Midface hypoplasia

[KronosAlphason]

some Lefort 1's for good measure:

I have wide cheekbones, eyebrows that are basically right above my eyes, positive canthal tilt, no scleral show, yet I know that my maxilla is retruded. Is this indicative that my midface has developed correctly apart from my maxilla?

[Rico]

VERY INTERESTING ARTICLE FOR ALL OF YOU , INCLUDING HYPOPLASIA ISSUE
http://www.aicef-chirurgiaplasticafacciale.it/contiene_i_PDF_e_allegati/Beauty%20Arch%20Concorso%20AICEF%20Marianetti.pdf

+ THIS http://www.readcube.com/articles/10.1097%2FSCS.0b013e3181f4ab9f  you can see preview

if anyone has free access for such articles, let me know. I started to buy some (others) but it's a  lot of many interesting articles. I will bankrupt buying all of them

[PloskoPlus]

Would a LF1 cut at an angle, sliding the upper jaw out and up help with a flat maxilla and "long face" syndrome?  I think my issue is that my maxilla hangs too low and leaves my mouth long and no tooth show when I smile or rather I have a shallow smile. I'm really wanting to get the LF2 but, it's a matter or experience and I haven't found anyone in the States that can provide.  I also found this article in regards to the mass fear of going blind during a LF2:

http://www.ncbi.nlm.nih.gov/pubmed/23351774 

Seems legit?  But again, who's getting it done and where are the actual results?

Eugene Keller at the Mayo clinic does Le Fort IIs.  FWIW, it seems that as rare as LFIIIs are, they are more common than LFIIs.  Probably because LFII is a "neither here nor there" operation.  Does not have the flexibility of a correcting bite issues that LFI has, does not address severe upper mid face recession the way LFIII can.

[nrelax11]

what a horrible results (except for the girl who undergone LF3). No wonder a doc straightly said that I need LF3 for midface deficiency, because doing anything else is just waste of everything.

The first woman looks good too

[terry947]

I remember seeing results of a woman that got a lefort II and it looked pretty good. I wonder though, if getting a lefort II would give you a fish face, if that makes sense. Since The zygos don't get advanced. If you have a big/ long nose wouldn't that make it bigger?

[Rico]

27F so you rule out ZSSO without knowing what it exactly is ?

[Rico]

I wrote about this 3 times....
http://www.readcube.com/articles/10.1097%2FSCS.0b013e3181f4ab9f

you can read one page there....unfortunately the rest you have to buy, but it's cheap
About 4 people here are interested in this article, we can do little kinda fund-raiser
It costs 40E   Generally I could buy it, but since I bought already 2 medical articles, I do not want spend too much money for such "fun"

[Cancerkid]

Great thread. I just wanted to add my own personal experience of midface hypoplasia.

I had Leukaemia when I was age 5, and was treated with cranial radiation. I started to notice a change in my face during puberty but only 20 years later I was able to get a rough diagnosis of midface hypoplasia from a plastic surgeon. After finding out about my condition I then went to go see a Maxilofacial surgeon and was given the diagnosis, plus he believed it was a direct result of the radiotherapy.

I am based in the UK so have been trying with great effort to get my condition treated on the NHS. Here it seems like the facial surgeons are living in the stone age. I have spent two years going to appointments with general plastic surgeons, as well as a jaw surgeon and orthodontist. They started out giving the belief that they would fix it, only to change their minds last minute.

Currently I have seen another surgeon that wants to fix my midface hypoplasia with a Lefort I, so having braces applied first to pull back the angle of my front teeth as well as make room. From all my research I know that only addresses half of the issue so I mentioned about the option of cheek implants and the surgeons reaction is "That's something we could think about".

My experience of maxilofacial surgeons has now become quite poor. So now having to see a third surgeon, whom I've already seen privately. He is the first maxilofacial surgeon I have seen that just sat me down, looked at the structure of my face and saw the issues and told me he would be happy to see me on the NHS and treat me.

