jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Brachy on March 31, 2018, 09:10:15 AM
-
Hi, I had undergone double jaw surgery and genioplasty 4 months ago.. I had maxiliary downgrafting, clockwise rotation and mandible brought forward to correct class 2 bite.. Unfortunately, plan was not correct and I would appreciate your help what needs/can be done to correct:
- lip incompetence - I can't close my lips without straining, it so much affects my speech
- protrusive profile - perhaps slight backward movement of both jaws (I have very high SNA/SNB values)
I am from Europe, what surgeon would You suggest to consult?
Please, I would appreciate your comments on my lateral view. Tnx
-
It looks like you had the type of genio to make your chin longer; a slide DOWN genio. So, now your chin muscles have to work HARDER to to close your lips. If you think you would look better with a shorter chin, then have the genio reversed so it's a slide UP genio.
-
Thank you very much.. I will post more pictures, my mandible seems to huge for the small face I have..can chin wing be performed after orthognatic surgery to increase vertical dimension and improve lip incompetence? Tnx
-
If your mandible is too huge for you, pretty dumb to get a chin wing to make things bigger.
-
Thanks, please find my pictures attached.. I would like to have less "angry" look, to be able to show emotions more easily.. can chin wing help achieve lip competence and maybe increase mandibular height posteriorly..what about reversing genioplasty..
I would appreciate your comments, many thanks..
-
Lip incompetence is from a STRAIN to the chin muscles. If your chin was made LONGER and too projected, you would need to seek out something that decreased the projection and made it shorter to reduce the strain on the chin muscles.
In general, chin wings are aimed at INCREASING the dimentions, you feel are too protrusive.
-
Thanks, please help me, should I go with mandibular setback 2-3mm and reversing genioplasty (e.g. 2-3mm up).. I would highly appreciate your opinion
-
Thanks, please help me, should I go with mandibular setback 2-3mm and reversing genioplasty (e.g. 2-3mm up).. I would highly appreciate your opinion
Will give general information, generally useful information that might help you understand things a little better. Sorry. Can't 'coach' as to specific mm displacements.
-
The projection of your jaws in and of themselves looks good, even attractive. But it's like both your upper and lower lips are being sucked in taught. That's what I notice as 'off' as my first impression and what my eyes draw attention to. I've kind of seen this lip issue before to different degrees with bimax, and don't understand it. I know the genio often slims lower lips a little. Were both lips noticeably fuller before braces + bimax? I could be assuming bimax made this change to your lips when they already looked kind of like this before. I guess something about the muscles controlling the lip don't take well to bimax. It's as if when the jaws go forward the lips complex try to maintain their old position and create this sucked in affect. Just speculating.
-
Thanks, please comment and ask.. you are helpful.. i had maxiliary downgrafting (6mm) and mandibular advancement cca 5-6mm.. so clockwise face rotation with chin slightly back (3mm) and down (4mm) my upper lip seems fuller after bimax, but lower one is very incompetent.. my surgeeon has offered slight backward movement dince I am really sad about profile..it seems like mandibula has streched my tissue significantly, I guess.. please, your opinions are very much welcome
-
My SNA/SNB values are very high, like 89...also sella to nasion distance is 71,6mm
Please advise
-
Please guys, I would appreciate your comments.. if needed, I can post more pictures.. my concerns are: protrusive profile, lip incompetence, speech problems due to lip incompetence.. thanks in advance
-
Hi,
I consulted one austrian surgeon and he said that I need more clockwise face rotation to decrease mandibular projection and improve lip incompetence. Could you please share your thoughts/comments.
I do not know whether I am midface defficient or biskeletal protrusive (SNA/SNB 90, sella nasion distance 71,6mm) If needed, I can post more pictures. Many thanks
-
More clockwise rotation would tend to just increase the strain on the chin muscles to close the lips.
-
Tnx.
This is original mail
Dear Mr. Xxx,
to peform a correction of your pofile, it is necessary to redo the complete surgery (more clockwise rotation).
(LFI, BSSO, chin).
Kind regards
I am really confused and sad - just want to look normal. I am scheduled for consultation with more surgeons. Does it seem that I am candidate for Lefort 3?
Reversing genio (moving up) will help improve my lip incompetence and closing lips? My original surgeon suggested slight backward movement.. please share your comments, thoughts.. thanks
-
Tnx.
This is original mail
Dear Mr. Xxx,
to peform a correction of your pofile, it is necessary to redo the complete surgery (more clockwise rotation).
(LFI, BSSO, chin).
Kind regards
I am really confused and sad - just want to look normal. I am scheduled for consultation with more surgeons. Does it seem that I am candidate for Lefort 3?
Reversing genio (moving up) will help improve my lip incompetence and closing lips? My original surgeon suggested slight backward movement.. please share your comments, thoughts.. thanks
Hi, I've given you my take which was to think about reversing the genio and making the chin shorter which is just a revision genio. Also explained why 'no' to chin wing. That's my 'take' on the matter. Won't opine on lefort 3 or anything else. But maybe others will chime in. END of giving my take on the matter.
-
Thanks,
You have helped me a lot. I will inform on results of other surgeons opinions in upcoming months. I would appreciate if You could reply is it better to perform revision genio (upward movement) as early as possible for the function of the lower lip? Thanks, once again
-
Thanks,
You have helped me a lot. I will inform on results of other surgeons opinions in upcoming months. I would appreciate if You could reply is it better to perform revision genio (upward movement) as early as possible for the function of the lower lip? Thanks, once again
First consult about having a revision genio.
-
Hi, yesterday I was at my original surgeon. My main concern is protrusive profile, lip incompetence and midface defficiency.
He has offered possibility to reduce the size of the chin verticaly, but also I would like to go back with my both jaws for e.g. 2mm because of the chimp look. My jaws are extremely wide and since my midface is underdeveloped it creates additionally effect of unbalanced face.
So, I would appreciate Your comments - slight backward jaw movement and reducing chin to achieve lip competence and smaller lower third.
I have scheduled consultation with dr. in Austria, Germany and Switzerland where I would seek opinion on zygomatic osteotomy since it is not done in Croatia (I have realistic expectations and my surgeon was very humble taking my concerns into consideration. He daid that I will have to rrmove the screws from the chin and if I decide to.we can make small backward movement).
As for consultations abroad, maybe widening zygomas could help since my jaws are very wide.
I will post cephalometric analysis after returning from work. Please, I would appreciate your comments. Thanks in advance.
-
For what its worth I think you look great.
If you have no funcitonal problems then seriously don't do another surgery. For all these tiny movements its not worth it and I doubt will make much difference as you think
Maybe what you need is the zygomatic osteotomy later but I can't tell causse you have no frontal picture. But you look greaat. And if you have no numbness don't risk another surgery.
-
Thanks on your comment, Lazlo.
To begin with, I had vertical maxiliary defficiency, class 2 and plan was 6mm maxiliary downgraft, clockwise rotation and mandibular advancement (7mm). Also, chin was vertically elongated and moved back (3 mm back, 4mm down)
Now, 5 months after I am pleased and thankful my team on tooth show.
However, I am really self consious regaring mandibular projection which has "taken over" my face and I was even bullied due to one. What is your opinion - would some camouflage treatment help - I am consulting dr. Brusco an
Additionally, I am posting frontal pictures and would appreciate your comments.
I have wide palates in contrast to midface (my midface is really unattractive - recessed, I believe both zygomas and orbital rims). I would not be interested and probably would not be able to find a surgeon to perform LF 3 in Europe, so I was wondering whether it is possbile to achieve more facial harmony via:
- zygomatic osteotomy to increase midface width and small anterior movement
- chin wing camouflage to decrease mandibular projection and achieve lip competence (I have seen on web some results were chin wing is actually used in clas 3 to decrease manidbular projection)
For both of these options I am consulting Mr. Zarrinbal and Mr. Brusco. If I will revise something with my original surgeon and I was thinking on genioplasty and small backward movement of both jaws)
Once agan, many thanks - appreciate your comments. If you would like to see CBCT or anything else, please do not hesitate to ask.
-
IF the surgery you got made your BITE RIGHT as in made 'right' where the teeth should meet and be oriented relative to the lips, which sounds to be somewhat the case, it's not for me to opine on moving the jaws again in revision surgery simply because it's not for me to second guess whether or not moving the jaws with the objective of getting a more ideal jaw balance will maintain the SAME bite balance. Since bite balance usually is PRIORITIZED in jaw surgeries, it's not uncommon to have some aesthetic trade offs.
I'm not going to opine either on Lefort 3 or modified L3 or bone cuts to bring forward the midface areas. Nor am I going to opine on whether or not the 'chin wing' doctors will do what you want.
What I will opine on would be a 'camouflage' procedure that does NOT involve moving both jaws and hence does not involve altering the bite. I think shortening the chin in addition to bringing it backwards would make less your protrusion and also make less the struggle with lip incompetence. I would suggest you ask the doctors if an isolated genio where the chin was shortened and brought back somewhat would accommodate the objective of camouflaging the protrusion to the lower jaw and making it easier for you to close your lips (lip incompetence is a 'struggle' when getting the lips to meet.)
Here is a morph of ONLY a possible camo procedure isolated to the chin.
[attachment deleted by admin]
-
Kavan, I am honestly grateful on your reply. Mandibular projection is making me self conscious and I was even having hard time due to bullying.. I have asked my surgeon even before this week's consultations and he has said that moving both jaws back is an option.. I hope that 2mm setback will decrease the protrusion and give me the cute "soft" profile as before.. also, I would wish to reduce the size of the chin.. next consultation with original surgeon are in 3 months time, meanwhile I am seeing other surgeons..tnx
-
Thanks on your comment, Lazlo.
To begin with, I had vertical maxiliary defficiency, class 2 and plan was 6mm maxiliary downgraft, clockwise rotation and mandibular advancement (7mm). Also, chin was vertically elongated and moved back (3 mm back, 4mm down)
Now, 5 months after I am pleased and thankful my team on tooth show.
However, I am really self consious regaring mandibular projection which has "taken over" my face and I was even bullied due to one. What is your opinion - would some camouflage treatment help - I am consulting dr. Brusco an
Additionally, I am posting frontal pictures and would appreciate your comments.
