jawsurgeryforums.com
General Category => Aesthetics => Topic started by: tara121 on August 06, 2018, 03:40:12 AM
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Hello,
I am really bothered by the asymmetry of my jaw, as one side of my mandible has grown longer than the other, causing my chin to be off centre relative to the rest of my face. I have had orthodontics in the past (removed about 12 years ago) which straightened my teeth reasonably well, however the abnormal jaw growth occurred later. I have had a bone scan which showed that my jaw is no longer actively growing so it will not get any worse. I do not have any symptoms or functional problems other than some clicking in my jaw but no pain or difficulties chewing. My bite is reasonably ok. I really just hate the appearance of the asymmetry so any surgery would be solely for cosmetic reasons.
I also feel like the midline of my teeth is off centre relative to the rest of my face (primarily my eyes and nose), however I am unsure if this is a result of the jaw deviation or a separate dental issue.
I have been assessed by an oral maxillofacial surgeon who suggested that I would get a good result with a sliding genioplasty but was unsure whether or not I would need orthodontic retreatment as well.
I would appreciate any input as to what other people think about possible avenues to address it and if it would be worth it.
See link below for photos:
https://www.dropbox.com/sh/qax5f993uwfqsco/AABw7Bzxp_8OOEcYCJoME5LAa?dl=0
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Your bite seems reasonably good, but I'm rather extremely bothered by the fact that a maxfac would try to mask a jaw deformity with a genio, that is poor judgment. Not only would you then have a deformed jaw, but the offset from the genio would double your problems.
You want to correct the underlining issue, not disguise it. In your situation, braces aren't required to have a corrective jaw procedure, it's merely a way to fixate the jaw so you don't open and use it while the bone is healing.
I would seek opinions from other surgeons.
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Your midline looks OK. One issue you have is the face is wider on the left side (right side of photo). The other issue is that the chin looks likes its going in the opposite direction; skewed to right side of face (left side of photo). Might be possible for genio to move, 'slide' chin more to the left. But the other issue could be soft tissue and perhaps addressed with filler if you want the right side to be as wide as the left.
It is hard for me to tell if your mandible, 'jaw' is longer or if it's mostly a matter of the chin being askew because there is no X ray of the actually bone structure to differentiate.
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Your bite seems reasonably good, but I'm rather extremely bothered by the fact that a maxfac would try to mask a jaw deformity with a genio, that is poor judgment. Not only would you then have a deformed jaw, but the offset from the genio would double your problems.
You want to correct the underlining issue, not disguise it. In your situation, braces aren't required to have a corrective jaw procedure, it's merely a way to fixate the jaw so you don't open and use it while the bone is healing.
I would seek opinions from other surgeons.
Why do you seem so shocked at his advice? Her jaw is barely inside the parameters of being "significantly asymmetrical" based on her photos, she has no functional problems and orthodontics proved sufficient to create a good occlusal relationship.
The risk of bimax might potentially outweigh the positives. A bimax might also exacerbate the asymmetry. I am speaking as someone who has a very similar situation to this woman.
Without an x ray or ct scan you also can't tell how far her chin is really deviated relative to the amount of mandibular overgrowth, but if the maxfac suggested a genio then you can assume he has assessed this.
Tara, I'm in a similar boat. I have overgrowth on one side, however if you check my recent thread you'll see that i had a 3D print done of my facial bones, and while I have clear asymmetry, it was also made worse by soft tissue asymmetry. Yours looks mostly boney though.
If your profile is good and you don't have a recessed/convex face, then a genio sounds like it might be a cheaper and more suitable fix imo.
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Thanks for your thoughts everyone.
I am getting OPG Xrays done tomorrow so will be able to post photos of them then and would appreciate further input. I agree that it's hard to tell what's boney asymmetry vs soft tissue.
Strongjawman, I've added profile shots from both sides, they look relatively symmetrical to me (moreso than front view anyhow), although one side is definitely more 'defined' than the other, particularly just below my ear. I'm not particularly happy with my profile but can't really identify what it is specifically that I don't like. See link below.
https://www.dropbox.com/sh/qax5f993uwfqsco/AABw7Bzxp_8OOEcYCJoME5LAa?dl=0
On a side note, I'm in Newcastle NSW, Australia. Can anyone recommend good surgeons in the area? I'd be happy to travel to Sydney as well. My previous consult was with Dr Ian Wilson, and I'm having consults with Dr Michael Bowler and Dr Paul Coceancig in the near future. Has anyone heard anything (good or bad) about any of these surgeons?
Thanks.
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kavan,
IF the OP posts xrays, both front and side and it shows abnormal growth of one side of her mandible, would you not change your opinion to NOT get a genio unless and until she gets this fixed first? There are several key factors in place here and yes I am very concerned about the advice she got, it's not just about the money or how invasive a jaw surgery can be, but there could be well other underlining issues that could cause problems down the road. If a jaw is misaligned, then there are undue stresses put on it, and it can cause it to deviate further, and by addressing a band-aid genio offset, then you got two problems now. And say she gets this (jaw deformity, if it is that) fixed in the future, then that means the genio will have to be corrected as well. My position is solid on here and will not change due to criticism that you need a correct underling skeletal relationship before going on addressing another issue to cover up for the first.
