jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Purist on December 17, 2015, 09:24:12 AM
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Hello everyone (first post please be kind)
In August, I approached a maxillofacial surgeon for advice on the best course of treatment for a retrognathic chin, lip incompetence and a protuberant lip. I was initially looking into a genioplasty as an implant would not fill the 15-20mm deficit.
At the time, the consultant said that I had a malocclusion class 2 and the best course of action would be surgery. Later that month I saw him again and an orthodontist. X-rays and impressions of my teeth were taken. I was then told to wait for an appointment with the orthodontist. Three and a half months later I was back at the hospital.
However, rather than getting a date for braces - which I was expecting and rather looking forward to. I was told that the Lefort and BSSO were too "high risk" because of the "characteristics" of my jaw and teeth. That been a very high angled jawline and deep roots. Mandibular advancement would cause excessive vertical chin length.
Despite the genuinely great effort of the surgeons/orthodontists, that's where my journey suddenly ended. Needless to say, it was all very disappointing.
I asked whether a genioplasty with bottom braces (to fix the teeth protusion causing the proturberant lip) could be at least be an option. I was told that it would not, due the high angle of the jaw which would cause the chin to appear vertically long. Surely the cut and slide would go against the jaw direction? The deep labiomental fold may also cause a "witches chin" type of appearance. Also, no to braces as the teeth may not move to the desired position due to the deep roots. The thick tissue on the lip may not have any discernable effect either...
Do I have any other options that would give me anything resembling a normal looking chin? Is the genioplasty worth pursuing despite comments to the contrary?
fyi - I'm a male, 41 years of age.
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Yes a steep plane. An implant was ruled out at the first consultation. No implant would fill the deficit I was told. I pretty much knew that myself. Another reason why I enquired about a genioplasty.
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Seek a second opinion... and a third. Find a highly skilled surgeon who deals with complex cases. I would be extremely surprised if absolutely nothing could be done. You may not be able to achieve perfection but you can surely achieve some degree of improvement. Get a consultation with A&G, they will give you an honest opinion of what your options are.
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Long roots is a problem. Steep angle puts you at risk, poor aesthetic outcome not one of them. Do you know what tha angle is? Mine is 41deg. Normal is 25-30 and I've seen reports up to about 50.
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45deg.
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Consult with Arnett/Gunson, your recession is more than 20mm, probably closer to 35mm which will only be corrected with CCW (counter-clockwise rotation) and a small-moderate genio. I bet the doc who refused does not utilize CCW. Yes a straight advancement of your lower jaw(s) would do little advancement because of the steep angle, giving you downward lengthening which is no bueno obviously.
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Consult with Arnett/Gunson, your recession is more than 20mm, probably closer to 35mm which will only be corrected with CCW (counter-clockwise rotation) and a small-moderate genio. I bet the doc who refused does not utilize CCW. Yes a straight advancement of your lower jaw(s) would do little advancement because of the steep angle, giving you downward lengthening which is no bueno obviously.
Agree with this as well as seeing other surgeons. Get all the scans and photos they took and send that off to anyone who'll listen. I don't see how advancement is going to cause an unsatisfactory result when there is no chin at all to project out and ruin the result. It looks like a case of micrognathia so surely implants are going to be required to achieve a big, full jaw?
Regarding the mandibular plane being too steep I'll do a bit of mental masturbation here... couldn't someone like the OP get the jaw surgery operation, bimax, extreme CCW, and if need be, actually shave down some of the bone then cover everything up once it's healed with a 3D printed implant?
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Hi mate, there's this guy on real self who had a really receding chin. He had a sliding genio with jaw implants. There's always some that can be done, as a surgeon told me before that nothing is impossible it's just finding the right surgeon
http://www.realself.com/chin-surgery/before-and-after-photos#media-photo-1070844-73044-3
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post a pic of your ceph for more detailed responses but yes get multiple opinions.
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Hi mate, there's this guy on real self who had a really receding chin. He had a sliding genio with jaw implants. There's always some that can be done, as a surgeon told me before that nothing is impossible it's just finding the right surgeon
http://www.realself.com/chin-surgery/before-and-after-photos#media-photo-1070844-73044-3
Is that case really just a SG? Really looks like lower jaw surgery atleast with the way the lower lip was brought forward.
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I've seen people with recession as bad as this guy being helped before. As a last resort he could get total jaw joint replacement and add 2-3 cm in one go. Maybe distraction might help him too, or getting bimax done twice, for extra advancement. He can easily change the angle of his occlusion with some rotation.
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I have seen pictures that were similar - - and end up with really nice results. It took a long time in braces working with an orthodontist and a good jaw surgeon.
The one thing that could in fact be a show stopper is the very long roots. Can you post up radiographs ?
Where do you live ? That may affect the best choice in surgeons.
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You need CCW rotation. Anything else would be a waste of time and money.
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I'm from the UK. Apologies I should have mentioned that in my original post.
The surgery would have been performed on the National Health Service (NHS).
I don't have an x-ray but I will ring the dental practice later today and request it. I was meaning to get it at my last appointment but got sidetracked with that bomb shell instead.
Deep roots appears to be a huge problem. The orthodontist even said that a simple procedure such as wisdom teeth extraction would be an issue. The thickness of the bone after extraction would make the jaw susceptible to fracture.
Thinking about it now maybe an SG is not possible if the roots are that deep?
I did mention distraction oesteogenesis when they ruled out the BSSO. I was told this was not used that much nowadays as it was a "90's" phenomenon. A new BSSO that didn't really take off (or words to that effect).
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Mandibular plane.
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just get off these boards and get your surgery (and have your ortho work supervised by them!!!) done by ARNETT and GUNSON. DOn't even waste time with ANYTHING else.
Also, 3 months is a f**king ridiculous time to wait for the surgeon to okay ortho work. That s**t should be conducted in a week.
Seriously bro, you're wasting your own and everyone else's time if you don't go with them.
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Thanks to everyone for their comments.
Right now I need to apply and pay to get my cephs. from the hospital.
I will also get a second opinion from Paul Johnson as he seems well qualified in the UK.
In the meantime I may consider having braces done separately to tidy up my mouth. I'm not sure whether to go back to the same orthodontist (as he is familiar with my case) or find someone new. We'll see.
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I finally received my radiograph.
Looks like the mandibular angle is 48 degrees.
Would you say these roots are "long"?
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