I see. Regarding the ANS movement stuff, the Dr. explained to me that his plan is to only rotate the maxilla by 7 degrees ccw. But he said that this rotation would result in a small advancement of 2mm for the ANS. Meaning the ANS isn't the exact rotation point..
Should I ask the Dr. for the exact movement table? I remember him showing it but he didnt share it with me. I feel like visuals go over numbers in this case, like you already mentioned.
The rough movements I managed to memorize were: Maxilla 7 degrees ccwr resulting in 2mm advancement of the ANS, BSSO 8mm, genioplasty 6mm, ramus widening 4mm on one side and 5mm on the other.
Two more questions:
-Do you think I would benefit from ramus widening? Straighter ramus viewed from the front and slightly increased gonial width? Or would it make my jaw too wide
-What do you think of my occlusion in the post OP pics. This plan is a surgery first/only approach since the Dr. said my occlusion is fine/stable and he wants to keep it. But I don't want to cut corners
That's the part that I found confusing when I looked at the ceph and started using geometrical observation to determine the rotation point. The ANS looked to be in the same place which is consistent with it being rotation point. Now on the (before) ceph, there was a RED DOT which was at or near a point called the 'A' point which is kind of behind the upper lip and below the ANS point. Now with CCW-r around the ANS point, the 'A' point (behind the soft tissue of lip) would go forward.
Both the ANS point and the A point are landmarks to the anterior maxilla which one sees on a ceph in profile view. The A point is displaced with CCW-r around the ANS point and the displacement of the A point (where the rotation is around the ANS point) can move the soft tissue of the upper lip forward.
Given that the overly OBTUSE angle formed by base of nose and upper lip was REDUCED by the rotation, (and that DID look GOOD), my GUESS is that he may have told you that part of the maxilla BELOW the ANS would move 2mm forward and something got lost in the translation.
The have advanced computer simulation programs that allow them to try different rotations and displacements as to get a prediction of the soft tissue response, bite, profile improvement etc. So, my guess is CCW-r around the A point kicked up a good profile contour.
None the less, the SALIENT thing is that it's an improvement.
Again, my MAIN aesthetic focus/concern here was with the ANS being unfavorably displaced with maxilla advancement. But the ceph (after) has ANS in same place but soft tissue of lips go forward to CLOSE IN on the OVERLY OBTUSE nose to lip angle and THAT makes you look better to the part I had aesthetic concerns over. So, that is SOLVED and not something you need to worry about.
Now the other things like ramus widening (increased gonial width) need to be things you SELF DETERMINE via the VISUALS he provided. The overall change looks GOOD to my eye and good occlusion is worked into the whole thing. But again, it's YOUR EYE that needs to like the proposed changes.
The exact displacement read-out is not needed at this point.
