Figured out what I dont like about my face.

[tdawg]

My midface is underdeveloped. I mean the part right below the eyes. My Maxillary dental arch is within the normal range.

What is the cause of this? And can it be fixed? I have a mild class one open bite. My sister has the same bite but has a normally developed midface.

Is plastic surgery my only answer to this, or is there an orthognathic procedure that can fix everything in one go?

[Krista]

I was told it is from mouth breathing and open mouth posture along with tongue thrust and tooth extractions.

[tdawg]

I dont have any extractions, and my palate is only slightly narrow. This s**t doesnt make sense.

[treevernal]

I have an underdeveloped midface as well.  My surgeon actually documented it as "maxillary hypoplasia".  Im a class 2 case so I also have mandibular hypoplasia.  He's doing a multisegment lefort 1 and bsso.  With the lefort, he's impacting the front of the maxilla a lot and lowering the posterior portion too.  I was actually surprised at how much he is planning to move the area around my nasal base forward.  He told me that because my nasal base and nostrils projected a lot with little support, hes able to shift this area forward quite dramatically. 

So yeah, a lefort 1 advancement might be able to give you the midface advancement you desire as long as there aren't many soft tissue limitations (small nose without much projection) in which case, a lot of maxillary advancement will make the nose look too small and squished.

[neferkitti]

My midface is underdeveloped. I mean the part right below the eyes. My Maxillary dental arch is within the normal range.

Do you have any upper arch crowding. If so, expansion may add volume to the midface.

I have a mild class one open bite.

Anterior or posterior open bite?

Is plastic surgery my only answer to this, or is there an orthognathic procedure that can fix everything in one go?

Remind me. Do you have photos posted, particularly of teeth?

[tdawg]

I have a narrow upper arch, but most of the constriction is in the posterior region. There isnt a significant amount of crowding. It is an anterior open bite, but it is camouflaged because I had veneers placed to correct permanent staining that occurred when I was younger. The top front 8 teeth were slightly lengthened(particularly the one on each side of the central incisors) without me realizing at the time.

I attached a pic of my teeth, and my x-ray.

[attachment deleted by admin]

[attachment deleted by admin]

[neferkitti]

I have a narrow upper arch, but most of the constriction is in the posterior region. There isnt a significant amount of crowding. It is an anterior open bite, but it is camouflaged because I had veneers placed to correct permanent staining that occurred when I was younger. The top front 8 teeth were slightly lengthened(particularly the one on each side of the central incisors) without me realizing at the time.

I attached a pic of my teeth, and my x-ray.

I see posterior narrowing, but no real crowding. That makes expansion difficult. However, I don't know if it would be impossible given that narrowness. How comfortable is your bite? From you xray, it looks uncomfortable. When you spoke to orthodontists, what treatment was suggested? Did they want to address bite only or aesthetics, too?

[tdawg]

Its pretty uncomfortable, in the sense that it is hard to close my lips without mentalis strain. I figured out a way to do it, but it is tiring to do it all day long. Also I have a crossbite in the back. As far as eating there is no problem. But surgery would be worth it just for me to be able to relax my mouth without looking like im zoned out.

One orthodontist didnt want to do anything, because he didnt think surgery was worth it, and he didnt think anything could be done with just orthodontics. Another wanted to do invalign treatment. Another wanted me to just do braces. No mention of TADs or anything else.

So I guess they were all just focused on the bite. Even when I brought up surgery, they dismissed it.

[tdawg]

Just got a reply to a question I asked on realself from a craniofacial surgeon

"Your chin does appear too long, but it is because of the way the ramus, or vertical portion of your jaw, has formed.  It appears that you may have a bit of an open bite on your x-ray.  If so, a Lefort osteotomy and genioplasty would probably be needed to correct the problem.   And yes, they would help with lip incompetence. Hope this helps, Dr. Hall"

That would indicate that the posterior intrusion+genioplasty plan is legit as a plan B. He didnt mention lower jaw surgery but it is still ambiguous because he said the ramus is a problem. Now that I think about the people who have open-bites that get just leforts without genioplasty dont really have drastic results.

[neferkitti]

They didnt shave any tooth off.

I was hoping not but wasn't sure in your case.

The ortho I brought up the veneer issue with, said they could stay on regardless of what I end up doing. Why do you think they would need to be removed? They might cause a very slight deepbite, but it would be in the acceptable range, as only like a mm was added to the length.

My ortho(s) had brought it up. They didn't like working with brackets on veneers but didn't elaborate. I assumed it was a bracket bonding issue or, perhaps, there was fear of damaging/breaking veneers.

When you bite down completely, does the upper arch close over the lower comfortably?

[tdawg]

I hoping not but wasn't sure in your case.
My ortho(s) had brought it up. They didn't like working with brackets on veneers but didn't elaborate. I assumed it was a bracket bonding issue or, perhaps, there was fear of damaging/breaking veneers.

When you bite down completely, does the upper arch close over the lower comfortably?

No, I have anterior openbite. My overjet is 1-3 mm so if the posterior interference is removed it should close comfortably.

[neferkitti]

Just got a reply to a question I asked on realself from a craniofacial surgeon

"Your chin does appear too long, but it is because of the way the ramus, or vertical portion of your jaw, has formed..."

That would indicate that the posterior intrusion+genioplasty plan is legit as a plan B. He didnt mention lower jaw surgery but it is still ambiguous because he said the ramus is a problem.

I wonder if he's willing to expand on the long ramus. I have a long ramus, as well. If you go with plan B, would that mean intrusion w/braces and a vertical reduction genio? If so, this approach seems far less invasive than a le fort.

[neferkitti]

No, I have anterior openbite. My overjet is 1-3 mm so if the posterior interference is removed it should close comfortably.

Ah, okay. It's difficult for me to judge your natural bite from the photo. I thought the veneers closed that anterior space.

[tdawg]

Ah, okay. It's difficult for me to judge your natural bite from the photo. I thought the veneers closed that anterior space.

It closed some of it in the front, but it is still open a bit in the back.

As for my ramus, another surgeon actually said it was too short relative to my maxilla. If they lengthened it vertically it might help.

I think I am going to go with the intrusion/genioplasty. Openbite cases seem to be very unstable in the long run.

[neferkitti]

I think I am going to go with the intrusion/genioplasty. Openbite cases seem to be very unstable in the long run.

I think this is a good idea, especially with your starting law school. You'll have enough on your plate.