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kavan,
IF the OP posts xrays, both front and side and it shows abnormal growth of one side of her mandible, would you not change your opinion to NOT get a genio unless and until she gets this fixed first? There are several key factors in place here and yes I am very concerned about the advice she got, it's not just about the money or how invasive a jaw surgery can be, but there could be well other underlining issues that could cause problems down the road. If a jaw is misaligned, then there are undue stresses put on it, and it can cause it to deviate further, and by addressing a band-aid genio offset, then you got two problems now. And say she gets this (jaw deformity, if it is that) fixed in the future, then that means the genio will have to be corrected as well. My position is solid on here and will not change due to criticism that you need a correct underling skeletal relationship before going on addressing another issue to cover up for the first.
Moot question. I gave her my opinion along with the reasoning of my opinion and did not do it by saying; 'I disagree with xxryan'. You gave your opinion. She may choose what ever opinion she wants. Your coming off AS IF my giving my opinion WAS TO disagree with yours or because my opinion differed from yours you need to 'defend' yourself. I don't have to read anyone elses opinion in order to give mine. Nor do I need to explain to you whether or not I would change my opinion to be the same as yours due to your concerns about the advice she got.
Also, if I have to worry that giving my opinion and giving reason behind my opinion, precipitates a defensive response like this AS IF I was offering it TO disagree with someone else, i will be disinclined to offer it to the recipients it was aimed to offer it to.
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UPDATE:
So I saw a surgeon today for a second opinion and he has said that I have anterior mandibular hypoplasia and secondary maxillary hypoplasia, and has recommended Bimax surgery and a double sliding genioplasty to fully correct my asymmetry. He feels that it is having a small jaw that is causing my asymmetry rather than abnormal growth of the mandible. He also thinks that has resulted in 2 of my wisdom teeth not erupting due to crowding.
He painted a pretty grim picture for my future health if I were to not go ahead with surgery: severe obstructive sleep apnoea, secondary asymmetry to my length length and subsequent scoliosis, and a few other things I can’t recall.
I’m quite overwhelmed and confused. I went into process just wanted to cosmetic fix to what I thought was a relatively mild jaw asymmetry and have come out with a recommendation for pretty fully on surgery for significant health concerns. I’m struggling to know whether to trust what the surgeon has said or if he is just blowing things out of proportion to make more money from me? He’s given me an estimate of $30 000 AUD out of pocket costs for the procedure (after Medicare and private health insurance rebates).
Would be keen to hear any opinions or feedback on this advice.
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That's a lot of money for an Australian surgeon.
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To my ear, it reaks of poor ethics and Kind of sounds like that jerk Coceancig who infiltrated here years back to give links to his You Tube videos with a screen name like 'ortho expert' or something like that where he HID disclosure but was eventually caught. Got a tip last year from a potential investor of that 'analize my face' dude who scammed here that Coceancig was part of that scammers network.
'anterior mandibular hypoplasia and secondary maxillary hypoplasia'. Sounds like the SOB is running SUBTERFUGE with that terminology, telling you that you will suffer severe health problems if you don't get surgery with him, SCARE TACTICS.
I wouldn't trust the guy. Get another opinion as IF you never saw that guy at all.
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Did he say how big your airway is? Did he recommend a sleep study? Your chin throat length looks pretty good, so not sure about the sleep apnea.
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I’ve had a sleep study in the past which showed no sign of sleep apnoea. He said he was ‘certain’ that my airway would be significantly impacted by my jaw size in the future even if it isn’t at the moment. Didn’t say how big my airway is though.
He did a front-on OPG X-ray at the beginning of the consultation but only looked at it briefly. He seemed to make most of his assessment recommendations just from looking at me visually. Didn’t even ask me to open my mouth. Not sure if this is usual or not?
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Most surgeons will 100% want to examine your mouth.
Stay away from him girl.
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I think he's snowing you.
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I’ve had a sleep study in the past which showed no sign of sleep apnoea. He said he was ‘certain’ that my airway would be significantly impacted by my jaw size in the future even if it isn’t at the moment. Didn’t say how big my airway is though.
He did a front-on OPG X-ray at the beginning of the consultation but only looked at it briefly. He seemed to make most of his assessment recommendations just from looking at me visually. Didn’t even ask me to open my mouth. Not sure if this is usual or not?
Yes, he made most of his assessment WITHOUT ANY REFERENCE to the appropriate X-ray (profile ceph) and thereby DEPRIVING you of any information OTHER than his scare tactic prediction which basically resolved to:
'Because I'm the doctor and that's why and IF you don't provide me with the EMPLOYMENT OPPORTUNITY I'm finding for MYSELF in YOUR face, you will suffer dire health consequences in the future.'
