jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Nikolai on September 20, 2024, 04:54:19 PM
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Hi, I am a candidate for DJS+BSSO, but I also have an incredibly narrow chin and narrow jaw. I have this post saved from a long time ago (potentially from this forum) and wanted to get opinions of whether what was proposed in that post is realistic, and if so, whether it would be a good idea to attempt this before, or after DJS+BSSO in my prospective surgery pipeline, and if this would prevent me from pursuing future surgeries (once healed) in any way. Also wondering who (in the US but would go overseas if needed) would consider doing this. Alternatively, I am open to being educated on the best way to achieve this widening effect if it's possible (in the first place) through another means (as I need a technique that affords me the most width I can get). I know this is jawsurgeryforums but I've also recently seen suggestions of the less invasive 'MSE' and 'MSDO' from videos on YouTube like this one and wanted to see if members here see this is as a viable way as well to achieve width: https://youtu.be/i_6RRfLGbhA?si=DM5i5g6UM3wRbNCg
Thanks!
(https://i.imgur.com/qyR8agu.png)
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That post is the dumbest ive read in a while...smh
Better of with getting implants probably
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That post is the dumbest ive read in a while...smh
Well it is probably over 10 years old too, to be fair.
Better of with getting implants probably
I wouldn't mind implants, I was discouraged from pursuing them though a while back by one of the doctors I had met with to get DJS+BSSO (the doctor stressed infection and bone resorption possibilities), but I figure they could accomplish something similar to this a lot more easily. Though I figure if I go the implant route, it would logically have to be after any kind of DJS+BSSO/Genio/Chin Wing to at least let the result from those surgeries settle and see what kind of implant I'd go for then.
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I don't really understand this post. I read it twice, and it seems like you posted a photo of a different person who isn't you, and then linked to a YouTube video that's 16 minutes long (nobody here has time to watch that). Post a photo of yourself so we can see what you're dealing with.
In general, the mandible can't be expanded because it puts undue stress on the condyles and will over time destroy them. It's generally done for facial deformity cases. Most credible surgeons won't do it outside of those cases. So, I'd think implants are going to be the only way to widen your mandible if you go to a credible surgeon.
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I don't really understand this post. I read it twice, and it seems like you posted a photo of a different person who isn't you, and then linked to a YouTube video that's 16 minutes long (nobody here has time to watch that). Post a photo of yourself so we can see what you're dealing with.
In general, the mandible can't be expanded because it puts undue stress on the condyles and will over time destroy them. It's generally done for facial deformity cases. Most credible surgeons won't do it outside of those cases. So, I'd think implants are going to be the only way to widen your mandible if you go to a credible surgeon.
Sorry, I didn't intend for this post to come off as a bit scatterbrained but I can see now how it did. The purpose of that YouTube video link was to see if anyone here has pursued MSE+MSDO for maxillary/mandibular widening, as it seemed like one potential way to achieve width. And then the other image was just inquiring if that posters suggestion was viable as well. Anyway, here's what I'm dealing with from a front view:
(https://i.imgur.com/3H6qSml.jpeg)
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Some notes:
1: Re: "DJS + BSSO": DJS is Double Jaw Surgery. DJS= BSSO + Lefort (to maxilla) and often with genio. So, someone doesn't have "DJS + BSSO". They have DJS + (maybe) a genio with it.
2: The MORPH shown here isn't actually an OUTCOME of any surgeries/procedures done on the person. It's an outcome of MOVING PIXELS. There is NO WAY of knowing that the morph shown here is actually even a predictor of what the morpher thinks it predicts. So, it isn't a prediction either of an outcome you could possibly get based on nothing more than someone moving pixels on ANOTHER person's photo.
3: The creator of the YT channel you linked to seems very knowledgeable about MSE and MSDO. He offers individual video consults. Maybe look into that to get his take on your candidacy for those things.
4: A 'T section' genio is a genio that widens the chin. A horizontal cut is made across the bottom of chin and a vertical cut down the middle. The bottom of the chin is then separated into 2 parts and a bone graft is used in-between to WIDEN the chin. It does not put any stress on the condyles because it is not aimed at expanding the entire mandible, ONLY the chin.
5: Implants can widen the entire ARC of the lower face; chin and mandible.
