jawsurgeryforums.com
General Category => Aesthetics => Topic started by: MaryPoppins66 on September 15, 2019, 09:56:03 PM
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Hi everyone!
English is not my first language so I apologize for my mistakes in advance. Also, thank you for all the advice I had found here, I've learned a lot from you in the past month.
I attached my cephalometric and panoramic X-rays and a couple of photos and I would be really thankful if somebody could help me with the analysis. I'm class II/II with a short/er face.
What I would like to know is
1. What kind of procedure do you think I could benefit from? Can BSSO alone improve my lower facial height at all? The thing is - my orthodontist is suggesting just getting BSSO because of my profile but I was always much more self conscious about the frontal view because my deep bite is making me look angry. I didn't post the photo but there's my profile pic and a pic of what my profile should look like to get my frontal view also in balance. I kind of overdid it but I guess I would be happy with as much of lower facial height I can get without going through multiple procedures. So - how to make a small improvement on lower facial height without touching the maxilla and by only adjusting the mandible?
2. Also, all of my angles are messed up – gonial, articular (and mandibular) – so I think my overbite in itself maybe isn't even that bad but is visually exacerbated by this. What do you think? Can BSSO improve any of those?
3. Could you please comment on my airway?
4. Is it possible to measure the absolute length of both of my jaws from the X ray? Also my upper and lower facial height? Could you please do that if it is possible?
Thank you for reading my post, I'm pretty new to all of this so I apologize if it is non-coherent or faulty. And thank you in advance for your answers, I'm looking forward to reading them very much.
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First of all, your gonial angle is good. You don’t want it too sharp, especially as a female. What I see is a mild lack of mandibular projection. The least invasive rout would be a geniolasty, where they cut your chin and reposition it forward and down. Genioplasty might also make your jaw look sharper by tightening the muscles and skin under your mandible.
From the point I see it right now I’d advise against any jaw intrusion. As far as I’m concerned, you have a functional bite, no sleep problems, no TMJ.
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How's your tooth show at rest? Smiling?
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Welcome. You should post smiling and front view photos too.
First I see you posted about profilos sugical, which is Dr Paul Coceancigs practice. Hes got a bad reputation on here, and i personally have a bad experience with him. I recommend you avoid him.
Your occlusional plane seems pretty flat, so its going to basically require your lower teeth to be moved forward in order to improve that projection with just a bsso. That will probably require some lower tooth extractions in order to move your jaw a meaningful ammount. Depending on your teeth, id lean more towards double jaw. Ofcorse talk to your ortho about this.
Airway looks ok, its basically impossible to tell if you have disordered breathing without a sleep study.
There is technology to measure the lengths of your jaws and compare them on a statistical distribution. Ask your ortho for a cephalometric tracing of your landmarks. I will say that alot of the tracing methods are basically obsolete now, and measurements relative to the cranial base in general have fallen out of favor among maxfac surgeons (in the US atleast).
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Let's see...to look at your photos, I've gotta keep 6 individual tabs open because instead of all your photos being placed on the same IMGUR link, you put on separate ones. Did you know that IMGUR lets you post ALL your photos on the SAME link and also allows you to describe each photo? So, no comment from me other than that.
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Let's see...to look at your photos, I've gotta keep 6 individual tabs open because instead of all your photos being placed on the same IMGUR link, you put on separate ones. Did you know that IMGUR lets you post ALL your photos on the SAME link and also allows you to describe each photo? So, no comment from me other than that.
I will address ONE thing here that doesn't involve opening 6 different links and flitting back and forth to address all your questions. That ONE thing is about Class 2 Division 2, deep bite.
In general, people who have that have a short lower facial height, recessive mandible with short recessive chin and low mandibular plane angle. Effective treatment proposals I've seen for that in the past involve CCW posterior downgrafts (to the maxilla) along with BSSO and a type of chin augmentation that AVOIDS vertical shortening. Not a sliding genio but rather what is called an 'oblique' genio where the chin is moved diagonally downward and a 'buttress' is placed between the cut sections. So bimax with chin work that AVOIDS shortening.
The surgery lengthens the lower face height by virtue of NOT having to lift the lower jaw up so high to occlude with the deep bite. However, it doesn't physically increase the distance between the roots of the lower teeth and the mandibular border.
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I will address ONE thing here that doesn't involve opening 6 different links and flitting back and forth to address all your questions. That ONE thing is about Class 2 Division 2, deep bite.
In general, people who have that have a short lower facial height, recessive mandible with short recessive chin and low mandibular plane angle. Effective treatment proposals I've seen for that in the past involve CCW posterior downgrafts (to the maxilla) along with BSSO and a type of chin augmentation that AVOIDS vertical shortening. Not a sliding genio but rather what is called an 'oblique' genio where the chin is moved diagonally downward and a 'buttress' is placed between the cut sections. So bimax with chin work that AVOIDS shortening.
The surgery lengthens the lower face height by virtue of NOT having to lift the lower jaw up so high to occlude with the deep bite. However, it doesn't physically increase the distance between the roots of the lower teeth and the mandibular border.
Ive seen something similar except it involved downgrafting to both the anterior and posterior maxilla, which the posterior one being larger and to create ccw while also increasing the lower anterior facial height. I suspect this is uses more when the maxilla is short vertically, and your genioplasty technique is used when the mandible is short vertically?
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Ive seen something similar except it involved downgrafting to both the anterior and posterior maxilla, which the posterior one being larger and to create ccw while also increasing the lower anterior facial height. I suspect this is uses more when the maxilla is short vertically, and your genioplasty technique is used when the mandible is short vertically?
A downgraft that also includes the anterior maxilla can also be considered a (net) CCW rotation if the downgraft is more to the back than the front. The genio technique is when the mandibular plane angle is considered 'low'.
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Ive seen something similar except it involved downgrafting to both the anterior and posterior maxilla, which the posterior one being larger and to create ccw while also increasing the lower anterior facial height. I suspect this is uses more when the maxilla is short vertically, and your genioplasty technique is used when the mandible is short vertically?
People with low mandibular plane angles (and deep bite) can be described as having 'short chin'. The overall facial height can be increased with a uniform downgraft but if the rotation is needed to be CCW, the downgraft has to be more posterior than anterior, in which case there would still be an increase in total facial height. The increase is coming from the alteration of the maxilla. But the height of the mandible bone itself isn't being increased. The distance between the lower border of mandible and the roots of the molars will remain constant. Since the CCW rotation tends to DECREASE the mandibular plane angle, someone who has an MPA on the LOW SIDE already, usually benefits from the oblique genio to both advance and elongate the chin because it gives 'look' of steeper MPA.
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Welcome. You should post smiling and front view photos too.
First I see you posted about profilos sugical, which is Dr Paul Coceancigs practice. Hes got a bad reputation on here, and i personally have a bad experience with him. I recommend you avoid him.
