Help with mandibular plane angle

[BlueShark7]

Hey everyone,

Just wondering if someone would be able to tell me from my picture if my mandibular plane angle is high or low?

Sorry I don't have a ceph on my computer.

Thanks in advance.

[notrain]

it looks low, i.e. horizontal growth type with an L-shaped growth pattern and an acute gonial angle.

[BlueShark7]

it looks low, i.e. horizontal growth type with an L-shaped growth pattern and an acute gonial angle.

thanks notrain. I was struggling to figure it out and interested because of its supposed bearing on stability post surgery.

[notrain]

i was also researching this for myself (we have the same growth type). the hypodivergent pattern (what you have) is generally preferable to the hyperdivergent (vertical / long face) pattern because it doesn't need extensive rotation to fix proportions. it makes the surgery much easier to perform and healing and post op stability is also better.

[dantheman]

Low angle, which contributes to your chin prominence. Do you even need surgery?

[Modigliani]

That's a seriously attractive profile you've got there.

[BlueShark7]

Low angle, which contributes to your chin prominence. Do you even need surgery?

Thanks for your reply.

As for needing surgery, not sure. I am in the process of deciding whether or not to go ahead with surgery for small airway and small mandible. I'm not entirely happy with where my lower jaw sits and I have breathing problems, but my bite is fine (previous orthodontics). Surgeon suggests either bimax advancement (no braces required) or BSSO only but I need orthodontics again to create 6-7mm overjet. I would prefer just to have lower jaw done but am really really anti having extractions. Waiting to see orthodontist and see if they can create a worthwhile overjet without extractions. If not, then I think I'm confined to non-surgical alternatives and learning to be ok with small jaw and how it looks.

[BlueShark7]

That's a seriously attractive profile you've got there.

Th-thank you, I appreciate it. I do wish my lower jaw was forward

[dantheman]

I think you look great. Do you have a ceph / X-ray? What's your breathing problem? I think women look good with a (mild) convex profile.

[BlueShark7]

I think you look great. Do you have a ceph / X-ray? What's your breathing problem? I think women look good with a (mild) convex profile.

Thank you Dan, I appreciate it. I don't have copies of my cephs unfortunately. I have sleep apnea and the surgeon showed me my CT scan with a (moderately) narrow airway. I also have bad TMJ on one side but I know surgery is no guarantee of helping that and can make it worse.

[dantheman]

What are your numbers like in terms of sleep apnea? Home study or in lab study? why was it done?

my problem with sleep apnea is that the ranges are too tightly defined. an apnea hypopnea index of under 5 is normal, and all of a sudden if your number is 6, you have mild sleep apnea, the same diagnosis that goes to someone with 15 on the AHI index.

Trouble breathing through your nose at all? Do you snore?

[BlueShark7]

What are your numbers like in terms of sleep apnea? Home study or in lab study? why was it done?

my problem with sleep apnea is that the ranges are too tightly defined. an apnea hypopnea index of under 5 is normal, and all of a sudden if your number is 6, you have mild sleep apnea, the same diagnosis that goes to someone with 15 on the AHI index.

Trouble breathing through your nose at all? Do you snore?

Totally get what you're saying. I'm having an inpatient hospital sleep study done in a week, so as yet what I have to go on is witnessed apneas and being told I snore. I always wake up feeling like a truck has run over my head, no matter how many hours sleep I've had, and I'm wondering if that's related. I'm not sure what the exact airway measurements were on my head scan but it was color coded, from green being a patent airway to red being the narrowest and mine was this sea of red. I can't breathe lying flat on my back. As for breathing through my nose, things feel tight, but I'm so accustomed to it that I don't know what's normal.

[dantheman]

I'm all-too-familiar with that morning feeling. I tell others that I'd rather be punched in the face and get on with my day than feel the way I do every morning. Without a doubt your study is worth doing. I'd also get my hands on the CT. Was it an iCAT? There are free viewers for dicom files (the type of file) that you can actually look at it yourself.

For what it's worth you don't look exhausted. I look and feel like a train hit me.

[BlueShark7]

I'm all-too-familiar with that morning feeling. I tell others that I'd rather be punched in the face and get on with my day than feel the way I do every morning. Without a doubt your study is worth doing. I'd also get my hands on the CT. Was it an iCAT? There are free viewers for dicom files (the type of file) that you can actually look at it yourself.

For what it's worth you don't look exhausted. I look and feel like a train hit me.

It was a cone beam CT, same kind of thing?

Thanks Dan. Out of interest, would a sliding genio help airway at all? Appearance? I know I'm at risk of having a chin that's too pointy and a deep labiomental fold if I go that route, but if bimax would give me a gummy smile and a BSSO on its own is out of the question without extractions, I'm not left with many options.

[dantheman]

The only way to increase airway size is to do a BSSO or double jaw advancement. Genios don't change jaw relationships, only make your chin more pronounced. The chin wing procedure has been shows to improve sleep apnea indices, however, without change to airway size. I would not touch your face if its just for appearance.