General Category > Functional Surgery Questions
Feedback on proposed plan correction of LFS
XXRyanXXL:
The VSP that is shown, was the plan the surgeon performed last year. It really just made my face even longer. Again, the surgeon never shared this with me prior to surgery. I would stay away from teaching hospitals as much as possible, but I can also see a staff member and not a surgeon who just completed his residency. The upper lip lift could be covered, but the cheek lift isn't, since it's purely cosmetic.
So this new technique that was described, is it this link?
http://www.sciencedirect.com/science/article/pii/S246878551630009X
What is the name for this new procedure? Just Vertical ramus elongation and mandibular advancement by endobuccal approach?
So it's possible to achieve greater ccw rotation than the inverted L- in all cases? Also would it be better for a patient who needs the bone grafts to use cadaver bone and not just hip bone self-harvested? I've read people who suffer long term pain from the latter approach.
I'm looking at the girl in the last case in general, and I see no functional airway increase, it seems as though it's really constricted? Actually I see no rotation in any of there cases, just the correction of the lower jaw. But the aesthetic look is substantial.
kavan:
--- Quote from: XXRyanXXL on December 10, 2017, 01:28:36 PM ---The VSP that is shown, was the plan the surgeon performed last year. It really just made my face even longer. Again, the surgeon never shared this with me prior to surgery. I would stay away from teaching hospitals as much as possible, but I can also see a staff member and not a surgeon who just completed his residency. The upper lip lift could be covered, but the cheek lift isn't, since it's purely cosmetic.
So this new technique that was described, is it this link?
http://www.sciencedirect.com/science/article/pii/S246878551630009X
What is the name for this new procedure? Just Vertical ramus elongation and mandibular advancement by endobuccal approach?
So it's possible to achieve greater ccw rotation than the inverted L- in all cases? Also would it be better for a patient who needs the bone grafts to use cadaver bone and not just hip bone self-harvested? I've read people who suffer long term pain from the latter approach.
I'm looking at the girl in the last case in general, and I see no functional airway increase, it seems as though it's really constricted? Actually I see no rotation in any of there cases, just the correction of the lower jaw. But the aesthetic look is substantial.
--- End quote ---
Yes, the new technique I saw is described in the link to the paper. I defer to the TITLE of the paper for the name of it. It certainly looks to me that significant elongation of ramus and forward advancement have been combined for a 'rotation' to the posterior mandible given that the mandibular plane angle is significantly LESS STEEP than a CCW at the maxilla alone would do. Seeing a correction of lower jaw to significantly reduce the STEEPNESS to the MPA is in effect a 'rotation'. I am unable to answer questions for which the information regarding them is not in the article.
XXRyanXXL:
So that fixes the high MP angle. However, the long face syndrome is still exhibited, and when I smile, my upper teeth look recessed in (my upper lip doesn't drape against them), and I was recommended to have impaction of the maxilla, but this introduces a plethora of problems. One is that when I smile, I barely show even half of my upper front teeth, so impacting would make that even worse, and also anytime you are impacting the maxilla, the widely known "monkey nose" issue is prevelant. One is to use an alar stitch, but even this has limitations.
What I think can offset these issues is that the CCW rotation with downgraft would effectively bring out and tilt up the upper teeth, and to have a upper lip lift. For every 3mm advancement of the upper teeth, there is 1mm increased tooth show, due to the elastic nature of the upper lip (which is non-existent in my case). The video below shows this
https://www.youtube.com/watch?v=fzZNTpklR3E&list=PLGx6L75hAkydVwn0XYGswdbxUDkPgKdN9&index=4
Plus, wolford published an article showing optimal occlusional angle for best smiles, and shows that 10 degree angle are optimal. So a 2 degree decrease in my case.
kavan:
--- Quote from: XXRyanXXL on December 15, 2017, 09:44:14 AM ---So that fixes the high MP angle. However, the long face syndrome is still exhibited, and when I smile, my upper teeth look recessed in (my upper lip doesn't drape against them), and I was recommended to have impaction of the maxilla, but this introduces a plethora of problems. One is that when I smile, I barely show even half of my upper front teeth, so impacting would make that even worse, and also anytime you are impacting the maxilla, the widely known "monkey nose" issue is prevelant. One is to use an alar stitch, but even this has limitations.
What I think can offset these issues is that the CCW rotation with downgraft would effectively bring out and tilt up the upper teeth, and to have a upper lip lift. For every 3mm advancement of the upper teeth, there is 1mm increased tooth show, due to the elastic nature of the upper lip (which is non-existent in my case). The video below shows this
Plus, wolford published an article showing optimal occlusional angle for best smiles, and shows that 10 degree angle are optimal. So a 2 degree decrease in my case.
--- End quote ---
The procedure in the article 'fixes' the high MP angle by making the ramus longer, thereby dropping to posterior jaw to lower the angle. It makes hyperdivergence much less than CCW alone would do.
If your teeth don't show when smiling and also are too far back, CCW via anterior impaction stands to make them show less even though the forward advancement will bring the teeth closer to the lips. If CCW via posterior downgraft is not an option, then most definitely a Lip lift would be needed to offset even LESS tooth show that could arise from CCW with anterior impaction. However, let's hope posterior down graft IS an option because that looks like a better one for the CCW.
I can't validate the 'for every 3mm advancement of upper teeth there is a 1mm increase in tooth show' statement. This could not be universally true. Advancement is over an angle of inclination in which the 'pure' vertical element (increased tooth show) and 'pure' horizontal element will be different 'vector components' of forward advancement on a DIAGONAL line where that diagonal line is at an angle from the horizont. Although elasticity modulus of tissue would factor in, there would still be the salient relationship of horizontal and vertical displacements being a function of the angle of inclination the displacement goes along.
PloskoPlus:
The 1 for 3 mm rule is what my surgeon told me as well and of course it's bulls**t. If you have a superflat op, you will get much less tooth show from advancement. Anyways, I'm still 2-3 mm short of ideal tooth show (I show none when taking, it's better when I smile due to the hyper mobile upper lip).
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