25mm advancement seems high?

[sventory]

Went to see Dr. Movahed in Saint Louis, took cephs and all that. Recommend after orthodonics that I get the BSSO, plus sliding genio. Moving my top jaw forward 10mm, and my bottom jaw forward 25mm. Doesn't 25mm seem quite high? I thought I read that anything over 10mm and the risks of issues like perm pain and numbness increase significantly.

[dardok]

thats a ridiculous amount lmao

[kavan]

Went to see Dr. Movahed in Saint Louis, took cephs and all that. Recommend after orthodonics that I get the BSSO, plus sliding genio. Moving my top jaw forward 10mm, and my bottom jaw forward 25mm. Doesn't 25mm seem quite high? I thought I read that anything over 10mm and the risks of issues like perm pain and numbness increase significantly.

Post your cephs and displacement proposal. Sounds like a lot but if you need that much and they can do it, than it might be OK. I would think that the CHIN movement will be part of the total 25mm advancement.

[Dogmatix]

Would be interesting to see your profile picture if you're willing to share.
To respond to your question, yes 25mm is much, but no idea if it may correlate to your case.

[ditterbo]

I highly doubt your lower jaw is literally being cut and slid forward 25mm. He must be doing some large rotations, possibly posterior and anterior to the maxilla, that combine to some number like 25. Maybe at the pogonion you'll get a net forward movement of 25mm, but yeah your face must be god awful to merit a 10mm maxilla advancement. You've left out a ton of details WRT his plan here.

[sventory]

Sorry for the slow reply took me some time to track this stuff down.

I've attached my ceph and profile views, though the quality isn't that great. I thought it was weird though how hard they made me push my chin down. Like holding that position was uncomfortable and makes my chin look more regressed than my natural state, but that's how they told me to pose for the ceph.




Here is the relevant text:

A high occlusal plane is appreciated. Maxillary and mandibular retrognathia apparent and noted to be severe. The maxilla is deficient at least 10mm and the madible by at least 25mm. Constriction of the airway at the soft palate and base of tongue region. Minimal cross sectional area of the airway measurement of 48mm2, with the average being 140mm2.

Surgery:

Multiple maxillary osteotomies with bone plate
Mandibular ramus osteotomy with bone screw stabilization
Genioglossus advancement
Partial Nasal Turbinectomies.

[apollo]

I've attached my ceph and profile views, though the quality isn't that great. I thought it was weird though how hard they made me push my chin down. Like holding that position was uncomfortable and makes my chin look more regressed than my natural state, but that's how they told me to pose for the ceph.

Extremely odd. I was going to tell you to get away from the surgeon, but then I saw the name. I believe Dr. Movahed was a student of (and had worked closely with) Dr. Wolford, and combined with the caliber of results on his website, he's certainly not "incompetent" (which many maxfacs are).

I don't see how one could plan a surgery with a ceph and clinical photos like that. The only thing I can think of is that having you tilt your head downwards would somehow help with insurance coverage (smaller airway, steeper occlusal plane, etc).

Doesn't 25mm seem quite high?

It's hard to judge how much advancement you need given your unnatural head posture in those photos -- do you have any others, in NHP (natural head posture)?

edit:

Your movement seem extreme. Not sure how 10mm of maxillary advancement (say at point A) wouldn't be very excessive. Maybe they used the ceph with the tilted down posture to generate the movements? There's no scale/ruler built into your ceph, but I measured A to N-perp to be about -10mm (A to N-perp is a cephalometric measure of maxillary anteroposterior position) and around 0 is considered average. But this theory sort of contradicts the earlier theory that the downwards position was only for insurance (unless the giant movements are somehow for insurance too).

Did Dr. Movahed himself say you would be having that much advancement? Who gave you those numbers?

[Lazlo]

judging from your pics you'll look awesome when done surgery with that much advancement. you need it. plus the genio is probably part of it.

get a rhino to fix your droopy nose and you'll be ballin in the looks category.

[kavan]

It does look like you need a SIGNIFICANT advancement. As I said prior, the NET mandible advancement would also include the chin.

He could have had you tip your head 'down', perhaps because you might tilt it up to compensate for the lower jaw recession or to align you with a horizont he uses for reference or to see the impingement on the airway given the head might tilt in that direction when sleeping.

I would not even attempt to do any numerical/quantitative measures on a PHOTO of a ceph because photos of cephs can have distortions. However, the photos of the cephs still provide enough qualitative information that show you would need a SIGNIFICANT advancement and that certainly cross references with the significant quantitative advancement the doctor indicated.

