jawsurgeryforums.com
General Category => Aesthetics => Topic started by: mick9876 on November 11, 2019, 07:11:03 AM
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Probably a linear/down movement since you have a short lower third. I don't think CCW is a good option for this case. You'd need good ortho treatment to get the teeth in a position to let the lower come forward as much as possible. There is a surgeon currently answering questions here, so maybe you can ask him.
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Unless you have a severe cant to your upper jaw, I'd advise you only get single jaw surgery.
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Unless you have a severe cant to your upper jaw, I'd advise you only get single jaw surgery.
Lower only with extractions?
I don't see how he'd get enough space without extracting the lower premolars.
That is a valid option in cases with a short lower third and flat occlusion. I can see it working for this case.
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Lower only with extractions?
I don't see how he'd get enough space without extracting the lower premolars.
That is a valid option in cases with a short lower third and flat occlusion. I can see it working for this case.
He is Angle Class II div 2. These cases present usually with too steeply inclined (retroclined) maxillary incisors which can be decompensated into a more natural proclined state. I'm not in the mood to download his ceph and trace everything out manually, but I figure he can get 7-8mm space for a combined (rotation and translation) movement of his lower jaw. The ortho will need to decompensate the curve of spee in the upper jaw (but not the lower!) as well to give a proper occlusal plane for the surgeon to work with. This allows him to adress the vertical deficiency without having to operate on the upper jaw as well.
See here: https://www.zmk-aktuell.de/fachgebiete/kfo/story/ein-integriertes-therapiekonzept-zur-korrektur-der-klasse-ii-dysgnathien-__5622.html
for some explanatory illustrations. Ctrl + F and enter "Chirurgische Rotation" to jump to the relevant piece or use google translator to read the entire thing if you are in the mood.
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Hello,
been lurking on this forum for a while and dedicated to make a thread to see if someone wants to give their general opinion comment my case in some way.
I have deep bite, short lower and upper jaw with zero teeth show, i think that aesthetically thinking the most important goal of the surgery is bringing both jaws forward since i feel like my face is pretty flat and recessed, also getting some tooth show would be nice too.
Two surgeons i have seen have suggested doing double jaw with cw rotation, one also talked about sarpe.
Btw, i am currently doing orthodontics and i have seen three surgeons, one from Belgium, one from Spain (you might guess who these are since they are pretty popular on these forums) and one from my home country, not 100% sure yet who i am choosing.
Thanks for taking the time to read this
You relay you're in ortho. Just tells me you are in ortho for something. The something to be in ortho for is ideally a pre-selected surgeon. Plans among surgeons differ and so does the ortho prep as it needs to be in reference to a plan and the 2 planners; maxfax and ortho should be in communication with each other. Posters who run around town (and this might include the world) seeking differnt opinions, who are in ortho (for who knows what) will be in perpetual uncertainty and in ortho longer than those who can pre-pick a surgeon.
Here is a quote of mine from another thread (on the educational section):
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' Absence of treatment plan, when orthodontist and surgeon do not communicate....'
I think that is often the case when patients are in braces (or invasaline) for 'something' and then they go around on multi consults in pursuit of the maxfax part of various treatment proposals where the situation is inherently one where there is no communication between which ever otho they have and the doctors they are consulting with. They are in braces for 'something' and the more consults they go on, the more they get confused and linger longer in indecision. Any treatment plan via braces should be that of the CHOSEN doctor such there is direct communication via him/her and ortho. All treatment plans from any doctor are always contingent on the braces doing what they want them to do.
You relay you have short upper and lower jaw with 0 teeth show. That part is consistent with with a DOWN GRAFT to the maxilla which would yield more teeth show and elongation to the lower '1/3rd' of face. You relay the suggestion of CW rotation (clockwise). CW rotation is consistent with 'short face' and LOW ANGLE mandibular plane. CW rotation is consistent with the maxilla moving forward and chin point moving down and back and also increasing the angle of inclination the mandibular plane has with a horizontal plane. You have 'short' lower 1/3rd and low angle mandibular plane.
