jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: x on February 14, 2013, 01:39:05 PM
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(http://s4.postimage.org/43n8bdwsd/jawlines.jpg)
As far as I know nothing can be done about them with surgery right? Would this have an effect on your occlusal plane angle as well?
I've heard noise that distraction osteogenesis can lengthen the pterygomasseteric sling although not much in the way of befores/afters and it seems reserved for serious cases involving major issues.
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yeah i wanna know about this too...
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i think in order to achieve that effect the surgeons would need to perform a counter clockwise rotation. i am not sure if many surgeons do this but i have read really reputable surgeons do.
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i think in order to achieve that effect the surgeons would need to perform a counter clockwise rotation. i am not sure if many surgeons do this but i have read really reputable surgeons do.
I don't think CCW rotation would lengthen the ramus though would it? It might give the illusion of a more natural angle...
Anyways there's 3 procedures that I know of that are done to correct a short ramus: mandibular distraction, inverted L osteotomy, and extraoral subcondylar ramus osteotomy.
If anyone knows anything about any of these 3 procedures, information would be appreciated!
Ok this site does a good job explaining the inverted L osteotomy, https://www2.aofoundation.org/wps/portal/!ut/p/c1/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3Q1dDA08XN59Qz8AAQwMDA6B8JJK8haGFgYFnqKezn7GTH1DahIBuP4_83FT9gtyIcgBttnJy/dl2/d1/L2dJQSEvUUt3QS9ZQnB3LzZfQzBWUUFCMUEwRzFFMTBJREZMVUlRUDEwMDA!/?redfix_url=1340269339758&implantstype=Inverted%20L%20osteotomy&segment=Orthognathic&bone=CMF&classification=95b-Mandible%2c%20Sagittal&approach=&showPage=redfix&treatment=&method=Mandibular%20prognathism
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You can get implants to make your jaw angles sharper.
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I don't think CCW rotation would lengthen the ramus though would it? It might give the illusion of a more natural angle...
Anyways there's 3 procedures that I know of that are done to correct a short ramus: mandibular distraction, inverted L osteotomy, and extraoral subcondylar ramus osteotomy.
If anyone knows anything about any of these 3 procedures, information would be appreciated!
Ok this site does a good job explaining the inverted L osteotomy, https://www2.aofoundation.org/wps/portal/!ut/p/c1/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3Q1dDA08XN59Qz8AAQwMDA6B8JJK8haGFgYFnqKezn7GTH1DahIBuP4_83FT9gtyIcgBttnJy/dl2/d1/L2dJQSEvUUt3QS9ZQnB3LzZfQzBWUUFCMUEwRzFFMTBJREZMVUlRUDEwMDA!/?redfix_url=1340269339758&implantstype=Inverted%20L%20osteotomy&segment=Orthognathic&bone=CMF&classification=95b-Mandible%2c%20Sagittal&approach=&showPage=redfix&treatment=&method=Mandibular%20prognathism
are we talking about lengthening a ramus vertically? i did not know they could actually do that. i do know that in ivro the cuts are made to lengthen the ramus horizontally instead of along the mandible
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I had a very steep mandibular angle, which is now pretty square. I don't know every detail of what was done to fix that specifically, but I did receive CCW and HA paste for gonial angles. I'm still healing, but my profile is much better now.
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You can get implants to make your jaw angles sharper.
I'm not concerned about the flaring out of the jaws or whatever
tdawg suggested that we both had similar cases, his hunch was that our ramus didn't grow long enough, so we have an underbite with the profile that looks like a class II
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i had an open bite and feel like because of that my ramus grew in too short
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i had an open bite and feel like because of that my ramus grew in too short
Same. I think our open bite is caused by the downward angle of the mandible because of the short ramus
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You can get implants to make your jaw angles sharper.
Apparently only Medpor implants can give you that "drop the jaw angle down vertically look" and we all know how icky Medpor is :( although I think Titanium Implants might be able to do that as well (not 100% sure)
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i also wanted to know what the root cause of my open bite was. whatever the reason, i am pretty sure my open bite is even why i have a sloped forehead. it can change the entire development of the face. tongue thrust, mouth breathing, forward head posture, all i feel can contribute to an open bite
I think mouth breathing is the thing that causes all of those.
