CelticCaveGirls cephs - class 2 div 2 short face

[Tiny]

Any idea why it's not possible to do DO in the ramus at the moment?

[x]

mainly the same issues as osteotomies, dealing with the counteractions of soft tissue. when we find a way to effectively grow the muscles, ligaments, etc. to accomodate the increased posterior length of the face, via stem cells or whatever comes up, then we can effectively lengthen the ramus.

[pekay]

only way to create the illusion of a low gonial angle is through a drop down Medpor implant and for this particular case (illusion of a low gonial) it has to be Medpor

jaw implants are icky though and all but 1 guy (out of 8 ) on lookyourbestuk had complications with their implants and ended up having it removed

[Tiny]

It's been done for congenital defects -

https://www2.aofoundation.org/wps/portal/!ut/p/c1/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I6B8JJK8haEFUD7U09nP2MkPqNSEgG4_j_zcVP2C3IhyADJvFMw!/dl2/d1/L2dJQSEvUUt3QS9ZQnB3LzZfQzBWUUFCMUEwRzEwMDBJNklGS05UMzIwTzI!/?redfix_url=&implantstype=Distraction%20osteogenesis%20of%20mandibular%20ramus&segment=Congenital&bone=CMF&classification=95a-HFM%2c%20Pruzansky%20IIa&approach=&showPage=redfix&treatment=Operative&method=Mandiubular%20ramus%20and%20condyle


Abstract from a 1995 paper -
Mandibular Elongation and Remodeling by Distraction: A Farewell to Major Osteotomies
Molina, Fernando M.D.; Monasterio, Fernando Ortiz M.D.

Plastic and Reconstructive Surgery . September 1995
Abstract

Servicio de Cirugia Plastica y Reconstructiva Hospital "Manuel Gea Gonzalez" Calzada de Tialpam 4800 Mexico, D.F. 14000

A modified technique for mandibular distraction is reported: An oblique corticotomy is made in the external cortex of the mandible at the level of the gonial angle. Two intraosseous stainless steel pins are inserted and are joined by a softer distraction screw. We make two corticotomies, one horizontal and one vertical, and insert three pins to achieve bidirectional distraction when the mandibular body and the ascending ramus are hypoplasic. This procedure has been used in 87 patients with unilateral hemifacial microsomia and 19 patients with bilateral mandibular hypoplasia. A mean elongation of 19 mm was obtained in the unilateral group. In the bilateral cases a mean vertical elongation of [7.5 mm and a mean horizontal elongation of 14 mm were obtained. A great improvement of the facial asymmetry was achieved in all the patients. The follow-up in this series varies from 3 months to 31/2 years (mean, 19 months in unilateral cases and 12 months in bilateral cases). No relapses have been observed. (Plast. Reconstr. Surg. 96: 825, 1995.)

(C)1995American Society of Plastic Surgeons

[x]

regarding the inverted-L osteotomy: http://www.head-neck.com/Digital-case2.pdf

[pekay]

regarding the inverted-L osteotomy: http://www.head-neck.com/Digital-case2.pdf

that is a damn good result

Wolford has like 3 before/after floating online as well (on teeneagers) and they are just as good

i believe this A&G patient had it as well

[Tiny]

Ah I remember seeing this.  Nice example of CCW rotation of the maxilla, although surprising how little his nose changed.  The inverted L osteotomy looks pretty brutal  in terms of the cutting and movements - but he had a crazy steep occlusional plane.   I don't think it's a good option in my case - I will probably have to make do with a BSSO as far back as possible on the body

I am going to check with Mommaerts that he definitely can't do DO in the mandibular ramus.  It's been done before and the main issue mentioned seemed to be lack of space inside the mouth for the DO apparatus and external apparatus leaves scars.

[Tiny]

that is a damn good result

Wolford has like 3 before/after floating online as well (on teeneagers) and they are just as good

i believe this A&G patient had it as well

Wow, that's a great result.  It seems so brutal, though.  It wasn't suggested as an option by Johnson

[CK]

i believe that's a gunson surgery.

[pekay]

Wolford/Pitta one

[x]

this one too or no?

[Tiny]

Uh, great results and all, but do we really think my case is bad enough to require an inverted-L??      I know I look a little like a mouse but....

[pekay]

Uh, great results and all, but do we really think my case is bad enough to require an inverted-L??      I know I look a little like a mouse but....

I don't even know what you look like 

but you said that you would like your ramus to be vertically longer and I merely pointed that an inverted L addresses that issue

[Tiny]

I don't even know what you look like 

Apparently, a little mouse-like, or so I am told.  But kindof...in a cute way.  I think the the way everything goes backwards from the nose tip makes the face look a little snout-like.  The big eyes and chubby cheeks contribute to the general mouse-like visage. 

I think I know what to go as for hallowe'en now.

[overbiter]

I thought in those Wolford cases he used total joint replacement. Are people saying these are all inverted L osteotomies now?

I think this woman had a joint replacement surgery with Wolford, but you're saying the others are inverted L osteotomies?