I have wide palates in contrast to midface (my midface is really unattractive - recessed, I believe both zygomas and orbital rims). I would not be interested and probably would not be able to find a surgeon to perform LF 3 in Europe, so I was wondering whether it is possbile to achieve more facial harmony via:
- zygomatic osteotomy to increase midface width and small anterior movement
- chin wing camouflage to decrease mandibular projection and achieve lip competence (I have seen on web some results were chin wing is actually used in clas 3 to decrease manidbular projection)
For both of these options I am consulting Mr. Zarrinbal and Mr. Brusco. If I will revise something with my original surgeon and I was thinking on genioplasty and small backward movement of both jaws)
Once agan, many thanks - appreciate your comments. If you would like to see CBCT or anything else, please do not hesitate to ask.
YOU DO NOT NEED ANY BACKWARD MOVEMENT. ANYONE TEASING YOU IS f**kING JEALOUS OF YOUR STRONG JAWLINE. MOVING THINGS BACK A BIT IS NOT WORTH IT FROM ANY STANDPOINT. I THINK A GOOD ZSO would help balance the face out a bit but do nothing the jaws.
-
YOU DO NOT NEED ANY BACKWARD MOVEMENT. ANYONE TEASING YOU IS f**kING JEALOUS OF YOUR STRONG JAWLINE. MOVING THINGS BACK A BIT IS NOT WORTH IT FROM ANY STANDPOINT. I THINK A GOOD ZSO would help balance the face out a bit but do nothing the jaws.
Wow. Suggesting a ZSO is quite a difference from unsuggesting it on another post. How'ed you change your mind so fast?
Yeah life is totally s**t now.
Honestly, I don't think the ZSO does s**t for cheekbones. Maybe just augments the width a little but I don't know, haven't seen enough results. Every person I know who has looked at Zarrinibal's before and afters says they're s**t. Can't see any difference.
-
Wow. Suggesting a ZSO is quite a difference from unsuggesting it on another post. How'ed you change your mind so fast?
Yes, yes I know. ZSO is not optimal. But for this guy who has great structure everywhere else the framing aspect of it will help. It will help balance his face out. Will it give him perfect cheekbones? Not on your life.
-
The maxilla looks over advanced.
-
YOU DO NOT NEED ANY BACKWARD MOVEMENT. ANYONE TEASING YOU IS f**kING JEALOUS OF YOUR STRONG JAWLINE. MOVING THINGS BACK A BIT IS NOT WORTH IT FROM ANY STANDPOINT. I THINK A GOOD ZSO would help balance the face out a bit but do nothing the jaws.
I have to move my jaws back, I have severe lip incompetence and was bullied due to protruding mouth.. my biggest problem is speech which is so incomprehensible and I have troubles at work. I do not know why but people are smiling when I talk (assume due to protruding mouth and everted lips which make sullen appearance)..apparently, my midface is underdeveloped.. I just want to look normal, I hope that 2mm backward movement could make me less bullied and improve speech.. I assume there is no surgeon who would adress my midface problems, so I just want to have smaller, rounder lower third.. please your comments are helpful
-
Agree with Kavan. Sometimes the plates in the chin themselves bind to the muscles and can cause strain or pulling down of the lip, too, so see if that's what is causing it and possibly just remove the chin plates.
-
Thank you very much. I will be removing the plates but surgeon told me it would be better, if I decide on reoperation, to have everything done during one operation. I have scheduled meeting with him in August, until then I am consulting other surgeons and hope to decide when having more treatment plans. All of you guys have been great support and your advices are very helpful.
Swiss doctor has replied if chin wing is possible after first operation, it could improve my incompetence. I hope he can help me. Also, do you know is there any time limit for revision surgery, i.e. whether is better to perform redo surgery in first 12 months or revision can be undertaken at any point in life (as long as you are healthy). Once again, many thanks.
-
Gunson told me the info above, if that means anything to you. Basically the lower lip can be pulled down by plates, especially with a vertical genio. I think a conservative approach of removing the plates, and if anything surgical, just redoing a more horizontal genio is the best option if your bite is good. Not seeing a needed revision here.
The strange thing is I know one of Gunson's patients very well and she had the plates removed because she was showing too much lower tooth, and it did nothing to help. And she had a horizontal genio. So there must be more to it. Likely impaction and rotation and how they interact.
-
Thanks GJ. I would appreciate if you could reply what do you mean by horizontal genio - is it advancement? I was hoping that chin wing could bring tissue and lowe lip up. Thank you very much.
-
Like Kavan described, a genio that shortens or moves upward and with some forward projection rather than the opposite movements (in theory these could make lip incompetence worse).
-
Please correct me if I am wrong, kavan suggested vertical shortening and I understood backward chin movement as a help in camouflage. I understood you were suggesting vertical reduction as well but with small forward movement (so up and forward). I believe this would be the main intension of the chin wing - bring the issue and lower lip up. Hope it is possible in my case..thank again
-
Please correct me if I am wrong, kavan suggested vertical shortening and I understood backward chin movement as a help in camouflage. I understood you were suggesting vertical reduction as well but with small forward movement (so up and forward). I believe this would be the main intension of the chin wing - bring the issue and lower lip up. Hope it is possible in my case..thank again
My bad, I looked at the photos again, and yes, more upward and reduction.
But honestly, if you remove the plates and it turns out it's the muscles balling up causing lip strain, that might fix things, so I'd try that first. If that doesn't work, try the genio revision. I don't think chin wing is going to help. It probably would make things worse.
You look pretty good overall, but to me your jaws look a bit too large for your overall structure. It's not something I'd notice in day to day life, nor will anyone, but if you post photos on a JSF and ask we'll see it then. Keep that in mind.
-
GJ, thanks, very kind of you. Movements were too big for me and I have hard time dealing with big jaws. Currently, I would revise both jaws slightly back and believe these 2mm can have impact on overall balance and lips. But first will consult with other surgeons and share their treatment plans with you. I read on realself that ir is better to revise genio as soon as possible, don't know what to think. I just wish to have softer, "cuter" lower third
-
GJ, thanks, very kind of you. Movements were too big for me and I have hard time dealing with big jaws. Currently, I would revise both jaws slightly back and believe these 2mm can have impact on overall balance and lips. But first will consult with other surgeons and share their treatment plans with you. I read on realself that ir is better to revise genio as soon as possible, don't know what to think. I just wish to have softer, "cuter" lower third
Yeah, big jaws don't look good on everyone. Only if you're a big guy and you're entire gestalt matches the jaw. Also the forehead's depth determine how far the jaws can go out. If your forehead slopes and is weak a strong jaw tends to look odd and very "anti face". A fine look for a body builder type but not for most males. For an average guy the jaws should just be aligned and balanced with one another and the forehead. I'm not sure surgeons consider all this, even the best surgeons. They tend to have their idea and go with it on everyone.
-
From my perspective, I have NO IDEA if any of my advice has been 'helpful'. That's because I have NO IDEA if you actually understand what the SALIENT problem is in terms of DISPLACEMENT vectors.
Let me first say that it doesn't matter what the surgeons tell you if YOU don't understand what the salient problem is and how it can be addressed. This is especially true if your told different things by different surgeons. If the number of surgeons telling you different things = 'X', you will have a '1/X' chance of choosing the right one if you don't understand what your salient problem is. If you understand what the salient problem is and how it can be addressed, THAT will allow you to ID which surgeon is on target with that.
Midface deficiency is NOT your salient problem. It can be addressed at a LATER time where you can explore the OPTIONS for it.
I will try ONE MORE TIME:
Your SALIENT problem, as I would define it is a BIO-MECHANICAL one. Basically a MECHANICAL problem that can be isolated to your CHIN and the type of genio you got. A DIAGONAL cut was made to the chin bone and your chin slid 'backwards' along that cut. 2 directional vectors; VERTICALLY downwards and HORIZONTALLY backwards. [I assume you have a high school education so that I don't have to explain why a DIAGONAL VECTOR of displacement is a combination of a 'pure' vertical vector and a 'pure' horizontal one.]
Your chin muscle, the ORIGIN of it 'goes along with the ride' hence, it was displaced vertically downward and horizontally backwards when your chin segment in your genio was displaced DIAGONALLY BACKWARDS.
Mechanical EFFICIENCY with regard to using the chin muscles to move the lower lip vertically upward is when the orientation of the muscle is basically aligned with a VERTICAL. It's more mechanically efficient to move your lip VERTICALLY UPWARD when the muscles don't have to strain over a DIAGONALLY upward path that you now have to struggle to move them over. The former is a SHORTER path. The latter is a LONGER path.
The genio you got has displaced the origin of your chin muscles so that they are NO LONGER aligned along a vertical path. The origin of your chin muscles has been displaced vertically downward and horizontally backwards where you now have to strain over a LONG DIAGONAL PATH (instead of a short vertical one) to move your lower lip. This is MECHANICAL INEFFICIENCY.
Who ever did your jaw surgery, elected to give you CLOCKWISE rotation. Maybe that was needed to get the 'bite right'. I don't know. But for BETTER aesthetic results as to OFFSET clockwise rotations of the mandible, one slides the chin upward along the diagonal cut which is a combination of vertically upward to SHORTEN and horizontally forward to project outwards.
DIAGONAL CUT.
Slide 'forward': LIMITED to 2 and only 2 combination displacements which are: vertically upward to decrease length and horizontally forward to increase chin projection.
Slide 'backward': LIMITED to 2 and only 2 combination displacements which are: vertically downward to increase length and horizontally backward to decrease chin projection.
The only option to slide backwards WITHOUT making the chin longer (or to slide backwards and also SHORTEN the chin) is to REMOVE a WEDGE section from the front of the chin so that the base of the chin can be rotated upwards COUNTER clockwise. Presently the area of your chin, where the chin muscle originates is basically diagonally pointing towards the floor. That area needs to be pointing towards the wall so that the chin muscle is on a more mechanically efficient vertical path. A wedge resection from the chin will allow a counter clockwise UPWARD movement to the base of the chin and also a backwards one if that is needed.
Again, you MAY have needed a backwards movement to the chin BUT you DIDN'T need the ELONGATION that came with that. Horizontally backwards and vertical downwards is what is making your lip STRAIN. The only way to move the chin backwards AND ALSO shorten it to reach objective of improving both lip strain AND protrusion of the chin is to remove a wedge section from the front of it.
HINT: The appropriate doctor to make LESS your protrusion at the CHIN and to also make less your lip STRAIN would be the one in the capacity to remove a WEDGE shape section from your chin, to rotate the base of the chin in a counter clockwise direction in order to shorten it in addition to moving it backwards.
If you don't understand why THOSE displacements are important you WON'T be able to choose the appropriate doctor.
