Issues

[Tom2]

Don't mess with muscles. 

I have heard many times that muscles want to go back where they were.  Maybe some have had luck but personally, that was one of the reasons I avoided this surgery until I assured my surgery wasn't going to do that.

Heck, I've had a hard enough time just teaching my muscles not to push my jaw out to talk, smile and eat.

Consider that you are going for improvement, not perfection.     Trust me - that simple mentality will help you in many ways.

[molestrip]

What anatomic landmark do you use to level the head? I've been struggling with this lately.

[introspect160]

Hi,

I live in Toronto now and have a consult with Tocchio next week. I want to make sure I'm ready with questions going in. Some of you suggested previously that the last two oral surgeons I consulted were taking me down a problematic path with lower premolar extractions + ortho + BSSO + genio. The consensus seemed to be that I needed CCW MMA + genio and that my bite was solid. I've uploaded some pictures/ceph to help with some questions I have.

1. Will CCW via anterior impaction alone get me enough rotation based on how gummy my smile is? Will impaction-only make the lower part of my face too short?
2. What is the main problem with extractions + bsso + genio in my case? Would this be an acceptable/stable option for sleep apnea treatment (I have moderate OSA)?
3. If Tocchio is willing to do CCW but brushes off my TMJ issues, what should I ask him/say? If he wants to do CCW and place me on Enbrel to mitigate TMJ issues, what should I ask him/say?
4. Could genio alone address some aesthetic concerns and perhaps lip competence?
5. Anything else I should bring up with him?

Thanks, I appreciate all the previous responses! Very helpful.

[attachment deleted by admin]

[kavan]

Genio ALONE will most certainly NOT fix your class 2 occlusion, recessive mandible and vertically long anterior maxilla. But it WILL help with the lip incompetence.

You most definitely need the FULL package of Lefort 1 with CCW (anterior impaction advance...), BSSO and genio.

[introspect160]

Kavan,

You don't think anterior impaction alone will give my lower face too short an appearance?

[kavan]

Kavan,

You don't think anterior impaction alone will give my lower face too short an appearance?

I don't think it matters and it's not something to fret about. You need ALL the proposed displacements to look and breath better.

[dammit_daniel]

Hey Introspect,

The rear of my mandibular also overlaps my spine, which i thought was odd and possibly cause for concern but I never found any info about it. I will upload my ceph. I also have narrow airways that require bimax to fix.

[dammit_daniel]

Yeah my jaw overlaps my spine lol

https://imgur.com/a/tJINsQA

Sorry I can't help with your other questions, but I found an interesting link on this forum for average airway sizes

 http://www.joomr.org/article.asp?issn=2321-3841;year=2013;volume=1;issue=2;spage=55;epage=60;aulast=Guttal

Did you get your sleep apnea diagnosed?

[introspect160]

Hey Daniel,

Yeah, not sure why we both have that. It does fit with the "everything being retrusive" pattern. Not sure if that is even a concern. Do you also have cervical vertebrae that protrude like a triceratops?

Will take a look at the study you sent. My airway doesn't appear too horrible in my ceph (~5-6mm), but when I stand with good posture I can feel it close off.

My sleep apnea was diagnosed with a in-clinic sleep study. I have 0 apneas per hour on my side and 50-60 on my back, which averaged out to 32 combined. Currently trying a positional belt that keeps me on my side while sleeping. I'm starting to get used to it but I sometimes remove it in my sleep, so I have to go for a follow-up study.

[dammit_daniel]

Yeah I agree with the "everything retrusive" view. Not 100% but I think I read if its less than 11mm in the narrowest area you have greater risk for apnea. How much advancement are you getting to treat the apnea?

[introspect160]

Right now I'm just trying to find a surgeon in Canada that'll do the surgery and address my TMJ issues. I have a consult with Tocchio next Tuesday so will update you.

[introspect160]

Had my consult with Tocchio today and he wants to do CCW MMA with anterior impaction and genio. I asked him about the TMJ issues and he felt that they were stable (no pain, I can open my mouth fairly wide). He was very patient and took the time to answer my questions. He also recommended that I get a consult with Meisami. He said that she is eventually taking over his practice and that they already do surgeries together. Cost is $5000 with no ortho.

My only lingering concern is the stability of the surgery and TMJ. Thoughts?

[CCW]

Anterior impaction only and no posterior downgrafting? Your OP is so steep that you need posterior downgrafting to level your OP and to maximize your airway and and to correct your profile and for optimal aesthetics.

[april]

re: TMJs, do you know what you're structurally dealing with? Displaced discs? Arthritis?

[introspect160]

I’m not sure about downgrafting--I didn’t ask him. He didn’t mention building up the back. In terms of TMJ, I haven't had anything diagnosed. Popping in my left TMJ and a weird mouth opening angle are the main two issues. Does popping mean the disc is displaced?