Now, that's JUST the ROTATION part of it. For rotations, they are best understood by people with a basis in GEOMETRY because rotation of the maxilla/mandible complex relates to rotating a TRIANGLE around a selected rotation point and that's what is happening in maxfax. On the educational section of this board, I've included a few diagrams about rotations. The diagrams show where the TRIANGLES are constructed.
Rotations take place to the maxilla and in reference to the TRIANGLE being rotated from a selected fixed rotation point and also the direction of the rotation, how the mandible displaces with the rotation is going to be 'self evident' to those who have no problem with the concept of rotating a triangle (elementary geometry).
In addition to the rotation, there are other movements or 'translations' where the jaw(s) are displaced along the CHANGE of PLANE the rotation has created. For example a CW rotation increases the angle of inclination of both the maxillary and mandibular planes; makes the planes steeper. (Works with flat planes.) A 'forward' movement/displacement is a translation along that plane. Hence advancing the maxilla; translating it 'forward' along the plane the rotation created can be added to address maxillary retrusion. Likewise, translating the mandible 'forward' (BSSO) along the steeper plane the rotation created can also be added.
Downward drops; a downgraft of the maxilla can also be added. For example, a downgraft to the WHOLE maxilla that was vertically longer in front than in back, would be in CW direction and one that was vertically longer in the back than the front would be in CCW direction.
All in all, I think your case looks consistent with a CW rotation via an overall downgraft that is more in front than in back. It would give more tooth show and elongate the short lower '1/3rd' of face. It will also make all of your overly 'FLAT' planes steeper (making them steeper contributes to the elongation) and from there, advancement to both upper and lower jaw follow along steeper planes. All that together would address your aesthetic issue.
The only other thing that could be added to this mix would be a genio if the BSSO does not compensate enough for the chin going backwards with the CW rotation.
I would suggest looking for similarities in what I explained here to the surgical suggestions.
To synopsize further, From your ceph, it looks like you could have a CW (overall downgraft) to the maxilla coupled with bimax advancement and quite possibly genio.
NOTES:
I will not direct in which doctor to choose. Nor will I engage in 'piecemeal' LATCHING onto an isolated mm measure.
Direction of rotations is always in reference to a profile facing the RIGHT.
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He is Angle Class II div 2. These cases present usually with too steeply inclined (retroclined) maxillary incisors which can be decompensated into a more natural proclined state. I'm not in the mood to download his ceph and trace everything out manually, but I figure he can get 7-8mm space for a combined (rotation and translation) movement of his lower jaw. The ortho will need to decompensate the curve of spee in the upper jaw (but not the lower!) as well to give a proper occlusal plane for the surgeon to work with. This allows him to adress the vertical deficiency without having to operate on the upper jaw as well.
See here: https://www.zmk-aktuell.de/fachgebiete/kfo/story/ein-integriertes-therapiekonzept-zur-korrektur-der-klasse-ii-dysgnathien-__5622.html
for some explanatory illustrations. Ctrl + F and enter "Chirurgische Rotation" to jump to the relevant piece or use google translator to read the entire thing if you are in the mood.
Except for the fact that no tooth show is part of the problem of the vertical deficiency and he has retrusion to the maxilla. I've seen that study or technique somewhere before and the selected candidates were those with NO issues to the maxilla.
He seems pretty intuitive or self aware of what's going on with his face. eg. little to no tooth show can be seen in his ceph. Although his ceph blacks out a lot of the soft tissue profile, his downward rotated nose tip and short upper lip with overly acute nose to lip angle is suggestive of maxillary retrusion. An isolated BSSO; the type in the link that does a selective CW rotation to the mandible only (which is a great maneuver for those needing nothing done to the maxilla) won't address what he has good cause to want to also address, lack of tooth show and retrusion to the maxilla.