-
One thing Sinn did AMAZING is he somehow reattached my lip etc. so that no lower teeth show.
I asked him that I wanted no lower teeth showing when I smile and that's the one thing he delivered on amazingly well.
That and his providing more tooth show at rest and smile was pretty good.
-
From my perspective, I have NO IDEA if any of my advice has been 'helpful'. That's because I have NO IDEA if you actually understand what the SALIENT problem is in terms of DISPLACEMENT vectors.
Let me first say that it doesn't matter what the surgeons tell you if YOU don't understand what the salient problem is and how it can be addressed. This is especially true if your told different things by different surgeons. If the number of surgeons telling you different things = 'X', you will have a '1/X' chance of choosing the right one if you don't understand what your salient problem is. If you understand what the salient problem is and how it can be addressed, THAT will allow you to ID which surgeon is on target with that.
Midface deficiency is NOT your salient problem. It can be addressed at a LATER time where you can explore the OPTIONS for it.
I will try ONE MORE TIME:
Your SALIENT problem, as I would define it is a BIO-MECHANICAL one. Basically a MECHANICAL problem that can be isolated to your CHIN and the type of genio you got. A DIAGONAL cut was made to the chin bone and your chin slid 'backwards' along that cut. 2 directional vectors; VERTICALLY downwards and HORIZONTALLY backwards. [I assume you have a high school education so that I don't have to explain why a DIAGONAL VECTOR of displacement is a combination of a 'pure' vertical vector and a 'pure' horizontal one.]
Your chin muscle, the ORIGIN of it 'goes along with the ride' hence, it was displaced vertically downward and horizontally backwards when your chin segment in your genio was displaced DIAGONALLY BACKWARDS.
Mechanical EFFICIENCY with regard to using the chin muscles to move the lower lip vertically upward is when the orientation of the muscle is basically aligned with a VERTICAL. It's more mechanically efficient to move your lip VERTICALLY UPWARD when the muscles don't have to strain over a DIAGONALLY upward path that you now have to struggle to move them over. The former is a SHORTER path. The latter is a LONGER path.
The genio you got has displaced the origin of your chin muscles so that they are NO LONGER aligned along a vertical path. The origin of your chin muscles has been displaced vertically downward and horizontally backwards where you now have to strain over a LONG DIAGONAL PATH (instead of a short vertical one) to move your lower lip. This is MECHANICAL INEFFICIENCY.
Who ever did your jaw surgery, elected to give you CLOCKWISE rotation. Maybe that was needed to get the 'bite right'. I don't know. But for BETTER aesthetic results as to OFFSET clockwise rotations of the mandible, one slides the chin upward along the diagonal cut which is a combination of vertically upward to SHORTEN and horizontally forward to project outwards.
DIAGONAL CUT.
Slide 'forward': LIMITED to 2 and only 2 combination displacements which are: vertically upward to decrease length and horizontally forward to increase chin projection.
Slide 'backward': LIMITED to 2 and only 2 combination displacements which are: vertically downward to increase length and horizontally backward to decrease chin projection.
The only option to slide backwards WITHOUT making the chin longer (or to slide backwards and also SHORTEN the chin) is to REMOVE a WEDGE section from the front of the chin so that the base of the chin can be rotated upwards COUNTER clockwise. Presently the area of your chin, where the chin muscle originates is basically diagonally pointing towards the floor. That area needs to be pointing towards the wall so that the chin muscle is on a more mechanically efficient vertical path. A wedge resection from the chin will allow a counter clockwise UPWARD movement to the base of the chin and also a backwards one if that is needed.
Again, you MAY have needed a backwards movement to the chin BUT you DIDN'T need the ELONGATION that came with that. Horizontally backwards and vertical downwards is what is making your lip STRAIN. The only way to move the chin backwards AND ALSO shorten it to reach objective of improving both lip strain AND protrusion of the chin is to remove a wedge section from the front of it.
HINT: The appropriate doctor to make LESS your protrusion at the CHIN and to also make less your lip STRAIN would be the one in the capacity to remove a WEDGE shape section from your chin, to rotate the base of the chin in a counter clockwise direction in order to shorten it in addition to moving it backwards.
If you don't understand why THOSE displacements are important you WON'T be able to choose the appropriate doctor.
Kavan, thank you very much. Honestly.
-
You have made it very clear to me.. besides genio, I will ask for small backward movement of both jaws
... What about counterclockwise rotation in my case?
-
You have made it very clear to me.. besides genio, I will ask for small backward movement of both jaws
... What about counterclockwise rotation in my case?
My long post was about counterclockwise of the CHIN via wedge resection. I've given you enough info to isolate what IMO is the salient problem.
-
Thanks, I apologise.
-
You have made it very clear to me.. besides genio, I will ask for small backward movement of both jaws
... What about counterclockwise rotation in my case?
Instead of asking ME for clarity or explanation on something I did NOT isolate as the salient issue, what about YOU write an explanatory post to demonstrate YOU understand the mechanical principles involved in YOUR double jaw revision proposal.
Basically, if your proposal is to UNDO something, you need to demonstrate what 'should have' been done in the first place and why. Use the concepts of directional vector displacements and rotations that justify UNDOING both jaws to do something else to them.
Avoid subjective material such as: 'I'm bullied', 'I'm too protrusive'. Instead, use the concepts of directional vector displacements and directional rotations that justify UNDOING both jaws to do something else to them.
Here is your HOMEWORK assignment:
Use your BEFORE photos and cephs in your explanation as to WHY:
a: Your upper jaw should have been counter clockwise rotated (CCW). Incorporate the OBJECTIVE of the original surgery aimed at MORE tooth show and getting the bite rite. That is to say, give a good explanation (in terms of directional displacements) WHY CCW would have been the preferable rotation to meet the objective of more tooth show and 'right bite'.
b: Both jaws were over advanced by a distance of 2mm (your request to push backwards by that specific distance.)
In essence, be able to SUBSTANTIATE that you understand what you will be requesting the surgeon to do in your proposal to UNDO the original surgery with explanation as to HOW that would work.
For EXTRA CREDIT, explain the displacements made via a 'chin wing' that would apply to the particular displacements that would be of benefit to you specifically.
-
Thanks.
To begin with, besides jaw (bite) issues I have learnt that I have midface deformity which was not explained to me. Hope with your and other members help, maybe in 5-10 years I could try solve it.
I am almost certain that frontal pictures looked better before - it seems that vertically short (but wide) maxilla was playing the role of zygomas, making impression of wide and square face. At rest it worked, however tooth show was minimal. My occlusal plane was oriented up above horizontal line of 0° Also, retruded mandible "blend in" on somewhat retrussive and short profile.
As for the treatment plan, I am very happy with the tooth show, however, profile is to protrusive in my opinion due to too much maxiliary clockwise rotation which was then accomodated with more mandibular advancement than initially needed. Also, plan included vertically elongation (and backward movement) of the chin
to compensate mentolabial relationship after 6mm bone graft was placed in maxilla. After seeing video one lecture from Mr. Triaca, it seems that only chin wing gives good lip competence for chin reduction (of cource if properly done).
So my thaughts: backward movement of both jaws (and I will definitely ask dr. Z. and B. on reducing tooth size since upper lip is incompetent too - don't know whether small maxiliary backward movement will lengthen upper lip) and vertical shortening of the chin will help lip incompetence. Other possibility, if still feasible, chin wing to decrease visible border of mandible (like in class 3) and bring up tissue around lower lip.
All this could improve profile, but due to short sella nasion line I will still be below average. But hope that lips will have their own function again.. I will post before pictures tommorrow. Thanks in advance.
-
Thanks.
To begin with, besides jaw (bite) issues I have learnt that I have midface deformity which was not explained to me. Hope with your and other members help, maybe in 5-10 years I could try solve it.
I am almost certain that frontal pictures looked better before - it seems that vertically short (but wide) maxilla was playing the role of zygomas, making impression of wide and square face. At rest it worked, however tooth show was minimal. My occlusal plane was oriented up above horizontal line of 0° Also, retruded mandible "blend in" on somewhat retrussive and short profile.
As for the treatment plan, I am very happy with the tooth show, however, profile is to protrusive in my opinion due to too much maxiliary clockwise rotation which was then accomodated with more mandibular advancement than initially needed. Also, plan included vertically elongation (and backward movement) of the chin
to compensate mentolabial relationship after 6mm bone graft was placed in maxilla. After seeing video one lecture from Mr. Triaca, it seems that only chin wing gives good lip competence for chin reduction (of cource if properly done).
So my thaughts: backward movement of both jaws (and I will definitely ask dr. Z. and B. on reducing tooth size since upper lip is incompetent too - don't know whether small maxiliary backward movement will lengthen upper lip) and vertical shortening of the chin will help lip incompetence. Other possibility, if still feasible, chin wing to decrease visible border of mandible (like in class 3) and bring up tissue around lower lip.
All this could improve profile, but due to short sella nasion line I will still be below average. But hope that lips will have their own function again.. I will post before pictures tommorrow. Thanks in advance.
C- on the HOMEWORK assignment. You did not use photos of cephs and before to explain your surgical proposal.
-
I apologise, will upload tommorrow with superimposition.. my incisors are 10mm long, is it too much, especially if your midface is so underdeveloped?
-
I apologise, will upload tommorrow with superimposition.. my incisors are 10mm long, is it too much, especially if your midface is so underdeveloped?
i told you to put midface issues on back burner for LATER time.
-
I apologise in advance, this is superimposition of my first surgery.. I think that too much clockwise rotation was performed, also, chin is vertically too big.. Protrussive profile is, I believe, due to midface deformity (SNA & SNB > 90, short anterior cranial length).. tomorrow I am consulting one austrian surgeon.. also I have started communication with one Italian surgeon on distraction osteogenosis and LeFort 3 and he promised to reply after he analyzes CBCT.. I believe that my speech problems and facial expressions can't be solved without LeFort 3 osteotomy.. however, even if I find a surgeon to perform it, I think I would rather go and revise my first surgery - counterclockwise rotation, less teeth visible, genioplasty up.. I would appreciate your comments
-
OK. Looks like you have some 'beliefs' where you think you got too much clockwise rotation and your protrusive profile is due to midface deformity and you 'need' LeFort3. Since those are not 'beliefs' I have, YOU will need to be the one to validate that your 'beliefs' result in the right decision.
Sorry, but your entry does not do what I asked. Beliefs don't demonstrate an understanding with regard to what you would be asking a surgeon to do for you.