Mouth breathing causes the jaws to grow downward, because the jaws grow downward you're forced to arc your head forward so that your chin isn't pressing against your neck. Maybe the tongue thrusting is due to lack of mouth space because the jaws grew downward rather than horizontally forward?
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Mouth breathing theory is complete and utter bulls**t, tongue thrusting however is a real issue.
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Mouth breathing theory is complete and utter bulls**t, tongue thrusting however is a real issue.
http://www.jeffersondental.com/assets/docs/mouthBreathing.pdf (http://www.jeffersondental.com/assets/docs/mouthBreathing.pdf)
http://www.myfaceology.com/2012/02/mouth-breathing-and-how-it-affects-your-health/ (http://www.myfaceology.com/2012/02/mouth-breathing-and-how-it-affects-your-health/)
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You're not going to convince me with two articles/links
Try 10+ peer reviewed journals and we will talk
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You're not going to convince me with two articles/links
Try 10+ peer reviewed journals and we will talk
2 is greater than your 0.
The first article references more than 80 other articles in it's compilation of information.
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This is pseudo-science at it's finest, I don't think you understand that people are BORN with prognathism or retrognathism but if you want to continue believing this little fairy-tale go ahead, I'm sure that you also believe in vaccines causing autism (lol)
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This is pseudo-science at it's finest, I don't think you understand that people are BORN with prognathism or retrognathism but if you want to continue believing this little fairy-tale go ahead, I'm sure that you also believe in vaccines causing autism (lol)
>claims pseudoscience
>makes unsupported claim
Anyone with half a brain will recognize your pathetic appeal to ridicule.
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Yes I'm sure that Dr. Kaban and the entire Department of Oral and Maxillofacial Surgery at Harvard School enjoys performing jaw distraction and/or double jaw on CHILDREN and PRE-TEENS when they could easily "fix" their problems by giving them a turbinectomy and septoplasty thus ensuring that they will grow up to have perfectly jaw alignment and let's not forget the daily dose of Flintstone vitamins.
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I don't see why that would have been an issue, I've seen dozens of video blogs and before/after pictures of young teenagers (16-17) who went through double jaw surgery without a hitch also it's no coincidence that the best results that you see online are of young people but you're right nothing good can come out of fretting over the past
i agree, earlier the better if abnormal growth is discovered.
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From what I've heard in most cases its an absolute no-no to operate on the jaws when the patient is still growing. This will cause relapse and most certainly another surgery years down the line. I was told in my case that I needed surgery when I was 15, but had to wait a few years to ensure I was done growing...
Certain cases can be handled at a much younger age, while you are actively growing with headgear and such.
Steep mandibular plane angles or the gonial angle can be a result of several factors into play . IMO, Part of it is genetic, but when it comes to environment elements, I've heard people who are thumb suckers, mouth breathers can be partially responsible for steep gonial angles. In my case for example my upper jaw grew too fast (too much gums) and pushed my lower jaw at a weird angle which makes it very steep.
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just so we are clear...
these two teenagers mouth-breathed their way into a retrognathic profile?
(http://i.imgur.com/obbVMKc.jpg)
(http://i.imgur.com/NWIrMEH.jpg)
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just so we are clear...
these two teenagers mouth-breathed their way into a retrognathic profile?
(http://i.imgur.com/obbVMKc.jpg)
(http://i.imgur.com/NWIrMEH.jpg)
I don't know because I don't know their case, but I wouldn't think so. Most mouth breathing cases I've seen have more slight retrognathia, and I thinik their issue wasn't a naturally retrognathic mandible but one that was pushed out of position by maxilla growth
(http://www.facesthatsmile.com/images/gummysmilepics/gummysmile9.jpg)(http://www.facesthatsmile.com/images/gummysmilepics/gummysmile10.jpg)
(http://www.facesthatsmile.com/images/gummysmilepics/gummysmile11.jpg)(http://www.facesthatsmile.com/images/gummysmilepics/gummysmile12.jpg)
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You don't have enough torque in your mouth or nose to reshape bone with air
You're just too arrogant to admit that your genes were predisposed to shape your face the way it currently is
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You don't have enough torque in your mouth or nose to reshape bone with air
[citation needed]
You're just too arrogant to admit that your genes were predisposed to shape your face the way it currently is
ad hominem that further proves you don't have any studies to support your 'mouth breathing is bulls**t' theory. I don't give a s**t what random guy on internet thinks, who the f**k are you and why should I believe anything you say? Because you said so? Get a grip, all I know about you is you're one of the guys who drifted over from puahate, bitter as anyone about your inadequacies in life, but manifesting that bitterness by flaming people over the internet.
