Analyze my CEPH please

[recessedmandible]

I talked to a surgeon and he recommend 17mm advancement of my mandible, 6mm of my maxilla and almost no rotation, mostly linear advancement but a bit of downgrafting I believe. My concern is that I feel my lower third is short, is my maxilla vertically short?

I'm not sure if these are the right movements, not sure what type of rotation I need, I got MSE done and definitely plan on moving my mandible forwards, it's just a question of what sort of rotation I need in my maxilla and how much advancement. He also said my chin is nearly the perfect height and recommended moving it forwards, I thought I would need to move it downwards to make it longer? Overall unsure what to do, any input will be highly appreciated. And ofc, my ramus, I feel like it's short. I did have orthodontics while young.

He also recommend extracting the lower pre-molars to create enough space for the movement, is this really necessary? I mostly want my maxilla to support my soft tissues and to stop looking recessed.

Also, do you guys think there's any surgeon who would be willing to perform surgery first on me? Any name you guys can recommend, I'm willing to travel if need be.

[GJ]

If you don't do CCW rotation, then you might need to extract lower premolars to achieve a movement that big. You have quite a bit of room with your overjet. It looks like 5mm or more. If your lower third is short, this could be why they want to do linear only. To me your lower third looks within the realm of normal, but I don't have time to measure it. Did the surgeon comment on the lower third?

What problem are you trying to fix? That would help to know.

[recessedmandible]

If you don't do CCW rotation, then you might need to extract lower premolars to achieve a movement that big. You have quite a bit of room with your overjet. It looks like 5mm or more. If your lower third is short, this could be why they want to do linear only. To me your lower third looks within the realm of normal, but I don't have time to measure it. Did the surgeon comment on the lower third?

What problem are you trying to fix? That would help to know.

My surgeon said that my lower third height is close to the ideal, didn't know having a recessed mandible would make my chin appear smaller, somehow it will look bigger when the mandible is moved forward I believe. Originally I thought I needed my chin moved downward but the surgeon said he will move it a bit forward instead

I'm trying to open up my airway and make it look as good as possible. To me this would mean that my maxilla supports my soft tissue properly and my mandible is aligned with it.

[kavan]

I talked to a surgeon and he recommend 17mm advancement of my mandible, 6mm of my maxilla and almost no rotation, mostly linear advancement but a bit of downgrafting I believe. My concern is that I feel my lower third is short, is my maxilla vertically short?

I'm not sure if these are the right movements, not sure what type of rotation I need, I got MSE done and definitely plan on moving my mandible forwards, it's just a question of what sort of rotation I need in my maxilla and how much advancement. He also said my chin is nearly the perfect height and recommended moving it forwards, I thought I would need to move it downwards to make it longer? Overall unsure what to do, any input will be highly appreciated. And ofc, my ramus, I feel like it's short. I did have orthodontics while young.

He also recommend extracting the lower pre-molars to create enough space for the movement, is this really necessary? I mostly want my maxilla to support my soft tissues and to stop looking recessed.

Also, do you guys think there's any surgeon who would be willing to perform surgery first on me? Any name you guys can recommend, I'm willing to travel if need be.

You're close to a low angle (MPA) patient which means that you DON'T need CCW (posterior downgraft or anterior impaction) to decrease the MPA or the OP (occlusal plane). So, that means you don't need ANY kind of extra ROTATION. That also means that your jaws can be advanced forward along their present LINE OF ORIENTATION as in 'linearly'.

You have somewhat of a short face which means a UNIFORM downgraft could be used to INCREASE the distance that is short.

You have a RECESSIVE mandible which means it needs to be advanced forward.

You have an overJET which means the mandible can be brought forward to close the overJET.

You have a pre-molar that IF they pluck out (both of them), that means they can push your lower teeth backwards (with braces) to advance your mandible MORE.

Your mandible is relatively more recessed than your maxilla which means the mandible needs MORE advancement than does the maxilla. This also means that advancement of the maxilla will allow for EVEN MORE advancement of the mandible.

When the lower jaw is brought forward, the CHIN goes along for the ride and is ALSO advanced out.

All those things together would OPEN your airway and also improve your profile.

All these observations are CONSISTENT with what the surgeon suggested to you.

[GJ]

You have an overbite which means the mandible can be brought forward to close the overbite.

Overjet.

But I agree with the rest.

[kavan]

Overjet.

But I agree with the rest.

correction made from overbite to overjet.

[recessedmandible]

You're close to a low angle (MPA) patient which means that you DON'T need CCW (posterior downgraftor anterior impaction) to decrease the MPA or the OP (occlusal plane). So, that means you don't need ANY kind of extra ROTATION. That also means that your jaws can be advanced forward along their present LINE OF ORIENTATION as in 'linearly'.

You have somewhat of a short face which means a UNIFORM downgraft could be used to INCREASE the distance that is short.

You have a RECESSIVE mandible which means it needs to be advanced forward.

You have an overJET which means the mandible can be brought forward to close the overJET.

