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Before/After Photos => Other => Topic started by: dammit_daniel on December 02, 2018, 09:08:55 PM
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Hey guys, I thought I would show you a video of the before and after effects of CCW bimax surgery on my airways. Surgeon seems happy with the improvement and I think I am slowly seeing the benefits from it as swelling goes down.
https://www.youtube.com/watch?v=4PK-kg7PQYA&feature=youtu.be
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Interesting I've never seen a bimax result without the genio, but have heard of people opting out of them. It's hard to see the changes in the airway from those x-rays. I see a spot towards the top of the throat that seems a bit cinched now but the lower half maybe opened up a little. I'm not terribly good at analyzing airways anyhow. Thanks for sharing!
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Thanks for sharing. What's your opinion on the surgery, what I've heard people with narrow airways almost notice an immediate imporvement post of with regard to airways and breathing, do you agree with this?
Do you know what your movements were, and would you mind posting before and after pictures?
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Interesting I've never seen a bimax result without the genio, but have heard of people opting out of them. It's hard to see the changes in the airway from those x-rays. I see a spot towards the top of the throat that seems a bit cinched now but the lower half maybe opened up a little. I'm not terribly good at analyzing airways anyhow. Thanks for sharing!
Hey ditterbo. My surgeon said my chin was a few mm behind the true vertical but he said it was still within the norm and I've read about genio increases nerve damage odds dramatically plus the additional cost I opted out of it. I've also head that genio helps some sleep apnea patients due to pulling the tongue forward too though.
Ditterbo and Dogmatix,
I used to actually feel my tongue pressing against my soft palate and close my airways alot of the time and believe I compensated for this by arching my neck forward and tilting my head upwards resulting in terrible posture. This pressure on my palate got much worse when I was lying down and made me feel like I was suffocating.
Yes Ditterbo I agree with the immediate improvement awareness. I no longer feel my tongue pressing against my palate and, even though I'm wearing elastics. I can breath out my mouth easier and talking feels easier.
Yep I will post pictures once the swelling goes down. Nothing prepared me for how much swelling there would be those first few days haha.
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I've also head that genio helps some sleep apnea patients due to pulling the tongue forward too though.
Really? I thought a genio was a pure bone movement with no medical interference, like a fancy implant.
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Really? I thought a genio was a pure bone movement with no medical interference, like a fancy implant.
I dont know if its the standard genio? But yeah the surgeon said it can help with apnea. Just reading about it apparentlya small piece of muscle connected to the tongue is moved forward with the sliced chin
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Ditterbo and Dogmatix,
I used to actually feel my tongue pressing against my soft palate and close my airways alot of the time and believe I compensated for this by arching my neck forward and tilting my head upwards resulting in terrible posture. This pressure on my palate got much worse when I was lying down and made me feel like I was suffocating.
Yes Ditterbo I agree with the immediate improvement awareness. I no longer feel my tongue pressing against my palate and, even though I'm wearing elastics. I can breath out my mouth easier and talking feels easier.
Yep I will post pictures once the swelling goes down. Nothing prepared me for how much swelling there would be those first few days haha.
Can you already feel this forced posture and neck abnormality release with the surgery?
Do you feel breathing in general improved, like if you take a deep breath, is it more satisfying getting a full breath and would you assume things like running etc may be easier?
How would you say your teeth contact is, did the surgeon manage to get a full good occlussion post op, or do you feel there is orthodontic work that needs to be done for this?
I'm glad you seem to have such great result and hope the swelling release soon and you can leave this behind you.
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Can you already feel this forced posture and neck abnormality release with the surgery?
Do you feel breathing in general improved, like if you take a deep breath, is it more satisfying getting a full breath and would you assume things like running etc may be easier?
How would you say your teeth contact is, did the surgeon manage to get a full good occlussion post op, or do you feel there is orthodontic work that needs to be done for this?
I'm glad you seem to have such great result and hope the swelling release soon and you can leave this behind you.
Dam Dogmatix, you are pretty much describing exactly how I feel with my breathing now.
Forced posture - Already correcting itself. My chin is now more comfortable point down to the ground instead of pointing upwards, which I assume I did because of an obstruction in my airways
Neck abdormality - My overall posture already feels like its getting better due to my jaws being able to sit in a "natural" position. I used to hunch my neck forwards combined with the pointed up chin.
Exercise - I can only assume that when I get back to exercise that it will be easier because my head,neck and jaws will be sitting in their proper position.
I have to say though my posture is still quite bad from years of arching my neck forward and only time will tell if it will all be fully reversed.
