jawsurgeryforums.com
Before/After Photos => Overbites => Topic started by: gmey on July 31, 2018, 10:57:00 AM
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Hello!
I am starting a treatmen for a jow surgery to fix my class II maloclussion. In my last consult with my doctor, she told me that they would touch only the lower jaw, I mean lower jaw advancement and genioplasty, but not advance the upper jaw because she said it was almost ok and it would not worth it.
I felt very confused with that. In a previous orthodontic treatment I had my upper premolars extracted, and my teeth were pulled back in order to camouflage my class II (which now I know it was terribly bad), so I always thought my upper jaw was VERY retruded.
I don't konw a way determine how much recessed is it, so I want your opinion and what would you do.
X-Rays here: https://imgur.com/wJo18XS (https://imgur.com/wJo18XS)
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Your occlusal plane is steep. You need CCW.
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Thanks for replying!
And what about the projection?
Now I have the results of the cephalometric analysis about both jaws and it says :
Maxillary Length: Value:80,6 Median:105+-4 Dif:-24,4 Class:Diminished
Mandibular Length: Value:99,3 Median:135+-4 Dif:-35,7 Class:Diminished
Both are very bad, all I want to konw is why my doctors would say that I just need a lower jaw advancement and genioplasty when my maxilla is also retruded. I think there are no posibilities to have a good result only with a lower jaw surgery.
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You should see someone else if you can. It doesn't sound like your surgeon cares about aesthetics.
Where are you from?
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The most likely possible reason WHY your doctor told you what he/she did was:
Your occlusal plane is approx 15 degrees relative to a horizont which isn't too far away from the norm. Your SNA angle, something looked at to see relative position of maxilla is approx 83 degrees which is not too far from norm of about 82 degrees. Your SNB angle, something to look at the position of the mandible, is about 75 degrees which is about 5 degrees away from the norm of about 80 degrees. ANB about 7 which is class 2.
Although SNA, SNB and ANB measures are RELATIVE angle measures and are not 'absolute' distance measures, they can be used by a maxfax to justify single (BSSO) lower jaw surgery if they feel the lower jaw RELATIVE recession is the salient problem and also if they feel they don't 'need' to move the upper jaw to accommodate the lower jaw advancement. So, THAT is the most likey reason WHY you were told what you were told which basically is there is no recession to the maxilla RELATIVE to ANGLE measures that use the S-N line for these relative measures.
Your other measures are absolute distances and could be in turn, RELATIVE to other absolute distances which are also 'small' and can't be changed. For example, Maxilla length= ANS-PNS (anterior nasal to posterior nasal spine) can be relative to an S-N distance which also could be 'small'. This could mean that the absolute measures of max, mandible length which are 'small' reflect that your entire skull structure is on the small side. A short or 'small' ANS-PNS measure called 'maxillary length' does not in it's own right mean 'retrusion'.
I don't see anything 'wrong' with the suggestion you got based on the above most probable reason why you got the proposal you got.
However, if you want you maxilla projected out past the norm (an SNA angle in excess of the norm) in order to accommodate a larger advancement to the lower jaw and feel you are on solid aesthetic grounds to want that, you could seek out a surgeon who does CCW via posterior downgraft for a second opinion.
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Thanks! Now it has sense.
As you said my values are SNA:83,2 SNB:76,4 ANB:6,8
Those angles may be ok but the problem is the way I look. My jaws looks very deep set, may be you could see something in my xrays pic but I am similar to Lionel Messi (I would say that I am more retruded). That is what worries me, I don´t want to go through this and feel bad for results at the end.
I will try to look for other surgeons...
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Thanks! Now it has sense.
As you said my values are SNA:83,2 SNB:76,4 ANB:6,8
Those angles may be ok but the problem is the way I look. My jaws looks very deep set, may be you could see something in my xrays pic but I am similar to Lionel Messi (I would say that I am more retruded). That is what worries me, I don´t want to go through this and feel bad for results at the end.
I will try to look for other surgeons...
WOW! I came pretty close to your high tech measures via my hand held protractor.
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Hello!
I am starting a treatmen for a jow surgery to fix my class II maloclussion. In my last consult with my doctor, she told me that they would touch only the lower jaw, I mean lower jaw advancement and genioplasty, but not advance the upper jaw because she said it was almost ok and it would not worth it.
