There is no ceph here to refer to and I can't address what ever dynamics are going on between you and many surgeons. But I can offer some CONCEPTUAL info that relates to CCW as to what it corrects and what it doesn't.
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The ROTATION of the mandible 'follows' the rotation the maxilla. So, with mouth breathing, what is (usually) going on with the maxilla is that it grows downward. So, when the mandible follows that type of growth pattern, the mandible is displaced downward and backwards. Relative to rotations, that would be a clockwise rotation. So, the concept here is that mouth breathing creates an unfavorable CW rotation of the MAXILLA and since the mandible follows what the maxilla is doing, the mandible will be displaced backwards and down in an unfavorable CW rotation.
In terms of CAUSALITY, excess downward growth of the maxilla from mouth breathing that results in unfavorable CW rotation of the maxilla will CAUSE the mandible to be set in an unfavorable CW rotation (backwards and down). That is to say, mouth breathing results in excess maxillary growth (in wrong direction) but it might not be the sole contributor that 'causes' excess downward mandibular growth or an excessively high mandibular plane angle or an excessively long and backwards chin. Excess downward mandibular growth or an incredibly high mandibular plan angle can exist in ADDITION to being forced into an unfavorable CW rotation by the maxilla. So, we can't really say that ALL unfavorable downward excess to the mandible or ALL incredibly STEEP (High mandibular plane angles) are 'CAUSED' by the unfavorable CW rotation at the maxilla. Although there is no way for me to tell if you, personally, have excesses to the MPA or excesses to chin area in addition to an excess of the OP (Occlusal plane) which CCW-r (a rotation to the maxilla) corrects, I can say that CCW-r doesn't correct all excesses that might exist to the mandible and/or chin in addition to excess of the OP .
Unfavorable CW rotation to the maxilla causes unfavorable rotation to the mandible but unfavorable GROWTH to the mandible or an unfavorable Mandibular plane angle can be COINCIDENT (happen at same time or in addition to) unfavorable rotation to the maxilla but not actually caused by the unfavorable rotation of the maxilla.
Consider that the OP (Occlusal plane angle) and the MPA (mandibular plane angle) are 2 different angles. Although the OP can be reduced by CCW-rotation and the MPA will follow somewhat in proportional/similar reduction of its angle, CCW-r of the OP can't compensate for an excessively HIGH MPA if the MPA is FAR in EXCESS of the OP. For example (although an extreme one), say someone has a high OP that could be reduced with CCW-r BUT they ALSO have something like a 'lantern jaw' (excess growth to the mandible INDEPENDENT of what's going on with the maxilla and also excess--very STEEP-- MPA). CCW-r would not 'fix' something like that or in that type of venue. Even if not 'lantern jaw', but only an incredibly STEEP MPA that is MUCH steeper than the OP, not all of the excess steepness to the MPA can be reduced by the reduction done to the OP via CCW-r. For example, if the excess steepness of the OP is reduced by let's say 'X' degrees but the the MPA is ['X' + 'Y'] degrees, the CCW-r to the maxilla will reduce the MPA by 'X' degrees but NOT the extra 'Y' degrees of steepness that the mandible has. Geometrically impossible.
Now, let's say someone had a very long and backwards chin, a problem independent from but in addition to an unfavorable CW rotation at the maxilla. CCW-r at the the maxilla to reduce the OP would not correct that problem either. Instead, a vertical reduction of the chin (excess cut from the middle of it) and a sliding outward and upward genio would correct and that could be considered in venue of independant CCW-r type rotation to a chin that is too long and too backward.
So, all this depends on what the PROBLEM SET actually is. If the problem set of excess MPA to the mandible is DIRECTLY CAUSED by excess STEEPNESS of the OP and the excess steepness to the MPA is EQUAL (or about that) to the excess steepness of the OP, then CCW-r to the maxilla will correct the unfavorable CW rotation to the mandible. However, if there is excess growth to the chin and/or excess steepness to the MPA (or both) and that type of excess is MORE than the excess to the OP (which is reduced via CCW-r), such a problem set will EXCEED what CCW-r can actually 'fix'.
Perhaps this could be the missing information that surgeons don't explain or the missing information that many on this board have when they think CCW-r is the magic bullet for a problem set that exceeds what CCW-r is aimed at correcting.
