Author Topic: Options for managing protrusion  (Read 808 times)

molestrip

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Options for managing protrusion
« on: February 03, 2015, 09:00:18 AM »
My surgical plan calls for 6-7mm of maxillary advancement (MMA+CCW). Some questions:

- That's 4mm to the nasal base. Is that going to be an unaesthetic amount of widening? I'm a guy and I have a narrow nose already at least. I'm thinking not right now.
- My upper lip is relatively thick and my upper lip is neutral to my nose right now. I noticed one surgical plan shows the upper lip as 3mm shorter afterwards so like 12mm instead of 15mm I think (numbers could be off). I think it was a VY-plasty. My philtrum is on the longer side as well. Is that a typical side effect of shortening the upper lip? Is this a tool surgeons use to manage protrusion sometimes?
- How much protrusion can be tolerated on a white guy without acquiring a simian look? My plan calls for a net of 4mm, after the lip work. I read a thesis suggesting than -3mm to 3mm was tolerated by laymen and 6mm was definitely on the unaesthetic side.
- One surgeon mentioned bicuspid removal as an option. How much can the orthodontist likely regain doing this? Can my wisdom teeth be removed instead? I suppose it's an acceptable sacrifice.
- Am I making too much out of this? 7mm seems to be about half the distance between my upper lip and tip of my nose right now.

I could ask to reduce advancement, at the cost of reduced odds of success in cure. 12mm PAS is considered normal and adequate. I'm 7-8mm now so I could probably afford to subtract 2mm of advancement to have a 5mm advancement and end up at 12-13mm, which to be fair is where most OSA patients end up after their MMAs. Combined with bicuspid removal and maybe lip work I'm hoping there's a workable solution here.
« Last Edit: February 03, 2015, 11:06:31 AM by molestrip »

Rico

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Re: Options for managing protrusion
« Reply #1 on: February 03, 2015, 12:00:18 PM »
how a surgeon knows he moved a bone 6 mm not 5 or 7 ?  what kind of measurement device he uses?

notrain

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Re: Options for managing protrusion
« Reply #2 on: February 03, 2015, 12:18:35 PM »
he uses 2 bite splints.

surgeon cuts the upper jaw and uses 1st splint to set the occlusion of upper jaw NEW in relation to lower jaw OLD, then the upper jaw gets bolted back on.

then lower jaw gets cut and 2nd splint sets the occlusion upper jaw NEW - lower jaw NEW

he knows the milimeters because he manufactures those splints after making measurments in his articulator where he does preop setup