Teeth contact - He said my occlusion plane was perfectly flat now, which I'm assuming means that the plane is not too steep anymore? There is some orthodontics to do but he is happy with how the teeth are sitting and set there shouldnt be much to do. However my bite does not feel perfect. it feels like there is early contact on my right side before the left. But I was talking to the surgeon and he said that people can feel fractures of a mm difference in bite, so if hes happy I'm happy and maybe the ortho will need to do some compensating.
Thanks dogmatix. Most importantly I am happy with the functional result I have had to stop working due to this illness, the aesthetic is icing on the cake and I gotta say I'm enjoying my new face. I will post some pre op and post op pictures at some point. I'm really interested in showing people the comparisons to the dolphin imaging to real result. I was always a bit nervous that the imaging software was not going to replicate the actual result, because well they say they don't pretend soft tissue movement well.
Sorry dogmatix or someone with a good eye if you have a chance can you look at the video I posted and pause it at the very start and the very end and compare the before and after chin vertical position. I'm really confused because the chin point looks a good 5mm up vertically now. But the dolphin imaging says POG is 1mm down vertically for the original plan. Has the surgeon done some maxilla impaction or am I just not understanding the movements correctly? The overlays I have done of before and after cephs arent perfect but i don't think they are 6mm out?
One more thing. From the original ceph you can see that the border of my lower jaws are not lining up. I think he said this was asymmetry. In the after picture that appear much more symetrical. What has the surgeon done here? Has he shaved my jawline? Because that looks like a huge shave?
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Dam Dogmatix, you are pretty much describing exactly how I feel with my breathing now.
Glad to hear, as I'm actually projecting some of my own problems and trying to figure how it may improve.
One thing that has been worrying me, and that I think you mentioned in your preop posts is the decompensation. First you have the orthodontist flare the teeth out, and then the surgeon comes along rotating them out even further. How has this worked out for you in practice. Are the teeth noticeable flared out now compared to when you started? Does it look natural, or how would you describe this outward angulation of the teeth experience?
I'm starting my decompensation soon and this part scares me a bit. First how much the orthodontist will flare out, and then what I'll wake up to after the surgeon has done his additional rotation magic.
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Right so you are in the market for CCW rotation? Is it a functional and aesthetic surgery you are wanting? It sounds like you might be having the surgery for both.
Yeah I forgot I talked about the flaring. I'm not sure if I followed up on this forum but the ortho said the teeth werent actually flaring, I'm guessing I was undergoing decompensation?
It's probably too early to say because my lips are so puffy and also having braces I think muddies the waters too. But it looks pretty normal to me. I can tell the teeth have dropped down in the back of my mouth because of the CCW rotation. I can see more of my other teeth now, besides just the two front "buck" teeth, before because of my steep occlusion angle I think it put emphasis on my two front buck teeth and smile didnt look all that great. Because I can see more of the other teeth and the upper lip covers the very top of all the teeth, the flaring just isn't noticeable and my teeth sort of just look like a set of teeth you know? Unless you pull the upper lip all the way up you can see they are flared a bit.
Do you have any eye for any of the things I mentioned about impaction etc?
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Right so you are in the market for CCW rotation? Is it a functional and aesthetic surgery you are wanting? It sounds like you might be having the surgery for both.
Yeah I forgot I talked about the flaring. I'm not sure if I followed up on this forum but the ortho said the teeth werent actually flaring, I'm guessing I was undergoing decompensation?
It's probably too early to say because my lips are so puffy and also having braces I think muddies the waters too. But it looks pretty normal to me. I can tell the teeth have dropped down in the back of my mouth because of the CCW rotation. I can see more of my other teeth now, besides just the two front "buck" teeth, before because of my steep occlusion angle I think it put emphasis on my two front buck teeth and smile didnt look all that great. Because I can see more of the other teeth and the upper lip covers the very top of all the teeth, the flaring just isn't noticeable and my teeth sort of just look like a set of teeth you know? Unless you pull the upper lip all the way up you can see they are flared a bit.
Do you have any eye for any of the things I mentioned about impaction etc?
As you can see from my questions, I'm interested in the relation between airways and posture, which you may also remember we discussed here.
http://jawsurgeryforums.com/index.php?topic=7438
Aside from this I have a class 2 bite and aesthetic concerns. You can see my full plan here, and feel free to participate if you maybe have something to add from your experience. I'm happy for any discussion or feedback, especially from someone with real experience.
http://jawsurgeryforums.com/index.php?topic=7466.0
Regarding decompensation. Decompensation is the act of setting the teeth up for the bite position that will be after surgery, as they've mostly grown into a compensated state with the incorrect jaw position. Orthos sometimes say the darnest things and want to make their profession sound like quantum physics that cannot be explained, if your impression was that the teeth were flared out, they probably we're and it's a common decompensation if you're advancing the mandible.
