SSRO Discussion Thread (Sagittal Split Ramus Osteotomy)

[Optimistic]

Discuss SSRO's in here!

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I've talked to a few surgeons who've mentioned it can improve the angle of the ramus and gonial angles, however no mention of actually lengthening them. If one was to have short rami then I don't see how rotating the rami could give a significant improvement.

Hypothesis:
SSRO done in the right way would allow for rotation along with the lower part being moved down.

Complications:
All surgeons have told me that relapse is a major problem due to the strength of the masseters. As such any SSRO is playing with fire.

Is any of this legit?

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Second part:
Can an SSRO be done simultaneously with a BSSO? In my case my rami and everything are pretty decent. Should I wait and see how my jawline and mandible border come out after the BSSO before committing to an SSRO? If HA paste could even give a mild improvement of rami length, angles, and gonials angles then I think it'd be enough to skip the entire thing.

[Tiny]

SSRO can improve the angle via rotation if the angle is too obtuse and the occlusional plane quite steep.  However, if there is no open bite, then you would have to rotate the upper jaw as well otherwise the teeth will not fit together, do you see?

I've not seen any patient examples of SSRO.  There is the guy with the long but recessed chin, caused by very steep plane and obtuse angle and short ramus, but he got inverted-L, not an SSRO

You can do distraction but the issue is there often isn't enough space inside the mouth for the equipment

I don't think you could get an SSRO after a BSSO in a separate surgery, because it will move the teeth, and the first surgery would be planned to put the teeth in a good position.

I'm going for a BSSO as far back as possible + paste, hopefully it's enough.  Implants on the gonial angles have a high complication rate

[Optimistic]

Sounds pretty much like what I'm getting too. If someone needed a BSSO with ccw and also wanted an SSRO wouldn't they really be asking for an IVRO?

I've taken some pictures to show my gonial angles, rami etc.

Left side:
Right side:

I know the quality and everything is awful, but yea....

Anyway, would anti-clockwise rotation with a BSSO improve the gonial angles a bit? And my main problem is really that there's just no definition on either side. I had to turn my head just to get it to show. otherwise it's almost completely hidden. It looks like right now my only option is to hope that HA paste will give me enough definition.

Do you think it might be an option to get DO to lengthen the ramus at the same time I get my braces put on? That way they can take the distractor out and stabilise it at the same time they do the BSSO and other things?

[x]

Sounds pretty much like what I'm getting too. If someone needed a BSSO with ccw and also wanted an SSRO wouldn't they really be asking for an IVRO?

I've taken some pictures to show my gonial angles, rami etc.

Left side:
Right side:

I know the quality and everything is awful, but yea....

Anyway, would anti-clockwise rotation with a BSSO improve the gonial angles a bit? And my main problem is really that there's just no definition on either side. I had to turn my head just to get it to show. otherwise it's almost completely hidden. It looks like right now my only option is to hope that HA paste will give me enough definition.

Do you think it might be an option to get DO to lengthen the ramus at the same time I get my braces put on? That way they can take the distractor out and stabilise it at the same time they do the BSSO and other things?

I believe a BSSO on it's own will pull the skin tauter and improve that look. A lot of people have that turkey neck look before BSSO's and the skin is a lot tighter afterward

DO is a pipe dream bro

[Optimistic]

Thanks for your opinion

Why do you believe DO is a pipe dream? I'd just really like to get a more defined border of the mandible and ramus with improved gonial and rami angles. With so many knocking HA paste it's made me look at what some of my alternatives might be, and sadly it doesn't look like there are any short of implants.

[x]

Thanks for your opinion

Why do you believe DO is a pipe dream? I'd just really like to get a more defined border of the mandible and ramus with improved gonial and rami angles. With so many knocking HA paste it's made me look at what some of my alternatives might be, and sadly it doesn't look like there are any short of implants.

I've seen before/afters of it on the ramus and it doesn't provide that drop down, square ramus look you're going for. it just looks like any other jaw surgery. Granted these guys had rami that were probably way more undeveloped than yours are. It also doesn't flare them which might be what you're looking for, that would mess with the condyles

I think you'd be hard-pressed finding a surgeon who would do it on you

[Optimistic]

I've seen before/afters of it on the ramus and it doesn't provide that drop down, square ramus look you're going for. it just looks like any other jaw surgery. Granted these guys had rami that were probably way more undeveloped than yours are. It also doesn't flare them which might be what you're looking for, that would mess with the condyles

I think you'd be hard-pressed finding a surgeon who would do it on you

Are you aware of any methods that would flare them?

I asked mommaerts about an SSRO and he said he would do it lol. I get the impression he'll do anything within reason. Heck, he transformed some Belgian guy into Michael Jackson!

[Tiny]

Are you aware of any methods that would flare them?

I asked mommaerts about an SSRO and he said he would do it lol. I get the impression he'll do anything within reason. Heck, he transformed some Belgian guy into Michael Jackson!

