Before and after scans: ANS missing? Over advanced?

[mazilla]

I had a big anterior nasal bone before, and I seem to have none in the after. My nose looks flat.

Also I believe my maxilla and jaw were advanced too much and I feel I have bimax protrusion now.

[kavan]

My comments are limited to questions about the photo presentation.

Your nose tip most certainly looks flat in the before photo. I've never seen a nose tip that was an even straight line before. What happened to it?

What is that 'thing' on your nose bridge in the before photo and how was it removed during the surgery?

Why don't the comparison lines in both photos line up and what are those fly swatter screen marks and folds on the cephs?

Why don't you have a hyoid bone in the before. Was one added during the surgery?

Is it common for your max fax to give that type of ceph presentation?


I've arranged the images side by side in case others have any insights as to these questions.

[kavan]

With flat I mean that it looks kind of like this (not as much): https://imgur.com/a/pcxpC

Do you see my ANS in the before scan? Do you see that it is tiny in the after? I believe that's why my nose looks how it does.

The thing on my nose bridge is just the mouse cursor. Those are pics I took from the doctors computer. He sent me the files in some weird format that needs a special program to be opened so I just took pics from their computer.

I don't know why the lines don't line up, im not even sure what those lines are.

I did have a hyoid bone, just the ceph is cut, so you can't see it (you can see the tip of it though).

Is it common for your max fax to give that type of ceph presentation? I see what you did here

So, my questions are:
-Can you tell from these scans if I was over advanced?
-Where is my ANS? You told me they are supposed to move it, right? Mine was almost removed!

Yes. You saw what i did. lol. I knew they were pics taken from different distances but not the actual ceph files. But that's the point. There is too much distortion in the presentation to use them for the question you're asking.

[kavan]

OK, I've taken a closer look for the ANS.

The red 'bow' curves trace some bone structure. The POINTED part between the 'dip-ins' would be the ANS. It is sharper in the before. It is somewhat of a prominent ANS but it's RECESSED.

Your upper jaw was advanced forward and lowered. IF the WHOLE PROMINENCE of the ANS were moved along with that, it would have given you a LONGER nose from nasion to sub-nasa, a boat load of columella show and a TETHERED upper lip labial ledge. Tethering with PROMINENT nasal spine is a deformity that rhino doctors address by REMOVING the prominence of the nasal spine. Based on the fact that you are not left with the deformity of a prominent nasal spine with tethered upper lip labial ledge which would NEED part of the ANS removed in a RHINO to correct, I would conclude he DID remove part of ANS to prevent you from being left with that type of deformity.



Here is an example of tethered nose (to lip labial ledge) with prominent nasal spine.

Re: Lines.
Lines are drawn through constant landmarks that don't change to look at areas that do change relative to the landmark lines.

[GJ]

What is a tethered upper lip?

Never heard that term happening from jaw surgery.

[kavan]

What is a tethered upper lip?

Never heard that term happening from jaw surgery.

It's when the base of nose is tethered to lip. It's something that comes along with a prominent anterior nasal spine and when the maxilla is forward with a prominent nasal spine. With Lefort 1 advancement, they can cut out or trim the ANS to prevent it from being too prominent when advanced forward. It's something they DON'T want to happen and can prevent. Some people have the prominent ANS and tethered lip naturally and a rhino maneuver cuts the ANS down to correct it. When the ANS is brought forward in L1, it can become too unfavorably prominent and the labial ledge where it's connected to the base of the nose can take on an unfavorable contour.

ETA: A large maxilla advancement with the ANS can cause too much upward rotation of tip and very WIDE/LARGE very open nasolabial angle. So, they can remove it to prevent that from happening.
A very open NLA is also referred to as large ANS with lip tethering. The 'lip' referred to is not the kisser but the labial ledge.



Overly FORWARD ANS with large NLA. NotE tethering of labial ledge.

[GJ]

Oh okay, I always called that area the philtrum. Never heard the term labial ledge.

[kavan]

Oh okay, I always called that area the philtrum. Never heard the term labial ledge.

The philtrum is the CLEFT or groove on the labial ledge. Philtrums are neither long nor short. They are either flat or grooved. Labial ledges are either long or short.

[kavan]

I don't know. Can't answer questions relative to what was needed for airway.

[kavan]

What about the downgraft? Is that done on a purely cosmetic basis?

The presentation I made is now missing as are your IMGUR links they were based on. So, no more easy reference/referral to them to address your questions.

ETA: Waste of time and effort on my part to prepare illustrations and examples to explain things and then have OP request take down of photos. Will be spending no more time addressing OP's questions.