[GJ]

Did the doctor ask you to tilt your head that far back? It's unnatural, and he might be doing that because he can't deliver proper movements to fix the problem. Always a red flag for me when the doc has a patient take photos like that.

10mm upper seems excessive. I've never seen over 5mm look right in Class II cases. The mandible is deficient in these people, not the maxilla. If anything, many times the maxilla is overdeveloped. 25mm also seems excessive, but I have seen a few cases like that were it was appropriate.

[april]

Here is the relevant text:

A high occlusal plane is appreciated. Maxillary and mandibular retrognathia apparent and noted to be severe. The maxilla is deficient at least 10mm and the madible by at least 25mm. Constriction of the airway at the soft palate and base of tongue region. Minimal cross sectional area of the airway measurement of 48mm2, with the average being 140mm2.

Surgery:

Multiple maxillary osteotomies with bone plate
Mandibular ramus osteotomy with bone screw stabilization
Genioglossus advancement
Partial Nasal Turbinectomies.

He's saying your deficient by those numbers, but it doesn't say he's going to move you that far (unless he actually said that to you?).

Like ditterbo said, you'll probably get massive CCW. I would guess your maxillary incisors will swing forward more than ANS and that's maybe where you'll see most of the advancement. But I'm only basing my thoughts on the uprighted incisors, which a) are before decompensation and b) from an unnatural exaggerated pose.

[sventory]

I will call the doctor to confirm, but I am pretty sure he said the 10mm and 25mm will be my advancements.
Here is a picture of my chin in what I feel is my normal position:




Yes I was thinking about getting a rhino too, Dr Movahed mentioned it. But I thought I should worry about that after the jaw surgery. The Dr mentioned his medical note taker he also did her and she was mid 20s advancement, and he also said this use case on the site: https://movahedoms.com/services/osa/case-study-1/ required similar movements. So I am pretty sure he's going to actually advance that far.

I remember him saying the reason for the advancements is for my profile view, from the nose to the upper lip, that should be almost straight down, but mine slants inward, and then same thing for upper lip to bottom lip to chin, they should all be in a relatively straight vertical line. but I slope like a mofo.

[kavan]

I think you will have a great improvements with his suggestions.

[apollo]

Here is a picture of my chin in what I feel is my normal position:

Yeah, you are way more deficient than I expected.

However, 10mm advancement of "maxilla" seems excessive to me. We don't know which part of the maxilla he's talking about, but assume it's upper incisor tip (this is best case, since everything else moves less). Even with 10mm of posterior downgrafting for CCW (this is a pretty large downgraft, so again, close to best case), you're still advancing A point 6mm or so.

In the case study you linked (https://movahedoms.com/services/osa/case-study-1/), I think the guy would've looked better with less maxillary advancement. To me, his upper jaw looks protrusive, particularly in the 3/4 and profile shots, and his overall facial balance looks a bit off. In his case, I believe he traded off the best cosmetic outcome for a more functional outcome (larger advancement to treat sleep apnea). Of course, this tradeoff isn't necessarily bad, but if aesthetics are of high importance to you, I would try to avoid that much advancement.

I'd recommend a digital consult with Dr. Gunson (or other top docs) if you're concerned about the appearance part.

[kavan]

Here is a picture of my chin in what I feel is my normal position:




Yes I was thinking about getting a rhino too, Dr Movahed mentioned it. But I thought I should worry about that after the jaw surgery. The Dr mentioned his medical note taker he also did her and she was mid 20s advancement, and he also said this use case on the site: https://movahedoms.com/services/osa/case-study-1/ required similar movements. So I am pretty sure he's going to actually advance that far.

I remember him saying the reason for the advancements is for my profile view, from the nose to the upper lip, that should be almost straight down, but mine slants inward, and then same thing for upper lip to bottom lip to chin, they should all be in a relatively straight vertical line. but I slope like a mofo.

Nose changes, in particular changes to to the base of nose, are part of the bimax surgery. That is because the nasal spine (near base of nose) is part of the Lefort 1 cut. In order for
changes to the nose base-- and also its relation to the upper lip-- to be favorable and not unfavorable, a good maxfax has (rhinoplasty) techniques to alter the base of nose with goal of  countering any unfavorable changes. So, if he suggested a rhino to you during this surgery, the objective of this would be to produce favorable changes to the nose when he has access to do so.


If, initially you got on here WITHOUT asking about a number (mm displacement) and instead showed your profile photos and asked members:

'Is my retrusion, minor, modest or EXCESSIVE?' What do you think the answers would be?

In YOUR opinion, how would you QUALITATIVELY assess the extent of retrusion you have to your face. NO numbers, just subjectively. Is your retrusion minor, modest or excessive?