You have a pre-molar that IF they pluck out (both of them), that means they can push your lower teeth backwards (with braces) to advance your mandible MORE.

Your mandible is relatively more recessed than your maxilla which means the mandible needs MORE advancement than does the maxilla. This also means that advancement of the maxilla will allow for EVEN MORE advancement of the mandible.

When the lower jaw is brought forward, the CHIN goes along for the ride and is ALSO advanced out.

All those things together would OPEN your airway and also improve your profile.

All these observations are CONSISTENT with what the surgeon suggested to you.

thanks a lot!

how short would you say my maxilla is? Not sure what the proper way to measure would be, is this dependent on the soft tissue? Also what does low angle (MPA) patient mean?

And would you say I don't need genio to make my mandible longer then? He said he would move my chin a bit forward instead of down, this was odd to me but like you said with BSSO maybe it changes the appearance of the chin also

Also would you say that in my case the ramus is not too short? Because I think if I were to push for downgrafting it might give me a pointy face so idk if maybe trying to make my face longer would end up making me look worst because of my short ramus, ofc I am not even sure that I have a short maxilla so maybe worrying about this is silly?

[GJ]

Personally I think your chin would look better moving down. You'd probably lose or smooth out some of that deep interlabial gap, and you'd lengthen your quasi-brachycephalic facial pattern. Something like this could come down to the taste of that surgeon or his ideology. Maybe he just likes short, compact faces? Just have a talk about it.

[recessedmandible]

Personally I think your chin would look better moving down. You'd probably lose or smooth out some of that deep interlabial gap, and you'd lengthen your quasi-brachycephalic facial pattern. Something like this could come down to the taste of that surgeon or his ideology. Maybe he just likes short, compact faces? Just have a talk about it.

Yes I agree, I essentially want to go from an Europrosopic to Mesoprosopic face. Putting it this way makes me pose my questions better, I essentially want to know, does my maxilla need to be made longer for this? What about my chin(I think you would say yes which I agree)? And if I make those longer will my ramus now look too short? Are there any options to make that longer if this is the case so that my face doesn't look pointy?

[GJ]

Yes I agree, I essentially want to go from an Europrosopic to Mesoprosopic face. Putting it this way makes me pose my questions better, I essentially want to know, does my maxilla need to be made longer for this? What about my chin(I think you would say yes which I agree)? And if I make those longer will my ramus now look too short? Are there any options to make that longer if this is the case so that my face doesn't look pointy?

Yes I think so on the chin. The maxilla: how much tooth are you showing? You want around 2 to 3mm of tooth show at rest. If you don't have that, then it's likely the maxilla could/should come down. It's possible the ramus can look shorter if the things around it get longer, yes. I'd actually expect that. Might not be a big deal, though, in the grand scheme of things.

Honestly, if this were me, I'd just want lower jaw surgery. I'd close the overjet by moving the lower jaw linear/forward. It looks like you get 5 to 6mm there. Then do the rest with the chin. This is ideal imo because you avoid touching the upper jaw, which is the area that leads to drastic and unwanted changes (e.g. nose, lips). You can probably get 10mm at POG with the lower jaw and chin and look natural, and take little risk in the process. If that's not enough advancement, there's the option to extract lower biscupids and move it forward move. But your surgeon's idea is not bad. You'll just take on the risks involved in the upper jaw and likely have the nostrils widen and lips sit differently. Without seeing your soft tissue, I have no idea if your face can withstand those types of changes.

[recessedmandible]

Yes I think so on the chin. The maxilla: how much tooth are you showing? You want around 2 to 3mm of tooth show at rest. If you don't have that, then it's likely the maxilla could/should come down. It's possible the ramus can look shorter if the things around it get longer, yes. I'd actually expect that. Might not be a big deal, though, in the grand scheme of things.

Honestly, if this were me, I'd just want lower jaw surgery. I'd close the overjet by moving the lower jaw linear/forward. It looks like you get 5 to 6mm there. Then do the rest with the chin. This is ideal imo because you avoid touching the upper jaw, which is the area that leads to drastic and unwanted changes (e.g. nose, lips). You can probably get 10mm at POG with the lower jaw and chin and look natural, and take little risk in the process. If that's not enough advancement, there's the option to extract lower biscupids and move it forward move. But your surgeon's idea is not bad. You'll just take on the risks involved in the upper jaw and likely have the nostrils widen and lips sit differently. Without seeing your soft tissue, I have no idea if your face can withstand those types of changes.

By at rest what do you mean? I could PM you some pictures if you don't mind that I took at my surgeon's office.

I also originally thought I only needed jaw surgery except that I have asymmetry and have never seen a result that looks as good with just the mandible as one where the maxilla is also moved. In my maxilla my teeth are also pushing outwards creating the overjet but they will be brought backwards so the overjet will decrease with orthodontics so I feel as if moving the maxilla is necessary unless I leave my teeth protuding outwards. Plus my lips don't look full, I forgot to ask the surgeon about this but right now only the middle of my lips where my teeth push out look full, in the edges the lips don't show and was hoping that pushing the maxilla outwards would fix this.