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Hi Kavan, thanks for weighing in. I have a few follow up's if you don't mind:
1: Re: "DJS + BSSO": DJS is Double Jaw Surgery. DJS= BSSO + Lefort (to maxilla) and often with genio. So, someone doesn't have "DJS + BSSO". They have DJS + (maybe) a genio with it.
1. Noted and thanks for the correction.
2: The MORPH shown here isn't actually an OUTCOME of any surgeries/procedures done on the person. It's an outcome of MOVING PIXELS. There is NO WAY of knowing that the morph shown here is actually even a predictor of what the morpher thinks it predicts. So, it isn't a prediction either of an outcome you could possibly get based on nothing more than someone moving pixels on ANOTHER person's photo.
2. Yep, you can disregard that. In hindsight I could've probably omitted the morph and kept the text section just to see if the movements sounded plausible, without the morph as a distraction to that question.
3: The creator of the YT channel you linked to seems very knowledgeable about MSE and MSDO. He offers individual video consults. Maybe look into that to get his take on your candidacy for those things.
3. Will do.
4: A 'T section' genio is a genio that widens the chin. A horizontal cut is made across the bottom of chin and a vertical cut down the middle. The bottom of the chin is then separated into 2 parts and a bone graft is used in-between to WIDEN the chin. It does not put any stress on the condyles because it is not aimed at expanding the entire mandible, ONLY the chin.
4. Are there any drawbacks/'contraindications' to this 'T section' genio? I've never heard of it before but that's more likely due to my own ignorance still; I'm also am curious if getting this type of genio would prevent me from getting any other chin or jaw work done afterward if necessary (hopefully only one surgery needed, but just curious for a worst case)? Also wondering if you have any names of surgeons that do this movement, or if it's really not that special of an augmentation and virtually any [big name] surgeon would both be capable and willing to do it.
5: Implants can widen the entire ARC of the lower face; chin and mandible.
5. Can you share your stance on implants (for mandible/chin)? That is, whether you believe in some cases they are comparably viable to moving bone? Or if they're always going to be notably an inferior option. And also, if there's a material you'd suggest for implants (i.e. titanium vs silicone).
Thanks!
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Hi Kavan, thanks for weighing in. I have a few follow up's if you don't mind:
1. Noted and thanks for the correction.
2. Yep, you can disregard that. In hindsight I could've probably omitted the morph and kept the text section just to see if the movements sounded plausible, without the morph as a distraction to that question.
3. Will do.
4. Are there any drawbacks/'contraindications' to this 'T section' genio? I've never heard of it before but that's more likely due to my own ignorance still; I'm also am curious if getting this type of genio would prevent me from getting any other chin or jaw work done afterward if necessary (hopefully only one surgery needed, but just curious for a worst case)? Also wondering if you have any names of surgeons that do this movement, or if it's really not that special of an augmentation and virtually any [big name] surgeon would both be capable and willing to do it.
5. Can you share your stance on implants (for mandible/chin)? That is, whether you believe in some cases they are comparably viable to moving bone? Or if they're always going to be notably an inferior option. And also, if there's a material you'd suggest for implants (i.e. titanium vs silicone).
Thanks!
As to the T section genio, I mentioned it as something for you to look into since you didn't know that procedure existed to widen the chin. My stance on implants is that if moving bone (jaw surgery) is needed, you do the jaw surgery first and later the implants. There are pros and cons with each material. But first you need to do your own research on that as to what they are because different people have difference preferences. Also, I lack the time to educate you on those things.
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That's fair. Thanks again for the info.
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There is another technique you may want to investigate to see if relevant called SFOT (Surgically facilitated orthodontic therapy) it is also mentioned on the Jaw hacks channel you listed in your post. With SFOT it combines using a corticotomy and bone graft to build out the bone around the edge of the jaw and then shift the teeth outwards to "expand" the arch but its not actually expanding the mandible itself in the way MSDO does. I dont know whether this technique would provide the desired effect but its one to look into.
As pointed out previously MSDO is only expanding the mandible at the front not the back and from what I have read it seems to be a mixed bag of some people having no issues vs others having problems with their condyles. The same can be said for MSE with potential for serious asymettry issues and visual disturbances vs others who experience breathing improvements and aesthetic benefits.
