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Aesthetics / Re: Why such little extra tooth show? Anterior downgrafting
« Last post by kavan on Today at 10:58:46 AM »
I REMOVED my prior entry which was my GUESS of as to why 'only getting 2.5mm upper tooth show'. I removed it because in hind site I was THROWN FOR A LOOP when the OP 'clarified' the downgraft measures to the posterior and anterior maxilla as being 10.5mm posterior downgrafting and 6.8 anterior downgrafting. Yet NO SUCH measures were listed on the displacement proposal.

So as to the question of :'... why am I only getting an extra 2.5mm of tooth show from the 6.8mm anterior downgrafting? Does the 10.5mm posterior downgrafting counter act the tooth show to some degree?', in retrospect was an invalid one to ask given the displacement proposal  NEITHER lists a 10.5mm posterior downgraft NOR a 6.8 anterior downgraft. So, I removed my response to the OP's question.

The actual displacement proposal cites 3.23 for ANS and 8.77 for PNS. Nothing in it about any 6.8 and 10.5.  Only the advancement at the pogonian cites a 10.5 measure.
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Functional Surgery Questions / Re: Improved nasal breathing through downgraft
« Last post by GJ on Today at 09:55:50 AM »
If you get CCW then the volume increase is going to be in the lower airway, which is what you want for apnea. To get more volume in the upper airway you'd have to move it linearly, though, maybe moving it down would do that, too. I'm not sure on that but it does make sense.
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Functional Surgery Questions / Re: SARPE while MMA for better breathing
« Last post by GJ on Today at 09:53:45 AM »
I made the text that extensive because I tried to convey my thought process in as much detail as possible.

To put it more simple: What are the odds that palate expansion (via a expander device) will impact the nasal cavity if expansion is performed shortly after DJS with CCW and posterior downgraft. Regarding the stability of the area, where the LF1 took place and the skull and the maxilla are now connected to the additional bone of the downgrafting.

I'm not convinced palate expansion is possible with stable results in adults, and might even cause complications to the tissue, etc. How old are you?
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Aesthetics / Re: Opinions on my plan
« Last post by GJ on Today at 09:50:38 AM »
That's a huge movement and probably not justified bases on the scan you posted. The ANS can be trimmed to help with protrusion, to some extent.
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Aesthetics / Re: Why such little extra tooth show? Anterior downgrafting
« Last post by GJ on Today at 09:47:23 AM »
My guess would be you have a long lip/a lot of soft tissue. Also, 2.5mm is a lot...
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Surgeon Reviews and Leads / Rhino Doctors
« Last post by GJ on Today at 09:46:06 AM »
Some positive names I have heard recently: Katrib, Hyman and Balikci.

I can't vouch for any of them as it's second hand information. But, maybe this helps someone looking for leads.
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Aesthetics / Re: Opinions on my plan
« Last post by Dex1816 on Today at 07:27:58 AM »
Yes. CCW rotates the triangle on a fixed point and all the other points and or line orientations rotate/change position in accordance.  Linear advancement is a term they use to convey no rotations and only the advancement of the entire triangle along the directional path of line AB (or BA since it's going forward to point A).

In addition to a triangle being rotated, things can be moved forward along the orientation path of the rotated lines. A rotation is a separate displacement operation than an advancement over a line. An advancement of a point over the path of a line is basically a 'translation' of that point. The path of the line is extrapolated further out and a point moved along that path gets displaced further out. CCW ALONE does not do that. Displacing a point along the path of a line is the advancement.

CCW is not performed alone. It's a geometrical operation that allows the surgeon to advance both the maxilla and the mandible along a better line of orientation. However, in some cases, the ANS point or A point of the triangle can stay put if a large advancement of the lower jaw is not needed. But still, the surgeon needs to perform a BSSO along with the rotation.

Some BACKGROUND in GEOMETRICAL relationships needs to be under belt to relate to the concept of rotating a triangle and also moving landmark points along altered lines orientations. It is NOT something I will discuss in terms of 'chimp lip'.

