJKSgmIrVQNVg_Lycr30_Pz0nFS95PxcVQNsWjLyi0v0I1BV6hfkhkZU-aSGAwDYYmkN/dl5/d5/L2dJQSEvUUt3QS80SmlFL1o2XzJPMDBHSVMwS09PVDEwQVNFMUdWRjAwME0z/?approach=&bone=CMF&classification=95a-TCS%2C%20Treacher%20Collins%20Syndrome&contentUrl=%2Fsrg%2F95a%2F05-RedFix%2FTCS%2FP840-Orthogn%2F01-Conventional_Orthognathic.enl.jsp&implantstype=&method=Conventional%20orthognathic%20surgery&redfix_url=1345644282821&segment=Congenital&showPage=redfix&soloState=lb&step=1&subStep=11&treatment=