Your occlusional plane seems pretty flat, so its going to basically require your lower teeth to be moved forward in order to improve that projection with just a bsso. That will probably require some lower tooth extractions in order to move your jaw a meaningful ammount. Depending on your teeth, id lean more towards double jaw. Ofcorse talk to your ortho about this.
Airway looks ok, its basically impossible to tell if you have disordered breathing without a sleep study.
There is technology to measure the lengths of your jaws and compare them on a statistical distribution. Ask your ortho for a cephalometric tracing of your landmarks. I will say that alot of the tracing methods are basically obsolete now, and measurements relative to the cranial base in general have fallen out of favor among maxfac surgeons (in the US atleast).
Thank you. :)
I posted that picture only because I wanted to show you what I think I need visually. I wasn't researching on who did it or how it was done.
I'll ask my orthodontist about the cephalometric tracing of landmarks, thank you.
It's a bit hard for me to follow your advice at this point so I apologize for the dumb question. What do you mean by 'depending on my teeth' that I should look into double jaw surgery? Can you tell approximately how much of mandibular advancement am I looking into?
I put more pictures as you advised so take a look. Also, I'm not sure if this matters but all of those 'smiles' are forced, I do not usually smile like that. I've been told all my life actually that my smile seems fake. I guess it's because when I do it, it doesn't really seem effortless. And it's not, I have to try pretty hard to show some teeth.
I kind of struggled with capturing the shortness of my face from the exact front so I took some photos from the sides. Again, I overdid it in the 'how it should look like' photo but just to give you a better impression of it all.
And just to add one more thing to my post, maybe it'll help with further advice although from what I've read these cases are treated exactly like recessive mandible. My maxilla seems to be the problem actually - my SNA is 88 and my SNB is 81.
https://imgur.com/a/7QMP7WR
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How's your tooth show at rest? Smiling?
Hi!
No tooth show whatsoever at rest. But I've gotten used to it. If I can avoid maxillary advancement, I will, regardless of that.
I put new photos, take a look.
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Let's see...to look at your photos, I've gotta keep 6 individual tabs open because instead of all your photos being placed on the same IMGUR link, you put on separate ones. Did you know that IMGUR lets you post ALL your photos on the SAME link and also allows you to describe each photo? So, no comment from me other than that.
Hi!
I'm sorry, I didn't know that. I made an album with new photos and posted the link in the answer I gave to Lefortitude so if you could take one more look at my photos, I would appreciate.
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Hi!
I'm sorry, I didn't know that. I made an album with new photos and posted the link in the answer I gave to Lefortitude so if you could take one more look at my photos, I would appreciate.
I took a look at them. The info I gave about class 2 div 2 is applicable. The elongation in your morph is in excess of what surgery would do.
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I took a look at them. The info I gave about class 2 div 2 is applicable. The elongation in your morph is in excess of what surgery would do.
Thank you. Yes, I am aware I overdid it, in aestethic terms as well.
I hope you won't mind me asking you just a few more questions.
What do you think would happen to my front face if I decide only to do BSSO and possibly that 'oblique' genio you mentioned.
And can you tell from my X-ray what is the root cause of my face being short, is it the vertically short maxilla or is it my mandible?
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Thank you. Yes, I am aware I overdid it, in aestethic terms as well.
I hope you won't mind me asking you just a few more questions.
What do you think would happen to my front face if I decide only to do BSSO and possibly that 'oblique' genio you mentioned.
And can you tell from my X-ray what is the root cause of my face being short, is it the vertically short maxilla or is it my mandible?
Please RE-READ what I wrote concerning Class 2 Div 2 to both your post and to Lefortitudes lest I deem taking time to explain how things work an exercise in futility.
Much like similar cases of Class 2 Div2 where SUCCESSFUL surgery involves a CCW DOWNGRAFT, in addition to the BSSO and oblique genio, so does yours. You're not an exception to the general type of surgery used to maximize aesthetic improvement for Class 2 Div 2 DEEP BITE, 'short chin' or 'short face'.
What would you look like WITHOUT the type of surgery needed to address what you have. Someone who still has shortness to the lower '1/3rd' of face. That's because the extra height you would need comes from DOWNGRAFTING the maxilla
Your case is NOT one that would resolve to single lower jaw surgery. It would resolve to CCW DOWNGRAFT. (bimax surgery with oblique chin advancement) Given you have NO front upper teeth show at rest and need to STRAIN a smile to show upper teeth, the downgraft would be MORE in the back than in the front. So, we are talking a CUT to the maxilla and NOT single lower jaw surgery or avoiding a cut to the maxilla. You wouldn't get close to a fraction of the changes on your morph by AVOIDING the maxilla cuts associated with the downgrafts. Without them, you would still look like someone with shortness to the lower 1/3rd of the face. Where do you think the extra height comes from? It comes from the downgrafting to the maxilla. BSSOs don't downgraft the lower border of the mandible. So, it doesn't matter if the vertical shortness comes from the mandible itself. What matters is that NO TOOTH SHOW at rest is consistent with vertically short maxilla and deep bite is consistent with the posterior part needing more of a downgraft than the anterior part in order to acheive a type of net CCW that would address your DEEP BITE and short facial height.
As to maxillary advancement along WITH the cut to the maxilla TO place the downgraft, aim of CCW is to minimize advancement. So, moot point to want to avoid something else that might be needed to do to the maxilla to maximize lower jaw advancement.
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Your angles are great. No need to worry about those at all.
You should get multiple opinions. Where are you from? If you're limiting to just a BSSO, you won't get full correction by the sounds of it.
I looked into BSSO-only when I was fretting out about my own case, and they seem to deal with deep bites with it in two ways.
Sometimes they will just "level" the bite during ortho, taking away a deep bite. I think they do this by extruding/intruding teeth (moving teeth out of the bone, or into the bone) Extruding back teeth might gain you a bit of height.
Don't let them intrude your upper teeth, especially if you have poor tooth show. I have suspicions they did this to me (totally ruined me).
Another way they seem to deal with a deep bite with just a BSSO is something called a "3 point landing" or "tripod". It's when they KEEP the bite deep for surgery, and then advance and rotate the mandible out clockwise to get rid of the deep bite. The point being clockwise rotation of the mandible increases lower face height. I think they only do that in severe deep bite cases, and yours isn't that severe at all. It's the opposite to CCW though. It reduces chin prominance and you would probably still need a genio depending on how you want your chin to be.
Again, none would address tooth show or any issues you might have with maxilla. DJS ususally is better to address everything.
To measure mandible height etc there's a ruler on top of your xray. Your ruler is 45mm. If you have photoshop you can copy and paste it a few times to create a longer ruler and use it to measure.
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......
