I got a Lateral Ceph, BUT WHAT DOES IT MEAN?

[Lefortitude]

Hey JSF.  I got a lateral ceph but have to wait a month before seeing the orthodontist again. What do you wonderful people make of this?

[PloskoPlus]

Jaws look small.

[ditterbo]

if you  don't get much info here, then I'd suggest get a cephx analysis and/or learn up on how to measure facial structures (SNB, etc.) to see where you fall in the range of what your skeletal 'norm' would be.

surprise question about your upper cheeks. i'm still not sure what exactly I'm seeing just below the eyeballs in the cephs, but I think it's the zygomatic bone. To me, they look fairly prominent relative to your lower face.  Am I basically reading this right? Your mid-face, specifically area around the upper the cheeks connecting to the orbital region doesn't look particularly flat / sunken in?

[CCW]

Your picture is too small to see properly, but your airway looks smallish, you have a Class II skeletal base, and your OP looks somewhat CW rotated. Incisors look proclined, chin(bone) is good.

[Lefortitude]

if you  don't get much info here, then I'd suggest get a cephx analysis and/or learn up on how to measure facial structures (SNB, etc.) to see where you fall in the range of what your skeletal 'norm' would be.

surprise question about your upper cheeks. i'm still not sure what exactly I'm seeing just below the eyeballs in the cephs, but I think it's the zygomatic bone. To me, they look fairly prominent relative to your lower face.  Am I basically reading this right? Your mid-face, specifically area around the upper the cheeks connecting to the orbital region doesn't look particularly flat / sunken in?

Thanks for your response.  youre 100 percent correct that my midface projection is relatively good, compared to my lower third. my zygomas are relatively wide and prominent. 

[Lefortitude]

Your picture is too small to see properly, but your airway looks smallish, you have a Class II skeletal base, and your OP looks somewhat CW rotated. Incisors look proclined, chin(bone) is good.

Youre right the pic was too small, ive fixed it now. 

I think my airway might be small ish because of moderately enlarged adenoids.  I certainly had a class II skeletal base.  However, i believe i am to understand that I cant get a CCW rotation because i dont have a gummy smile and i have perfect tooth show.  Ideally i would like a posterior downgraft and anterior impaction but im not certain it would come out aesthetically in terms of my smile and tooth show   

[ditterbo]

Just from the ceph your case seems kinda easy. you don't have a bad mandibular plane angle, like at all, your ramus is well defined, strong chin bone, strong brow ridge, very decent mid-face projection, very normal occlusal plane.  I'm not well read on this stuff so this is totally personal opinion, take it with a grain of salt.

seems to me all you need is straight forward advancement bimax and then gamble with adding heft to your jaws, later on, if you so choose.  the orthodontic situation may or may not require teeth extractions though, depending on how much advancement you need. I suspect you can't advance very much (I dono maybe 6-10mm) due to that strong chin already masking a lot of the jaw recession.

[Lefortitude]

Just from the ceph your case seems kinda easy. you don't have a bad mandibular plane angle, like at all, your ramus is well defined, strong chin bone, strong brow ridge, very decent mid-face projection, very normal occlusal plane.  I'm not well read on this stuff so this is totally personal opinion, take it with a grain of salt.

seems to me all you need is straight forward advancement bimax and then gamble with adding heft to your jaws, later on, if you so choose.  the orthodontic situation may or may not require teeth extractions though, depending on how much advancement you need. I suspect you can't advance very much (I dono maybe 6-10mm) due to that strong chin already masking a lot of the jaw recession.

i hope my case is as straight forward you see it.  Im going for very close to ante-face.  I think something around the 6-8mm mark for advancement should give me the aesthetic and functional result im looking for.

[CCW]

Youre right the pic was too small, ive fixed it now. 

I think my airway might be small ish because of moderately enlarged adenoids.  I certainly had a class II skeletal base.  However, i believe i am to understand that I cant get a CCW rotation because i dont have a gummy smile and i have perfect tooth show.  Ideally i would like a posterior downgraft and anterior impaction but im not certain it would come out aesthetically in terms of my smile and tooth show   

Nope, your airway is small due to your recessed jaws. It's smallest at the hyoid bone. As for CCW, it doesn't really matter if you have a gummy smile or not because CCW just means flattening of the OP with posterior downgrafting (slightly simplified). Sometimes you combine it with an anterior impaction, downgraft or leave it unchanged. Posterior downgrafting is the difference maker.

If you do a straight MMA, you won't look much different at all. You don't have a huge overbite, so the only way your mandible can be advanced enough to straighten your profile is via CCW. Gunson and Wolford do CCW with huge posterior downgrafts and without anterior impaction all the time.

[kjohnt]

Disagree about rotation, occlusal plane looks fine.  Agree lower incisors are proclined - get those up righted with braces to create small over jet then bsso to bring mandible forward.  Sliding genie as well because your chin bone should roughly line up with lower incisors.

What's interesting to me is the relative lack of vertical height of the mandibular body.  I've not seen that before.

[PloskoPlus]

Disagree about rotation, occlusal plane looks fine.  Agree lower incisors are proclined - get those up righted with braces to create small over jet then bsso to bring mandible forward.  Sliding genie as well because your chin bone should roughly line up with lower incisors.

What's interesting to me is the relative lack of vertical height of the mandibular body.  I've not seen that before.

That may make a wing osteotomy not worth while.

[Lefortitude]

What's interesting to me is the relative lack of vertical height of the mandibular body.  I've not seen that before.

Its very interesting, because that may make osseous genioplasty or chin wing difficult, because of how close the cut would have to be to the dental roots.  From my understanding, if bone cut is too thin, resorption increases.

[CCW]

Disagree about rotation, occlusal plane looks fine.  Agree lower incisors are proclined - get those up righted with braces to create small over jet then bsso to bring mandible forward.  Sliding genie as well because your chin bone should roughly line up with lower incisors.

What's interesting to me is the relative lack of vertical height of the mandibular body.  I've not seen that before.

It's too steep in this case since he has a dental Class I occlusion. It needs be flattened so that the mandible can be advanced enough.