I've given you my take on the salient problem associated with the look of protrusion and it's isolated to the CHIN. In fact, the most obvious change in your overlay is the CHIN.
Best of luck with your beliefs with regard to their working out in terms what ever surgery you choose based on them.
-
Kavan, I apologise.. main reason why I wanted ro get surgery is to improve my speech.. my speech did not improve at all, even got worse due to lip incompetence.. I appreciate Your comments and will definitely ask surgeons for their treatment plan, not suggesting my since I am newbie and do not have any knowledge.. I am drivibg to Austria and will keep posting.. tnx
-
Kavan, I apologise.. main reason why I wanted ro get surgery is to improve my speech.. my speech did not improve at all, even got worse due to lip incompetence.. I appreciate Your comments and will definitely ask surgeons for their treatment plan, not suggesting my since I am newbie and do not have any knowledge.. I am drivibg to Austria and will keep posting.. tnx
Well, I have NO IDEA how L3 or any of the other things you 'believe' you need which you mention for aesthetic reasons is going to improve your speech. Nor did you mention the initial surgery was to improve your speech. As to lip incompetence, it's usually associated with chin imbalance.
-
Hi, regarding speech I was reffering to fact that while I speak, I tend to look like I smile, to be more precise, often I notice smile on my counterparty's face, althought nothing is funny to me - just want to be serious at work and not having problems at presentations.. regarding LeFort 3, I would appreciate if you could look attached picture - my main concern are emotions, I am often described as angry and unfriendly countenance, although I am nice person and would just want to show my emotions more naturally.. what is your opinion on my midface?
Thank you very much on help.
-
As for today's consultations with austrian surgeon - I have mixed impressions.. his plan is CLOCKWISE rotation of maxillomandibular complex and he specifically said that my chin can't go up after first surgery.. I am being honest.. he sees assimetry as my main problem and would solve my concern regarind protrusive profile with clockwise rotation..
I said that I have mixed impressions, because I am very unsure about his plan for me, while on the other hand I saw 2 LeFort 3 osteotomies he performed and they were so natural.. he said that he performed > 25 of them
I would just like to look more cute, so smaller chin, less mandibular projection and more midface.. thanks on comments
-
Hi, regarding speech I was reffering to fact that while I speak, I tend to look like I smile, to be more precise, often I notice smile on my counterparty's face, althought nothing is funny to me - just want to be serious at work and not having problems at presentations.. regarding LeFort 3, I would appreciate if you could look attached picture - my main concern are emotions, I am often described as angry and unfriendly countenance, although I am nice person and would just want to show my emotions more naturally.. what is your opinion on my midface?
Thank you very much on help.
Please, I would appreciate Your comments.. thanks
-
Your comments are self contradictory. You relay you look like you smile when you speak but in the same paragraph also relay you are often described as having an angry and unfriendly looking countenence.
That's my comment on your comment and I'm passing the torch here to OTHERS who can make heads or tails concerning your 'beliefs' of what you should do. So use the information I've given you already, try to process it so you can relate the advice to what doctors are telling you. Because nothing in your 'speech' on HERE gives me any indication you processed the info I already gave you.
-
When my mouth is closed, I have angry, depressed look, I would say it is associated to midface problems. However, when I start talking I often see that my counterparty is not looking me into eyes, or even face :(
-
When my mouth is closed, I have angry, depressed look, I would say it is associated to midface problems. However, when I start talking I often see that my counterparty is not looking me into eyes, or even face :(
OK, so what you have as you describe it is beyond what I can help with.
-
Tnx kavan on all your comments. I know it sounds strange, but if You look at my last photo, there is something wrong with my facial expressions, at least they are somewhat different from other people.
You are absolutely wright, I should concentate on lower third problems, i.e. lip incompetence.
I am seeing dr. Z. on Tuesday, I hope that genioplasty can be revised. I read that is better to revise it as soon as possible. Do you know whether it is true, is there any explanation behind?
Yet, I would be interested in small backward movement of jaws since I have really hard time dealing with it. Thanks.
-
I'm sorry. Communication is not working out here. I'm unable to solve your problems based on your communication as to what they are. We've already gone through 4 pages only to find on page 4 you got the initial surgery for some 'speech problems' and later to find these 'speech problems' are how people look at you when you speak. I also can't validate what your 'beliefs' are as to Lefort 3 being the solution to these 'speech' problems
If you recall, I already asked you to put your BEFORE photos and cephs up and with explanation as to the MECHANICAL reasoning that would SUBSTANTIATE your beliefs/assessments that you 'needed' CCW and 2mm set back which you felt was the solution to your problem. What I was looking for was some demonstration of some understanding on your part. I found NO demonstration on your part. Nor did I find you even PROCESSED the request to show BEFORE and after cephs/photos as was requested. What I found was your 'beliefs' with added TOSS IN of Lefort 3. I can't validate each of your beliefs in the way you present them where it pans out during the course of the posts, your problems are a MOVING TARGET.
Then come the entries of: Such and such a surgeon told you this or that along with your beliefs where I CAN'T evaluate EACH AND EVERY doctor's assessments against a back drop of your stated objective to solve these 'speech' problems.
So. NO. I won't be addressing each further moving target twist and turn you bring in when the pattern here is that each time I address one of your questions, a new moving twist and turn is brought in.
Again, the WAY you present your problem here is BEYOND my capacity to help with.
If you need explanation as to how going forward with any of your beliefs as they apply to surgical displacements of any to many parts of the face with the objective of however YOU define your 'speech problem' or 'expression issue', you need to cross reference all of those many things with the DOCTORS you consult with.
Sorry, I'm getting frustrated here and need to pass the torch to OTHERS who might be able to help.
-
I apologise, after I come from work will post before pictures. I do not have exact lateral ceph before surgery at home, but will ask orrho to pass me. I only have CBCT before surgery at home. Sorry, once again
-
I apologise, after I come from work will post before pictures. I do not have exact lateral ceph before surgery at home, but will ask orrho to pass me. I only have CBCT before surgery at home. Sorry, once again
It's TOO LATE. I already gave up on this thread. You certainly can show them if you like. But a request from me to do so prior, followed by your not doing so in a timely manner must not be construed as an implied promise from me to continue on with this thread. I'm still passing the torch for OTHERS to participate here. Time to continue on with this thread given the communication problem her EXCEEDS my capacity to give it.
-
To begin with, I apologise for communication without arguments. Still my knowledge is very much limited and have to learn a lot. I would just use the opportunity to say high words about dr. Z. He certainly very much cares about his patients, excellent doctor.
He suggested removing screws and plates from jaws and chin before adressing possible revision in future. I would say that he thinks that my surgeon has overcorrected me and conventional genioplasty going back is not the best option. I would appreciate whether someone on the forum has the experience of how much swelling will be present after removing the hardware and would I be able to travel from Berlin to Croatia in 2 days time. Thanks in advance
-
I think he meant the type of genioplasty that reduces your chin's height. Not one that goes back.
-
https://youtu.be/0XlsOlSmYDk
20:37 specifically said that going back is the hardest to achieve with genioplasty.. in my case vertical lengthening only made lip incompetence worse
-
No, no. I'm pretty sure Kavan is saying you should look into a genio that vertically shortens your chin because the vertical lengthening you got is likely contributing to your lip issues. I think this is what he's talking about. So by moving it in the direction of the arrow they would be reducing the height. Or that's how I understand it anyways. Not sure if that's what you understood from what Kavan was saying to you.
https://imgur.com/4qoH8OZ (https://imgur.com/4qoH8OZ)
(https://imgur.com/4qoH8OZ)
-
No, no. I'm pretty sure Kavan is saying you should look into a genio that vertically shortens your chin because the vertical lengthening you got is likely contributing to your lip issues. I think this is what he's talking about. So by moving it in the direction of the arrow they would be reducing the height. Or that's how I understand it anyways. Not sure if that's what you understood from what Kavan was saying to you.
https://imgur.com/4qoH8OZ (https://imgur.com/4qoH8OZ)
(https://imgur.com/4qoH8OZ)
Yes. That's basically what I was saying. I also said this:
[HINT: The appropriate doctor to make LESS your protrusion at the CHIN and to also make less your lip STRAIN would be the one in the capacity to remove a WEDGE shape section from your chin, to rotate the base of the chin in a counter clockwise direction in order to shorten it in addition to moving it backwards.
If you don't understand why THOSE displacements are important you WON'T be able to choose the appropriate doctor.]
Then I GAVE UP on him because after 5 pages I didn't feel he was processing information/communication.
-
Thanks guys, I really appreciate your help.. I understand that to improve my lip incompetence I need vertical reduction of the chin.. I am just saying that in my case chin was brought back and down and in video from dr. Triaca it is said that conventional genioplasty going back is not possible (or at least not good for lips and estetics).. dr. Z. explained it is the hardest move
still my jaws are too big for the small midface that I have and I had a lot of unpleasant situations and hard time.. in long term, I am thinking on revising whole surgery (less teeth show, vertically smaller chin, jaws slighlty back).. still waiting for lateral view before surgery, I will post before pictures.. it is face that I really liked, apart from smile, but at reast it worked.. my jaw width is > 35mm.. thank you very much
-
I would appreciate if anyone on the board had experience with removing screws and plates.. how long does swelling last approximately? Also, if anyone tried to contact professor Obwegesser, how long does it take to receive a reply? I have used this mail.. thanks in advance
mkg-zuerich@hin.ch
-
I would appreciate if anyone on the board had experience with removing screws and plates.. how long does swelling last approximately? Also, if anyone tried to contact professor Obwegesser, how long does it take to receive a reply? I have used this mail.. thanks in advance
mkg-zuerich@hin.ch
Is there more than one Dr. Obwegesser? One died last year and was probably the OG surgeon.
-
Is there more than one Dr. Obwegesser? One died last year and was probably the OG surgeon.
Good find. Yes. It was the OG (and lefort3) surgeon.
[Hugo Obwegeser (21 October 1920 – 2 September 2017) was an Austrian Oral Surgeon and Plastic Surgeon who is known as the father of the modern orthognathic surgery. In his publication of 1970, he was the first surgeon to describe the simultaneous procedure which involved surgeries of both Maxilla and Mandible involving Le Fort I and Bilateral Sagittal Split Osteotomy technique.]
-
Thanks, I have tried to contact professor Joachim Obwegesser, dr. Sinn and few surgeons in Italy for opinion on midface problems before deciding on revision jaw surgery..thanks
-
I would appreciate if anyone on the board had experience with removing screws and plates.. how long does swelling last approximately?
