Maxillary Impaction For Non Gummy Smile

[Picollo30]

Will it age my face considerably?

I will have a BSSO with CCW rotation + Le Fort I + Genio in May

I also have Severe Sleep Apnea (i have a 4 mm airway). I'm on CPAP right now, but i'm not seeing any difference.

Max fac says this is the way to go and i will also like the cosmetic results (i have weak chin, retruded jaws and facial assymetry caused by bad jaw development).

Is there any other solution?

[PloskoPlus]

Will it age my face considerably?

I will have a BSSO with CCW rotation + Le Fort I + Genio in May

I also have Severe Sleep Apnea (i have a 4 mm airway). I'm on CPAP right now, but i'm not seeing any difference.

Max fac says this is the way to go and i will also like the cosmetic results (i have weak chin, retruded jaws and facial assymetry caused by bad jaw development).

Is there any other solution?

How much impaction?  How much will your posterior maxilla be down grafted?

[kjohnt]

If you don't have a gummy smile and are getting CCW rotation, the anterior maxillary impaction is used in conjunction with posterior maxillary downgrafting for the rotation, and then the added projection from the maxillary advancement should offset the impaction so you have the same amount of tooth show or upper lip coverage as before.  I'd think the rotation will be achieved more with downgrafting and less impaction since it sounds like your vertical height in the front is okay.

Your face shouldn't "age."  You should just look better.

Who is your surgeon?

[Picollo30]

It's here in Portugal

It's in a public hospital, Dr. Rui Balhau Mendes in Oporto. I wont pay anything because of the sleep apnea problem. My MMA is related to it.

Are there any risks of blindness because of the Lefort?

[terry947]

Does the posterior maxilla have to me dropped/downgraded if you already have a longer posterior maxilla/skull? In my face I have a longer face downgrading the maxilla would make everything worse.

To op it all depends on how much excess gum show you have. People say that either the maxilla shirks over time or soft tissue like your upper lips gets longer making it seems like you have less tooth show. I'd say get a second and third opinion.

[ForeverDet]

To op it all depends on how much excess gum show you have. People say that either the maxilla shirks over time or soft tissue like your upper lips gets longer making it seems like you have less tooth show. I'd say get a second and third opinion.

It's the latter mostly, soft tissue loses support overtime due to aging and gravity inflicts the downward pull to cause physical alterations.

So to the OP, by itself no jaw surgery procedure just automatically ages people. Generally at any age of surgery it's good to leave 2-3mm of upper incisor show at rest (up to 4-5 in teens and/or women) and all your incisors (plus up to 2mm of gum if desired) when smiling. When you hit middle age and beyond that's when the soft tissue really starts to show lengthening and older people usually have negative incisor exposure at rest and 50% or less tooth show smiling.

And without a gummy smile, a skilled doctor can prevent "aging" via CCW so that's good they're utilizing it. That allows the occlusal plane alteration while maintaining tooth display if needed.

[kjohnt]

Does the posterior maxilla have to me dropped/downgraded if you already have a longer posterior maxilla/skull? In my face I have a longer face downgrading the maxilla would make everything worse.

If you have a long face but normal tooth show, then I'd think three possibilites:

1) The maxilla isn't the problel check your lower and upper thirds

2) Large soft tissues covering large maxilla

3) MOST LIKELY IMO - It could be that the steep occlusal plane is what's making your face look longish and the downgrafted posterior maxilla will actually make your face appear shorter since the CCW rotation would be achieved, because what you see is the front of your face, and the convex profile is part of what gives people "long faces."  Also note that as I mentioned in my previous post, maxillary advancement will add to tooth show (gumminess) because you are stretching the soft tissues, so impaction would be performed to offset this.

If you think about a face from profile view and create three vertical sections: back, middle and front... the middle would then be lengthened but the front would be shortened... like a maxillary teeter-totter.  And when you talk about a long face, you're talking about the front.

This is how I understand it anyway. 

[kjohnt]

One thing I don't understand that someone with knowledge can hopefully answer:

How is the mandible treated in cases of maxillary posterior downgrafting?  Because the rotation of the maxilla, even after advancement, would then cause an open bite, correct?  I.e. if maxillary posterior downgrafting for rotation plus horizontal projection of both jaws is performed, the molars would touch but there would be space between the incisors?  So in these cases,  as part of the BSSO, the mandible must be somehow rotated as well? 

I'm just trying to picture it in my head.

[ForeverDet]

I haven't read up on this stufff in a looong time but IIRC, lower jaw autorotates when the upper is rotated so it follows it's position yes. With CCW, the occlusal plane flattened so it can create an excess overjet (maybe a momentary openbite too?) then the lower jaw is advanced via BSSO to create a normal overbite/overjet while also correcting the usual retrognathia that's pre-existing.