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Yeah Dogmatix, I remember now, I think all the drugs I've been taking have fried my brain a bit haha.
I would be happy to leave my opinion.
Yeah I agree with you on the orho's. Mine did a good job but somehow couldn't grasp that I had developed a cross bite from the braces, which my maxfac said was fine and would be correct.
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I had a look at your cephs and drew some lines to try to see the displacements.
https://imgur.com/26zwvgk
All lines are anticipated to have same length for comparison, and hopefully the resolution is same at both cephs.
For airways I drew a line from your vertebra as it was hard to find any other good reference point. To me it seems like the airways are opened A-P 30%+.
Regarding if pog is moved vertically up or down. Assuming you hold your head in exact same angle, it does seem like it's moved very slightly up.
What you refer to as shaving of the bone is probably assymetry that was fixed. You see that the right and left side of the mandible doesn't line up in the before picture, the left side is vertically more down. Is this what you were seeing? In the after picture they seem to line up much better.
Regarding the advancement, it's clear that the mandible is advanced when looking at a vertical line drawn from the most anterior part of the forehead. Your upper incisor tip cuts the line perfectly, which looks like the anticipation in my plan as well.
Do you know how much the additional genio would've been if you would've opted for it? When looking at my own plan it looks like my surgeon wants to get the pog to meet the vertical line as well. In your case that would be almost twice the advancement, 14 additional mm if I remember right, which sounds like a lot. Would be interesting to see the meassurements if you got all 14mm, or if it's somewhat less, or maybe the movements are more subtle than one might think.
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Hey guys, I thought I would show you a video of the before and after effects of CCW bimax surgery on my airways. Surgeon seems happy with the improvement and I think I am slowly seeing the benefits from it as swelling goes down.
https://www.youtube.com/watch?v=4PK-kg7PQYA&feature=youtu.be
Please do keep us updated with your progress. I'm keen to see if you see any enhancement in your quality of sleep as your swelling goes down. Also, have you seen a marked improvement in your breathing?
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I had a look at your cephs and drew some lines to try to see the displacements.
Thanks for making the comparison Dogmatix, sorry I didn't see someone commented on the thread, I don't get a notification or anything.
30% increase sounds pretty good.
I think the photos I supplied were on funny angles making it appear that the pog has gone up vertically when it hadn't.
Yes the right and left side of the mandible lining up was what I was refering to. I spoke to the surgeon he said that he corrected misalignment of the lower jaw and upper jaw and it can be seen in the after photo, so no shaving going on.
Cool good to hear you think the upper incisors tips are in the right position. I was sort of worried I didn't get the right amount of advancement, but I think a large part of that was because my lips and face were so swollen making it look like my chin was still recessed, which I've heard is quite common. The surgeon said it all went to plan though.
I think the additional genio would of been 2-3k more, he said it would be cheaper to do it with the bimax than separately, which makes sense.
The surgeon seems to think I got the 14mm that was planned. I was a little thrown by the morph he gave me though, as you know. The morph showed my chin coming forward a few mm more than it has actually come been moved. Not sure if that was the result of some poor photoshopping or what haha.
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Please do keep us updated with your progress. I'm keen to see if you see any enhancement in your quality of sleep as your swelling goes down. Also, have you seen a marked improvement in your breathing?
Hi Journey,
I am a little disappointed on the impact on my sleep so far. My breathing in general I would say is much better. I can speak more clearly and I don't struggle to breathing during the day so much. However I still find I am feeling obstruction when I lie down and I continue to sleep almost sitting upright in bed, only in this position I can say I am sleeping better than pre surgery. It has been 6 weeks now, and the surgeon said I should expect to see improvement in my airways now. I am still noticeably swollen in parts of my face so I am hoping there is swelling to go down in my airways still. If my airways does not improve I am thinking about trying CPAP again.
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Thanks for making the comparison Dogmatix, sorry I didn't see someone commented on the thread, I don't get a notification or anything.
30% increase sounds pretty good.
I think the photos I supplied were on funny angles making it appear that the pog has gone up vertically when it hadn't.
Yes the right and left side of the mandible lining up was what I was refering to. I spoke to the surgeon he said that he corrected misalignment of the lower jaw and upper jaw and it can be seen in the after photo, so no shaving going on.
Cool good to hear you think the upper incisors tips are in the right position. I was sort of worried I didn't get the right amount of advancement, but I think a large part of that was because my lips and face were so swollen making it look like my chin was still recessed, which I've heard is quite common. The surgeon said it all went to plan though.