I felt very confused with that. In a previous orthodontic treatment I had my upper premolars extracted, and my teeth were pulled back in order to camouflage my class II (which now I know it was terribly bad), so I always thought my upper jaw was VERY retruded.
I don't konw a way determine how much recessed is it, so I want your opinion and what would you do. Let me know if it bothers you to have your xray visible or w/e on the site.
X-Rays here: https://imgur.com/wJo18XS (https://imgur.com/wJo18XS)
To me it looks like you have pretty bad forward head posture and your head is pointed up (I had the same posture prior to jaw surgery). I've attached what I think would be the ideal result for you based on your xray...
note: it's an animated gif, so you have to click on the attachment to see it I guess. Anyway, ideally your neck/spine would be less arched after jaw surgery.
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(I had the same posture prior to jaw surgery).
Did the surgery change your posture? What displacement did you have?
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Did the surgery change your posture? What displacement did you have?
The surgery itself didn't change my posture, but allowed me to slowly correct my bad forward head posture to be quite good now without having my jaw jutting into my neck.
Unfortunately, I don't know enough about surgery numbers/measurements. I know my mandible B point change was +14 A-P. Is that 14mm? I'm not sure what the B point is either...
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The surgery itself didn't change my posture, but allowed me to slowly correct my bad forward head posture to be quite good now without having my jaw jutting into my neck.
Unfortunately, I don't know enough about surgery numbers/measurements. I know my mandible B point change was +14 A-P. Is that 14mm? I'm not sure what the B point is either...
That means (non-scientifically speaking) the tip of your chin was advanced (a-p i believe is anterior-posterior) 14mm from whatever combination of jaw cuts and rotations. B point is the leading edge of your chin in profile.
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That means (non-scientifically speaking) the tip of your chin was advanced (a-p i believe is anterior-posterior) 14mm from whatever combination of jaw cuts and rotations. B point is the leading edge of your chin in profile.
Thank you yeah, that sounds exactly right. It was a fair bit of advancement - with the standard lf1+bsso+genioplasty combo Gunson tends to do.
Something to consider if you go down this path Gmey: If you do the typical lf1+bsso(+genio? maybe), your orbit region will be recessed afterwards in relation to the advancement. Looking at your xray this is completely obvious to me that your face is recessed from the lower orbital ridge down. I don't personally think there's a good solution to this currently, but you may want to just go for it anyway as your posture and jaw will be in a much better position.
That's my input anyway...
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Not sure how his orbitals are actually recessed, or how to measure for that - landmark proportions etc.. Sure he's got a huge brow ridge, but I don't see anything to indicate they're extra recessive relative to some standard point.
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Not sure how his orbitals are actually recessed, or how to measure for that - landmark proportions etc.. Sure he's got a huge brow ridge, but I don't see anything to indicate they're extra recessive relative to some standard point.
I'm just analyzing this stuff visually and intuitively, so I could definitely be wrong. From what I've noticed, retrognathia tends to follow a backward sloping curve down the features of the face affecting them in different ways. I'm not saying every skull shape should look the same, but there seems to be a strong pattern between the features of a person with malocclusion/underdeveloped (like my development for instance) and a well projected face.
I've attached an image showing what I mean. OP: please let me know if you don't like your xray being attached in here - just trying to explain my thoughts.
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The surgery itself didn't change my posture, but allowed me to slowly correct my bad forward head posture to be quite good now without having my jaw jutting into my neck.
Unfortunately, I don't know enough about surgery numbers/measurements. I know my mandible B point change was +14 A-P. Is that 14mm? I'm not sure what the B point is either...
The B point is the most concave point on mandibular symphysis
https://www.youtube.com/watch?v=0YENjFgTRCE
Here you have the B point.
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I don´t see anything special in my orbital area, honestly I don´t know how are recessed orbitals... the only thing I ca say is that I have a huge brow ridge, actually (excluding lower third) I look somethig like this football player (Google: Lisandro Magallan).
I had another consult with my surgeon an asked why he suggested to move only my lower jaw, and he said it was only a proposition, now its too early and the best solution will be planed when my teeth get aligned (I have not even started with brackets), but it would be an option to move both jaws.
About the posture: Yes, I have a terribly bad posture, but I can´t do much for it because when I try to correct it I cant even breath well because my airways closes. Should I correct it before I have the surgery? I mean does the posture influence in the surgical planning?
Note: you can use my xrays, no problem.