Another way they seem to deal with a deep bite with just a BSSO is something called a "3 point landing" or "tripod". It's when they KEEP the bite deep for surgery, and then advance and rotate the mandible out clockwise to get rid of the deep bite. The point being clockwise rotation of the mandible increases lower face height. ...
Can you elaborate more about this BSSO that AVOIDS surgery to the maxilla to (selectively) rotate the mandible with no surgery to rotate the maxilla? I'm somewhat familiar with this 3 point landing (but where they do surgery to the maxilla for CW rotation) and of course, it's possible to do just a BSSO. But in the event she asks me about that option, I'm not familiar with the type you seem to be suggesting here that ALSO rotates as to avoid surgery to maxilla for a rotation.
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I'd kill for a jawline like that. Leave it alone man.
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I'd kill for a jawline like that. Leave it alone man.
What are you looking at, her actual jaw line or a morph of it OR did you mean to post on another string?
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Please RE-READ what I wrote concerning Class 2 Div 2 to both your post and to Lefortitudes lest I deem taking time to explain how things work an exercise in futility.
Much like similar cases of Class 2 Div2 where SUCCESSFUL surgery involves a CCW DOWNGRAFT, in addition to the BSSO and oblique genio, so does yours. You're not an exception to the general type of surgery used to maximize aesthetic improvement for Class 2 Div 2 DEEP BITE, 'short chin' or 'short face'.
What would you look like WITHOUT the type of surgery needed to address what you have. Someone who still has shortness to the lower '1/3rd' of face. That's because the extra height you would need comes from DOWNGRAFTING the maxilla
Your case is NOT one that would resolve to single lower jaw surgery. It would resolve to CCW DOWNGRAFT. (bimax surgery with oblique chin advancement) Given you have NO front upper teeth show at rest and need to STRAIN a smile to show upper teeth, the downgraft would be MORE in the back than in the front. So, we are talking a CUT to the maxilla and NOT single lower jaw surgery or avoiding a cut to the maxilla. You wouldn't get close to a fraction of the changes on your morph by AVOIDING the maxilla cuts associated with the downgrafts. Without them, you would still look like someone with shortness to the lower 1/3rd of the face. Where do you think the extra height comes from? It comes from the downgrafting to the maxilla. BSSOs don't downgraft the lower border of the mandible. So, it doesn't matter if the vertical shortness comes from the mandible itself. What matters is that NO TOOTH SHOW at rest is consistent with vertically short maxilla and deep bite is consistent with the posterior part needing more of a downgraft than the anterior part in order to acheive a type of net CCW that would address your DEEP BITE and short facial height.
As to maxillary advancement along WITH the cut to the maxilla TO place the downgraft, aim of CCW is to minimize advancement. So, moot point to want to avoid something else that might be needed to do to the maxilla to maximize lower jaw advancement.
I feel uncomfortable contradicting you because I am aware of the huge gaps in my knowledge at this point.
I do think you could be right - for the best - aesthetic outcome I should be looking into double jaw surgery. The reason being - lack of tooth show, strained smile.
Regarding the shortness - you know it and you're saying it - downgrafting the maxilla is not the only procedure that vertical height could come from. It can also come from the vertical genioplasty you yourself mentioned. I am aware that that could just be me trying to mask the problem and possibly failing - putting chin on an angry looking short face. But still, there is a slight possibility that I can recognize looking at my face that is allowing me to assume BSSO plus that type of genioplasty could be enough for me to be satisfied.
My opinion is that BSSO could address 80 percent of the aesthetic concerns I've got and if I'm right I won't be getting double jaw surgery just because of my lack of tooth show or my strained smile. At least I think so at the moment. If I could somehow get 3 mm of lower facial height by advancing my mandible + orthodontic work and another 3/4 with genio/fillers that would be enough for me.
You keep telling me what is the best procedure I should be looking into - and thank you for that, I asked for it and I truly appreciate your help but I am also here so you all could give me some insight into why exactly (X-rays and numbers) is my face short/er. Because it would really help me understand everything better. If you could comment on my angles and cause of me lacking in lower facial height, I would appreciate.
I attached the link - they mention two approaches for handling short faces - I have no idea what they are trying to do in the first one but the alternative (first sentence, page 133) seems to be exactly what I'm suggesting here.
Second link is about what I think I need - did she have double jaw surgery?
And sorry for asking you this but when you say 'posterior downgraft' you're talking about a segmental Lefort I, so no anterior advancement?
https://pdfs.semanticscholar.org/44b1/8fe9e7b481e51647115d31678970c6147ff7.pdf
https://www.semanticscholar.org/paper/Esthetic-Aspects-of-Orthodontic-Surgical-Treatment-Watted-Bartsch/ef74c9568c7d541aff846d0796aed40cf5f7c66b#citing-papers
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Your angles are great. No need to worry about those at all.
You should get multiple opinions. Where are you from? If you're limiting to just a BSSO, you won't get full correction by the sounds of it.
I looked into BSSO-only when I was fretting out about my own case, and they seem to deal with deep bites with it in two ways.
Sometimes they will just "level" the bite during ortho, taking away a deep bite. I think they do this by extruding/intruding teeth (moving teeth out of the bone, or into the bone) Extruding back teeth might gain you a bit of height.
Don't let them intrude your upper teeth, especially if you have poor tooth show. I have suspicions they did this to me (totally ruined me).
Another way they seem to deal with a deep bite with just a BSSO is something called a "3 point landing" or "tripod". It's when they KEEP the bite deep for surgery, and then advance and rotate the mandible out clockwise to get rid of the deep bite. The point being clockwise rotation of the mandible increases lower face height. I think they only do that in severe deep bite cases, and yours isn't that severe at all. It's the opposite to CCW though. It reduces chin prominance and you would probably still need a genio depending on how you want your chin to be.
Again, none would address tooth show or any issues you might have with maxilla. DJS ususally is better to address everything.
To measure mandible height etc there's a ruler on top of your xray. Your ruler is 45mm. If you have photoshop you can copy and paste it a few times to create a longer ruler and use it to measure.
Hi!
Thank you so much, this is exactly the type of information I was looking for.
I was thinking of combining that type of ortho work with BSSO. If I can gain a couple of millimeters with the extrusion, a couple with BSSO and a couple with genio, I'll be fine. :) Did you manage to solve your problem after all?
I'm from central Europe so can get anywhere in Europe quite easily. I'm still in the research phase but soon will start to look for a surgeon, do you have any suggestions on who should I contact?
I'll look more into that procedure you suggested, I've read about it somewhere already and I was planning to ask about it here but didn't get the chance still. As you probably know, it's pretty difficult to find any information on different types of mandibular advancement surgeries other then BSSO. But this is exactly the type of suggestion I was looking for because the vertical shortness is my main aesthetic concern and I would be glad to disregard any maxillary disadvantages if I manage to solve my problem with just mandible work.
https://pdfs.semanticscholar.org/44b1/8fe9e7b481e51647115d31678970c6147ff7.pdf
This is it?
