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General Category => Functional Surgery Questions => Topic started by: BlueShark7 on May 12, 2014, 01:50:46 AM

Title: Help with mandibular plane angle
Post by: BlueShark7 on May 12, 2014, 01:50:46 AM
Hey everyone,

Just wondering if someone would be able to tell me from my picture if my mandibular plane angle is high or low?

Sorry I don't have a ceph on my computer.

Thanks in advance.
Title: Re: Help with mandibular plane angle
Post by: notrain on May 12, 2014, 02:41:29 AM
it looks low, i.e. horizontal growth type with an L-shaped growth pattern and an acute gonial angle.
Title: Re: Help with mandibular plane angle
Post by: BlueShark7 on May 12, 2014, 02:59:31 AM
it looks low, i.e. horizontal growth type with an L-shaped growth pattern and an acute gonial angle.
thanks notrain. I was struggling to figure it out and interested because of its supposed bearing on stability post surgery.
Title: Re: Help with mandibular plane angle
Post by: notrain on May 12, 2014, 03:11:03 AM
i was also researching this for myself (we have the same growth type). the hypodivergent pattern (what you have) is generally preferable to the hyperdivergent (vertical / long face) pattern because it doesn't need extensive rotation to fix proportions. it makes the surgery much easier to perform and healing and post op stability is also better.

Title: Re: Help with mandibular plane angle
Post by: dantheman on May 13, 2014, 07:12:10 AM
Low angle, which contributes to your chin prominence. Do you even need surgery?
Title: Re: Help with mandibular plane angle
Post by: Modigliani on May 13, 2014, 12:19:08 PM
That's a seriously attractive profile you've got there.
Title: Re: Help with mandibular plane angle
Post by: BlueShark7 on May 13, 2014, 03:21:51 PM
Low angle, which contributes to your chin prominence. Do you even need surgery?

Thanks for your reply.

As for needing surgery, not sure. I am in the process of deciding whether or not to go ahead with surgery for small airway and small mandible. I'm not entirely happy with where my lower jaw sits and I have breathing problems, but my bite is fine (previous orthodontics). Surgeon suggests either bimax advancement (no braces required) or BSSO only but I need orthodontics again to create 6-7mm overjet. I would prefer just to have lower jaw done but am really really anti having extractions. Waiting to see orthodontist and see if they can create a worthwhile overjet without extractions. If not, then I think I'm confined to non-surgical alternatives and learning to be ok with small jaw and how it looks.
Title: Re: Help with mandibular plane angle
Post by: BlueShark7 on May 13, 2014, 03:25:34 PM
That's a seriously attractive profile you've got there.

Th-thank you, I appreciate it. I do wish my lower jaw was forward
Title: Re: Help with mandibular plane angle
Post by: dantheman on May 13, 2014, 04:57:19 PM
I think you look great. Do you have a ceph / X-ray? What's your breathing problem? I think women look good with a (mild) convex profile.
Title: Re: Help with mandibular plane angle
Post by: BlueShark7 on May 13, 2014, 06:06:46 PM
I think you look great. Do you have a ceph / X-ray? What's your breathing problem? I think women look good with a (mild) convex profile.

Thank you Dan, I appreciate it. I don't have copies of my cephs unfortunately. I have sleep apnea and the surgeon showed me my CT scan with a (moderately) narrow airway. I also have bad TMJ on one side but I know surgery is no guarantee of helping that and can make it worse.
Title: Re: Help with mandibular plane angle
Post by: dantheman on May 13, 2014, 07:59:20 PM
What are your numbers like in terms of sleep apnea? Home study or in lab study? why was it done?

my problem with sleep apnea is that the ranges are too tightly defined. an apnea hypopnea index of under 5 is normal, and all of a sudden if your number is 6, you have mild sleep apnea, the same diagnosis that goes to someone with 15 on the AHI index.

Trouble breathing through your nose at all? Do you snore?
Title: Re: Help with mandibular plane angle
Post by: BlueShark7 on May 13, 2014, 08:30:15 PM
What are your numbers like in terms of sleep apnea? Home study or in lab study? why was it done?

my problem with sleep apnea is that the ranges are too tightly defined. an apnea hypopnea index of under 5 is normal, and all of a sudden if your number is 6, you have mild sleep apnea, the same diagnosis that goes to someone with 15 on the AHI index.

