Author Topic: Revision double jaw surgery - advice  (Read 19934 times)

Brachy

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Re: Revision double jaw surgery - advice
« Reply #105 on: June 08, 2018, 11:49:46 AM »
Thanks Kavan on all your comments, especially ceph and effort to explain the issues. I am consulting two italian surgeons next week, just to have more opinions on midface defficiency before adressing lower third. (since in e-mail one responded that he would move my upper jaw during LF3). I myself am very scared of such surgery and would just wish that never entered into ortho-jaw process.
To sum up, according to two surgeons I was overcorrected (which I fully agree) and will most likely revise jaw and chin surgery. However, before final decision I would consult few craniofacial surgeons to have clear picture. Thanks on all the comments, I will share my experience after cons

kavan

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Re: Revision double jaw surgery - advice
« Reply #106 on: June 08, 2018, 01:37:42 PM »
Thanks Kavan on all your comments, especially ceph and effort to explain the issues. I am consulting two italian surgeons next week, just to have more opinions on midface defficiency before adressing lower third. (since in e-mail one responded that he would move my upper jaw during LF3). I myself am very scared of such surgery and would just wish that never entered into ortho-jaw process.
To sum up, according to two surgeons I was overcorrected (which I fully agree) and will most likely revise jaw and chin surgery. However, before final decision I would consult few craniofacial surgeons to have clear picture. Thanks on all the comments, I will share my experience after cons

Personally, I think enough of your excess protrusion could be isolated to the CHIN area, 'enouugh' in the sense you might be able to spare yourself the risks of revision double jaw by isolating correction to the chin. If a WEDGE section were removed from the FRONT of chin, the rest of the chin would ROTATE CCW and in that way it could be SHORTENED do REDUCE (lower) lip strain. Of course with that sort of wedge removal, the CUT would ALSO allow pushing (some of) chin backwards.

To the best of my knowledge (but I forgot the link I read it on--sorry--), Triaca (chin wing guru) sometimes removes such a section from there in the type of surgery he does when he wants to push a slice of the mandible backwards but when the chin is too 'diagonally long'. I would consult with him AGAIN (or the other doctors he actually taught; Z and Brusco) to ask IF that can be done for YOU, (given the prior chin elongation you got prior!) and with OBJECTIVE to AVOID double jaw revision.

IF it works for you, you might be happy with that ALONE. If not, it does not preclude you from getting the doublejaw revision later down the line.
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Brachy

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Re: Revision double jaw surgery - advice
« Reply #107 on: June 08, 2018, 01:42:51 PM »
Thank you very much.

PloskoPlus

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Re: Revision double jaw surgery - advice
« Reply #108 on: June 10, 2018, 08:20:24 PM »
Forget the LF3, your jaws were overadvanced plain and simple.  Revise your jaw surgery and your cheeks won't bother you.

Brachy

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Re: Revision double jaw surgery - advice
« Reply #109 on: June 11, 2018, 09:36:28 AM »
Thanks Plosko, I share your opinion. I was really stressed after first jaw-ortho journey.
To begin with today I have consulted prof. Iannetti on midface problems and he offered me "malar" osteotomy. Actually, we were discussing 3 options: implants, LeFort 3 and zygoma osteotomy.
It appearas that they call malar osteotomy (osteotomy of the zygoma) modified LeFort 3. I apologise if I understood something wrong.
So LeFort 3 includes coronal incision and we were discussing it for the first 15minutes. Than, after I asked about risks, complications we moved just to zygoma osteotomy.
I asked multiple times and they were assuring me that most (if only) projection of the zygoma will be anterior (like 3-5mm anteriorly). Yez again, when I asked about the incision it was similar to zygomatic sandwich osteotomy, but again they assured that they wouldn't sandwich me (no widening), i.e. zygomas will be pulled anteriorly and bone gap will be filled with lateral zygoma. His estimation in my case is 4-5mm.
Cost is very much high.
Please, I would appreciate your comments.. still shoked that was offered conventional LF3, and he showed me coronal incision

Brachy

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Re: Revision double jaw surgery - advice
« Reply #110 on: June 11, 2018, 09:37:59 AM »
Coronal incision on my head

Brachy

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Re: Revision double jaw surgery - advice
« Reply #111 on: June 11, 2018, 11:49:27 AM »
https://goo.gl/images/L65tWK

I was discussing middle picture (cuts labels red on the skull) with one of his assistants.. this is what they call malar osteotomy, is it really? He told me several times that it is not zso and anterior projection of 5mm is posssible.. they were only afraid of asymmetry.. also, they offered full LF3 but warned me that I will than certainly need jaw surgery after.. any thoughts? I am very confused, but professor seemed skilled

kavan

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Re: Revision double jaw surgery - advice
« Reply #112 on: June 11, 2018, 12:24:15 PM »

Lefort 3, the FULL L3 is Lefort 1 + Lefort 2...and YES, OF COURSE, they need a full coronal (ear to ear) incision to perform it which should be INTUITIVELY OBVIOUS if you've ever actually looked up full L3 to see the ENTIRE area it includes.