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I feel uncomfortable contradicting you because I am aware of the huge gaps in my knowledge at this point.
I do think you could be right - for the best - aesthetic outcome I should be looking into double jaw surgery. The reason being - lack of tooth show, strained smile.
Regarding the shortness - you know it and you're saying it - downgrafting the maxilla is not the only procedure that vertical height could come from. It can also come from the vertical genioplasty you yourself mentioned. I am aware that that could just be me trying to mask the problem and possibly failing - putting chin on an angry looking short face. But still, there is a slight possibility that I can recognize looking at my face that is allowing me to assume BSSO plus that type of genioplasty could be enough for me to be satisfied.
My opinion is that BSSO could address 80 percent of the aesthetic concerns I've got and if I'm right I won't be getting double jaw surgery just because of my lack of tooth show or my strained smile. At least I think so at the moment. If I could somehow get 3 mm of lower facial height by advancing my mandible + orthodontic work and another 3/4 with genio/fillers that would be enough for me.
You keep telling me what is the best procedure I should be looking into - and thank you for that, I asked for it and I truly appreciate your help but I am also here so you all could give me some insight into why exactly (X-rays and numbers) is my face short/er. Because it would really help me understand everything better. If you could comment on my angles and cause of me lacking in lower facial height, I would appreciate.
I attached the link - they mention two approaches for handling short faces - I have no idea what they are trying to do in the first one but the alternative (first sentence, page 133) seems to be exactly what I'm suggesting here.
Second link is about what I think I need - did she have double jaw surgery?
And sorry for asking you this but when you say 'posterior downgraft' you're talking about a segmental Lefort I, so no anterior advancement?
https://pdfs.semanticscholar.org/44b1/8fe9e7b481e51647115d31678970c6147ff7.pdf
https://www.semanticscholar.org/paper/Esthetic-Aspects-of-Orthodontic-Surgical-Treatment-Watted-Bartsch/ef74c9568c7d541aff846d0796aed40cf5f7c66b#citing-papers
You asked for advice. I gave mine and the reasoning behind it. Although I knew my advice was against a backdrop of AVOIDANCE of any surgery to the maxilla, your query was on the AESTHETIC section of the board AND your case was one that also included NO upper teeth show at rest. So, right there, it became one that didn't justify AVOIDING surgery to the maxilla. Not in terms of aesthetics and not in terms of where some shortness to the face comes from.
I also mentioned that of the cases/displacement proposals I've seen (Class2 Div2), they included CCW downgrafting. Some with just posterior downgrafting, others with an element of anterior downgrafting with the net rotation was CCW. To clarify further, those cases came from docs who would do CCW for Class2 div 2 and also would add a lengthening genio to that. The CCW aspect of it is the part that basically gives a 'free ride' to the mandible advancement (where the chin point rotates forward in this ride) and that's BEFORE, the recessive mandible, itself, is advanced further via the BSSO. Given the cases were class2 div2; cases with low angle mandibular planes where CCW does NOT make them steeper, they involved the type of genio that had an element of lengthening to it (as opposed to type that slid upward having a shortening element to it). Those cases ALL had RECESSIVE mandibles.
Now, in the process of looking for cases that involved CW rotation for short face, they had LACK of upper tooth show as you do but NOT as much recession to both the mandible chin as you do.
If you want to take a look at some of those cases, here they are:
https://pocketdentistry.com/23-short-face-growth-patterns-maxillomandibular-deficiency/
https://pocketdentistry.com/9-case-reports/
Now, with reference to the ROTATION at the maxilla, there are indeed, 2 approaches; CCW and CW but I just resolved your case to the CCW because despite the CW working for short face cases, the short faces shown in the papers did not ALSO have the extent of the retrusion to the mandible and chin as you do. Hence my suggesting the CCW approach that gives a 'free ride' or extra push out to the whole mandible and chin even before the BSSO is done along with it.
So, here, I'm just giving my REASONING behind the suggestion I made. But either way, CCW as would do some doctors and CW as would do others, what they BOTH have in common is SURGERY to the MAXILLA.
Of the links you gave:
They helped clarify what I mentioned to April where I said I was not familiar with a type of BSSO only where the BSSO rotated without rotation of the maxilla. Looks like there is a type of BSSO that rotates (CW) independently of any rotation to the maxilla. So, that answered my question aimed to her in this thread.
I also looked at the photos of patients on them. They had AMPLE tooth show and a LESSER extent of the type of mandibular and chin retrusion you do. No downgrafts to the maxilla were needed to increase tooth show. Nor was any CW rotation to the maxilla needed to do it.
So, from those links, I would conclude that the BSSO only technique with CW to the BSSO look to work well for patients who already have AMPLE upper tooth show and DON'T have the extent of mandibular retrusion you do.
Admittedly, I looked at them in terms of whether or not I gave the 'wrong' advice. For example, if I found that the cases had the extent of both the mandibular and chin retrusion you do AND the patients in them ALSO had NO upper tooth show at rest as you do, I would have seen the 'err' of reasoning process behind the advice I gave. But I didn't.
ETA: I can't call it exactly because your case could also fit into a type of downgraft that would involve CW rotation where the downgrafting is more in front than in the back. But that is often one where the mandible is recessive BUT the chin itself is not. Yet still something where a downgraft is done and not something that avoids surgery to the maxilla.
What I also looked at is your opinion which is STRONGLY rooted in AVOIDANCE of any possible surgery to the maxilla. Your FILTERING process is one in favor of AVOIDANCE of any surgery to the maxilla. Now, April's mention of this '3 point landing' BSSO technique, was very well received by you and was exactly the type of information you were looking for because it went through your filter of wanting to AVOID any surgery to the maxilla.
Now, I'm not the one who gave you 'exactly the type of information' you were looking for (information that filtered through and appealed to your desire to avoid any surgery to the maxilla). April did. So, you should direct your questions to HER as to WHY you should move TOWARD the type of surgery she mentioned that doesn't include surgery to the maxilla. Thing is, I'm NOT going to give advice or fill in any info gaps of understanding just because the advice I already gave and the reasoning behind it didn't go through your avoidance filter.
IMO, GAPS of understanding can arise from avoidance filters. Case in point is that you don't seem to understand that someone with a short face who ALSO has NO upper tooth show at rest would also have SOME of the shortness to it attributable to the maxilla in which case moving the maxilla downward would be included into a surgery. You don't understand that because a strong avoidance filter is a MENTAL BLOCK.
