Please help me plan my next step

[temporeiches13]

Hello everyone,

I am at the beginning of the journey to correct my jaw asymmetry. As you can see in my picture, the left side of my jaw is much steeper than the right side, and also appears to be quite a bit more narrow. This may have to do with the cant, which I have tried to highlight with the lines I have added. Additionally from a profile view my maxilla is too far behind my lower jaw, making the lower lips appear even larger. Additionally, my palate is quite narrow. What procedures would you suggest to undergo to fix these issues?

Mainly I want to fix the jaw asymmetry, how would I go about doing this? Additionally I would like to make my jaw less round at the bottom and more square (would this be achieved by a ccw or a cw rotation of the mandible??)

I went to a surgeon and he suggested me to do: maxillary advancement, rotation of lower jaw (forgot the exact details) and SARPE

Thank you

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[kavan]

Perhaps a cut to the maxilla and/or mandible that allows the doc to shift one side either up or down more than the other in hopes of addressing the frontal asymmetry.

If the roundness to the chin is actually SOFT TISSUE, the advancement of the maxilla which in turn allows the doc to advance/rotate the mandible, should help straighten out the roundness seen under the chin.

[temporeiches13]

Thank you so much for your response! I see you helping people a lot on this forum, your dedication to this forum is inspiring!

I think that's the approach the surgeon suggested as well. Do you think major improvements can be achieved in terms of symmetry or is it more of a let's see if it will improve things?

Also I attached another image from a 3/4 angle to give a better impression of the positioning of the maxilla and mandible. To me it looks like the maxilla needs to go forward and the mandible needs a slight ccw rotation... do you agree?

[kavan]

Pragmatically speaking, they don't get the symmetry 'perfect' but can improve on the asymmetry as to make it less.

Well, the maxilla would need to come forward and with some CCW in order to affect the CCW in the BSSO advancement. I think more CCW of the lower jaw than 'just a slight' one is needed to reduce the aparant excess visual length of the chin and also to straighten out/reduce the round excess under it. That could be done via a type of bone cut where some CCW of the lower jaw can be done independent of that of the CCW of the upper. (Advanced technique)

May I ask if the X ray you showed is from a Dr. in Spain.

[temporeiches13]

Thank you for your thorough response. I went to a doctor in Belgium... I do not know if it is allowed to drop names on the forum but I would be more than willing to share the info if it is? Also when you speak of an advanced technique, do you mean doing a lefort with ccw and then a bsso with ccw or something more complex entirely?

[kavan]

Thank you for your thorough response. I went to a doctor in Belgium... I do not know if it is allowed to drop names on the forum but I would be more than willing to share the info if it is? Also when you speak of an advanced technique, do you mean doing a lefort with ccw and then a bsso with ccw or something more complex entirely?

Hard to explain. But it's a technique that kind of puts a 'twist' on the BSSO cut to give more CCW to it.  Maybe done more in Europe than US.

[temporeiches13]

I see. Do you know he name of it or a paper related to it so I can look into it further? Thanks

[kavan]

I see. Do you know he name of it or a paper related to it so I can look into it further? Thanks

Not sure if it has a name. It's something I've seen in a Spanish surgeons paper. Although the link is for another topic matter (surgery first), if you scroll down to the profile 3 d sims of 'Figure 1', you can see. https://www.institutomaxilofacial.com/wp-content/uploads/2016/05/Surgery-What-have-we.pdf

[temporeiches13]

I see. I'll have the surgeon (defrancq) take a look at it. Maybe he does something similar. Don't want to risk too much though.

[temporeiches13]

Hey @kavan and others. I did a quick morph and I am wondering whether or not it would be realistic? Would this be achievable through CCW rotation or will I need genioplasty as well?

[kavan]

Hey @kavan and others. I did a quick morph and I am wondering whether or not it would be realistic? Would this be achievable through CCW rotation or will I need genioplasty as well?

Well, it's kind of time intensive to measure out all of the displacements done on an 'auto' morph to address the question or use it as predictive tool. So, not only is there morphing but there is the act of keeping track of all the displacements done to acheive it.

At first glance, it looks like you have shortened the chin but with little to no advancement there.

It is actually the genioplasty with a diagonal cut to advance the chin outward and UPWARD which helps decrease the apparent excess of the chin length and also take some under the chin 'flub' with it.

[temporeiches13]

Thanks for your answer. Do you think its possible to go for a genioplasty and then at some later point go for double jaw surgery if I still deem it necessary? Or will this cause problems

[kavan]

Thanks for your answer. Do you think its possible to go for a genioplasty and then at some later point go for double jaw surgery if I still deem it necessary? Or will this cause problems

Not really. They all should be done at same time if you are getting maxfax surgery.

[temporeiches13]

I see. So I suppose doing it stage wise is not an option.

[kavan]

I see. So I suppose doing it stage wise is not an option.

No, because if your maxilla is to be moved in a surgery, the jaw and chin orientation should be planned in at the same time.