[kavan]

thanks a lot!

how short would you say my maxilla is? Not sure what the proper way to measure would be, is this dependent on the soft tissue? Also what does low angle (MPA) patient mean?

And would you say I don't need genio to make my mandible longer then? He said he would move my chin a bit forward instead of down, this was odd to me but like you said with BSSO maybe it changes the appearance of the chin also

Also would you say that in my case the ramus is not too short? Because I think if I were to push for downgrafting it might give me a pointy face so idk if maybe trying to make my face longer would end up making me look worst because of my short ramus, ofc I am not even sure that I have a short maxilla so maybe worrying about this is silly?

The MPA (mandibular plane angle) is formed by the line of the mandibular border and a horizontal plane; the angle of inclination that the line of the mandible has with a horizontal. Suffice to say (and REPEAT) the salient point is that you don't need any type of rotation.

DISCLOSURE: I find it meaningless to describe things that relate to basic geometrical relationships if a poster does not have good grounding in basic geometry.

You have a short face where the shortness is found in the middle '1/3rd'. The way to increase that shortness and to increase the facial height is via a uniform graft to the maxilla.

DISCLOSURE: I do not discuss exact mm measures as in how short or how long or 'how much'. Suffice to say that shortness was found to the face and that is consistent with a suggestion for a downgraft that has NO ROTATION which would be a uniform downgraft.

Even IF someone has a low MPA, the 'line' of the mandible is still in a DOWNWARD DIAGONAL direction. So, when the mandible is moved 'forward' along it's MPA the direction is outward and down. Those are the 2 directional displacement vectors. Hence the chin gets displaced with the BSSO and moves both horizontally forward and vertically down because it's being moved 'forward' along a downward diagonal. So, you will also get length to the face via the mandibular 'forward' displacement.

DISCLOSURE: Again, to understand what I said above, you would need to already have under your belt very basic math grounding; geometry and basic understanding of what a 'directional displacement vectors' are with regard to displacement along a DIAGONAL DIRECTION.

IN CLOSING: The observations I made and relayed in my prior post are consistent with what the surgeon relayed to you. As to what is 'DEPENDENT' on what, being able to understand what is going on with maxfax displacements and my explanations thereof (no matter what they are) depends on the poster asking questions to have some very basic math grounding under belt to relate my answers to.

[GJ]

By at rest what do you mean? I could PM you some pictures if you don't mind that I took at my surgeon's office.

I also originally thought I only needed jaw surgery except that I have asymmetry and have never seen a result that looks as good with just the mandible as one where the maxilla is also moved. In my maxilla my teeth are also pushing outwards creating the overjet but they will be brought backwards so the overjet will decrease with orthodontics so I feel as if moving the maxilla is necessary unless I leave my teeth protuding outwards. Plus my lips don't look full, I forgot to ask the surgeon about this but right now only the middle of my lips where my teeth push out look full, in the edges the lips don't show and was hoping that pushing the maxilla outwards would fix this.

Gotcha, if they need to retract your incisors then you would need bimax, agreed.

I'll take a look at the photos tomorrow. A bit busy the rest of the night.

[recessedmandible]

The MPA (mandibular plane angle) is formed by the line of the mandibular border and a horizontal plane; the angle of inclination that the line of the mandible has with a horizontal. Suffice to say (and REPEAT) the salient point is that you don't need any type of rotation.

DISCLOSURE: I find it meaningless to describe things that relate to basic geometrical relationships if a poster does not have good grounding in basic geometry.

You have a short face where the shortness is found in the middle '1/3rd'. The way to increase that shortness and to increase the facial height is via a uniform graft to the maxilla.

DISCLOSURE: I do not discuss exact mm measures as in how short or how long or 'how much'. Suffice to say that shortness was found to the face and that is consistent with a suggestion for a downgraft that has NO ROTATION which would be a uniform downgraft.

Even IF someone has a low MPA, the 'line' of the mandible is still in a DOWNWARD DIAGONAL direction. So, when the mandible is moved 'forward' along it's MPA the direction is outward and down. Those are the 2 directional displacement vectors. Hence the chin gets displaced with the BSSO and moves both horizontally forward and vertically down because it's being moved 'forward' along a downward diagonal. So, you will also get length to the face via the mandibular 'forward' displacement.

DISCLOSURE: Again, to understand what I said above, you would need to already have under your belt very basic math grounding; geometry and basic understanding of what a 'directional displacement vectors' are with regard to displacement along a DIAGONAL DIRECTION.

IN CLOSING: The observations I made and relayed in my prior post are consistent with what the surgeon relayed to you. As to what is 'DEPENDENT' on what, being able to understand what is going on with maxfax displacements and my explanations thereof (no matter what they are) depends on the poster asking questions to have some very basic math grounding under belt to relate my answers to.

makes sense thank you

Gotcha, if they need to retract your incisors then you would need bimax, agreed.

I'll take a look at the photos tomorrow. A bit busy the rest of the night.

thanks, I think the pictures will expire but let me know