As to 'malar' and 'zygoma', the terms can be used interchangably.

Now, it's QUIZ TIME for you! Answer the following questions:

1: Looking at the photo of the FULL L3, WHERE would the modification CUT be if you DID NOT want one area included in the full L3 advanced forward? HINT: Think in terms of the area on YOU you don' want pushed forward. This is a simple question so answer in terms of the diagrams.

2: Does 'modified L3' refer to just ONE way to modify it or are there a number of ways the L3 can be modified? Simple question, multiple choice:

a: One way it can be modified and called 'modified L3'

b: More than one way it can be modified and called; 'modified L3'

3: What area under the eye can look RELATIVELY recessive when the 'cheek' area is brought forward whether it be done by a bone cut to advance forward the malar/zygomatic area or an implant aimed at advancing same area? (This question assumes some BASIC knowledge of the bone support under the eye and names of those bones even though only PART of them yield the support.)

NOTE 1: This quiz is not to advocate/encourage, one way or the other, the pursuit of L3 or any one doctor's use of term 'modified L3'. It's only to test some very basic information processing abilities about what you are consulting about. So, NO GO as far as further discussion from me about L3 if you don't pass this simple quiz.

NOTE 2: The 'history' of the L3 as it applies to this board, came into being because a patient/member tooK YEARS researching it and what CUTS would specifically apply to HIS situation. He was as sharp as a tack ie. BRIGHT as to know exactly what he wanted and WHY and was able to cross reference the KNOWLEDGE he aquired ON HIS OWN (via reading tons of med articles) with the doctors he consulted with. EVER SINCE then, there has been quite a LARGE crop of mindless members wanting a L3 who aquired LITTLE to NO knowledge on their own other than they 'want a L3'. So, 'NO GO' as far as I'm concerned as to having to FILL IN the GAPS of knowledge people would need to have filled FOR THEM in any pursuit of any type of L3, modified or not. So, IMO, a LOT of KNOWLEDGE about the L3 is something someone should ALREADY have under their belt to even consult about it just like the person who had it aquired on his own. So, for people with GAPS of knowledge about the L3, my policy here is NOT to 'spoon feed' them what they need to know.


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Brachy

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Re: Revision double jaw surgery - advice
« Reply #113 on: June 13, 2018, 12:09:11 PM »
Thanks Kavan.. I have started reading publications on LF3

https://youtu.be/Hk_AUbVuDWE

kavan

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Re: Revision double jaw surgery - advice
« Reply #114 on: June 13, 2018, 12:59:50 PM »
Thanks Kavan.. I have started reading publications on LF3

https://youtu.be/Hk_AUbVuDWE

Answer the QUIZ QUESTIONS.
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Brachy

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Re: Revision double jaw surgery - advice
« Reply #115 on: June 14, 2018, 11:17:46 AM »
1. Modification cut in most cases would be below the eyes
2. Multiple modifications (e.g. kufner, z type)
3. Eyes could look sunken if zygomas are advanced. Since my irbital rims are recessed, I was offered conventional LF3 which will also effect the nose (bigger and wider)

kavan

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Re: Revision double jaw surgery - advice
« Reply #116 on: June 14, 2018, 12:16:21 PM »
1. Modification cut in most cases would be below the eyes
2. Multiple modifications (e.g. kufner, z type)
3. Eyes could look sunken if zygomas are advanced. Since my irbital rims are recessed, I was offered conventional LF3 which will also effect the nose (bigger and wider)

OK.

Answer to #1 is the mod cut would have to be to the L1 area so the L1 area is NOT brought forward (given you want the L1 area brought backwards along with lower jaw). So ABOVE L1 area, eg. below eyes is sufficient answer. Correct.

Answer to #2 is multiple modifications. Correct.

Answer to #3, eyes could look sunken if just zygomas advance is CORRECT. Also CORRECT conventional 'full' L3 advances out NOSE.

ALL CORRECT. Very GOOD.

Now with #3, which you got right, along with #2 that you got right as to there being multiple modifications of the L3, in YOUR opinion, do you think the modified L3 offered to you and explained to you as something to ADVANCE out the ZYGOMA/malar area will be advancing out ALL the areas below the eyes or will it leave an area you would also like advanced out 'behind'?

Please. No PMs for private advice. Board issues only.

Brachy

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Re: Revision double jaw surgery - advice
« Reply #117 on: June 15, 2018, 02:36:14 AM »
Orbital rims will still be recessed, i.e. eyes could easily appear sunken (left behind)

PloskoPlus

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Re: Revision double jaw surgery - advice
« Reply #118 on: June 15, 2018, 03:46:06 AM »
Are you sure that what he's talking about is not mlf3, but a sagittal split ZSO?

Brachy

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Re: Revision double jaw surgery - advice
« Reply #119 on: June 15, 2018, 07:28:13 AM »
He said makar advancement, cut seemed similar to sandwich osteotomy, but he told me multiple times that anterior projection of 5mm is possible and no widening of zygoma