procedure to cure a high MP angle with mandibular inferior contour issues?

[XXRyanXXL]

I have a high MP angle, 46 degrees, with OP of 12 degrees, with long face syndrome caused by mouth breathing at a earlier age. I am now 40 years old. My dentist noticed facial deformities by the time I was 13 but nothing was done to address the issue. I recently had a BSSO to just correct a 12 mm overbite.
I was recommended to have double jaw surgery to have CCW rotation with posterior downgrafting. The rotation that is suggested is through an inverted-L osteo, posterior downgrafting with maxilla impaction and BSSO to set backwards to offset the rotational movement of the upper bone. I however have another issue.
Not only do I have mandibular inferior bony contour issues, I have a high MP angle caused by downward growth of the mandible. I am using photos available from the internet that is related to my xrays. These were available from nycoms.com. Besides any rotation, is there any way to address this steep slope of the downward growing mandible bone? Would a chin reduction address some of this issue?

 

[PloskoPlus]

How healthy are your joints? CCW-r could make them worse.

[thedude]

How healthy are your joints? CCW-r could make them worse.

How does CCW put more stress on the joints? I’ve never heard this before.

[GJ]

How does CCW put more stress on the joints? I’ve never heard this before.

Basically the muscles pulling the jaw back into the original position. This generally only happens with extreme movements. There will always be remodeling of the joints of some type, and the more extreme the movement, the more of this you generally get.

[PloskoPlus]

I've seen some remarkable chin wing results. It's a question of having enough bone below the nerve though.

[GJ]

I've seen some remarkable chin wing results.

Links?

[kavan]

Inverted L can decrease a high MP angle (when short ramus is a key contributer to high MPA) and can be used with CCW-r when MP angle needs to be decreased MORE than CCW (to maxilla) could do alone. That assmumes person getting it not only has a high MPA but also needs to have the mandible advanced. A chin procedure can be added such as an upward sliding genio which advances forward horizontally AND decreases vertical chin height.

However, it is not something that could be said to 'cure' a high MPA (but it can decrease it) or to make the bony contours of the mandibular border smooth. The inverted L has some 'step offs'to it. So, those combined procedures can reduce a very high MPA but step-offs to the inferior border of mandible are part of the process. So, it doesn't remove contour irregularities and there will be some afterwards but with a decreased MPA.



DISCLOSURE: This is GENERAL info about combining an inverted L with CCW in cases where person has very high MPA and also needs both mandibular advancement and some shortening and/or alteration to the chin.

[GJ]

The inverted L has some 'step offs'to it.

Can't these be filled in with bone grafts or synthetic grafting materials like HA?

[kavan]

Can't these be filled in with bone grafts or synthetic grafting materials like HA?

Yes. Of course. But I just wanted to make clear that the inverted L does have some step offs to it as can be seen in the photo.