Trouble breathing through your nose at all? Do you snore?

Totally get what you're saying. I'm having an inpatient hospital sleep study done in a week, so as yet what I have to go on is witnessed apneas and being told I snore. I always wake up feeling like a truck has run over my head, no matter how many hours sleep I've had, and I'm wondering if that's related. I'm not sure what the exact airway measurements were on my head scan but it was color coded, from green being a patent airway to red being the narrowest and mine was this sea of red. I can't breathe lying flat on my back. As for breathing through my nose, things feel tight, but I'm so accustomed to it that I don't know what's normal.
Title: Re: Help with mandibular plane angle
Post by: dantheman on May 14, 2014, 07:22:23 AM
I'm all-too-familiar with that morning feeling. I tell others that I'd rather be punched in the face and get on with my day than feel the way I do every morning. Without a doubt your study is worth doing. I'd also get my hands on the CT. Was it an iCAT? There are free viewers for dicom files (the type of file) that you can actually look at it yourself.

For what it's worth you don't look exhausted. I look and feel like a train hit me.
Title: Re: Help with mandibular plane angle
Post by: BlueShark7 on May 14, 2014, 04:40:19 PM
I'm all-too-familiar with that morning feeling. I tell others that I'd rather be punched in the face and get on with my day than feel the way I do every morning. Without a doubt your study is worth doing. I'd also get my hands on the CT. Was it an iCAT? There are free viewers for dicom files (the type of file) that you can actually look at it yourself.

For what it's worth you don't look exhausted. I look and feel like a train hit me.

It was a cone beam CT, same kind of thing?

Thanks Dan. Out of interest, would a sliding genio help airway at all? Appearance? I know I'm at risk of having a chin that's too pointy and a deep labiomental fold if I go that route, but if bimax would give me a gummy smile and a BSSO on its own is out of the question without extractions, I'm not left with many options.
Title: Re: Help with mandibular plane angle
Post by: dantheman on May 14, 2014, 05:28:38 PM
The only way to increase airway size is to do a BSSO or double jaw advancement. Genios don't change jaw relationships, only make your chin more pronounced. The chin wing procedure has been shows to improve sleep apnea indices, however, without change to airway size. I would not touch your face if its just for appearance.
Title: Re: Help with mandibular plane angle
Post by: ticktickatick on May 16, 2014, 07:52:22 AM
Aesthetically your profile looks perfect to me.

I would kill to have been born with a jaw like that.
Title: Re: Help with mandibular plane angle
Post by: BlueShark7 on May 17, 2014, 01:59:09 AM
Aesthetically your profile looks perfect to me.

I would kill to have been born with a jaw like that.

thank you, that's really kind. I had extensive orthodontic work as a teenager because I had a massive overbite and overjet that my parents were told would likely require surgery initially but after braces came off etc, orthodontist said my jaw grew well enough with twin block appliances etc. I've never quite gotten over how it felt to have a messed up jaw as a kid/teenager and in my mind I would have preferred if they would have just operated back then. I still feel like my profile is weak, I mean, I'm grateful for the improvement from when I was a kid, but I still feel like it could be better. My breathing is an issue, as is jaw pain on one side, so if I could improve all of that via surgery, then I would. I get that there are people heaps worse off, but if I could get a net benefit from a BSSO, even if it's not the same magnitude of benefit as someone worse off, then I would still be for it.
Title: Re: Help with mandibular plane angle
Post by: lcmn on May 17, 2014, 02:38:16 PM
It was a cone beam CT, same kind of thing?

Thanks Dan. Out of interest, would a sliding genio help airway at all? Appearance? I know I'm at risk of having a chin that's too pointy and a deep labiomental fold if I go that route, but if bimax would give me a gummy smile and a BSSO on its own is out of the question without extractions, I'm not left with many options.


I'm fairly sure that one of the surgeon's I saw said that they can do a sliding genio with tongue advancement to increase airway size, but it may not enough to cure sleep apnea.  Something to ask about for sure.  I have the same problem with small airway and sleep apnea.