What you need--or WANT--is someone to ACCOMMODATE your opinion/desire to AVOID surgery to the maxilla and to do so DESPITE some of the shortness (lack of upper tooth show) coming from the maxilla. You GOT that. April gave you info that involved 'BSSO only' (3 point landing). You even seemed to filter out the parts where she said it wouldn't address issues to the maxilla related to lack of tooth show where she said DJS is usually better to address everything. Also, April commented on your angles. So, direct your question to her as to how your angles apply to avoiding any surgery to the maxilla and/or directly relate to your opinion about BSSO only doing what you want or think it will do.
I'm not going to do a ceph analysis for you, measure all your angles and distances and from there, tutor you just because I gave advice that included something you had a MENTAL BLOCK against entertaining (ANY surgery to the maxilla). Ball is in your court to address your mental block. Not for me to UNBLOCK it for you.
Again, I looked at the links to the type of surgery you wanted. Although it looked very successful for the patients in them, the patients in them didn't start with LACK of UPPER TOOTH SHOW (short maxilla) and their chin and jaw recession was not as extensive as yours. I think it's great April gave you the name of a surgery which you could find a LINK to an article about. So, look at the names on the article and maybe consult with some of the authors based on your strong opinion you are a candidate for JUST THAT and with NO surgery to the maxilla. They should be in the capacity to either confirm or deny you candidacy for it or accommodate your desire to maintain what ever extent of shortness your maxilla with its lack of upper tooth show is contributing to the total shortness you have.
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Did you manage to solve your problem after all?
I'm from central Europe so can get anywhere in Europe quite easily. I'm still in the research phase but soon will start to look for a surgeon, do you have any suggestions on who should I contact?
https://pdfs.semanticscholar.org/44b1/8fe9e7b481e51647115d31678970c6147ff7.pdf
This is it?
Yes that's it. No, I haven't solved my problem. My case is not the same as yours. While I am a bit vertically maxillary deficient, I don't have a short mandible/chin. I also have a higher occlusal/mandibular plane than you. I was only being proposed BSSO plans by local surgeons so I looked up the different types and that's how I came across the 3-point/tripod/cw style. It wasn't a suggestion to do it per se, but it was to answer your question of whether or not lower facial height can be improved with just a BSSO without touching the maxilla. I touched on some issues of why it may not work for you, as has Kavan in more detail above.
In Europe, the big names are Dr Alfaro and Dr Raffaini. I don't think they'll skimp on a plan though; if they think you need DJS then that's what they'll propose.
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Yes that's it. No, I haven't solved my problem. My case is not the same as yours. While I am a bit vertically maxillary deficient, I don't have a short mandible/chin. I also have a higher occlusal/mandibular plane than you. I was only being proposed BSSO plans by local surgeons so I looked up the different types and that's how I came across the 3-point/tripod/cw style. It wasn't a suggestion to do it per se, but it was to answer your question of whether or not lower facial height can be improved with just a BSSO without touching the maxilla. I touched on some issues of why it may not work for you, as has Kavan in more detail above.
In Europe, the big names are Dr Alfaro and Dr Raffaini. I don't think they'll skimp on a plan though; if they think you need DJS then that's what they'll propose.
Seems to me, she's wanting you to suggest doctors who would perform the type of surgery you mentioned to her who might accommodate her CONSTRAINTS of not touching the maxilla.
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Hah well I'm actually sure there's lots of conservative surgeons/orthos out there who restrict their patients to single jaw surgery. My country is full of them.
Mary Poppins, what are some reasons of why you want to avoid double jaw? Is it because you're worried about adding more risk to the surgery (fair enough, if that's your worry about it), or is only because the ortho said you only need lower jaw? Some orthos only care about the bite, and don't consider overall aesthetics. Did the ortho comment at all on lack of tooth show?
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You asked for advice. I gave mine and the reasoning behind it. Although I knew my advice was against a backdrop of AVOIDANCE of any surgery to the maxilla, your query was on the AESTHETIC section of the board AND your case was one that also included NO upper teeth show at rest. So, right there, it became one that didn't justify AVOIDING surgery to the maxilla. Not in terms of aesthetics and not in terms of where some shortness to the face comes from.
I also mentioned that of the cases/displacement proposals I've seen (Class2 Div2), they included CCW downgrafting. Some with just posterior downgrafting, others with an element of anterior downgrafting with the net rotation was CCW. To clarify further, those cases came from docs who would do CCW for Class2 div 2 and also would add a lengthening genio to that. The CCW aspect of it is the part that basically gives a 'free ride' to the mandible advancement (where the chin point rotates forward in this ride) and that's BEFORE, the recessive mandible, itself, is advanced further via the BSSO. Given the cases were class2 div2; cases with low angle mandibular planes where CCW does NOT make them steeper, they involved the type of genio that had an element of lengthening to it (as opposed to type that slid upward having a shortening element to it). Those cases ALL had RECESSIVE mandibles.
Now, in the process of looking for cases that involved CW rotation for short face, they had LACK of upper tooth show as you do but NOT as much recession to both the mandible chin as you do.
If you want to take a look at some of those cases, here they are:
https://pocketdentistry.com/23-short-face-growth-patterns-maxillomandibular-deficiency/
https://pocketdentistry.com/9-case-reports/
Now, with reference to the ROTATION at the maxilla, there are indeed, 2 approaches; CCW and CW but I just resolved your case to the CCW because despite the CW working for short face cases, the short faces shown in the papers did not ALSO have the extent of the retrusion to the mandible and chin as you do. Hence my suggesting the CCW approach that gives a 'free ride' or extra push out to the whole mandible and chin even before the BSSO is done along with it.
So, here, I'm just giving my REASONING behind the suggestion I made. But either way, CCW as would do some doctors and CW as would do others, what they BOTH have in common is SURGERY to the MAXILLA.
Of the links you gave:
They helped clarify what I mentioned to April where I said I was not familiar with a type of BSSO only where the BSSO rotated without rotation of the maxilla. Looks like there is a type of BSSO that rotates (CW) independently of any rotation to the maxilla. So, that answered my question aimed to her in this thread.
I also looked at the photos of patients on them. They had AMPLE tooth show and a LESSER extent of the type of mandibular and chin retrusion you do. No downgrafts to the maxilla were needed to increase tooth show. Nor was any CW rotation to the maxilla needed to do it.
So, from those links, I would conclude that the BSSO only technique with CW to the BSSO look to work well for patients who already have AMPLE upper tooth show and DON'T have the extent of mandibular retrusion you do.
Admittedly, I looked at them in terms of whether or not I gave the 'wrong' advice. For example, if I found that the cases had the extent of both the mandibular and chin retrusion you do AND the patients in them ALSO had NO upper tooth show at rest as you do, I would have seen the 'err' of reasoning process behind the advice I gave. But I didn't.
