Why is it the least stable? Is it due to the need of a bone graft/or some kind of filling to fill the gap? Do you know of any good sources where someone could learn more about this type of surgery?
Tremendous forces are exerted on the maxilla in the vertical dimension. As for the graft material... some use autologous bone (which may be infeasible if you need a lot due to the negative effect on the donor site) taken from the iliac crest, or even the skull. Some use cadaver bone. Some use bovine bone. Some use porous HA.
http://www.baylorhealth.edu/Documents/BUMC%20Proceedings/1999%20Vol%2012/No.%204/12_%204_%20Wolford.pdfThe argument against bone, any bone in fact, is that while it first vascularises, it loses calcium, then sucks calcium back in... in other words it may shrink during the healing and it's unpredictable how much it does so.
The argument against porous HA is that the coral will always be there, even as bone grows into the pores, and it may make it hard to revise the osteotomy later (hopefully you never need to).
Arnett and Gunson use some kind of autogenous bone, HA, plasma mix:
http://www.arnettgunson.com/technology/grafting-materialsWhat is the reason for waiting? I hear from some places that the sooner the better for these types of surgeries and some that say that the surgeries should be delayed until after full growth.
Your jaws may still grow some still. You should really research this. You have nice features. You may come out looking WORSE after surgery.
OTOH, the younger you are, the better the nerves recover, the better the skin shrink wraps your bones.
I don't mean to be nitpicky here, but I'm fairly certain this kind of situation youd be treated with a clockwise rotation of the maxilla, as a CCW would be used to treat someone with a "long face type."
Correct.