I think the additional genio would of been 2-3k more, he said it would be cheaper to do it with the bimax than separately, which makes sense.
Don't know if it's a typo, but I meant how much more advancement in mm for the genio, not the cost :)
I think you get best evaluation if you get your photos from your surgeon, they should be most consistent and easiest to evaluate.
When I say 30% wider, that was just something I guessed from looking at the picture. But however, the area and volume increase may be even bigger, depending on the shape of your airways. Airways are normally round shaped, and e.g if you consider it a circle, an increase of 30% in the radius, means that the area increase is squared, 1.3^2 = 1.69%. Best way to evaluate would be if you would get the raw cbct file from your surgeon, both pre and post op so it can be compared in iCatVision or other cbct software.
I'm sorry to hear you don't feel that your airways have improved enough for sleep quality. I'm no expert, but what I've heard from people is that they seem to get almost immediate relief after surgery, and that swelling doesn't affect it so much. But who am I to speak to you about this, you of course have better experience of this. How do you notice and know that you still have obstruction, snoring, bad sleep, or just that it was better with cpap than it's now? Thinking if it's maybe that the airways actually have opened and that it's something else disturbing your sleep? Is it mainly the upper nasal airways you feel still are narrow, or is it all around? As I said, the raw cbct file would be very interesting to look at for your case if you could get that.
How ever, you must have come a long way in the recovery now and things starting getting back to normal?
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Hi Journey,
I am a little disappointed on the impact on my sleep so far. My breathing in general I would say is much better. I can speak more clearly and I don't struggle to breathing during the day so much. However I still find I am feeling obstruction when I lie down and I continue to sleep almost sitting upright in bed, only in this position I can say I am sleeping better than pre surgery. It has been 6 weeks now, and the surgeon said I should expect to see improvement in my airways now. I am still noticeably swollen in parts of my face so I am hoping there is swelling to go down in my airways still. If my airways does not improve I am thinking about trying CPAP again.
Actually, if your airways don't improve that much after all the swelling goes down (the swelling could be cramping in on the airways), consider thinking about getting the GENIO that was originally offered to you because that's the part related to genioglossus muscle advancement as part of 'whole package' to alleviate breathing problems. The fact that your doc let you opt out of it during the main surgery but also told you, it would be more expensive during a later separate surgery is basically same as his saying you have the option to have it later down the line.
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Hi Journey,
I am a little disappointed on the impact on my sleep so far. My breathing in general I would say is much better. I can speak more clearly and I don't struggle to breathing during the day so much. However I still find I am feeling obstruction when I lie down and I continue to sleep almost sitting upright in bed, only in this position I can say I am sleeping better than pre surgery. It has been 6 weeks now, and the surgeon said I should expect to see improvement in my airways now. I am still noticeably swollen in parts of my face so I am hoping there is swelling to go down in my airways still. If my airways does not improve I am thinking about trying CPAP again.
Hey, Daniel, it's disheartening to read that you haven't felt any improvements in your sleep despite going through with jaw surgery. Have you mentioned this to your surgeon? I would definitely follow Kavan's advice and speak to your surgeon about considering a genio if you see no improvements, or at least find out what benefits you would see from potentially getting it done. Also, I wouldn't discount their being another issue at play esp with your nose/palate, would be wise to consult with an ENT who has a background in treating patient who have sleep apnea.
From my very basic understanding, the benefits of a genio are to do with the muscles attached to the chin which are in turn connected on the other end to the hyoid bone. With a BSSO and SG you in turn make the hyoid bone pull upwards and out, which in turn pull the tongue + epiglottis[both attached to the hyoid bone] in the same direction increasing the support and area for air to pass through in the larnygopharnx. The video below should help in giving you an insight on what i'm trying to say:
https://www.youtube.com/watch?v=gU5QOv8IdbI
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Hey, Daniel, it's disheartening to read that you haven't felt any improvements in your sleep despite going through with jaw surgery. Have you mentioned this to your surgeon? I would definitely follow Kavan's advice and speak to your surgeon about considering a genio if you see no improvements, or at least find out what benefits you would see from potentially getting it done. Also, I wouldn't discount their being another issue at play esp with your nose/palate, would be wise to consult with an ENT who has a background in treating patient who have sleep apnea.
From my very basic understanding, the benefits of a genio are to do with the muscles attached to the chin which are in turn connected on the other end to the hyoid bone. With a BSSO and SG you in turn make the hyoid bone pull upwards and out, which in turn pull the tongue + epiglottis[both attached to the hyoid bone] in the same direction increasing the support and area for air to pass through in the larnygopharnx. The video below should help in giving you an insight on what i'm trying to say:
https://www.youtube.com/watch?v=gU5QOv8IdbI
Wow!. You said that very well.
