jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: lcmn on May 16, 2014, 11:52:46 AM
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I would love to find a quick summary of some of the senior member's information on their post surgical results. Maybe someone can direct me to where I can find this info?
Things such as: 1)Surgeon name 2)Reason for surgery 3) General thumbs up or down on results 4) Any notable complications like chronic pain, joint problems, relapse, deformity.
Thank you!
A little about me: Age 33 in San Diego, currently considering jaw surgery for sleep apnea caused by a small airway due to recessed jaw--not severely so. I've consulted with Dr Kasey Li, Dr. Grant McGann and several ENT's in San Diego. Considering consult with Dr. Gunson. I am totally afraid of the risks of chronic pain and facial changes associated with maxilla movement.
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Hi, I was wondering how your consult with Dr. Kasey Li went? I was considering having a consult with him as well, and was wondering where he stands as far as the function/aesthetics question goes? I would really appreciate any insight you could provide, thanks!
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Dr. Li is regarded as one of the top authorities on maxillofacial surgery so I would suggest consulting with him. He is nice, helpful and very skilled. He is also a board certified plastic surgeon (he's the only maxillofaical surgeon in the world who is).
However, in regard to your question, he seems mostly concerned with making the airway as big as possible and less so with aesthetics. He has a standard approach to advance the jaw at least 12mm for sleep apnea patients, and counter clockwise rotation of the maxilla to reduce the amount of forward maxilla movement needed. He'll even do MMA's for patients without using orthodontics first.
He showed me photos of two MMA patients and I thought they looked really bad. They had that chimp look (which can result from big forward movement of the maxilla with counter clockwise rotation) and pig looking noses (widened base and big nostrils).
To give you a comparison, he suggested 12mm jaw advancement with no orthodontics, while another doctor proposed 8mm with use of orthodontics. My face definitely would not look good with 12mm advancement.
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What does MMA stand for?
He is also a board certified plastic surgeon (he's the only maxillofaical surgeon in the world who is).
Did he tell you this himself? There are dozens of board certified plastic and oral surgeons in the US alone.
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I believe I should have said that he is the only one who is triple certified as an ENT, oral maxillofacial surgeon and plastic surgeon.
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What does MMA stand for?
Mixed Martial Arts.
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Mixed Martial Arts.
Maxillo-Mandibular Advancement maybe?
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What does MMA stand for?
MaxilloMandibularAdvancement
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I believe I should have said that he is the only one who is triple certified as an ENT, oral maxillofacial surgeon and plastic surgeon.
oh ok, that makes sense.
Mixed Martial Arts.
made me laugh :)
Maxillo-Mandibular Advancement maybe?
so basically bi-max
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...my surgeon was double certified and i still got butchered.
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Nola, would you be prepared to name and shame your butcher?
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The alar-cinch stitch is suppose to help with the widening of the nose and then they can shave down the anterior nasal spine to help try and prevent the nose from upturning. Thats what my surgeon is doing. Ill see if it helps lol. M surgeon already told me he doesnt want my nose to upturn cuz its already up a little, so hopefully he'll do his best there.
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The surgeon i had consult with also mentioned about alar-cinch preventing the widening effect. Did he tell you how many mm he wants to move your jaw forward?
He said he wants to move my upper 4 or 5 mm and I dont know about my lower yet. Im also having an impaction done too, but I dont know how much. Possibly 3mm. I know he doesnt want to do too much because of the aging affect.
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Yea he says he doesnt want to advance it too much, and im perfectly fine with that.
Impaction is just reducing the vertical length of the upper jaw. I have excess incisor show at rest and a really gummy smile. That was one of the main reasons I wanted surgery, and also the strain it puta on my mouth not being able to close my mouth naturally. Are you just having upper jaw surgery?
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I dont really know if theres a name for the downward movement. Im guessing it just an inferior movement, but I do know they tend to more unstable and susceptible to relapse.
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It's called downgrafting of the maxilla. Bone is taken from the front of the hip and used as a graft, along with rigid fixation (plates and screws basically) relapse is said to be minimal, apparently.
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This sounds really terrible.
Does the counter clockwise rotation cause the chimp look + pig looking nose?
