Midface hypoplasia

[x]

I've been increasingly interested in this form of underdevelopment and how best to treat it lately, so decided to start a topic

Options seem pretty limited in bringing the whole midface forward, as it can't be done efficiently without compromising a lot of safety/invasiveness. In an ideal world we could all get Lefort III's  , but that seems unlikely in the near future given it's high risk



From the location the cuts are made it seems that the Lefort I (and II) leaves a lot to be desired. Usually when a maxilla is flat it's cause the entire midface (zygoma + nasal base too) is recessed and failed to grow horizontally and laterally. When it's ONLY the maxilla that's recessed, you get results like this:

Kristian: Upper Jaw Surgery before and after (thanks Ben)

People here keep talking about midface distraction, would be interested to see some examples of that.

Also if anyone knows anything about this case or has her profile pic, I'd really like to know her movements. Somehow maxillary advancement caused her cheekbones to pop, no idea why (unless implants/grafting)

[x]

some Lefort 1's for good measure:

[CK]

the problem with discussing underdevelopment is the bones are already hard so there is no real frame of reference. you can make educated guesses but the only sure way to see where your features should be is to take your DNA and make a copy of yourself LOL.

[x]

the problem with discussing underdevelopment is the bones are already hard so there is no real frame of reference. you can make educated guesses but the only sure way to see where your features should be is to take your DNA and make a copy of yourself LOL.

True, but would you not agree that optimal healthy puberty tends to result in balanced faces with proper positioning and contour? Obviously there will be deviations here and there, but there's also clear cut cases of normal and abnormal growth

[CK]

True, but would you not agree that optimal healthy puberty tends to result in balanced faces with proper positioning and contour? Obviously there will be deviations here and there, but there's also clear cut cases of normal and abnormal growth

generally yes, but some people simply have less ideal genes than others. but when you see a pattern of people that are showing very similar proportions combined with diagnosed jaw/facial growth deformity something is definitely up. we cant kid ourselves genes are not set in stone.

[x]

generally yes, but some people simply have less ideal genes than others. but when you see a pattern of people that are showing very similar proportions combined with diagnosed jaw/facial growth deformity something is definitely up. we cant kid ourselves genes are not set in stone.

Not disputing that, but in my case as well as the befores/afters posted itt and the posters on this forum, the root cause seems likely environmental issues not bad genetics

[CK]

Not disputing that, but in my case as well as the befores/afters posted itt and the posters on this forum, the root cause seems likely environmental issues not bad genetics

unfortunately that ship has sailed and you'll probably end up even more frustrated if you decide to explore this problem further. i rather be ignorant than aware of this knowledge.

[pumukka]

hey he even got a mandibular wing osteotomy

What do you mean by that? Like they put HA on the mandibular gonial angle to make less steep or some inverted L procedure or what do you mean? I have a steep gonial angle but I dont think they can do CCW because my oclusion line is a little to the flat side and Id probably need CW because of my recessed maxilla and flared teeth

[x]

What do you mean by that? Like they put HA on the mandibular gonial angle to make less steep or some inverted L procedure or what do you mean? I have a steep gonial angle but I dont think they can do CCW because my oclusion line is a little to the flat side and Id probably need CW because of my recessed maxilla and flared teeth

http://translate.google.com/translate?hl=en&sl=de&u=http://de.wikipedia.org/wiki/Chin_Wing&prev=/search%3Fq%3Dmandibula%2Bwing%2Bosteotomy%26safe%3Doff%26biw%3D768%26bih%3D912

[pumukka]

http://translate.google.com/translate?hl=en&sl=de&u=http://de.wikipedia.org/wiki/Chin_Wing&prev=/search%3Fq%3Dmandibula%2Bwing%2Bosteotomy%26safe%3Doff%26biw%3D768%26bih%3D912

Oh, I see, its only a bit of the outer part, thanks

[pekay]

I was the one that originally linked that picture



surgeon was Dr Santana (supposed to be an A&G prodigy)

while I'm not sure on her exact movements I know that she had a maxillary impaction + upper/lower jaw advancement + genio and buccal fat removal

+1 to what CK said. abnormal/improper and lack of proper growth must be spotted, addressed (braces and/or distraction osteogenesis) + corrected (surgery: appropriate alignment and rotation of jaws) ASAP.

Dr Schendel has an interesting presentation on this ^

[pekay]

I don't think Le Fort I affect the cheek-bones all that much tbh

[x]

I don't think it would affect them at all. A high lefort might provide a minor improvement but not much. That girl's cheekbones obviously popped from the buccal fat removal

Palatal expansion can add a bit of fullness to the midface

[CK]

+1 to what CK said. abnormal/improper and lack of proper growth must be spotted, addressed (braces and/or distraction osteogenesis) + corrected (surgery: appropriate alignment and rotation of jaws) ASAP.

i cant believe how casual and disinterested so many dentists/orthos and at times surgeons are in discovering abnormal growth. doctors seem fearful of operating on children but it's the only time growth can be altered. after that it's just correction according to a surgical standard...

[pekay]

alright found a bunch of before/afters that showcase mid-face deficiencies (everyone had a Le Fort 1 + some form of grafting)















This girl had a Le Fort 1 + Le Fort III and a BSSO