What surgery do I need?

[Marbleking]

Hi,

I have uploaded photos and cephalograms of me to Imgur and would like to have your evaluation and advice.

I believe I have the following issues, and I am trying to get a grasp on what a good detail plan for orthofacial surgery would look like in order to achieve an optimal functional and aesthetic outcome:

* Facial Asymmetry
* Maxillo-mandibular retrusion
* Long Face Syndrome

I would love to have your input regarding which types and extent of surgical interventions would serve my case well. And perhaps also some suggestions for surgeons in Europe who would be a great choice for this.

X-ray cephalograms:

https://imgur.com/a/3fVbcfJ

COGS-Burstone cephalometric analysis:

https://imgur.com/a/HwMwsoW

Facial photographs:

https://imgur.com/a/Cj0jUI6

Intraoral photographs:

https://imgur.com/a/Bf1Z41p


Best regards,
Marbleking

[GJ]

I think double jaw is appropriate. Could fix the cant that way (probably level the maxilla and then shorten the left mandible). Moving both jaws a little bit forward/linear would probably be the best movement, too.

I'm not sure on European surgeons, but we have a lot of European patients and tons of threads asking about that. Names that come up a lot are Zarinbal, Raffaini, Alfaro, etc. Look through here: https://jawsurgeryforums.com/index.php/board,6.0.html

[Tomasjohn]

Sorry i don't know anything about jaw surgery so i dont have an answer. But can i ask why do you think that you have "Long face Syndrom"?

[GJ]

Sorry i don't know anything about jaw surgery so i dont have an answer. But can i ask why do you think that you have "Long face Syndrom"?

Yeah I'm not seeing that, either.

[kavan]

I don't see any long face syndrome either and that analysis system is pretty foreign to me. Like each time you scroll down where they list the same points between which , they measure a linear distance, the distances can differ .  For example, look at the values for the cranial base on the 3 different pages of the analysis. They all differ. Likewise with other values from page to page.

[Marbleking]

Thanks for the feedback!

I had a video consultation with a surgeon who confirmed the facial asymmetry, but also estimated that there might be some maxillo-mandibular retrusion and long face syndrome from what he saw during the call. A proper cephalometric analysis and an in person consultation would be necessary to confirm this, though.

But if I, as a layman, should guess about the long face syndrome, it would perhaps be because my face is rather narrow that it gives an impression of an elongated face, even if the dimensions are approximately normal. I haven't considered any alterations to the zygomatic structure in this respect, but perhaps it might be an option for my face type?

The surgeon in question suggested bimaxillary surgery with some anti-clockwise rotation of the occlusal plane. But I have spoken to another surgeon in person who didn't put that much emphasis on the retrusion, long face or necessity of anti-clockwise rotation. But I don't know whether that is because the bimax operation becomes more complicated then or because it simply isn't indicated.

When I take selfies I tend to take them showing more of my left side, which is the de facto longest side, as I think that side looks better in isolation than the right side, which I think looks a bit compressed/squeezed at times. So I am a bit anxious about shortening the ramus on the left side to match the right side. Is it normal/possible to shorten the ramus a bit on one side and extend it on the other side in order to even out asymmetries?

The cephalometric analysis I attached in the Imgur-link was automatically calculated by an online Artificial Intelligence service. I had to calibrate the sizes of the x-rays by using a ruler on my computer screen. Any inaccuracies in my measurements may account for differing results in the analysis. (The left side x-ray, the side where I am missing a tooth in the lower jaw, is flipped because the analysis required nose to the right, by the way). As GJ's subtext says: "Millimeters are miles on the face". 

What type of cephalometric analysis would be most useful for discussions in this forum?


Regards,
Marbleking

[GJ]

Yes I believe shortening the longer side is more standard because it's more stable.

In your ceph, your head appears to be tilted upward just a little, but that can really throw things off in terms of us seeing what rotation you need. Based on the way the ceph stands today, it looks like your bite plain is flat and CCW would "invert" it almost (posterior gummy smile, etc). Your mandible doesn't look unusually steep or anything like that, either. These are the reasons I said no to CCW. But, I'm not a doctor, and you should probably get more opinions from surgeons.

[kavan]

There's something off with that ceph. Looks like an area of it is cut out and a key landmark; 'S' which is usually easy to spot on a ceph is hard (at least for me) to find. Not to mention, it LACKS a ceph stat RULER which they place between forehead and top of nose to show vertical direction and mm length. So, it doesn't matter what type of AI analysis you get because the thing lacks a ceph stat to determine the scale.

Here is a photo of a good ceph, profile to the right showing entire head and with ceph stat ruler which would not require that you, yourself, estimate scale in the event you used any AI ceph analysis service.

[Marbleking]

Thanks, guys!

I’m actually glad to hear that something might not be quite right with the cephs, because although I can see with the bare eye that something is a bit off with my face, e.g. the asymmetry, I was quite surprised to see that so many measurements diverged considerably from the normal values.

I’ll keep researching how to proceed. I’ll start the new year by pulling my impacted wisdom tooth on the left side of my lower jaw. Then I’ll see how to best communicate pre-surgical orthodontic treatment with an orthodontist. I suspect there’s nuances about this that need to be discussed between a surgeon of choice and a suitable orthodontist.

Thanks again.

Regards,
Marbleking