ETA: I can't call it exactly because your case could also fit into a type of downgraft that would involve CW rotation where the downgrafting is more in front than in the back. But that is often one where the mandible is recessive BUT the chin itself is not. Yet still something where a downgraft is done and not something that avoids surgery to the maxilla.
What I also looked at is your opinion which is STRONGLY rooted in AVOIDANCE of any possible surgery to the maxilla. Your FILTERING process is one in favor of AVOIDANCE of any surgery to the maxilla. Now, April's mention of this '3 point landing' BSSO technique, was very well received by you and was exactly the type of information you were looking for because it went through your filter of wanting to AVOID any surgery to the maxilla.
Now, I'm not the one who gave you 'exactly the type of information' you were looking for (information that filtered through and appealed to your desire to avoid any surgery to the maxilla). April did. So, you should direct your questions to HER as to WHY you should move TOWARD the type of surgery she mentioned that doesn't include surgery to the maxilla. Thing is, I'm NOT going to give advice or fill in any info gaps of understanding just because the advice I already gave and the reasoning behind it didn't go through your avoidance filter.
IMO, GAPS of understanding can arise from avoidance filters. Case in point is that you don't seem to understand that someone with a short face who ALSO has NO upper tooth show at rest would also have SOME of the shortness to it attributable to the maxilla in which case moving the maxilla downward would be included into a surgery. You don't understand that because a strong avoidance filter is a MENTAL BLOCK.
What you need--or WANT--is someone to ACCOMMODATE your opinion/desire to AVOID surgery to the maxilla and to do so DESPITE some of the shortness (lack of upper tooth show) coming from the maxilla. You GOT that. April gave you info that involved 'BSSO only' (3 point landing). You even seemed to filter out the parts where she said it wouldn't address issues to the maxilla related to lack of tooth show where she said DJS is usually better to address everything. Also, April commented on your angles. So, direct your question to her as to how your angles apply to avoiding any surgery to the maxilla and/or directly relate to your opinion about BSSO only doing what you want or think it will do.
I'm not going to do a ceph analysis for you, measure all your angles and distances and from there, tutor you just because I gave advice that included something you had a MENTAL BLOCK against entertaining (ANY surgery to the maxilla). Ball is in your court to address your mental block. Not for me to UNBLOCK it for you.
Again, I looked at the links to the type of surgery you wanted. Although it looked very successful for the patients in them, the patients in them didn't start with LACK of UPPER TOOTH SHOW (short maxilla) and their chin and jaw recession was not as extensive as yours. I think it's great April gave you the name of a surgery which you could find a LINK to an article about. So, look at the names on the article and maybe consult with some of the authors based on your strong opinion you are a candidate for JUST THAT and with NO surgery to the maxilla. They should be in the capacity to either confirm or deny you candidacy for it or accommodate your desire to maintain what ever extent of shortness your maxilla with its lack of upper tooth show is contributing to the total shortness you have.
Listen, I mentioned three times so far that my knowledge on this subject is scarce. You keep saying that my face is severely retruded but it is not - my maxilla and my mandible are BOTH PROGNATHIC with my SNA being 88 and my SNB 81. I've been reading your post for three days and I think I finally managed to understand it fully because at the time I was writing my first post I had no idea what a CW/CCW rotation even means. Where I'm coming from they would put me in a mental institution just to hear me utter the words tooth show. :D So, I need to be fully prepared before my consultation which I plan on doing locally one more time because I am pretty sure they will tell me I shouldn't do bimax because the numbers are not adding up. As they already (I guess) did.
Thank you for being so thorough, it helped. I'm forcing the bsso because I am also looking at my analysis and my profile and I am wondering how much my proghnatic maxilla contributes to my profile looking like that.
In a normal profile the base of the nose should be aligned with the nasion (otherwise, you would get a monkey;). There's no such a thing in my profile because my maxilla+philtrum are indeed huge and much further away from my forehead so I just think that any type of horizontal and vertical advancement of my maxilla could possibly look weird. I am still missing that part of information on whether my maxilla is indeed vertically deficient and I can sense you are hesitant about confirming that in your post - because if the only criteria for confirmation is lack of tooth show - I am thinking what will happen if with a bimax I reveal my PROGNATHIC MAXILLA and TEETH. And I am aware of the fact that I should not be bringing it back because I need forward projection of the mandible.
Thanks for the psychological evaluation, I didn't know you can get that one here as well. :P
Also, I would like to know why my articular angle is so high (158, should be 140). And does it change with mandibular advancement. Thank you.
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Hah well I'm actually sure there's lots of conservative surgeons/orthos out there who restrict their patients to single jaw surgery. My country is full of them.
Mary Poppins, what are some reasons of why you want to avoid double jaw? Is it because you're worried about adding more risk to the surgery (fair enough, if that's your worry about it), or is only because the ortho said you only need lower jaw? Some orthos only care about the bite, and don't consider overall aesthetics. Did the ortho comment at all on lack of tooth show?
I just posted my answer to kavan, I think it pretty much answers all of your questions. ;) Plus the fact that yes, I am terrified of the risks and of the pure thought of my maxilla being out in the open and in somebody's hand. :D
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Did you do those angles yourself or do you already have a ceph analysis? If you already have an analysis, why not post it?
I am still missing that part of information on whether my maxilla is indeed vertically deficient and I can sense you are hesitant about confirming that from your post - because if the only criteria for doing that is lack of tooth show
Lack of tooth show can be from a short maxilla, a long lip, short upper teeth, or a combination. Maybe some other things too that I'm not aware of. You will need to figure out which of those you suffer from.
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Did you do those angles yourself or do you already have a ceph analysis? If you already have an analysis, why not post it?
Lack of tooth show can be from a short maxilla, a long lip, short upper teeth, or a combination. Maybe some other things too that I'm not aware of. You will need to figure out which of those you suffer from.
I posted SNA and SNB values at the beginning.
I also thought you can tell by looking at my Xray. I've seen a few similar posts here where people immediatelly knew from the cephs maxilla was protruded without any numbers attached.
And I wrote in my first post that my angles are not fine but I've gotten two answers so far that they are so I was kind of discouraged to say more.
I've got SNA, SNB, ANB (7), gonial (111), ariticular (158), saddle (118) and interincisal angle (119).
Yes, I have a feeling that my 'short maxilla' is actually huge philtrum, that's why I keep saying to kavan that maxillary advancement in my case should be approached carefully.
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And I wrote in my first post that my angles are not fine but I've gotten two answers so far that they are so I was kind of discouraged to say more.
I've got SNA, SNB, ANB (7), gonial (111), ariticular (158), saddle (118) and interincisal angle (119).
When we have said your jaw angles look good, it's because they literally look good in your pictures. Not do to with a number. Most people want a strong gonial angle.
I don't know what articular angle measures for. Do you?
