How did the ramus get longer here?

[molestrip]

Just watching this video here showing a BSSO. Anyone notice that @20s the ramus suddenly appears to get longer? It disappears from view for a second then reappears longer than it was before. How does that work??

[terry947]

Maybe it just appears longer since the angle is changed.

[Lazlo]

you can get your ramus dropped.

[Vic]

you can get your ramus dropped.

How do you get your rams dropped? and whats the maximum you can get it dropped? Also, wouldn't that create a space between your upper and lower bite?

[molestrip]

How do you get your rams dropped?

That was my question. My research revealed that it was tried many years ago and found not to be stable but it had been revisited recently with DO. Since bone is formed more quickly the stability problems were addressed. Some reported that it works and others reported other problems, such as inaccuracy and TMJ problems. I didn't think it was possible, hence my surprise at seeing it suddenly change in the video. Looking at it more closely now, looks like the ramus rotated downward instead. They don't show the top part so I don't know how that works. I wonder if they just didn't want to show what it really looks like afterwards?

Also, wouldn't that create a space between your upper and lower bite?

That's undesirable if you have a normal bite but desirable if you have an open bite, like I do.

[molestrip]

I think the sad reality of jaw surgery today is that there is no surgical technique for lengthening the ramus. Jaw surgery for retrognathia is, in large part, the surgery they can do not the surgery they'd like to do. In many cases I think it's close enough though.

[hellohello]

Interesting find FaceNit. I'd love to see some pictures of that procedure, but I doubt they can be found easily  .

[molestrip]

That's the cut I referred to in another post. There aren't many papers about it and they mention it's not stable since the masseters are so strong. Also, I wonder if surgeons don't want to introduce a second surgical site since a BSSO is still needed to fix the vertical growth. There's also mention of TMJ issues, increased pressure leading to remodeling I think. The near complete lack of literature would make me nervous about undergoing it and whether it'd be that much better/different than leaving the ramus untouched and just accepting a steeper MPA w/compensatory advancement to make the bite work. It would be useful to know if there are surgeons which really do have experience with techniques to lengthen the ramus (and not just the appearance, I could care less).

[Breakingbad]

I'm not quite sure, but I think I heard somewhere that Zarrinbal utilizes that cut, the HOSSO, or something similar. I believe he does it in order to free up the jawline, making it possible to do a chin wing at the same time. Can anyone confirm?

[molestrip]

It's clearly more invasive to lengthen the ramus but when it's really short, as in anterior open bite cases, seems that the extra invasiveness would be worthwhile. Plus, it avoids excessive advancement of mandible, which itself carries it's own risks to IAN and TMJ, not to mention aesthetics. At the end of the day, it's only a few mm however so I can see why many practitioners don't want to bother. Surgery mills.

[PloskoPlus]

I'm not quite sure, but I think I heard somewhere that Zarrinbal utilizes that cut, the HOSSO, or something similar. I believe he does it in order to free up the jawline, making it possible to do a chin wing at the same time. Can anyone confirm?

What I've been told by notrain is that the downside of the technique used by zarrinbal is that while it spares the nerve more than a standard BSSO cut, it limits the amount of advancement possible, therefore necessitating a chin wing, which again raises the field to the nerve... No free lunch.