LyraM45 has had it: http://www.confessionsofametalmouth.com/plate-removal-surgery.html
"1 month post plate removal! I still have a little bit of puff. Bruising was gone about 2 weeks ago."
Also found this:
Screw and Plate Removal Surgery
Part 1: https://doublejawsurgery.wordpress.com/2013/03/05/screw-and-plate-removal-surgery/
Part 2: https://doublejawsurgery.wordpress.com/2013/03/05/titanium-plates-and-screws-continued/
Recovery from Plate & Screw Removal
Part 1: https://doublejawsurgery.wordpress.com/2013/03/07/recovery-from-plate-screw-removal/
Part 2: https://doublejawsurgery.wordpress.com/2013/03/12/recovery-after-titanium-plate-and-screw-removal-surgery/
"Me 10 weeks post operation still having swelling on and off"
"Me 4 months post plate removal.... swelling nearly gone..... at last!"
Anyone know how much this usually runs if paid privately? Is there any risk of permanent numbness?
-
Thanks so much... up to 4 months?? I am so sad that they can't be removed during revision surgery
-
Thanks so much... up to 4 months?? I am so sad that they can't be removed during revision surgery
Brachy, every surgeon I've asked says they remove the hardware during revision. Have any surgeons told you differently?
Thank you very much. I will be removing the plates but surgeon told me it would be better, if I decide on reoperation, to have everything done during one operation. I have scheduled meeting with him in August, until then I am consulting other surgeons and hope to decide when having more treatment plans. All of you guys have been great support and your advices are very helpful.
I apologize if I missed it, but who was your surgeon?
-
Local croatian oral surgeon.. I have consulted another doc and he suggested removing screws and plates 6-7 months after surgery, while revision should take place 12 months after surgery.. should I ask him again on doing both things at the same time.. what is your opinion.. thank you very much
-
Guys, I would appreciate if You could take a look at my
-
Guys, I would appreciate if You could take a look at my cephalometrics from last week.. appreciate Your comments, thanks in advance
[attachment deleted by admin]
-
The ceph is just a TRACING of your profile and dental/jaw relationships to the cranial base. It isn't a displacement analysis where any displacement proposals are shown overlayed to the tracing.
The analysis of the ceph tracing give the measurements and angles along with the standard deviations and how much you deviate from the norm. 1* asterisk is one standard deviation, 2** and 3** asterisks are two and three deviations respectively.
It reveals that although your S-N line DISTANCE, which is the anterior cranial base, is within the NORM, the ceph tracing SHOWS that your S-N LINE is parallel to the HORIZONT. Although it might not give the norm angle the S-N line is inclined away from the horizont, (or it's in a language I can't read the whole thing), 'normal' SNA, SNB and ANB measures USUALLY are in reference to the S-N line being angled about 7 degrees or more away from the horizont. I don't know the exact cut off point for the range of angled away from the horizont to be 'norm'. But I don't think being flush with the horizont is normative. (But pursue that question further with the maxfax who sees LOTS of ranges and can give you insight into norms for the range of how the normative S-N lines are angled AWAY from a pure horizont).
The S-N line being basically a 'pure HORIZONT' and it ALSO being the measure and angle inclination of the CRANIAL BASE from which other measures are RELATIVE TO is what is kicking up a number of DEVIATIONS from the norm to your measures. For example your SNA and SNB angles are NOT normative (3 standard deviations= 3 * asterisks) BECAUSE the horizontal S-N line is what is INCREASING the angle measures from the norm. Basically IF the S-N line were 'SLOPED' (positive slope line) AWAY from the pure horizont, both the SNA AND SNB angles woud DECREASE more towards the norm. (Just basic geometry concept). So, you will find other deviations with distance or angle measures that have S-N in them.
It MUST be NOTED that the S-N line, it's DISTANCE and it's angle INCLINATION away from a horizont CAN NOT BE CHANGED. It is CONSTANT. It is the line that a lot of maxfax measurements are related to when you consider that maxfax surgery and displacements they do is going to be RELATIVE to the anterior CRANIAL BASE which is what that S-N line is. So, one has to be AWARE of that before they start thinking; 'Oh, my SNA and SNB angles are "too protrusive" and therefore I need both my jaws pushed backwards.' The HIGH SNA AND SNB angles arise from the S-N line being flush with a PURE horizont which DIFFERS from when the 'A' and 'B' points of those angles are 'too protrusive'. So, it's MORE about the S-N line being HORIZONTAL than it is about the A and B points being 'too protrusive' or absolutely 'needing' both jaws to be pushed backwards.
Now the ANB angle (SNA-SNB=ANB) you have is normative for Class 1 skeletal pattern from the surgery. The ANB (and also the S-N line) is used in STEINER analysis. He didn't use the 'Frankfurt plane' because there was a point in there that was HARD TO SEE on a lot of X rays. Incidentally, your Frankfort line or plane is NOT horizontal (dashed angled line you see cutting through the nose on your ceph).
In situations where someone has Class1 skeletal pattern according to STEINER analysis and or when the SNA and SNB angles are still 'off' from the norm, it's cross referenced with the WITS. Here the WITS tells you there is Class 3 skeletal pattern. The Wits is done by drawing a line through the occusial plane. Then lines from BOTH the 'A' and 'B' points are drawn TO the OP so that the lines; 'AO' and 'BO' are PERPENDICULAR to the OP which I have APPROXIMATED on your ceph tracing in RED. When line 'BO' is anterior to (ahead of) line 'AO', which is the case with YOU, the WITS reveals a Class 3 skeletal pattern. That is WHY the (Steiner) ANB angle you have is associated with the Class 1 skeletal on your SUMMARY ANALYSIS but the WITS says Class 3 skeletal.
The SUMMARY ANALYSIS also says you are BRACHY (cephalic), hence, I guess your selected screen name where you probably know you are brachiocephalic which means you have a high ratio of WIDTH to head vs LENGTH of the entire cranial base (anterior to posterior). This is OFTEN associated with a 'SHORT' lower 1/3rd of the face or 'short chin'. A lot of ethnic groups in Eastern Europe are brachiocephalic and not doliocephalic. So having a shorter lower 1/3rd of the face can be considered normative for many groups of people such that they don't have the 'equal 1/3rds'. So 'Facial Pattern: Brachy-facial' on your chart could just be an assessment that you are brachiocephalic (skull measures) and have facial pattern associated with that. It could also reveal (I'm guessing here) that you started off with SHORT lower 1/3rd (or short chin) and PERHAPS you wanted an INCREASE in that dimension and perhaps the doctor felt the surgery justified if he found also that your UPPER JAW was also short (lack of upper teeth show). Your ceph certainly shows (and also your initial statement) your upper jaw was dropped down (made longer). Also that CLOCKWISE rotation was used in ADDITION to making the CHIN longer which would be the case of someone wanting a LONGER lower 1/3rd and/or chin who wanted to look LESS brachy-facial.
-
Dear Kavan,
thank You very much. I appreciate Your comments on sella-nasion inclination and its impact on overall analysis..
-
Dear Kavan,
thank You very much. I appreciate Your comments on sella-nasion inclination and its impact on overall analysis..
Thanx for the thanx. Another way to thank is to give an upvote for a post which means to hit the 'applaud' option below a person's screen name. That is what gives me the right feedback as to whether or not a post was helpful.
-
I have consulted dr. Z and dr. B. and I can say only high words about them.. they care very much about their patients, are pleasant to talk and discuss all the issues.. since I bite only on two teeth and am very unhappy with my face, I have decided to revise my first surgery to:
Fix maxilla and mandibula asymmetry
Counterclockwise rotation of the occlusal plane
Small backward setback to reduce protrusive profile
Genioplasty revision to solve lip incompetence
In general, I feel like I was overcorrected and liked my face before. My jaws are so big and wide for the small face I have.. I hope that some "middle" solution could work for me.. thanks in advance
-
I have consulted dr. Z and dr. B. and I can say only high words about them.. they care very much about their patients, are pleasant to talk and discuss all the issues.. since I bite only on two teeth and am very unhappy with my face, I have decided to revise my first surgery to:
Fix maxilla and mandibula asymmetry
Counterclockwise rotation of the occlusal plane
Small backward setback to reduce protrusive profile
Genioplasty revision to solve lip incompetence
In general, I feel like I was overcorrected and liked my face before. My jaws are so big and wide for the small face I have.. I hope that some "middle" solution could work for me.. thanks in advance
Please spell out the names.
-
I have consulted dr. Brusco, dr. Zarrinbal, dr. Iannetti, dr. Malek
-
I have consulted dr. Z and dr. B. and I can say only high words about them.. they care very much about their patients, are pleasant to talk and discuss all the issues.. since I bite only on two teeth and am very unhappy with my face, I have decided to revise my first surgery to:
Fix maxilla and mandibula asymmetry
Counterclockwise rotation of the occlusal plane
Small backward setback to reduce protrusive profile
Genioplasty revision to solve lip incompetence
In general, I feel like I was overcorrected and liked my face before. My jaws are so big and wide for the small face I have.. I hope that some "middle" solution could work for me.. thanks in advance
OK. Sounds like Dr. Z and B are nice guys. Now, let's RELATE your EXTRAPOLATION/conclusion of what you have decided to do to THEIR suggestions for you:
[Fix maxilla and mandibular asymmetry
Counterclockwise rotation of the occlusal plane
Small backward setback to reduce protrusive profile
Genioplasty revision to solve lip incompetence]
Here, I'm wanting to know if both Dr. Z and B AGREE with YOUR conclusion that you need the first 3 things listed on your 'to do list'.
The first 3 things on your 'to do' list appear to OVERLAP with what your FIRST surgeon (who you say did not give you the right surgery in the first place; "Unfortunately, plan was not correct" which you said in your opening post) wants to do.
Is that correct? Are the first 3 things on your list ALSO the things your FIRST surgeon wants to do for you?
Next question:
Are those ALSO the SAME 3 things both Dr. B and Dr. Z who are 'chin wing' docs (but of course also do max fax) want to do for you? Both of those doctors also want to give you more COUNTER clockwise rotation and move both your jaws backwards????
In particular, please relay what BOTH Dr. B and Dr. Z suggested to you. Their both being 'nice guys' tells me NOTHING about HOW what they suggested to you RELATES to your conclusion that you need the first 3 things you listed.
So:
1: Do both Z and B AGREE you need to do what your FIRST doctor is willing to do for you?