If you're currently fellating to the thought of getting me angry about 's**tty genes', you're gonna be sorely disappointed that the thought doesn't bother me in the slightest.
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I'm not bitter over anything, you're the one constantly b*tching and moaning over your long philtrum, flat cheeks, microgenia, vertical maxillary excess, etc... whereas my threads are either pure trollery or informative, but good luck prolonging the inevitable = that you were not born attractive and will remain that way, it's not like jaw surgery will do you much for you anyway it ain't a magic pill that automatically turns you into a hunk pal!
and here are your citations:
The problem is often a hereditary trait that runs in some families. Injuries during early childhood can cause jaw deformities, particularly when the end of a developing jawbone is broken and heals improperly. Severe trauma such as a gunshot wound can cause jaw deformities, as can bone infections and certain diseases involving hormonal imbalances. Radiation and surgical treatments for oral cancer may also produce jaw deformities.
Epidemiological studies have shown that around 20% of the world?s population suffers from some major maxillofacial deformity. In some cases, the severity is so high that it influences their facial proportion; finally, 5% can be considered to have a physical disability. Approximately 12% of the American population has class II malocclusion, whereas class-III occurs in 1% of this society of which 33% are candidates for surgery
Malocclusion and other deformities in facial skeletal components may be acquired or hereditary. Indeed, genetics plays an important role in maxillofacial deformities. Hereditary patterns such as familial adherence to a prognathic or retrognathic mandible are often seen in patients with such deformities. However, multifactorial characteristics of facial development make it difficult to predict a genetic pattern in a specific maxillofacial deformity, but epidemiological evaluations can reveal relationships between such deformities and some genetic characteristics or accompanied diseases which will help to recognise and treat them.
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guys...chill!
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Team X :D
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who gives a s**t what complex series of determinations caused it --I just want to know how to fix it.
And as for the question of "steep mandibular plane," --I bet there's a way to shape it through surgery and grafting alone, DO, rather than having to use medpor.
I read an interesting study recently in the field of behavioral economics. If two treatement options are present for a surgeon they'll usually choose the better one, but if more than two exist, then surgeons we'll
always just go to their default, even though this third, new option may be better.
Let me let all of you guys in on something, surgeons aren't spending time at home(or in their offices) studying your case, agonizing over the details, exerting themselves over how to produce the best aesthetic results for you.
They make rapid fire decisions, in the moment, sometimes during the surgery itself and maybe for a couple of hours the day before. That's why it's really, really important to do all your homework and figure out what all the best treatment options are. Did any of you know that mandibular widening was an option? I didn't until a few weeks ago --it's just that there aren't many surgeons practiced in doing it.
Ask some surgeons about a high lefort --and they'll tell you it's dangerous, whereas others who are practiced in it, do it routinely. DO? Well, you've even further narrowed down the pool.
Throughout all of this I've come to realize a lot more is possible through this surgery than the average max fac knows or is capable of doing.
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what actually is a high lefort? please "illuminate me"!
I'm getting CCW rotation. what's better for typical mild II class mouth breathers ?
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(http://s4.postimage.org/43n8bdwsd/jawlines.jpg)
As far as I know nothing can be done about them with surgery right? Would this have an effect on your occlusal plane angle as well?
I've heard noise that distraction osteogenesis can lengthen the pterygomasseteric sling although not much in the way of befores/afters and it seems reserved for serious cases involving major issues.
This is my problem. I have a mild openbite but it is exacerbated by my steep mandibular plane. In fact my x-ray is one of the few I have seen like it. Of course this complicates things because I think there is a resistance to perform the surgery needed to correct it for a few mm change in an open bite.
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For future reference in case anyone would fall into the same search pattern, with no answers, that I fell into.