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Strange. I never heard of a genio helping breathing.
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Strange. I never heard of a genio helping breathing.
I guess something attached to the base of the tongue goes along for the ride that also has an association with obstructing the airway which is most likely why it's part of the whole sleep apnea package. Journey to Serenity gave good elaboration on it.
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Very interesting points guys. Dogmatix, the surgeon said the genio would be 2-3mm I think to get a more aesthetically pleasing result.
I am very glad/worried you brought up the genio/hyoid bone guys because thats exactly where the obstruction I am feeling seems to be and when I push on the hyoid bone slightly my throat seems to close up completely. Before you mentioned it I was noticing that it seemed be a point in my airway that was very narrow.
Is it possible that there is swelling causing pressure on/around the hyoid bone causing obstruction? I notice that when I am sleeping I am still point up my head upwards which I think actually pulls my hyoid bone outwards. It still feels very firm and hot around the lower jaw tissue. I am not sure if I had a problem with the hyoid bone area before the surgery.
With a BSSO and SG you in turn make the hyoid bone pull upwards and out..
Does the BSSO by itself help to pull the hyoid bone out?
I am looking at my pre op cone beam images, am I seeing the hyoid bone here that I have outlined, there is a top down view and side view linked
https://imgur.com/a/L43WsGA
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https://www.ncbi.nlm.nih.gov/pubmed/11890065
The hyoid bone moved forwards horizontally in 78 per cent of the subjects, backwards in 17 per cent, and in 5 per cent of patients it retained its pre-operative position.
The amount of horizontal and vertical change of the hyoid bone was associated with the corresponding change of the mandible after surgery.
Just from this one study only on mandibular advancement and hyoid bone movement I am hoping I got some beneficial movement to my hyoid bone..I am really hoping it is just swelling I am feeling...
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Strange. I never heard of a genio helping breathing.
https://www.ncbi.nlm.nih.gov/pubmed/25721920
The upper airway may be further opened by an advancement genioplasty
It also makes sense when looking at the anatomy of what the part being mobilized in a genioplasty is connected to. It also looks like the epiglottis could be coming forward with this, as discussed earlier.
http://orlandomedicalnews.com/files/image/rev_fig_2.jpg
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https://www.ncbi.nlm.nih.gov/pubmed/11890065
Just from this one study only on mandibular advancement and hyoid bone movement I am hoping I got some beneficial movement to my hyoid bone..I am really hoping it is just swelling I am feeling...
I don't think there's any magic going on that the hyoid bone is only moved by a genioplasty. Moving the entire package seems like it should move everything that is included in a genioplasty as well. An additional genioplasty would just be further advancement of what is already advanced. With this, I can also speculate that if you already had 14mm advancement, 2-3mm additional would be a lot less additional improvement from what you got in the surgery you had. The major movement and improvement is already done.
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Does the BSSO by itself help to pull the hyoid bone out?
I am looking at my pre op cone beam images, am I seeing the hyoid bone here that I have outlined, there is a top down view and side view linked
https://imgur.com/a/L43WsGA
Yes, I would assume so providing you had CCW + large advancement of the mandible. However, don't take my word for it, speak to your maxfax surgeon he's the one who should be able to shed more light on this. The only way to really gauge the amount of movement of the hyoid bone is by looking at scans pre and post surgery. As for the airways, I know various surgeons who use ICAT[cbct] where it calculates the improvement of the airways.
If I was in your position, I would wait for the swelling to subside before doing anything, however, I would still speak to your surgeon[notify him of your concerns with regards to your sleep/benefits + advancement of a poss genio/your desire to start CPAP etc], see what he says, then either take his opinion on board or maybe get a second opinion, and then take it from there.
I still think you should definitely consult with an ENT[i know i've said it before but it's imperative he's experienced in sleep apnea] once the swelling subsides and get them to use a scope to check your nose/throat/airways etc where any potential areas of obstruction can be highlighted. The last thing you want is to undergo the pain and expense of another surgery while the underlying problems go untreated and you don't experience any benefit whatsoever.
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Below you can see why it's interesting to look at the cbct after such surgery. In this case the airway improvement is obvious, and if you had the cbct it could probably easy be seen how the surgery has affected your airways.
https://www.instagram.com/p/Bnis742giHZ/
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Yeah I'll just wait for now, maybe I am a odd case or maybe the size of the mandible movement has something to do with the swelling persisting. Thanks for the tips regarding airway imaging and seeking a ENT. I'll post an update in the future, hopefully with some good news :P