ETA: ETA:
If you could or would get ANY of the health consequences he predicted you would get in the future, IF you didn't get surgery, then you have PLENTY OF TIME to seek out an ETHICAL surgeon. There is NO NEED to have what ever he's proposing 'now' or ASAP with HIM.
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I can't imagine why he'd say you're at risk of sleep apnea. From my experience, a standard ceph can somewhat misrepresent a person's airway. My old ceph from when I was 22 showed my airway being smaller than my most recent ceph & my head was in the same position. A CT scan is much more accurate over a standard ceph for measuring airway size IMO. I had a scan recently and one of the first points the surgeon brought up was that my airway was larger than the patients he treats for sleep apnea.
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"Anterior mandibular hypoplasia with maxillary hypoplasia" huh?? Can someone elaborate on this because to me this definition seems like nonsense.
For someone who did little to no real examination on you, he sure seems confident that you will develop a whole host of other problems. Your jaw also doesn't look small to me like he alluded to.
Seems like fear-mongering, I would proceed with caution with this guy. Get other opinions, perhaps from surgeons in Europe. If you have any scans/data you can send them you could do a skype consultation first; at least to hear a second/third opinion.
I don't like his prediction that you will get scoliosis; musculoskeletal imbalances are not easy to predict and I'm not sure how mild mandibular asymmetry would even cause this; what is the mechanism along the kinetic chain?
If you don't have sleep apnea now, it seems unlikely you will suddenly develop it later; your bones are fully developed and your airway isn't small by the sounds of things? I'm not a surgeon, but I hate wishy washy answers and fear mongering.
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"Anterior mandibular hypoplasia with maxillary hypoplasia" huh?? Can someone elaborate on this because to me this definition seems like nonsense.
For someone who did little to no real examination on you, he sure seems confident that you will develop a whole host of other problems. Your jaw also doesn't look small to me like he alluded to.
Seems like fear-mongering, I would proceed with caution with this guy. Get other opinions, perhaps from surgeons in Europe. If you have any scans/data you can send them you could do a skype consultation first; at least to hear a second/third opinion.
I don't like his prediction that you will get scoliosis; musculoskeletal imbalances are not easy to predict and I'm not sure how mild mandibular asymmetry would even cause this; what is the mechanism along the kinetic chain?
If you don't have sleep apnea now, it seems unlikely you will suddenly develop it later; your bones are fully developed and your airway isn't small by the sounds of things? I'm not a surgeon, but I hate wishy washy answers and fear mongering.
BINGO. Upvote.
It's SUBTERFUGE language given with the expectation that the recipient of it, the patient, attach MORE medical importance to it than is needed to attach to it and so given in an attempt to legitimize an assessment done in the absence of what would be needed to make such an assessment. For example, in absence of profile X-ray (ceph) to look at her airway, he used it in the contex or convey DIRE health consequences coming to her in the future IF she did not get the surgery with HIM. Literally, mandibular hypolasia means small lower jaw and the prefix (anterior) before the term could mean small front of mandible which is the chin. Maxillary hypoplasia means small maxilla or recessed maxilla. But I've never heard term 'secondary' used before as a prefix simply because it's the mandibular growth that is secondary to maxillary growth.
In layman's terms, it's BULLs**t given the CONTEXT in which he rendered the assessment which was to SCARE her so she would get DOUBLE JAW surgery AND genio.
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Thanks so much for the feedback everyone. You helped confirm what I was already thinking. I didn't get a good 'vibe' from the surgeon and felt he was very quick to make surgical recommendations without doing a very thorough assessment or imaging. I also had a strong feeling that his health 'warnings' were probably scare tactics as I have never before been given any indication that my jaw asymmetry is of any concern from a health perspective. I also couldn't find much about him online other than his youtube channel which seems a bit suss in itself...
But I didn't want to write him off completely without getting some other opinions that corroborate my suspicions. So thankyou everyone. :)
I have any appointment for a consultation with another surgeon in September who I have heard good things about, so hopefully that is a more positive experience.
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Only because a sliding genioplasty is what has been recommended to me by a surgeon in the past. My understanding is that a chin wing osteotomy moves the chin forward, which isn’t something I have any particular desire to do. I may be wrong in my assumption though? What would be the pros for the chin wing vs genio (from your perspective)?
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or just watch this lecture by Triaca
www.youtube.com/watch?v=0XlsOlSmYDk&feature=autoshare
Thanks for this link, I hadn't seen it. Great lecture, first time I see an original source for all the different posibilitiesa chin wing provides (movements, segmentations, etc).
The string of results starting at 18:35 are very impressive.
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Though I don't want to sound like im shilling for them,
That's exactly what you sound like.
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Thanks for this link, I hadn't seen it. Great lecture, first time I see an original source for all the different posibilitiesa chin wing provides (movements, segmentations, etc).
The string of results starting at 18:35 are very impressive.
Let me get this straight. This is the first time you saw this YET, you are morphing people with the suggestion for them to get chin wings.