Why does the nose end up looking widened +flared nostrils anyway? I was told that my nose might end up looking more up-turned. I guess that's like the "gentle" way of saying it might end up looking flared and like a pig's. What can be done to avoid that sort of thing? If there were downward movement of the maxilla, how does it affect your nose?
I think it's more the forward movement (than the counter clockwise rotation) of the maxilla that causes the chimp look/pig nose. If you think about moving the maxilla bone forward, the bone pushes the nose cartilage and soft tissue, at the base of the nose, forward and up. The result is a widened, upturned nose. And a weird looking fullness at the philthrum (just under the nose)--not a good look. It's described very well here by Arnette and Gunson http://www.arnettgunson.com/fab-treatment-planning/airway/sleep-apnea-treatment/summary
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How much does shaving down the anterior nasal spine help with the nose upturning? This was the one concern my surgeon mentioned. He really doesnt want my tip to upturn and said he will do everything he can to prevent it. I think it should help that I wont be getting large foward movements
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How much does shaving down the anterior nasal spine help with the nose upturning? This was the one concern my surgeon mentioned. He really doesnt want my tip to upturn and said he will do everything he can to prevent it. I think it should help that I wont be getting large foward movements
I can show you a textbook case where the ANS reduction was excessive (it is possible to remove it completely), and the tip ended up pointing completely down.
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How much does shaving down the anterior nasal spine help with the nose upturning? This was the one concern my surgeon mentioned. He really doesnt want my tip to upturn and said he will do everything he can to prevent it. I think it should help that I wont be getting large foward movements
Overzealous ANS reduction.
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Just wanted to chime in on this old thread for anyone who stumbles upon it. The aesthetics of the nose is not necessarily a function of the surgeon but of the surgical plan. Alar cinch and shaving of ANS are standard surgical techniques that all oral surgeons are trained with. I've consulted with a few patients from all the major practices and flaring of the nostrils is a common side effect of the surgery. With CCW rotation, the effect should be minimal but it's unavailable as there's simply going to be more support on the outside of the nostrils. Typically the advancement at the nasal base is only about 4mm in an CCW-MMA so the effect is minimal. There are undoubtedly some cases where CCW rotation can't be used or where the surgeon didn't know or want to use it. I don't know if Dr Li wasn't doing the CCW rotation at that time maybe. In those cases, surgeons often want to push the maxilla forward as much as possible and that's when you get into real trouble. In my unqualified aesthetic opinion, in general men tend to tolerate wide noses better and women upturned noses. Most of the time people have sleep apnea there's going to be deformities affecting support behind the nose anyway so you can expect an aesthetic improvement. All volume providers advance the mandible 10-13mm. Only one I met didn't propose being at the upper end of the spectrum.
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I would love to find a quick summary of some of the senior member's information on their post surgical results. Maybe someone can direct me to where I can find this info?
Things such as: 1)Surgeon name 2)Reason for surgery 3) General thumbs up or down on results 4) Any notable complications like chronic pain, joint problems, relapse, deformity.
Thank you!
A little about me: Age 33 in San Diego, currently considering jaw surgery for sleep apnea caused by a small airway due to recessed jaw--not severely so. I've consulted with Dr Kasey Li, Dr. Grant McGann and several ENT's in San Diego. Considering consult with Dr. Gunson. I am totally afraid of the risks of chronic pain and facial changes associated with maxilla movement.
Yes, it's been a pain to track this info down and should be easier than what we have today. I just so happen to be a web developer and maybe I can help solve this! I started another thread regarding this to see if there's enough interest and to gather feedback @ http://jawsurgeryforums.com/index.php/topic,4777.0.html
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I can show you a textbook case where the ANS reduction was excessive (it is possible to remove it completely), and the tip ended up pointing completely down.
Hi PloskoPlus,
I joined this forum to message you and a few others. I would really love to see this textbook case and I think you shared it somewhere but attachments are removed since then. If you could kindly show me more about this specific case as well as generally ANS reduction reducing nose upturning, I would appreciate you so much! I am getting DJS with a big maxillary advancement- and I'm worried as heck of the pignose effects which I've pretty much seen in every single before/after of big underbite patients doing DJS like myself. I'd much rather get a wide nose than a pig nose! :'(
Cheers,
tonebame