He's got 'short chin' which is a term for short lower 1/3rd or just 'short face', the type consistent with low or 'flat' angles to the maxillary plane and mandibular plane, Class2 div2. (Toss in the occlusal plane too if you like.) Vertical shortness of the lower 1/3rd via CW (clockwise rotation) could be addressed with an overall downgraft that's longer to front of maxilla than it is to the back of it. From there, both the translations of maxilla and mandible (forward displacements) along the planes that are made less flat by the max rotation can be done to increase his lower 1/3rd. Hence, isolated CW BSSO only technique is a limited 'fix' when no tooth show and visage of retrusive maxilla are present.
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He is Angle Class II div 2. These cases present usually with too steeply inclined (retroclined) maxillary incisors which can be decompensated into a more natural proclined state. I'm not in the mood to download his ceph and trace everything out manually, but I figure he can get 7-8mm space for a combined (rotation and translation) movement of his lower jaw. The ortho will need to decompensate the curve of spee in the upper jaw (but not the lower!) as well to give a proper occlusal plane for the surgeon to work with. This allows him to adress the vertical deficiency without having to operate on the upper jaw as well.
See here: https://www.zmk-aktuell.de/fachgebiete/kfo/story/ein-integriertes-therapiekonzept-zur-korrektur-der-klasse-ii-dysgnathien-__5622.html
for some explanatory illustrations. Ctrl + F and enter "Chirurgische Rotation" to jump to the relevant piece or use google translator to read the entire thing if you are in the mood.
I think in English they call this either tripod setup or 3-point landing BSSO. Like a CW of just the lower jaw.
But it won't be addressing his tooth show, if his tooth show is his concern.
Mike9876, it seems you have a consensus between the 2 surgeons you've seen, so you're in a pretty good position in that regard. Choose from the two, and make sure your ortho is on board and not currently doing their own thing.
ETA: what Kavan said. I didn't see his reply just above as I posted.
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i also could get bsso to fix the bite and the lower jaw for free on the national health care thing, the upper the Le Fort would be for cosmetic reasons.
Every surgeon i have consulted this far has seemed to believe that there would be good aesthetic reasons to also do the upper jaw and i would benefit from it and one of them even straight up said that i will not be happy with the bsso only results.
I certainly agree you would benefit from extra work to the Lefort 1 area. My other posts on this thread explain such.
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I think in English they call this either tripod setup or 3-point landing BSSO. Like a CW of just the lower jaw.
But it won't be addressing his tooth show, if his tooth show is his concern.
Mike9876, it seems you have a consensus between the 2 surgeons you've seen, so you're in a pretty good position in that regard. Choose from the two, and make sure your ortho is on board and not currently doing their own thing.
Oh, ya. That's where I remember I saw a paper on same/similar. I knew i saw that somewhere before. My critique of it, as I recall, was that the patients were cherry picked and limited to those with enough tooth show and/or no issues to the maxilla.
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You know, his xray actually confused me at first glance because it looks like he would show more than zero tooth show at rest as his upper teeth extend below his upper lip. But I remember jsf member Apollo saying in short-faces scans apparently aren't reliable to assess tooth show. This is because of the lip smooshing. So he probably shows even less than what the x-ray makes it look like.
"When patients have lip overclosure (often due to a deep bite), it's impossible to assess incisor show (as well as relaxed lip contour) if they bite down during the scan. For example, a patient might have -2mm of incisor exposure in repose, but when they bite down and their lips overclose, measuring the incisor tip to bottom of upper lip in a scan could be 0mm (as the upper lip is driven upwards by the lower lip when they come together)." -- Apollo
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First of all thank you for taking the time and effort to answer everyone! This is greatly appreciated.
The reason i have not locked down a surgeon yet is that i am waiting for a transfer to other university hospital to see if they think that double jaw surgery is the best choice for me and if that happens i have an option to get the djs for free, right after that i will make the final dedication.
The thing that concerns me about cw rotation plan is the chin going backwards and limitations of the lower jaw advancement, when the aesthetic goal is having the pogonion in line with glabella or at least close to that. I have heard some surgeon say that the biggest advancement to the lower jaw he will do is like 6-8mm so even with genio i wonder that will it be enough.