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I don't really understand this post. I read it twice, and it seems like you posted a photo of a different person who isn't you, and then linked to a YouTube video that's 16 minutes long (nobody here has time to watch that). Post a photo of yourself so we can see what you're dealing with.
In general, the mandible can't be expanded because it puts undue stress on the condyles and will over time destroy them. It's generally done for facial deformity cases. Most credible surgeons won't do it outside of those cases. So, I'd think implants are going to be the only way to widen your mandible if you go to a credible surgeon.
Dr Ramieri said he could widen mine by about 5mm on each side during thr bsso by essentially flaring the ramus out. Now I'm concerned with his suggestion.
I wonder if expanding the mandible at the chin via MSDO would be safer...
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Dr Ramieri said he could widen mine by about 5mm on each side during thr bsso by essentially flaring the ramus out. Now I'm concerned with his suggestion.
I wonder if expanding the mandible at the chin via MSDO would be safer...
I was thinking the same, related to another post not long ago. What's the impact on the joints when this sort of widening happens and what exactly are the mechanics behind it.
If you ever get a good explanation from him, let us know :D
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I was thinking the same, related to another post not long ago. What's the impact on the joints when this sort of widening happens and what exactly are the mechanics behind it.
If you ever get a good explanation from him, let us know :D
You had the right idea about how the gonial angle area can get flared out in your replies # 11 and #13 in the thread where the guy was AFRAID of that happening and was having a hard time understanding why: https://jawsurgeryforums.com/index.php/topic,8745.0.html
You have a thinking process I can build on and I've PEGGED you as being very close to the basic mechanics behind this because this was something in the other thread that was basically intuitively obvious to you or pretty close to it but admittedly, a challenge to explain.
One needs to be able to break down things in a series of mental steps in the form of questions and answers to ONES SELF and not get 'stuck' in thinking that the gonial angle area doesn't move and/or the contention that area could not possibly get wider. You realized that a part of it did move and started with the premise of knowing what a sagittal split actually was.
I'll PM you a self learning type of QUIZ on this that builds on what I think you already know. If the 'building' process helps, the basic 'mechanics' and/or explanation should become self evident.
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You had the right idea about how the gonial angle area can get flared out in your replies # 11 and #13 in the thread where the guy was AFRAID of that happening and was having a hard time understanding why: https://jawsurgeryforums.com/index.php/topic,8745.0.html
You have a thinking process I can build on and I've PEGGED you as being very close to the basic mechanics behind this because this was something in the other thread that was basically intuitively obvious to you or pretty close to it but admittedly, a challenge to explain.
One needs to be able to break down things in a series of mental steps in the form of questions and answers to ONES SELF and not get 'stuck' in thinking that the gonial angle area doesn't move and/or the contention that area could not possibly get wider. You realized that a part of it did move and started with the premise of knowing what a sagittal split actually was.
I'll PM you a self learning type of QUIZ on this that builds on what I think you already know. If the 'building' process helps, the basic 'mechanics' and/or explanation should become self evident.
Alright, thanks for the quiz!
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Alright, thanks for the quiz!
You're welcome. Let me know if it's helpful or not.
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You're welcome. Let me know if it's helpful or not.
It was a lot.
Of topic:
When thinking about the sagittal split I started to imagine a sagittal split genioplasty asking myself if this is possible or has been done. And apparently it is/was.
https://www.joms.org/article/S0278-2391(09)01824-2/abstract
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It was a lot.
Of topic:
When thinking about the sagittal split I started to imagine a sagittal split genioplasty asking myself if this is possible or has been done. And apparently it is/was.
https://www.joms.org/article/S0278-2391(09)01824-2/abstract
I don't have full access to that article. But the part I can read, the author (Stephen Schendal MD) states: "The most frequently performed osteotomy for correction of the small and retruded chin is the horizontal sliding genioplasty". That doesn't ring true to me simply because a sliding genio can include a diagonally oriented cut for the sliding to have vectorial components of horizontally outward and vertically upward. I don't know about his contention that horizontal ones are the most frequently used (a sliding genio with no vertically upward vector component). Maybe a matter of semantics. However, it is true that sliding genio; horizontally displaced or diagonally upward can kick up some scalloping to what they call the 'pre-jowl sulcus' area which is the part of the mandibular border lateral to* and close to the chin itself.