So fingers crossed I will now be able to get my condition fixed. Will update the post later.

_Ck

[UKMaxfac]

Great thread. I just wanted to add my own personal experience of midface hypoplasia.

I had Leukaemia when I was age 5, and was treated with cranial radiation. I started to notice a change in my face during puberty but only 20 years later I was able to get a rough diagnosis of midface hypoplasia from a plastic surgeon. After finding out about my condition I then went to go see a Maxilofacial surgeon and was given the diagnosis, plus he believed it was a direct result of the radiotherapy.

I am based in the UK so have been trying with great effort to get my condition treated on the NHS. Here it seems like the facial surgeons are living in the stone age. I have spent two years going to appointments with general plastic surgeons, as well as a jaw surgeon and orthodontist. They started out giving the belief that they would fix it, only to change their minds last minute.

Currently I have seen another surgeon that wants to fix my midface hypoplasia with a Lefort I, so having braces applied first to pull back the angle of my front teeth as well as make room. From all my research I know that only addresses half of the issue so I mentioned about the option of cheek implants and the surgeons reaction is "That's something we could think about".

My experience of maxilofacial surgeons has now become quite poor. So now having to see a third surgeon, whom I've already seen privately. He is the first maxilofacial surgeon I have seen that just sat me down, looked at the structure of my face and saw the issues and told me he would be happy to see me on the NHS and treat me.

So fingers crossed I will now be able to get my condition fixed. Will update the post later.

_Ck

Which surgeon was it? Tell us

[downwardgrowth]

I have the paper.  This guy had a 13 mm (!!) maxillary advancement at the LeForte 1 level!

Overall:


Case 2: retromaxillism, narrow maxilla,
mandibular retroalveolism
Clinical characteristics
Frontal view showing narrow facies with poor
gonial angle contour (Fig. 2A)
Concave profile
Flat midface: maxilla and malar
??Edentulous?? facial expression
The chin prominent but in normal position
Lack of dental support to the upper and lower lip
Prominence of nasolabial folds and crease
Narrow alar base
Class I molar and canine relation
Crowding in the maxillary and mandibular
dental arches
Incongruent curves of Spee
Protrusive maxillary incisors

Treatment plan
The treatment plan is a combined surgical and
orthodontic approach. The two-stage surgical
approach (Figs. 2B?D) is
1. Anterior mandibular alveolar segment distrac-
tion osteogenesis [4,5] and surgically assisted
rapid palatal expansion (see Fig. 2B).
2. Orthodontic alignment of two dental arches,
including full decompensation of the existing
skeletal anomalies. Now it becomes clear that
this case is a class III case (retro-/micromaxil-
lism). The occlusion before the second surgical
procedure shows class III molar relation and
a negative overjet. The opened space behind
the canines will be managed by dental implants
at the end of the treatment.
3. Bimaxillary surgery: 13 mm of maxillary
advancement at the LeFort I level, mild mandib-
ular set back through BSSO [6], and clockwise
rotation of both jaws. In addition, vertical chin
augmentation and, again, mandibular segmen-
tal osteotomy for widening of the mandible
(see Fig. 2D).
Outcome
The outcome shows improved facial aesthetics with
good lip support, balanced skeletal relation, and
widened maxilla and mandible (Fig. 2E). From
the frontal view, the face has harmonized, with
normal mandibular width and gonial angles. The
occlusion shows a normal overbite and overjet.
The creation of a gap behind the canines allows
class II molar relation. The bone and gingiva gener-
ated there through distraction is excellent and ready
for dental implants.


What I put in bold may be of interest to those with narrow faces.

if you have this paper can you tell me the name of the doctors? I have a very similar case except with a steep mandibular plan and high occlusal plane. My case is very complex and I haven't received good advice from anyone on the forum, despite researching all day. It seems the best option for me would unironically be a lefort 3 with BSSO, but maybe this doctor, who in my opinion, treated case 2 very successfully, can help. Can you tell me that doctor's name??