2: Are they willing to do that FOR you in ADDITION to revising your chin OR do they want you to get that done by the first doctor before they revise the chin for you?
Just answer the questions. No other self assessments of what you think you need to do.
What I'm trying to establish here is whether or not both Dr. Z and B ALSO AGREE with the first 3 things that YOU think you need to do which are same things your FIRST surgeon has agreed to do for you.
ETA: I'm a bit confused. Does your original doctor want to do clockwise rotation (more of it with his double jaw set back) or counterclockwise with his double jaw set back?
-
Here, I'm wanting to know if both Dr. Z and B AGREE with YOUR conclusion that you need the first 3 things listed on your 'to do list'.
[I have significant asymmetry and my teeth do not meet properly. All 3 doctors agree it can't be fixed with elastics. Maxilla is very much rotated to the right and even chin is asymmetric. As for the protrusivness, both dr. Z. and dr. B. are of opinion that I was overcorrected and my occlusal plane is to steep. So too much teeth show, too much clockwise rotation. ]
Is that correct? Are the first 3 things on your list ALSO the things your FIRST surgeon wants to do for you?
[From the last visit, I would say yes. I am seeing doc on Wednesday again.]
Are those ALSO the SAME 3 things both Dr. B and Dr. Z who are 'chin wing' docs (but of course also do max fax) want to do for you? Both of those doctors also want to give you more COUNTER clockwise rotation and move both your jaws backwards?
[Jaw setback would be minimal 1-2mm, but too much teeth show and clockwise rotation is common opinion.]
1: Do both Z and B AGREE you need to do what your FIRST doctor is willing to do for you?
[In general yes, all 3 doctors say I was overcorrected. ]
2: Are they willing to do that FOR you in ADDITION to revising your chin OR do they want you to get that done by the first doctor before they revise the chin for you?
[They both told me I need ortodontic preparation for revision surgery, especially dr. B. was unhappy about my teeth preparation. As of today, I do not have formal document (letter), but they were positive
about the surgery (in approximately next 6-9 months, not before)]
Last question - counterclockwise
-
If several surgeons have suggested similar plans, this is probably reasonable.
Hi, I had undergone double jaw surgery and genioplasty 4 months ago.. I had maxiliary downgrafting, clockwise rotation and mandible brought forward to correct class 2 bite.. Unfortunately, plan was not correct and I would appreciate your help what needs/can be done to correct:
- lip incompetence - I can't close my lips without straining, it so much affects my speech
- protrusive profile - perhaps slight backward movement of both jaws (I have very high SNA/SNB values)
Jaw setback would be minimal 1-2mm, but too much teeth show and clockwise rotation is common opinion.
There is some unpredictability/variabilty to the soft-tissue response, but I have been told that 1 mm bony movement presents as 0.5 mm at the soft-tissue level.
Did your first surgeon give you a copy of the plan prior to surgery? Were you shown the soft-tissue simulation? If so, how does this compare with how you look now?
Do you have any numbness?
-
I appreciate your comment. I wish I had never undergone jaw surgery process and would wish to come back to my old situation (no teeth show, short face). I hate my big, protrusive jaws and even consider going back to the old situation.
However, surgeons would probably consider "middle" version as solution. I have very much regreted the operation and the worst thing is that I often notice smile on people's faces while I talk.
I have been shown simulation prior to surgery, but then again it is not realistic I would say. I know approximate movements (like do not know the amount of clockwise rotation), but will ask on Wednesday.
Numbmess is present, I would say chin area 50%, lower lip 10%. Upper lip - no problem. 6 months post op. I have noticed much more muscular tention after increasing lower third.
Please do not hesitate to ask in case of further questions.
-
Who was your surgeon?
-
Local croatian oral surgeon, why do You ask?
-
Guys, what if theoretically I found a surgeon who is willing to perform LeFort 3, would it be a better solution than making lower third less protrusive.
Also, I have read on one of posts that S-N line can't be increased - is it the case if monobloc is performed?
Thank you very much
-
I appreciate your comment. I wish I had never undergone jaw surgery process and would wish to come back to my old situation (no teeth show, short face). I hate my big, protrusive jaws and even consider going back to the old situation.
However, surgeons would probably consider "middle" version as solution. I have very much regreted the operation and the worst thing is that I often notice smile on people's faces while I talk.
Brachy,
How many mm were you advanced? Surely you could be set back the same, if you didn't have apnea before?
I'm sorry this has happened to you; I actually feel similarly about my surgery :'(
-
Guys, what if theoretically I found a surgeon who is willing to perform LeFort 3, would it be a better solution than making lower third less protrusive.
Also, I have read on one of posts that S-N line can't be increased - is it the case if monobloc is performed?
Thank you very much
If you are unhappy with your jaw surgery, getting a risky operation like LF3 to match it doesn't sound like a very logical approach. If you're unhappy with your jaw surgery, you should get a revision. It looks as though you got too much linear advancement when you should've gotten CCW. You need a setback with CCW because your OP is still too steep.
-
Brachy,
How many mm were you advanced? Surely you could be set back the same, if you didn't have apnea before?
I'm sorry this has happened to you; I actually feel similarly about my surgery :'(
Thanks on the comment - lower jaw was advanced 7mm, upper 1 but was downgrafted 5mm.. a lot of clockwise rotation has been performed.. i will most probably revise cca 50% of the movement, i.e. jaws setback, counterclockwise rotation of the occlusal plane, decrease in anterior face height (chin counterclockwise)
-
If you are unhappy with your jaw surgery, getting a risky operation like LF3 to match it doesn't sound like a very logical approach. If you're unhappy with your jaw surgery, you should get a revision. It looks as though you got too much linear advancement when you should've gotten CCW. You need a setback with CCW because your OP is still too steep.
Thank you very much on the comment, yes most probably I will revise jaw surgery and go back to prior situation, i.e. less teeth show, counterclockwise rotation of the occlusal plane, jaws setback..
-
What questions should I ask craniofacial surgeon?
How many LF3 surgeries performed, results b/a, complications, range of possible advancements, type of incision, vision damage
-
What questions should I ask craniofacial surgeon?
How many LF3 surgeries performed, results b/a, complications, range of possible advancements, type of incision, vision damage
Ask him how easy it is to revise IF you don't like it.
-
If you are unhappy with your jaw surgery, getting a risky operation like LF3 to match it doesn't sound like a very logical approach. If you're unhappy with your jaw surgery, you should get a revision. It looks as though you got too much linear advancement when you should've gotten CCW. You need a setback with CCW because your OP is still too steep.
BINGO!
-
Ask him how easy it is to revise IF you don't like it.
How easy to revise LF3 or jaw surgery?
-
How easy to revise LF3 or jaw surgery?
Yes. That's exactly the question you need to ask what ever surgeon you ask for a LF3; 'How easy it is to revise IF I DON'T LIKE IT?' You could also ask which ever surgeon you plan on doing your REVISION surgery how easy is that to revise again IF YOU DON'T LIKE IT.
Repeat after me: 'Doctor, how easy it is the surgery I am requesting from you to be revised IF I DON'T LIKE IT?'
-
Thanks Kavan, I will most probably revise jaw surgery.. however, I have few surgeons to consult on LF3 before making final decision. I will post more information after next week's consultation
-
AFAIK LF3 is not revisable.
-
Repeat after me: 'Doctor, how easy it is the surgery I am requesting from you to be revised IF I DON'T LIKE IT?'
If I were a surgeon and got a question like that, I would think twice about even offering to perform the surgery. Doing a LF3 on a patient that is not even sure he wants it, doesnt need it for functional reasons, and already is talking about revision is a setup to get an unhappy patient. Patient should also understand that it would be a logical approach to wait with the decission then.
-
This guy doesn't need a LF3. Getting a revision jaw surgery with a reputable surgeon is way easier and safer. Why does everyone suddenly think they need a LF3? Have you actually seen what LF3 patients look like?
-
If I were a surgeon and got a question like that, I would think twice about even offering to perform the surgery. Doing a LF3 on a patient that is not even sure he wants it, doesnt need it for functional reasons, and already is talking about revision is a setup to get an unhappy patient. Patient should also understand that it would be a logical approach to wait with the decission then.
Yes. BINGO!
He needs to DISCLOSE to the doctors he's consulting about L3 that he has a HISTORY of asking for things he does not/did not fully understand ramifications of request and NOT LIKING the result. Hence, he SHOULD NOT implicitly assume he will like the RESULT of the surgery he requests to be done which is WHY he needs to ask the doctor; 'What if I don't like the result, can it be reversed if I don't like it.'
My impression of the OP is that he might not understand what he is asking for and why or just has a hard time processing information. I've already told him in this (long) thread not to toss in L3 with the myriad of possibilities he is juggling and struggling with because it is something to put on BACK BURNER and something people consider AFTER their jaw to jaw situation is already in BALANCE. Not to mention, there is also the option of 'mimicking' a (modified) L3 with face implants. Not to belabor that particular option BUT the SALIENT point (at least the one I, myself have tried to stress to him) is NOT TO EVEN THINK about L3 at this point in time.
If you 'read between the lines', he's asking OTHERS to THINK ABOUT this FOR HIM. Also, if you read some of my earlier responses to him where I became frustrated when it did not appear to me that he was PROCESSING INFORMATION, my concern is that he's just asking for stuff in the absence of understanding the ramifications of what he is asking for. You will also note in this (long) string where I began to grill him of what he possibly asked for in the first place and why, he mentions he was hoping to 'CORRECT HIS SPEECH' via the first surgery. But as the grilling went on, he equated speech with the way PEOPLE LOOK AT HIM when he talks. That made NO logical sense to me that this 'speech problem' turned out to be HOW PEOPLE LOOK AT HIM and to me, IMO, revealed a FAULTY REASONING process where the END RESULT is that he ASKS FOR SOMETHING, (a surgery) for a weird reason and later DOES NOT LIKE HOW it looks ON HIS FACE.
That said, I most certainly will not give him any information about L3 or what to ask a doctor about concerning that OTHER than what he REALLY NEEDS TO THINK ABOUT which is 'What if he does not like' what he is requesting after it's accommodated and done.
-
Thanks Kavan on all your comments, especially ceph and effort to explain the issues. I am consulting two italian surgeons next week, just to have more opinions on midface defficiency before adressing lower third. (since in e-mail one responded that he would move my upper jaw during LF3). I myself am very scared of such surgery and would just wish that never entered into ortho-jaw process.