Again, I don't see the illustrations for what he calls a sagittal split genio. But what I do 'see' (in my head) is that on Figure 2 of his illustration (pointing to the area that can show scalloping with the 'horizontal' sliding genio) that the cut could be extended to include some of the body of the anterior part of the mandibular border.
*Note the pre-jowl sulcus area is next to the chin (lateral to). It's on the anterior aspect of the border of the body of the mandible.
You know how in SOME chin wings (with some people), they can't angle the cut all the way back to the posterior part of the mandibular border because the person's nerve hole is too close for comfort. Well, that type of chin wing can include some of the anterior aspect of the mandibular border. One time I called that a 'glorified genio' (which would not be the 'medical name for it). So, maybe he's extending the cut to include that area which would tend to mitigate scalloping. Again, I don't see what his cut is because I don't have full access to the article. I'm just using my imagination of what it could be.
ETA: OK. I found some illustration that seems to show he is including part of the anterior aspect of the mandibular border. (https://www.joms.org/cms/10.1016/j.joms.2009.09.082/asset/792f5332-d789-413c-8897-f8a5ec7ae6cc/main.assets/gr3.sml)
ETA #2: OK, still can't see more illustrations. But if it's a sagittal cut it's dividing something vertically. So, it looks like a curved cut that includes the anterior aspect of mandibular border that extends downward to release that chin segment.
ETA #3: If you wanted a type of genio that mitigated scalloping (the look of step-offs), the type of 'patient speak' to the doctor would be: 'I'd like a type of genio that also includes the part of the mandible right next to the chin because I'm concerned about step-offs with some other types.'
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ETA #2: OK, still can't see more illustrations. But if it's a sagittal cut it's dividing something vertically. So, it looks like a curved cut that includes the anterior aspect of mandibular border that extends downward to release that chin segment.
ETA #3: If you wanted a type of genio that mitigated scalloping (the look of step-offs), the type of 'patient speak' to the doctor would be: 'I'd like a type of genio that also includes the part of the mandible right next to the chin because I'm concerned about step-offs with some other types.'
Yes exactly this is the illustration I meant.
Good point on the Patient to Doc communication.
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Dr Ramieri said he could widen mine by about 5mm on each side during thr bsso by essentially flaring the ramus out. Now I'm concerned with his suggestion.
I wonder if expanding the mandible at the chin via MSDO would be safer...
I wouldn't worry about that too much because the BSSO can kick up a width increase to the very back of the jaw line; increase in inter-gonial distance and I think the surgery itself, incorporates making some accommodations to the jaw joints (condyles) to mitigate stress on them. It doesn't affect a width increase to the ENTIRE mandible or to the lower lateral sides below the gonial region that one sees from the front which is part of the discussion in this thread.
Consider, that you jumped into a thread where the info in it applied not only to someone ELSE but also SOMETHING else other than the BSSO you've consulted about; one where the doctor told you where the widening would take place. So, there is no basis to start reconsidering what your doctor told you based on what GJ said to someone ELSE about something OTHER than the type of surgery you are getting.
GJ was referring to expansion of the ENTIRE mandible and/or something that would expand the lower lateral sides of the mandible that one would see frontal view. For example, something where one would have to make a vertical cut to the CHIN to affect such an expansion which, indeed could/would, in general put undue stress on the condyles as a function of the extent of that type of expansion. That could be concluded from the context of the thread.
What could NOT be concluded or applied to yourself from what GJ said to another was what you concluded from it as to 'wonder' if the very thing that could put stress on the condyles (the MSDO) would be 'safer' than the surgery offered to you.
Information that was not directed to you or had NOTHING to do with a BSSO most likely offered to you by the surgeon you consulted with is no reason to be concerned about what the doctor told you about what his surgery would/could do and where. Basically, you are 'wondering' about something you should get instead of what the doctor offered you which is the very thing that could stand to put stress on the condyles; expanding the mandible at the chin.
I'd say that's a pretty abgefuked 'wondering' process to concern yourself with based on acting on information directed to another and about another type of thing that has nothing to do with getting a BSSO that could widen where the doctor said it would as to even think the MSDO (the type of surgery that could be unsafe to the condyles) could be 'safer'.