The third surgeon i got consultation from talked about ccw and bringing my lower jaw out more or something like that but this was when he had just seen my face by a glance and not examined me or seen the x-rays, i should have asked for the final plan.
But yeah the next thing i will do is choosing a surgeon
I think CW is more on target with your case than is CCW. To this regard, I will show you a case from a 'Grand Wazoo' of CCW (Gunson) who has actually done a CW rotation on a patient who is pretty much similar to you. But, of course, he avoids telling people straight out it's a CW case and not a CCW case.
Here's a Gunson case, pretty similar to yours (although no case is 'exactly' like anothers'). The red lines I drew on the model to illustrate what I meant by an overall down graft in direction of CLOCKWISE rotation for the short face. Observe it is longer in front than in back. Gunson, doesn't seem to tell people straight out when he's doing CW. He certainly didn't announce it on the FB page I found this example. But this is an example of CW with the the type of overall downgraft I was suggesting in my posts.
As I said prior, the CW will give you the elongation to the face needed and a genio can also be added. The Gunson case has the CW via overall downgraft to the maxilla, advancement of both maxilla and mandible and also a genio.
photo or diagram included in this post.
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Agree CW case (or linear).
Probably could get away with linear and lower only if you extract two lower premolars. Alternative plan would would be clockwise rotation of both jaws, adjusting chin as needed. The latter comes with the risk of more nerve damage/nose issues, but it might be better. Hard to say. Get more records, etc.
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I think CW is more on target with your case than is CCW. To this regard, I will show you a case from a 'Grand Wazoo' of CCW (Gunson) who has actually done a CW rotation on a patient who is pretty much similar to you. But, of course, he avoids telling people straight out it's a CW case and not a CCW case.
Here's a Gunson case, pretty similar to yours (although no case is 'exactly' like anothers'). The red lines I drew on the model to illustrate what I meant by an overall down graft in direction of CLOCKWISE rotation for the short face. Observe it is longer in front than in back. Gunson, doesn't seem to tell people straight out when he's doing CW. He certainly didn't announce it on the FB page I found this example. But this is an example of CW with the the type of overall downgraft I was suggesting in my posts.
As I said prior, the CW will give you the elongation to the face needed and a genio can also be added. The Gunson case has the CW via overall downgraft to the maxilla, advancement of both maxilla and mandible and also a genio.
photo or diagram included in this post.
Yeah, this looks like a really good result
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Btw, here is a morph that one of the surgeons did. Looks pretty strange because of that "cheek augmentation" and nose but other than that the movements of the jaws look okay to me, if the results were something like that i would definitely want genio.
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Looks pretty strange because of that "cheek augmentation" and nose
Yeah, if it was up to Dr D, nearly 100% of people would walk around with those PEEK implants in the cheek and a nose job lol. Funny how a lot of surgeons have one or two favourite procedures (chin wing or whatever) and they're (hopefully, genuinely) convinced everyone would just look sooo much better if they got that one thing done.
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Yeah, if it was up to Dr D, nearly 100% of people would walk around with those PEEK implants in the cheek and a nose job lol. Funny how a lot of surgeons have one or two favourite procedures (chin wing or whatever) and they're (hopefully, genuinely) convinced everyone would just look sooo much better if they got that one thing done.
To be fair the nose looks pretty good
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To be fair the nose looks pretty good
Just out of curiosity, i wonder how others see me in the morphed version, since i think i look really really weird and not in a good way but when i crop those photos to show only the lower third, i think the morphed version is 10x better and looks good for a double jaw result.
So i thought to myself that it is the cheek augmentation thing that is making me look weird but is it just me and might it be because it is a photo of me and i look so different?
And yeah, i really hope moving the upper jaw will rotate my nose like that, i mean right now it looks pressed down/down turned and when i smile or laugh it highlights and i look like a troll.