Yes, I have a feeling that my 'short maxilla' is actually huge philtrum, that's why I keep saying to kavan that maxillary advancement in my case should be approached carefully.
It should be easy enough for you to get some quick measure of your philtrum/upper lip. Just use a ruler or tape and measure with your lips relaxed. For the philtrum - measure from under you nose until the top border of your upper lip. For "upper lip length" measure from under your nose and this time include your actual upper lip too.
On your xray your philtrum looks around 15mm
And your 'upper lip length' (that's philtrum + upper lip) maybe around 20mm.
Those are total eyeball estimates, so if you could do the actual measurements, you should.
Also, it's obviously super easy for you to measure the length of your upper teeth as well.
According to Arnett's analysis for females, the 'upper lip length' should be 19-22mm and also the 'upper incisor crown heights' should be within 9.5-11.5mm.
Now about your last line. CCW/CW are technically rotations. Not maxillary advancements (although maxillary advancement can be done alongside them).
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When we have said your jaw angles look good, it's because they literally look good in your pictures. Not do to with a number. Most people want a strong gonial angle.
I don't know what articular angle measures for. Do you?
It should be easy enough for you to get some quick measure of your philtrum/upper lip. Just use a ruler or tape and measure with your lips relaxed. For the philtrum - measure from under you nose until the top border of your upper lip. For "upper lip length" measure from under your nose and this time include your actual upper lip too.
On your xray your philtrum looks around 15mm
And your 'upper lip length' (that's philtrum + upper lip) maybe around 20mm.
Those are total eyeball estimates, so if you could do the actual measurements, you should.
Also, it's obviously super easy for you to measure the length of your upper teeth as well.
According to Arnett's analysis for females, the 'upper lip length' should be 19-22mm and also the 'upper incisor crown heights' should be within 9.5-11.5mm.
Now about your last line. CCW/CW are technically rotations. Not maxillary advancements (although maxillary advancement can be done alongside them).
I measured, it all fits. 😐 Philtrum 15, teeth 10.5 and upper lip lenght 21 mm. And no bloody tooth show. 😐
https://www.researchgate.net/figure/Cephalometric-measurements-1-Saddle-angle-2-articular-angle-3-gonial-angle-4_fig1_238268401
You can find the articular angle here. I guess high values mean recessed mandible. I asked because I've read somewhere that it changes after BSSO but I can't really see how because the surgery should move the gonion forward what really doesn't make sense to me knowing where they make the cut. I guess mine is high because my gonion is somewhere behind my ear, it sometimes feels like I'm going to swallow my mandible. 😁
Thank you april so much for the explanation and measurements, I'm going to do the polisomnography in a couple of days because I've got troubles sleeping and then decide what to do next.
Kavan, thank you for the lenghty post, I'll keep your advice in mind.
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I posted SNA and SNB values at the beginning.
I also thought you can tell by looking at my Xray. I've seen a few similar posts here where people immediatelly knew from the cephs maxilla was protruded without any numbers attached.
And I wrote in my first post that my angles are not fine but I've gotten two answers so far that they are so I was kind of discouraged to say more.
I've got SNA, SNB, ANB (7), gonial (111), ariticular (158), saddle (118) and interincisal angle (119).
Yes, I have a feeling that my 'short maxilla' is actually huge philtrum, that's why I keep saying to kavan that maxillary advancement in my case should be approached carefully.
You didn't answer April's question as to whether or not you had a ceph tracing with the angle charted out (and if so, why didn't you post it) or if you did the measures yourself to come up with the angles. Kavan never told you to actually pursue maxillary advancement. But rather that surgery TO the maxilla, avoidance of such existed as a MENTAL BLOCK in understanding the information I gave you. I already told you that shortness to the MAXILLA contributes to the shortness of lower 1/3rd of the face and that lack of tooth show is an indicator.
Clearly the info April gave you (in a later post) RULED OUT your lack of tooth show coming from from your upper lip being too long.
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Listen, I mentioned three times so far that my knowledge on this subject is scarce. You keep saying that my face is severely retruded but it is not - my maxilla and my mandible are BOTH PROGNATHIC with my SNA being 88 and my SNB 81. I've been reading your post for three days and I think I finally managed to understand it fully because at the time I was writing my first post I had no idea what a CW/CCW rotation even means. Where I'm coming from they would put me in a mental institution just to hear me utter the words tooth show. :D So, I need to be fully prepared before my consultation which I plan on doing locally one more time because I am pretty sure they will tell me I shouldn't do bimax because the numbers are not adding up. As they already (I guess) did.
Thank you for being so thorough, it helped. I'm forcing the bsso because I am also looking at my analysis and my profile and I am wondering how much my proghnatic maxilla contributes to my profile looking like that.
In a normal profile the base of the nose should be aligned with the nasion (otherwise, you would get a monkey;). There's no such a thing in my profile because my maxilla+philtrum are indeed huge and much further away from my forehead so I just think that any type of horizontal and vertical advancement of my maxilla could possibly look weird. I am still missing that part of information on whether my maxilla is indeed vertically deficient and I can sense you are hesitant about confirming that in your post - because if the only criteria for confirmation is lack of tooth show - I am thinking what will happen if with a bimax I reveal my PROGNATHIC MAXILLA and TEETH. And I am aware of the fact that I should not be bringing it back because I need forward projection of the mandible.
Thanks for the psychological evaluation, I didn't know you can get that one here as well. :P
Also, I would like to know why my articular angle is so high (158, should be 140). And does it change with mandibular advancement. Thank you.
Whoa! You get on here 'Looking for Advice'. But when you get advice that doesn't conform to YOUR OWN advice for yourself, the advice giver is then obliged to 'prove' their advice via ceph angle analysis with tutorial or otherwise disprove your doctor's advice by same?
I don't even know IF you realize you are expecting that or entitling yourself to that. But let me just say that if you are expecting to know everything about your angles and would need a TUTORIAL as to how they relate so you can better understand things more, I'm not volunteering to do all that in any contingency for your wanting to know all that via JSF. It's TEDIOUS to measure out someones angles by hand and it's WORK to to cater a tutorial for them based on all the GAPS they have. It EXCEEDS what I'm willing to do on JSF for $0/hour.
It sounds like I would need me to draft up a document showing how you differed from the patients who were successfully treated via the 3 point landing procedure in the links you found in order for you to understand that I didn't need to mention anything about your SNA and SNB angles when I conveyed to you that your retrusion of the mandible (relative to your maxilla) EXCEEDED the relative retrusion that the patients who had successful outcomes from that 3 point (no cut to the maxilla) surgery. I'm not volunteering to do that for $0/hour here. Nor am I even offering privatized for pay tutorials on JSF. Just saying, for people who would need that to 'prove' to them why my advice was in CONFLICT to their 'understanding', it's not something I volunteer to do.