Basically, what the surgeon is doing is CHANGING the TRIANGLE of the maxillary mandibular complex via rotating it and selecting which lines within it should be increased/elongated and by how much. The goal of the change is toward a better aesthetic balance, a better upper jaw to lower jaw line up. He's got a computer program to rotate the MM complex and from there, he can look at how much to advance the maxilla and mandible with reference to orientation of lines changed by the rotation. The program will show the allowable displacements of the upper and lower jaw like how much they can move each jaw 'forward' along the new orientation lines and still be within a norm and to effect good aesthetic balance. For every 'x' the maxilla is moved 'forward' (along the changed line of its orientation), the mandible will move 'y' amount 'forward along its changed line of orientation. The advancements of both are INTERRELATED or a function of each other. For example, for every mm he moves the maxilla forward on the displacement program, it will show the corresponding increase the mandible can be advanced. The program is used to manipulate a start point triangle in such a way where the end point construct of an altered triangle is also within the venue of a better aesthetic balance. THAT is what your surgeon has done in the diagram/s he showed you. That can be said in the absence of elaborations on geometrical relationships

I don't want to belabor this any further because it all boils down to simply LOOKING AT, observing, what the displacement proposal SHOWS you.  AT very LEAST you should have the conceptual abilities to observe that nothing about it kicks up a monkey muzzle contour, nothing about the upper teeth flaring out can be seen and nothing about the jaw advancement shows disproportion with the rest of the scull. Your anxiety/fears precludes you from the very salient ability you are expected to have when getting a proposal from a surgeon which is to look at the damn thing and decide whether or not you like the PLAN. You like the new contour or you don't.

As to the OTHER persons plan vs the outcome and what OTHER people said about it on a forum, that is neither here nor there. What I observe is that her outcome is in accordance to the displacement proposal. That is to say the her displacement diagram of scull is consistent with her outcome. The displacement proposal was predictive enough for her to decide whether or not she liked it. I would assume she had ample conceptual/perceptual abilities to decide whether or not the proposed bone structure changes would be to her liking as to make a decision.

In closing, what ever decision you make an with what ever abilities or worries you are using to make one, I wish you the best of LUCK. But I need to close this back and forth due to time constraints.

What you've said makes a ton of sense. I'm very grateful for the time you've taken to explain.
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Functional Surgery Questions / Improved nasal breathing through downgraft
« Last post by jawguy14 on May 28, 2024, 07:09:00 AM »
I wanted to ask what you guys think about the following plan:

I think that I will do a DJS directly, with CCW and a posterior downgraft. A relatively large rotation should be made, with 7mm downgraft so that around 14 degrees rotation is achieved.

I have problems with both, the nasal cavity and the upper airway, which are both too narrow/small. In my unterstanding, the DJS solves both of these Problems due to the downgraft.

Because as I understand it, downgrafting makes the nasal passage longer (i.e. unlike MSE, where the nasal passage becomes wider). Whether wider or longer, in both cases the nasal cavity becomes larger, which I don't think makes any difference.

But since there is no downgrafting in the anterior part, it is almost like a transition from front to back, so that the enlargement of the nasal cavity towards the posterior part of the maxilla is more significant, the further back it is. So it's not a proportional prolongation, the average downgraft (in the example of 7mm posterior downgraft) would be 3.5mm.

Many palate expanders also achieve expansion of around 6, 7, 8mm. But with the palate expansion, it is also not the case that the nasal passage expands completely proportional. It expands more in the lower area (near the nose floor) compared to the area at the top, which is already between the eye sockets. Because not the entire skull is divided down the middle, only the palate is divided (expanded).

In my eyes, an average expansion of 7mm would be similar effective as the 7mm posterior downgraft.

What do you think about this plan. Do you think, that 7mm downgraft would have a similar impact as 7mm expansion?
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Functional Surgery Questions / Re: SARPE while MMA for better breathing
« Last post by jawguy14 on May 28, 2024, 02:51:45 AM »
I made the text that extensive because I tried to convey my thought process in as much detail as possible.

To put it more simple: What are the odds that palate expansion (via a expander device) will impact the nasal cavity if expansion is performed shortly after DJS with CCW and posterior downgraft. Regarding the stability of the area, where the LF1 took place and the skull and the maxilla are now connected to the additional bone of the downgrafting.
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Aesthetics / Re: Why such little extra tooth show? Anterior downgrafting
« Last post by SV123 on May 28, 2024, 02:42:18 AM »
Just to clarify, these are the movements I am getting:


(Roughly) 4.5mm LF1

10.5mm Pognonion advancment

10.5mm Posterior downgrafting

6.8mm Anterior downgrafting


Despite this, only a total of 3.5mm of extra tooth show. Not saying that I need any more, but am wondering as to how this is possible despite the large anterior downgrafting
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