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So i thought to myself that it is the cheek augmentation thing that is making me look weird
Yeah, I think it is. I suspect the same person did exactly the same thing to me (cheek stuff) and it looked weird on me too. (I mean in the morph, not in real life, as I didn't actually get it.) I agree that the projected result of the jaw surgery itself looks good on you. One of the problems with morphing is that while it's quite easy to do from profile, it's very difficult to do from the front and at the end of the day, it's the front view that counts because you'll spend the rest of your life looking at yourself from the front in mirrors etc. I'm not saying it would not look good from the front if you got the surgery, just pointing it out that it's difficult to visualize.
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Just out of curiosity, i wonder how others see me in the morphed version, since i think i look really really weird and not in a good way but when i crop those photos to show only the lower third, i think the morphed version is 10x better and looks good for a double jaw result.
So i thought to myself that it is the cheek augmentation thing that is making me look weird but is it just me and might it be because it is a photo of me and i look so different?
And yeah, i really hope moving the upper jaw will rotate my nose like that, i mean right now it looks pressed down/down turned and when i smile or laugh it highlights and i look like a troll.
I see the morph as a suggested 'add-on' or 'toss-in' in the absence of it being made CLEAR to you why it's been thrown in to you your morph.
You have very good aesthetic self perception and observational ability.
The lower '1/3rd', area from base of nose to base of chin, is certainly improved in the morph. That area would get advanced in bimax.
Now the area above base of nose, and the paranasal area (lower medial cheek area next to sides of nose) would also get advanced as to yield a better slope to the whole nose.
Downward rotated nose tip/base (which you have) is common thing to see with maxilla recession.
When base of nose is advanced in cases like that, there is 'de-rotation' to it which is in reverse direction of what ever rotation it has. An overly downward rotated nose (often consistent with maxilla retrusion) can get a better slope to nose profile from the advancement. Sunken cheek areas beside lower 1/2 of nose can get better curvature.
Another way to say this, is that you effectively get a 'FREE' rhino and even though the base of nose is advanced with the Lefort 1, together with the area beside nose, that also gets advanced, the nose will look not only straighter on the face, but also LESS prominent.
Now, I know that and they know that as to BONUS rhino effect. But there would be some doctors who might want you to attribute changes that could arise from the bimax alone to EXTRA-ADD ONS; act of 'upselling' ancillary procedures.
No idea IF the guy is conveying in morph; 'Here's what you'd look like with an (extra charge) rhino and cheek augment. But IF that's the case, I can tell you that the positive nose effect and the fuller sagittal cheek curve--the PART of it beside the LOWER 1/2 of nose-- is pretty much consistent with Lefort 1 advancement when someone has retrusive maxilla along with prominent and downward rotated nose as you have.
Sagittal cheek curve is convex curve running from below eye to beside base of nose area. On the morph, the WHOLE curve is filled out which includes the part of it besides the UPPER 1/2 of it beside upper 1/2 of nose. THAT part of it would not get advanced out with the Lefort 1.
Basically, the doctor morphed the ORBITAL RIM area below the eye which is area that contributes to 'sagittal' CURVE. He even morphed it TOO HIGH because the bone is found BELOW the lash line and he started the curve right under the lash line.
So, as to the whole SAGITTAL CURVE he enhanced where only the upper 1/2 of that curve would apply to extra augmentation, it would depend how he communicated to you. Like if he said something like; 'Your ORBITAL RIM area below your eyes will look more recessive to you.', well ya, it could look more recessive to you after L1 advancement. But when they use the word: 'CHEEK' area, common usage refers to an area more LATERAL to where he augmented the midface sagittal curve.
I would try to narrow down WHAT he was wanting to convey to you in the morph, and let's hope it was NOT an extra rhino because as I said, the type of surgery you would be getting would have with it a 'free rhino effect'. The area in the morph that clearly would not be part of L1 advance was to ORBITAL RIM area. That's the area seen via the SAGITTAL (midface) curve on PROFILE view. The other curve; 'ogee' is one where common usage calls it 'CHEEK' curve and that curve is seen in 3/4 view. So, establish WHICH part of bone structure to upper midface he's wanting to augment. Because when they augment the area commonly called 'cheek', it can be an area LATERAL to where the augmentation is needed and can even exaggerate the area that really needs the augmentation (orbital rim).