Here is a "lengthening" of the ramus and angle change (gonial angle) via bimax surgery. "Bilateral stepwise body osteotomies and bilateral sagittal split osteotomies (Obwegeser)" on the mandible.
https://www2.aofoundation.org/wps/portal/!ut/p/a1/jY9LD4IwEIR_DVd2gUSNtx6U-AoHfEAvpsRSSLDblCKJv17kjI-57WS-zQxwyIBr8aiVcDVp0bxvPruGCWK8SXGXJMcAWboK4vMaEQ_REMi_BNj8Px4_iOEvfgtcNVSMVXOmi2ihgFtZSiut39nBrpwz7dJDD_u-D31BJXX6Ng70yarBNq2HhqybflJR6yCbZMHcT9lzLy8vkhZ3ng!!/dl5/d5/L2dJQSEvUUt3QS80SmlFL1o2XzJPMDBHSVMwS09PVDEwQVNFMUdWRjAwME0z/?approach=&bone=CMF&classification=95b-Special%20considerations&contentUrl=srg%2F95b%2F05-RedFix%2FP410-2JawSurg%2F02_Introduction.enl.jsp&implantstype=hidden&method=Special%20considerations&redfix_url=1340701672038&segment=Orthognathic&showPage=redfix&soloState=lb&step=1&subStep=11&treatment=
(https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/05-RedFix/95b/P410-2JawSurg/95_P410_i100_540.gif)
(https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/05-RedFix/95b/P410-2JawSurg/95_P410_i120_540.gif)
(https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/05-RedFix/95b/P410-2JawSurg/95_P410_i140_540.gif)
(https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/05-RedFix/95b/P410-2JawSurg/95_P410_i160_540.gif)
(https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/05-RedFix/95b/P410-2JawSurg/95-P410_p180_540.jpg)
EDIT: You just need to find the right surgeon who is willing to perform the procedure. The following two images are of an extreme case of course:
(https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/05-RedFix/95a/TCS/95-P840_i100_540.gif)
(https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/05-RedFix/95a/TCS/95-P840_i120_540.gif)
https://www2.aofoundation.org/wps/portal/!ut/p/a1/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKN_A0M3D2DDbz9_UMMDRyDXQ3dw9wMDAx8jYEKIvEocDQnTr8BDuBoQEi_l35Uek5-EtipkY55ScYW6fpRRalpqUWpRXqlRUDhjJKSgmIrVQNVg_Lycr30_Pz0nFS95PxcVQNsWjLyi0v0I1BV6hfkhkZU-aSGAwDYYmkN/dl5/d5/L2dJQSEvUUt3QS80SmlFL1o2XzJPMDBHSVMwS09PVDEwQVNFMUdWRjAwME0z/?approach=&bone=CMF&classification=95a-TCS%2C%20Treacher%20Collins%20Syndrome&contentUrl=%2Fsrg%2F95a%2F05-RedFix%2FTCS%2FP840-Orthogn%2F01-Conventional_Orthognathic.enl.jsp&implantstype=&method=Conventional%20orthognathic%20surgery&redfix_url=1345644282821&segment=Congenital&showPage=redfix&soloState=lb&step=1&subStep=11&treatment=
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Before and after animated GIF (1-2.gif). ~11° decrease (~143° to ~132°) in the gonial angle. A 0° change in the occlusal plane:
(http://i.imgur.com/lEPwsH7.gif)
(https://northamericanpharmacal.com/SG3/images/gonialangle.jpg)
Full process animated GIF (1-4.gif):
(http://i.imgur.com/ec9uTxR.gif)
His results are undeniable, however I think he could have used a CCW rotation (CW rotation in reference to these images) which would have made his gonial angle even smaller. Though that would put him in a near 0° occlusal plane (not ideal). Maybe if they cut his mandible a little bit lower, coupled with a counterclockwise rotation, could they have achieved a near 120° gonial angle.
[attachment deleted by admin]
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That's awesome! I've done a ton of research and I've yet to see a mid-ramus horizontal split until now. It would seem much more appropriate for the mandible regarding CCW rotation when compared to BSSO but I assumed the masseter muscle prohibited it either surgically or recovery-wise.
I'll have to read up tomorrow :)
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That's awesome! I've done a ton of research and I've yet to see a mid-ramus horizontal split until now. It would seem much more appropriate for the mandible regarding CCW rotation when compared to BSSO but I assumed the masseter muscle prohibited it either surgically or recovery-wise.
I'll have to read up tomorrow :)
The masseter muscle would be affected the same way as with an implant. I've read of implants increasing the ramus length by an additional 10 mm with no issues. Granted you can only go so far with lengthening before/until the masseter muscle ruptures.