Techniques to widen chin & jaw?

[Tomasjohn]

You're welcome. Let me know if it's helpful or not.

It was a lot.

Of topic:
When thinking about the sagittal split I started to imagine a sagittal split genioplasty asking myself if this is possible or has been done. And apparently it is/was.
https://www.joms.org/article/S0278-2391(09)01824-2/abstract

[kavan]

It was a lot.

Of topic:
When thinking about the sagittal split I started to imagine a sagittal split genioplasty asking myself if this is possible or has been done. And apparently it is/was.
https://www.joms.org/article/S0278-2391(09)01824-2/abstract

I don't have full access to that article. But the part I can read, the author (Stephen Schendal MD) states: "The most frequently performed osteotomy for correction of the small and retruded chin is the horizontal sliding genioplasty". That doesn't ring true to me simply because a sliding genio can include a diagonally oriented cut for the sliding to have vectorial components of horizontally outward and vertically upward. I don't know about his contention that horizontal ones are the most frequently used (a sliding genio with no vertically upward vector component). Maybe a matter of semantics. However, it is true that sliding genio; horizontally displaced or diagonally upward can kick up some scalloping to what they call the 'pre-jowl sulcus' area which is the part of the mandibular border lateral to* and close to the chin itself.

Again, I don't see the illustrations for what he calls a sagittal split genio. But what I do 'see' (in my head) is that on Figure 2 of his illustration (pointing to the area that can show scalloping with the 'horizontal' sliding genio) that the cut could be extended to include some of the body of the anterior part of the mandibular border.

*Note the pre-jowl sulcus area is next to the chin (lateral to). It's on the anterior aspect of the border of the body of the mandible.

You know how in SOME chin wings (with some people), they can't angle the cut all the way back to the posterior part of the mandibular border because the person's nerve hole is too close for comfort. Well, that type of chin wing can include some of the anterior aspect of the mandibular border. One time I called that a 'glorified genio' (which would not be the 'medical name for it). So, maybe he's extending the cut to include that area which would tend to mitigate scalloping. Again, I don't see what his cut is because I don't have full access to the article. I'm just using my imagination of what it could be.

ETA: OK. I found some illustration that seems to show he is including part of the anterior aspect of the mandibular border. 

ETA #2:  OK, still can't see more illustrations. But if it's a sagittal cut it's dividing something vertically.  So, it looks like a curved cut that includes the anterior aspect of mandibular border that extends downward to release that chin segment.

ETA #3: If you wanted a type of genio that mitigated scalloping (the look of step-offs), the type of 'patient speak' to the doctor would be: 'I'd like a type of genio that also includes the part of the mandible right next to the chin because I'm concerned about step-offs with some other types.'

[Tomasjohn]

ETA #2:  OK, still can't see more illustrations. But if it's a sagittal cut it's dividing something vertically.  So, it looks like a curved cut that includes the anterior aspect of mandibular border that extends downward to release that chin segment.

ETA #3: If you wanted a type of genio that mitigated scalloping (the look of step-offs), the type of 'patient speak' to the doctor would be: 'I'd like a type of genio that also includes the part of the mandible right next to the chin because I'm concerned about step-offs with some other types.'

Yes exactly this is the illustration I meant.
Good point on the Patient to Doc communication.

[kavan]

Dr Ramieri said he could widen mine by about 5mm on each side during thr bsso by essentially flaring the ramus out. Now I'm concerned with his suggestion.

I wonder if expanding the mandible at the chin via MSDO would be safer...

I wouldn't worry about that too much because the BSSO can kick up a width increase to the very back of the jaw line; increase in inter-gonial distance and I think the surgery itself, incorporates making some accommodations to the jaw joints (condyles) to mitigate stress on them. It doesn't affect a width increase to the ENTIRE mandible or to the lower lateral sides below the gonial region that one sees from the front which is part of the discussion in this thread.

Consider, that you jumped into a thread where the info in it applied not only to someone ELSE but also SOMETHING else other than the BSSO you've consulted about; one where the doctor told you where the widening would take place. So, there is no basis to start reconsidering what your doctor told you based on what GJ said to someone ELSE about something OTHER than the type of surgery you are getting.

GJ was referring to expansion of the ENTIRE mandible and/or something that would expand the lower lateral sides of the mandible that one would see frontal view. For example, something where one would have to make a vertical cut to the CHIN to affect such an expansion which, indeed could/would, in general put undue stress on the condyles as a function of the extent of that type of expansion. That could be concluded from the context of the thread.

What could NOT be concluded or applied to yourself from what GJ said to another was what you concluded from it as to 'wonder' if the very thing that could put stress on the condyles (the MSDO) would be 'safer' than the surgery offered to you.

Information that was not directed to you or had NOTHING to do with a BSSO most likely offered to you by the surgeon you consulted with is no reason to be concerned about what the doctor told you about what his surgery would/could do and where. Basically, you are 'wondering' about something you should get instead of what the doctor offered you which is the very thing that could stand to put stress on the condyles; expanding the mandible at the chin.

I'd say that's a pretty abgefuked 'wondering' process to concern yourself with based on acting on information directed to another and about another type of thing that has nothing to do with getting a BSSO that could widen where the doctor said it would as to even think the MSDO (the type of surgery that could be unsafe to the condyles) could be 'safer'.