Furthermore, I find it STRANGE that you just happen to know all the measurements of all those angles in the ABSENCE of having a ceph TRACING that included read outs of the angles. Could it be that your doc gave you such a ceph tracing where the angles were drawn from the appropriate points and lines drawn from there to measure the angles. BUT instead of putting that up here, you elected to WITHHOLD it in favor of putting up a ceph with no tracings on it?
How is that you know exactly what those angles are? Did you get a ceph tracing from the doctor with the read outs. If so, why are you asking me to 'look at your angles' which is something that requires me to chart out the points, connect them and then measure with a protractor and to do so because you elected to WITHOLD a ceph tracing?...OR is this something you can do by yourself to do your own ceph tracing. Which one is it?
Yes. You do have GAPS of understanding and realize you do. But another thing you do which really doesn't sit well with me is despite your being aware that you have GAPS of understanding, you contend that your SNA and SNB angles ALONE 'mean your maxilla and mandible are BOTH PROGNATHIC'. Again, I volunteered NO information about your angles. Others did. What I told you was that your mandible and chin were MORE retrusive than the patients I looked at who had successful treatment for short face and also your mandible/chin was MORE RETRUSIVE than the patients in the link where they had successful 3 point landing rotation of mandible only.
The reason, I volunteered NO information about your angles (and let others volunteer) was because I had reason to suspect you already had a ceph tracing that you were WITHHOLDING. That was due to the angle measures being correct. Quite frankly, I detected somewhat of a passive aggressive 'challenge' of 'Let's withhold the ceph tracing to see if Kavan will do one, get it right, if I withhold it'. Also, to see if you keep asking ME about angles despite OTHERS telling you about your angles but not asking them directly.
Here's what I'll volunteer about your angles: SNA, SNB, ANB and SArGo are consistent with the angle measures you mentioned. Given that it's tedious for me to hold up a hand held protractor to cross reference all of them, I'm just confirming those 4. So, I would assume that all the other ones you have measures of are probably correct. However, given that the angles I measured are consistent with those you ALREADY HAVE info about, I would conclude that you also have a CEPH TRACING with read outs of what those angles are BUT elected to withhold putting that up in favor of putting up an un marked out (un charted out) ceph instead. Am I right or wrong on that OR is this something where you can find all those points yourself, and construct the lines needed to measure the angles?
Another thing I'll confirm here is what Lefortitude told you which is that 'measurements relative to the cranial base in general have fallen out of favor among maxfac surgeons (in the US atleast).' However, to his statement, I would add the qualifier of 'GOOD' surgeons in the US. So, SNA and SNB (ANB is just angle SNA-SNB) are angle measures relative to the cranial base. A good surgeon who is in capacity to kick up a nice aesthetic change doesn't necessarily rely on those. For example, Gunson and the doctors April mentioned, all of whom are TOP doctors, would most likely NOT tell you that BOTH of your jaws are 'prognathic' or advise you to forego surgery to the maxilla for that reason. They would be MORE LIKELY to include surgery to the maxilla that included a ROTATION of it via a DOWNGRAFT. Doesn't matter if it's CW or CCW, it would still be a downgraft with a ROTATION (surgery to the maxilla).
Angle measures RELATIVE to the cranial base just convey the relationship between the maxilla and the mandible and whether someone is class 1 relationship or Class 2 or 3. They don't preclude someone who has a maxilla relatively MORE forward than the mandible from having a rotation to it if such a rotation would allow the mandible to come more forward for a better 'line up of the lips' in a circumstance where someone's lower lip is found more behind the upper lip.
I'll also confirm what April told you which is that CW/CCW are rotations and not advancements.
Rotations are separate and different displacements from TRANSLATIONS. For example a CCW rotation of the maxilla eg. an overall downgraft that's more in the posterior direction than anterior can be done WITHOUT moving the maxilla 'forward'. Moving either one of the jaws along a 'path' is a translation. When ever you move along a path where the line of that path has an angle of inclination relative to a horizont, the movement is a translation. The ROTATION is when they CHANGE the angle of inclination of the path (relative to a horizont) they are wanting to do the translational displacements over. For example if they feel they could kick up a good aesthetic result with a BSSO that say the mandibular plane doesn't have a 'good enough' angle of inclination to it so that the translation they do brings it out to the 'right' place, they can set the path over which to do the translation to a more favorable angle of inclination by ROTATING the maxilla. So a rotation of the maxilla is DIFFERENT from moving it along a linear path which is a 'translation'.
As to another one of Aprils questions to you she asked:
Did you do those angles yourself or do you already have a ceph analysis? If you already have an analysis, why not post it?
You didn't answer it. Same question I have. Why are you asking people to look at your angles if you actually HAVE a ceph tracing with them all listed on it OR do you know how to measure them yourself via charting out the exact points on your ceph?
Maybe I gave too much info for you to digest despite it being very generous of me to offer that much. However, on the grounds of my having some reason to believe that you withheld posting a ceph TRACING (when you had one already) and not answering April's question whether or not you had such when you asked people to 'look at your angles', this marks the END of the information I'm going to volunteer to you.
Enclosed, my measures of the same angles you somehow already know in the absence of answering April's question to you whether or not you actually had a ceph tracing that measured those angles (or in the presence of avoiding a DIRECT answer to the question.)
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I measured, it all fits. 😐 Philtrum 15, teeth 10.5 and upper lip lenght 21 mm. And no bloody tooth show. 😐
https://www.researchgate.net/figure/Cephalometric-measurements-1-Saddle-angle-2-articular-angle-3-gonial-angle-4_fig1_238268401
You can find the articular angle here. I guess high values mean recessed mandible. I asked because I've read somewhere that it changes after BSSO but I can't really see how because the surgery should move the gonion forward what really doesn't make sense to me knowing where they make the cut. I guess mine is high because my gonion is somewhere behind my ear, it sometimes feels like I'm going to swallow my mandible. 😁
Thank you april so much for the explanation and measurements, I'm going to do the polisomnography in a couple of days because I've got troubles sleeping and then decide what to do next.
Kavan, thank you for the lenghty post, I'll keep your advice in mind.
What don't you understand...your own advice to yourself where you need to avoid any cuts to the maxilla and just need BSSO ONLY?
Could it be that CCW rotation (involving surgery to the maxilla, a CONSTRAINT of yours) could rotate your gonian forward because CCW rotation rotates whole mandible forward and could it be that your gonian that is too far back would also come forward in that rotation?
Could it be that your articular angle is high because your mandible is rotated posteriorly (backwards) and the only way to rotate it away from it's posterior position would be to rotate the maxilla CCW?
Here's a diagram in the event April doesn't already have it and/or wants to explain why your gonian COULD be rotated in such a way to make your articular angle high .