To sum up, according to two surgeons I was overcorrected (which I fully agree) and will most likely revise jaw and chin surgery. However, before final decision I would consult few craniofacial surgeons to have clear picture. Thanks on all the comments, I will share my experience after cons
-
Thanks Kavan on all your comments, especially ceph and effort to explain the issues. I am consulting two italian surgeons next week, just to have more opinions on midface defficiency before adressing lower third. (since in e-mail one responded that he would move my upper jaw during LF3). I myself am very scared of such surgery and would just wish that never entered into ortho-jaw process.
To sum up, according to two surgeons I was overcorrected (which I fully agree) and will most likely revise jaw and chin surgery. However, before final decision I would consult few craniofacial surgeons to have clear picture. Thanks on all the comments, I will share my experience after cons
Personally, I think enough of your excess protrusion could be isolated to the CHIN area, 'enouugh' in the sense you might be able to spare yourself the risks of revision double jaw by isolating correction to the chin. If a WEDGE section were removed from the FRONT of chin, the rest of the chin would ROTATE CCW and in that way it could be SHORTENED do REDUCE (lower) lip strain. Of course with that sort of wedge removal, the CUT would ALSO allow pushing (some of) chin backwards.
To the best of my knowledge (but I forgot the link I read it on--sorry--), Triaca (chin wing guru) sometimes removes such a section from there in the type of surgery he does when he wants to push a slice of the mandible backwards but when the chin is too 'diagonally long'. I would consult with him AGAIN (or the other doctors he actually taught; Z and Brusco) to ask IF that can be done for YOU, (given the prior chin elongation you got prior!) and with OBJECTIVE to AVOID double jaw revision.
IF it works for you, you might be happy with that ALONE. If not, it does not preclude you from getting the doublejaw revision later down the line.
-
Thank you very much.
-
Forget the LF3, your jaws were overadvanced plain and simple. Revise your jaw surgery and your cheeks won't bother you.
-
Thanks Plosko, I share your opinion. I was really stressed after first jaw-ortho journey.
To begin with today I have consulted prof. Iannetti on midface problems and he offered me "malar" osteotomy. Actually, we were discussing 3 options: implants, LeFort 3 and zygoma osteotomy.
It appearas that they call malar osteotomy (osteotomy of the zygoma) modified LeFort 3. I apologise if I understood something wrong.
So LeFort 3 includes coronal incision and we were discussing it for the first 15minutes. Than, after I asked about risks, complications we moved just to zygoma osteotomy.
I asked multiple times and they were assuring me that most (if only) projection of the zygoma will be anterior (like 3-5mm anteriorly). Yez again, when I asked about the incision it was similar to zygomatic sandwich osteotomy, but again they assured that they wouldn't sandwich me (no widening), i.e. zygomas will be pulled anteriorly and bone gap will be filled with lateral zygoma. His estimation in my case is 4-5mm.
Cost is very much high.
Please, I would appreciate your comments.. still shoked that was offered conventional LF3, and he showed me coronal incision
-
Coronal incision on my head
-
https://goo.gl/images/L65tWK
I was discussing middle picture (cuts labels red on the skull) with one of his assistants.. this is what they call malar osteotomy, is it really? He told me several times that it is not zso and anterior projection of 5mm is posssible.. they were only afraid of asymmetry.. also, they offered full LF3 but warned me that I will than certainly need jaw surgery after.. any thoughts? I am very confused, but professor seemed skilled
-
(http://faculty.washington.edu/jeff8rob/wordpress/wp-content/uploads/2017/02/Lefort-1024x576.jpg)
Lefort 3, the FULL L3 is Lefort 1 + Lefort 2...and YES, OF COURSE, they need a full coronal (ear to ear) incision to perform it which should be INTUITIVELY OBVIOUS if you've ever actually looked up full L3 to see the ENTIRE area it includes.
As to 'malar' and 'zygoma', the terms can be used interchangably.
Now, it's QUIZ TIME for you! Answer the following questions:
1: Looking at the photo of the FULL L3, WHERE would the modification CUT be if you DID NOT want one area included in the full L3 advanced forward? HINT: Think in terms of the area on YOU you don' want pushed forward. This is a simple question so answer in terms of the diagrams.
2: Does 'modified L3' refer to just ONE way to modify it or are there a number of ways the L3 can be modified? Simple question, multiple choice:
a: One way it can be modified and called 'modified L3'
b: More than one way it can be modified and called; 'modified L3'
3: What area under the eye can look RELATIVELY recessive when the 'cheek' area is brought forward whether it be done by a bone cut to advance forward the malar/zygomatic area or an implant aimed at advancing same area? (This question assumes some BASIC knowledge of the bone support under the eye and names of those bones even though only PART of them yield the support.)
NOTE 1: This quiz is not to advocate/encourage, one way or the other, the pursuit of L3 or any one doctor's use of term 'modified L3'. It's only to test some very basic information processing abilities about what you are consulting about. So, NO GO as far as further discussion from me about L3 if you don't pass this simple quiz.
NOTE 2: The 'history' of the L3 as it applies to this board, came into being because a patient/member tooK YEARS researching it and what CUTS would specifically apply to HIS situation. He was as sharp as a tack ie. BRIGHT as to know exactly what he wanted and WHY and was able to cross reference the KNOWLEDGE he aquired ON HIS OWN (via reading tons of med articles) with the doctors he consulted with. EVER SINCE then, there has been quite a LARGE crop of mindless members wanting a L3 who aquired LITTLE to NO knowledge on their own other than they 'want a L3'. So, 'NO GO' as far as I'm concerned as to having to FILL IN the GAPS of knowledge people would need to have filled FOR THEM in any pursuit of any type of L3, modified or not. So, IMO, a LOT of KNOWLEDGE about the L3 is something someone should ALREADY have under their belt to even consult about it just like the person who had it aquired on his own. So, for people with GAPS of knowledge about the L3, my policy here is NOT to 'spoon feed' them what they need to know.
-
Thanks Kavan.. I have started reading publications on LF3
https://youtu.be/Hk_AUbVuDWE
-
Thanks Kavan.. I have started reading publications on LF3
https://youtu.be/Hk_AUbVuDWE
Answer the QUIZ QUESTIONS.
-
1. Modification cut in most cases would be below the eyes
2. Multiple modifications (e.g. kufner, z type)
3. Eyes could look sunken if zygomas are advanced. Since my irbital rims are recessed, I was offered conventional LF3 which will also effect the nose (bigger and wider)
-
1. Modification cut in most cases would be below the eyes
2. Multiple modifications (e.g. kufner, z type)
3. Eyes could look sunken if zygomas are advanced. Since my irbital rims are recessed, I was offered conventional LF3 which will also effect the nose (bigger and wider)
OK.
Answer to #1 is the mod cut would have to be to the L1 area so the L1 area is NOT brought forward (given you want the L1 area brought backwards along with lower jaw). So ABOVE L1 area, eg. below eyes is sufficient answer. Correct.
Answer to #2 is multiple modifications. Correct.
Answer to #3, eyes could look sunken if just zygomas advance is CORRECT. Also CORRECT conventional 'full' L3 advances out NOSE.
ALL CORRECT. Very GOOD.
Now with #3, which you got right, along with #2 that you got right as to there being multiple modifications of the L3, in YOUR opinion, do you think the modified L3 offered to you and explained to you as something to ADVANCE out the ZYGOMA/malar area will be advancing out ALL the areas below the eyes or will it leave an area you would also like advanced out 'behind'?
-
Orbital rims will still be recessed, i.e. eyes could easily appear sunken (left behind)
-
Are you sure that what he's talking about is not mlf3, but a sagittal split ZSO?
-
He said makar advancement, cut seemed similar to sandwich osteotomy, but he told me multiple times that anterior projection of 5mm is possible and no widening of zygoma
-
Orbital rims will still be recessed, i.e. eyes could easily appear sunken (left behind)
OK. That's a legitimate opinion to have concerning that possibility.
Now, given that you spent some time, perhaps a large chunk of it, grilling the doctor as to whether or not this 'modified' L3 would be making your zygoma to zygoma distance WIDER, in which case he told you it would not but instead would project out your malar area,
a: did you forget to ask about what would happen to the rest of the orbital rim area (medial part that is comprised of maxilla bone)
OR
b: were you just MORE concerned that this procedure would give anterior projection to zyg. (malar) area INSTEAD of more width such that that particular concern took time PRIORITY over any concern of what would happen to the rest of the orbital rim area.
OR
c: did you only recently form this opinion subsequent to this QUIZ using the Socratic method to stimulate critical thinking.
-
100% b
I am in process of learning and was unhappy with questions asked on cons.. I was very much surprised that conventional LF3 was offered to me.. I am planning trip to dallas for another opinion
-
I think you getting a mLF3 would be absolutely absurd and a huge mistake.
If you want to address upper midface deficiencies, given that you already have a history of being dissatisfied with surgery results (and are even contemplating a second jaw surgery), why would you choose by far the most invasive -- and very possibly irreversible -- procedure?
If I were you, and I knew I was getting a revision jaw surgery no matter what, I'd start with the revision jaw.
If I were you, and I thought that the upper midface augmentation would have a chance (even if it's not that high) at fixing my issues without the jaw, I'd start with cheek implants or maybe even filler. These procedures wouldn't preclude jaw surgery and are also reversible / revisable if you don't like the results.
-
I think you getting a mLF3 would be absolutely absurd and a huge mistake.
If you want to address upper midface deficiencies, given that you already have a history of being dissatisfied with surgery results (and are even contemplating a second jaw surgery), why would you choose by far the most invasive -- and very possibly irreversible -- procedure?
If I were you, and I knew I was getting a revision jaw surgery no matter what, I'd start with the revision jaw.
If I were you, and I thought that the upper midface augmentation would have a chance (even if it's not that high) at fixing my issues without the jaw, I'd start with cheek implants or maybe even filler. These procedures wouldn't preclude jaw surgery and are also reversible / revisable if you don't like the results.
He's been told many times and many ways it's poor logistics on his part to be throwing a wrench into the gears regarding pursuing L3 surgery (questions here and consultations with docs) in the absence of processing information as to what is to be done regarding correcting the FIRST jaw surgery (or parts of it such as the chin). He doesn't get much out of the consults he goes on because he doesn't know much about L3 at all (or it's modifications) to ask the right questions. Given his history of being unhappy with his surgery (and also what I picked up on as asking for surgery for the wrong reasons--or who knows what the reasons he asked for the first surgery--), I reduced the SALIENT question for him to ask as to L3 to: 'Ask him how easy it is to revise IF you don't like it.' But I don't think he asked THAT one on his consult(s).