As to any 'extras' or 'add-ons', 'toss-ins' a doctor suggests along with the SALIENT surgery, they actually should be CLEARER about those things than the bimax surgery itself. WHY? Because the add ons are (I'm assuming) something you did NOT specifically ask for where the maxfax/bimax itself was. So, it will depend on how clear he was explaining to you YOUR 'need' for any of his suggested add ons.
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Yeah, I think it is. I suspect the same person did exactly the same thing to me (cheek stuff) and it looked weird on me too. (I mean in the morph, not in real life, as I didn't actually get it.) I agree that the projected result of the jaw surgery itself looks good on you. One of the problems with morphing is that while it's quite easy to do from profile, it's very difficult to do from the front and at the end of the day, it's the front view that counts because you'll spend the rest of your life looking at yourself from the front in mirrors etc. I'm not saying it would not look good from the front if you got the surgery, just pointing it out that it's difficult to visualize.
An automatic morph program would not be able to show changes to front as easily as those to side view. It would need extra programming in 'artificial intelligence' to relate profile changes back to the frontal view. However, an artist could easily show such things as how projected out curves look from the front. Think portrait painting. Like not a thing where they say; 'I can only paint your profile.' Artists know how to use light and shadow where auto morph programs don't. I've had people ask me; 'What PROGRAM did you use to show projection in front?'Answer: 'No auto morph program. Just knowledge in art concepts.'
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Thank you once again for taking the time and effort to reply!
We did not talk anything about extras like the cheek augmentation in the consultation, he just dedicated to include them in the morph, might be mentioning them when we go further in to treatment.
But yeah, i am going for the djs, will be interesting to see how my cheeks will look after that tho.
With this surgeon communication was a bit off, otherwise he seemed proficient but i guess i cant expect more since it was a fast skype consultation.
Also this surgeon seems to think that sarpe is mandatory for me. Other surgeons have not mentioned sarpe at all expect one whom i asked about it and he said that i do not seem to need it at this point at least. Anyways, i will be asking about this in the upcoming meetups with whomever surgeon i will be seeing.
Hard for me to opine on the SARPE because that expands distance from teeth on one side of maxilla to the other side. SARPE can fill in the smile by filling in what they call the 'buccal corridors' which are shadowed areas to the smile where you don't see the back teeth in the smile. Thing is that when the maxilla (with it's teeth) is brought forward, the back teeth that you don't see in the smile, when it's backward, are brought more into the FOREground and then you see them more in the smile. Segmental lefort can also help with filling out transverse smile deficiencies. Hence, I can't really call it, from here or opine much on the need for the SARPE other to tell you that if it's suggested to fill in buccal corridors, the act of bringing the maxilla forward and also possibly doing segmental lefort would also assist with that objective IF that were the objective.
My 'antennae' are picking up that there is a doctor in the mix wanting to do extra add ons and might be of type of; 'I'm the doctor and I said so.' I'm picking up that this might be an older doctor. Are the 'vibes' I'm getting correct?
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Hard for me to opine on the SARPE because that expands distance from teeth on one side of maxilla to the other side. SARPE can fill in the smile by filling in what they call the 'buccal corridors' which are shadowed areas to the smile where you don't see the back teeth in the smile. Thing is that when the maxilla (with it's teeth) is brought forward, the back teeth that you don't see in the smile, when it's backward, are brought more into the FOREground and then you see them more in the smile. Segmental lefort can also help with filling out transverse smile deficiencies. Hence, I can't really call it, from here or opine much on the need for the SARPE other to tell you that if it's suggested to fill in buccal corridors, the act of bringing the maxilla forward and also possibly doing segmental lefort would also assist with that objective IF that were the objective.