I like Mommaerts, but this is Not A Good Thing!  What did he say about relapse when he said he would do SSRO?

Anyway, and BSSO you get is going to be in front of the gonial angles.  It will improve the general angle of the jawline but on it's own it won't massively improve the gonial angles themselves.  Yours don't look invisible so a BSSO and paste should give you OK results, I would think.  Implants give a stronger visual result but...complications.  Better to wait til you can get custom titanium

Did you take those pics in the dark?! 

[Optimistic]

Well he just sort of hinted at it. He said that sometimes a SS of the ramus can be "playing with nature too much" and can cause complications. Which I assumed to mean relapse due to the masseters pulling them back to their original position.

[Modigliani]

 

[Lazlo]

hey weakjawbrah, i was just kidding i hope you know, just trying to introduce some levity into the absurdity of all of this (absurd for all of us, not just you, absurd in the sense of remember when we were kids and never thought about bulls**t like gonal angles and all of this f**king crap). I understand now that it's become a thing we have to sort of follow it through, but I also realize we tend to not treat people like real people when we're on online forums (or at least I've been discovering that as this has been my first participation in such a thing). so anyway, I'm erasing my silly skit. Please don't take offence, you're doing a great job with your research and I'm sure everything will be fine for you. Only piece of advice I'll give, if there's nothing actually effecting your physical health, think twice about doing a procedure for cosmetic reasons only, especially when they're so untried and tentative and controversial, you don't want to regret it. Once you do something like this, it usually can't be reversed.

[Optimistic]

hey weakjawbrah, i was just kidding i hope you know, just trying to introduce some levity into the absurdity of all of this (absurd for all of us, not just you, absurd in the sense of remember when we were kids and never thought about bulls**t like gonal angles and all of this f**king crap). I understand now that it's become a thing we have to sort of follow it through, but I also realize we tend to not treat people like real people when we're on online forums (or at least I've been discovering that as this has been my first participation in such a thing). so anyway, I'm erasing my silly skit. Please don't take offence, you're doing a great job with your research and I'm sure everything will be fine for you. Only piece of advice I'll give, if there's nothing actually effecting your physical health, think twice about doing a procedure for cosmetic reasons only, especially when they're so untried and tentative and controversial, you don't want to regret it. Once you do something like this, it usually can't be reversed.

Yeah, I'm hoping to have a second consult with mm this year where I can talk to him about a few more of my cosmetic concerns.

I'd still like to improve the angles of the rami.

Think about it:

If the rami can come back slightly, and the jaw is moved forward with ccw, then I'd get a dramatically improved gonial angle.

I just wonder about what effect an SSRO would have on a BSSO. If the rami came back then the mandible would need to be moved even further forward with the BSSO, right? Could this affect relapse? Lots of questions..

[Tiny]

I don't see why one would get an SSRO and a BSSO.  If you get an SSRO, you can more the mandible down (lengthen the ramus), rotate it (flatted occlusional plane and make gonial angles appear less obtuse) and move the entire mandible forward, in the same op.

I'm not sure moving the rami down and back would be the way to go about better gonial angles.  Your angles don't look like they're too far forward...if you move it back they'll wind up in your ear!  Usually in classIIs, they're high up, and too obtuse

An SSRO isn't gone to change the actual degree of the gonial angle, just the appearance of the degree and the line of the jaw, because of where the cut is (above the angle).  If you want to actually change the shape of the angle you would need an inverted-L or a BSSO with the cut going diagonally through the angle itself.  I guess this is partially why the guy with the super-steep plane (and long but recessed chin) got the inverted-L and a bone graft to fill the gap

[x]

Yeah, I'm hoping to have a second consult with mm this year where I can talk to him about a few more of my cosmetic concerns.

I'd still like to improve the angles of the rami.

Think about it:

If the rami can come back slightly, and the jaw is moved forward with ccw, then I'd get a dramatically improved gonial angle.

I just wonder about what effect an SSRO would have on a BSSO. If the rami came back then the mandible would need to be moved even further forward with the BSSO, right? Could this affect relapse? Lots of questions..

Hmm I don't know. My left ramus is too far forward I think (relative to the right) causing an underbite on only side, but you're class II right?

Your right ramus looks shorter than your left, but it's hard to tell from the poor image quality. Both of our ramii look to have grown inward, opposite of that outward flared look you like. I don't think there's anything that can be done about that barring implants

[Optimistic]

Hmm I don't know. My left ramus is too far forward I think (relative to the right) causing an underbite on only side, but you're class II right?

Your right ramus looks shorter than your left, but it's hard to tell from the poor image quality. Both of our ramii look to have grown inward, opposite of that outward flared look you like. I don't think there's anything that can be done about that barring implants

You're right, I do think my right ramus is worse than the left. Shorter and the angle is not as sharp and defined (more rounded). I'm hoping distraction, SSRO, IVRO, or HA paste are viable ways of improving this.

What do you think of the overall angle of my rami? Are they close enough to vertical or would I need to improve that too?