-
Thanks on all the comments.
To begin with, since 3 surgeons responded positively on my request for midface operation in general (whether some modified version of LF3), it is certainly true that I have midface defficiency at level which justifies the operation.
But what I am trying to say that I regret my initial jaw surgery and before which my midface problems were not so visible, it is all relative and what draws intentions to the eyes is that I have big, wide, protrusive jaws and severly underdeveloped zygoma and orbital rims.
I really regret jaw surgery and ortho process and before revision just wanted to hear your thoughts on my midface problems and seek opinions from craniofacial surgeons.
I would never put implants and I want my old face back.
It is the fact that anterior cranial length is 71,5mm - so less developed and followed by smaller midface and jaws (vertically). So middle and lower third were less developed, but it kind of matched together in a short, brachy facial appearance. (no teeth exposure, although incisors were 11mm long)
Augmenting just jaws made for me such imbalance that I started seeking opinion whether it is justified to have midface osteotomy at any point in time. Since I have bite issues (open posteriorly), asymmetryies, too much clockwise rotation and anterior face height was performed (two highly skilled doctors, together with my original surgeon and myself share this opinion) I will revise my jaw surgery certainly.
It is just the questions of movements and how much of initially performed:
maxilla downgrafting,
mandibula advancement,
clockwise rotation of the occlusal plane
and genioplasty (back and down)
should be revised to have balanced face at rest (not the amount of teeth exposure when smiling).
-
Thanks on all the comments.
To begin with, since 3 surgeons responded positively on my request for midface operation in general (whether some modified version of LF3), it is certainly true that I have midface defficiency at level which justifies the operation.
But what I am trying to say that I regret my initial jaw surgery and before which my midface problems were not so visible, it is all relative and what draws intentions to the eyes is that I have big, wide, protrusive jaws and severly underdeveloped zygoma and orbital rims.
I really regret jaw surgery and ortho process and before revision just wanted to hear your thoughts on my midface problems and seek opinions from craniofacial surgeons.
I would never put implants and I want my old face back.
It is the fact that anterior cranial length is 71,5mm - so less developed and followed by smaller midface and jaws (vertically). So middle and lower third were less developed, but it kind of matched together in a short, brachy facial appearance. (no teeth exposure, although incisors were 11mm long)
Augmenting just jaws made for me such imbalance that I started seeking opinion whether it is justified to have midface osteotomy at any point in time. Since I have bite issues (open posteriorly), asymmetryies, too much clockwise rotation and anterior face height was performed (two highly skilled doctors, together with my original surgeon and myself share this opinion) I will revise my jaw surgery certainly.
It is just the questions of movements and how much of initially performed:
maxilla downgrafting,
mandibula advancement,
clockwise rotation of the occlusal plane
and genioplasty (back and down)
should be revised to have balanced face at rest (not the amount of teeth exposure when smiling).
Last I checked 71.5mm anterior cranial length (S-N) was within the norm. Where it looks like you deviate from the norm is that your S-N line is basically on a pure horizont. So, in terms of the S-N line being aligned on a horizont, the angles formed by; S, N, A, and B will be beyond the norm. For that reason and will deviate from the norm approximately by the same extent the S-N line does. S-N orientation is something that can't be changed.
What most advice on here boils down to address what bothers you MOST before pursuing L3 procedures.
You mention your midface 'problems' were NOT visible before your jaw surgery and you wish you DID NOT HAVE the jaw surgery. You also mention that the midface looks RELATIVELY behind compared to the jaw surgery you got. Well LOGIC would have it to FIRST correct the jaw surgery and LATER evaluate midface for any procedures to it aimed at balance since midface issues (or let's call it; 'modified L3 issues') will be relative to displacements to the L1, BSSO and chin area.
ONLY IF someone LIKED what ever balance L1, BSSO and genio brought to the jaws (or already had good balance there) and knew for certain that they had recession to a 'modified L3 area' that was ABSOLUTE (as opposed to RELATIVE to the jaw advancement) would it be logical to pursue mL3 later down the line as 'add on' procedure.
If you think your prior surgery should be revised, then do that FIRST. Otherwise you risk the mL3 procedure to be 'balanced' with the IMBALANCE you presently don't like about the prior surgery.
If you really think you need mL3 where the ORDER of pursuing that is to get the jaws in balance FIRST and you wish to pursue it outside of that order, then don't expect 'coaching' on here or info to fill in the blanks that you might not fully understand as to what docs you consult with are telling you.
-
Thanks on all the comments. Furthermore, please find my revision plan:
1. Le Fort I Osteotomy with slight counterclockwise rotation and backward movement to reduce the steepness of the occlusal plane, to adjust the midline and to reduce the exposure of the entire upper dental arch when smiling.
2. BSSO to fix the occlusion, to close the bite and to correct the asymmetry of the Mandibular Angles and Jawlines
3. Mandibular WingOsteotomy („Chin Wing“) as far as technically still feasible to futher improve symmetry in lower third, correct the vertical dimension and eliminate lip strain.
4. Malaror teotomies to enhance midface projection, eventually in combination with plate removal, to be discussed in a second step 6 months after the first surgery.
Please, I would appreciate your opinion on maxiliary teeth length - mine are 12mm long and I would like to decrease them for 2mm. Teeth are too big for the face I have and, in my opinion, if only impaction of e.g. 2mm is performed they will still be huge. Thankvery much.
-
Thanks on all the comments. Furthermore, please find my revision plan:
1. Le Fort I Osteotomy with slight counterclockwise rotation and backward movement to reduce the steepness of the occlusal plane, to adjust the midline and to reduce the exposure of the entire upper dental arch when smiling.
2. BSSO to fix the occlusion, to close the bite and to correct the asymmetry of the Mandibular Angles and Jawlines
3. Mandibular WingOsteotomy („Chin Wing“) as far as technically still feasible to futher improve symmetry in lower third, correct the vertical dimension and eliminate lip strain.
4. Malaror teotomies to enhance midface projection, eventually in combination with plate removal, to be discussed in a second step 6 months after the first surgery.
Please, I would appreciate your opinion on maxiliary teeth length - mine are 12mm long and I would like to decrease them for 2mm. Teeth are too big for the face I have and, in my opinion, if only impaction of e.g. 2mm is performed they will still be huge. Thankvery much.
I must wonder, are there actually any surgeons available that will let you come in and dictate what's going to happen like that. I would assume that you would have to go pretty low on the ranking of surgeons for that to happen. I mean, Gunson would for sure send you home before you say hello.
-
Sorry, don't understand your comment. These are the recommendations from surgeons.
-
Sorry, don't understand your comment. These are the recommendations from surgeons.
Ok sorry. Haven't read the entire thread. Thought this was a plan you had figured out and now was going to find a surgeon.
-
Sounds like you chose one of the chin wing doctors to do your surgery. Sounds also like they even told you that discussion of midface osteos comes AFTER the jaw surgery.
-
This is the proposal, I would appreciate your opinion on decreasing teeth length since they are too huge for the face I have (12mm)
-
This is the proposal, I would appreciate your opinion on decreasing teeth length since they are too huge for the face I have (12mm)
There is nothing in your proposal that indicates the TEETH themselves will be shortened.
[1. Le Fort I Osteotomy with slight counterclockwise rotation and backward movement to reduce the steepness of the occlusal plane, to adjust the midline and to reduce the exposure of the entire upper dental arch when smiling.]
-
Kavan, I understand, I was just wondering whether additional shortining of crown size for 1-2mm will help in overall balance.. I have huge upper teeth (maxiliary incisors are 12mm long) and I am self conscius about them..additionally, I have severe lip incompetence and was wondering whether smaller teeth could also help in reducing steepness of the occlusal plane.. so my question is not related to maxiliary impaction..tnx
-
Kavan, I understand, I was just wondering whether additional shortining of crown size for 1-2mm will help in overall balance.. I have huge upper teeth (maxiliary incisors are 12mm long) and I am self conscius about them..additionally, I have severe lip incompetence and was wondering whether smaller teeth could also help in reducing steepness of the occlusal plane.. so my question is not related to maxiliary impaction..tnx
OK, so you 'understand' that the proposal does not include reducing the actual length of the teeth themselves and it just proposes to reduce the amount of visibility of the entire dental arch when smiling and this would/could include reducing excess gum show if you have that and MAY include reducing excess tooth SHOW when you smile.
You would need to determine from the doctor/s who gave you this plan whether the gum line would not be visible when smiling and what amount of tooth show would be visible when smiling.
Any excess related to cosmetic preferences you might have as to how much tooth show you want could be evaluated at a later time.
If this consideration were important to you, did you discuss it with the doctors you consulted with?
Here is a link regarding aesthetic proportions of the teeth.
http://www.cosmetic-dentistry-and-porcelain-veneers.com/files/2010/10/short_normal_long.jpg
ref: http://www.cosmetic-dentistry-and-porcelain-veneers.com/smile-design/tooth-length-porcelain-veneers-porcelain-crowns
-
Thanks. So I have small face, underdeveloped midface, shorter anterior cranial height, yet again my upper teeth are 12mm big. Currently, I show small gum line, but since I have very small nose (and midface) big teeth do not suit my face. I haven't mentioned it on consultations but multiple doctors have suggested anterior impaction (e.g. 2mm) In general, this would go in favour (in relative terms) to my midface and wideness of the face which I really like.
-
Thanks. So I have small face, underdeveloped midface, shorter anterior cranial height, yet again my upper teeth are 12mm big. Currently, I show small gum line, but since I have very small nose (and midface) big teeth do not suit my face. I haven't mentioned it on consultations but multiple doctors have suggested anterior impaction (e.g. 2mm) In general, this would go in favour (in relative terms) to my midface and wideness of the face which I really like.
Then go back to the surgeon you consulted with who gave you the PLAN and introduce this concern. Otherwise, you just end up throwing a wrench into the gears when you get a plan proposal and then 'wonder' about doing other things that are NOT listed in the proposal. Ultimately, you will need to put ALL your concerns TOGETHER and present ALL of them to EACH doctor you consult with and also what OTHER doctors told you.
You don't seem to be bringing to the table all your concerns to each consult you go to where a lot of them are what the docs could be figuring out for you. It's a situation where you might not be able to depend on the board to incorporate NEW concerns you have that you come up with or otherwise introduce AFTER you go on a consult.