My 'antennae' are picking up that there is a doctor in the mix wanting to do extra add ons and might be of type of; 'I'm the doctor and I said so.' I'm picking up that this might be an older doctor. Are the 'vibes' I'm getting correct?
Yes he is an older doctor, has been talked about a lot in the surgeon reviews and leads but have not found that many who has done surgery with him, a lot of consultations tho.
In his proposal he said that we could skip sarpe for now but then i sent him some extra questions over email and then he i guess looked at my pictures again and told that he thinks sarpe is mandatory, i never got a proposal for sarpe tho so i might be mistaken too.
I think i should just email him and ask
about the extra add on vibes, i cant really tell since he did not yet suggest anything else than sarpe and bimax and might be that i really need sarpe, will have to look in to this.
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Yes he is an older doctor, has been talked about a lot in the surgeon reviews and leads but have not found that many who has done surgery with him, a lot of consultations tho.
In his proposal he said that we could skip sarpe for now but then i sent him some extra questions over email and then he i guess looked at my pictures again and told that he thinks sarpe is mandatory, i never got a proposal for sarpe tho so i might be mistaken too.
I think i should just email him and ask
about the extra add on vibes, i cant really tell since he did not yet suggest anything else than sarpe and bimax and might be that i really need sarpe, will have to look in to this.
Well, as I conveyed...I can't fine point 'call it' as to need or not for SARPE. Just to say IF it's suggested for buccal corridor filling what the other things were to do similar. In general, the more you can target your own short comings ('your' is used in the collective sense and can apply to everyone/anyone), the more you can 'ID' with a doctor's aesthetic suggestions.
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To mick9876,
I think the KEY thing to look for, in your case, is the over-all DOWNGRAFT (CW) that I mentioned. That alone would tend to narrow down your selection and knock some doctors out of the mix.
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An automatic morph program would not be able to show changes to front as easily as those to side view. It would need extra programming in 'artificial intelligence' to relate profile changes back to the frontal view. However, an artist could easily show such things as how projected out curves look from the front. Think portrait painting.
Interesting you say that, I have just started searching for someone that would sketch my portrait showing projected results of different kinds of jaw surgeries. I am not a visual type at all, always find it very hard to visualize anything. One of the surgeons I contacted offered to show me possible outcomes based on CBCT and other data, and he said it would cost me EUR 1,500! I think there must be a cheaper way to do this. I feel I cannot make a decision about major surgery like this while I simply have no idea what I'd possibly look like as a result.
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I think CW is more on target with your case than is CCW. To this regard, I will show you a case from a 'Grand Wazoo' of CCW (Gunson) who has actually done a CW rotation on a patient who is pretty much similar to you. But, of course, he avoids telling people straight out it's a CW case and not a CCW case.
Here's a Gunson case, pretty similar to yours (although no case is 'exactly' like anothers'). The red lines I drew on the model to illustrate what I meant by an overall down graft in direction of CLOCKWISE rotation for the short face. Observe it is longer in front than in back. Gunson, doesn't seem to tell people straight out when he's doing CW. He certainly didn't announce it on the FB page I found this example. But this is an example of CW with the the type of overall downgraft I was suggesting in my posts.
As I said prior, the CW will give you the elongation to the face needed and a genio can also be added. The Gunson case has the CW via overall downgraft to the maxilla, advancement of both maxilla and mandible and also a genio.
photo or diagram included in this post.
Hi Kavan, I am trying to find the photo you included in this post. I only see the line saying "photo or diagram included in this post". Where can I find the actual photo? Thank you.
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Hi Kavan, I am trying to find the photo you included in this post. I only see the line saying "photo or diagram included in this post". Where can I find the actual photo? Thank you.
The original poster who started the string must have had all removed given he/she deleted their posts. So, I have no idea what the file name of the illustration was.
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The original poster who started the string must have had all removed given he/she deleted their posts. So, I have no idea what the file name of the illustration was.
Ok, thanks!