17M - Marpe + Double jaw surgery + genioplasty, need input on movements/ccw, aesthetics and airway

[ptown069]

17M, from australia SEQ, posting my full case with CBCT, dental photos. currently doing pre jaw surgery orthodontics, about to get marpe in 2 weeks then jaw surgery after marpe and damon braces. i'm tryna optimise airway function and aesthetics. so need some help with movements, surgical planning etc. Yes i used gpt could not be asked to write this out.

Timeline

• In active orthodontic treatment
• MARPE planned for skeletal expansion
• Double jaw surgery planned after teeth decompensation (flared incisors to mask underbite, tipped in lower teeth to mask underbite)
• Booked consultation with Nigel Johnson (Brisbane) in ~2 weeks
• Planning consultation with Lydia Lim (Sydney)
• Upcoming GP appointment to investigate:
  • possible POTS / dysautonomia
  • ongoing systemic symptoms
• History of scoliosis (recent X-ray: ~27° for both double curves, 1.5cm longer right leg than left leg, pelvic tilt)

What ortho is doing for me
- doing marpe around 8mm (rapid expansion protocol)
- beneslider to push back molars to create space to decompensate my flared incisors
- full upper and lower damon braces

what i would want from jaw surgery
- high cut quadrangular lefort 1: advancement 10mm minimum (lefort 2 if possible, probably won't happen tho)
- ccw rotation of atleast 6 degrees
- impaction
- genioplasty 6mm preferably
- mandibular ccw rotation and minimal setback
- yaw, roll and cant correction for assymetry

my orthodontic findings from scans, ortho input and CBCT

• Dolichofacial (long narrow face)
• incompetent lips
• facial asymmetry (right side more developed/forward, left side more recessed/ downward grown)
• likely reduced airway space behind tongue
• concave facial profile
• right nasolabial angle
• shallow labiomental fold (chin crease)
• wide buccal corridors
• underbite/ class 3 bite
• Skeletal Class III-Mandibular prognathic
• narrow maxilla
• deep vaulted palate
• Skeletal asymmetry (Inter-arch)
• Skeletal asymmetry (Intra-arch)
• Permanent dentition with impacted upper wisdom teeth.
• edge to edge overbite
• edge to edge over jet
• Unilateral posterior right crossbite
• No apparent TM joint signs or symptoms
• Deviated nasal septum
• total airway volume = 18.206cm cubed
• region area = 871mm squared space
• narrowest part = 159mm squared

i've attached the photos at the bottom of the thread

Aesthetic concerns
- Horrible maxilla recession
- downward growth
- horrible underbite/ long downward grown mandible
- recessed infras just shit under eye support
- terrible midface projection super recessed
- unprotected chin/ flat chin angle
- super downward grown chin
- asymmetrical as hell
- just look at my facial profile photos attached

Aesthetic goals
- forward growth
- striaght nose
- projected chin
- ccw rotation
- better infras and under eye support
- prominent zygos
- symmetry
- lmk what else




Functional/ Health symptoms
These are a big part of why I’m pursuing surgery, not just aesthetics:

• extreme Chronic fatigue / low energy (it's horrible)
• horrible Brain fog, poor focus
• Morning headaches or headaches after sleeping in general
• Mouth breathing (especially during sleep)
• Difficulty breathing through nose at times
• “Throat closing” sensation when breathing, especially lying down
• Witnessed breathing pauses during sleep (suspected sleep apnea, doing a sleep study soon)
• Suspected POTS or dysautonomia (which i researched can be related to airway and sleep apnea) (going to gp in 2 weeks to check) the symptoms are below
• Constant heart pounding / palpitations
• Heat intolerance, excessive sweating
• Cold, clammy hands and feet
• Lightheadedness when standing, occasional vision blackouts
• Frequent urination
• Restless legs / constant movement

Previous treatments
- horrible retraction and traditional braces for 2 years
- turbinate reduction
- adenoid removal
- lower wisdom teeth removal (will probably have to remove my upper wisdom teeth)
didn't get any meaningful or any results in breathing from the reduction and removal surgeries which definitely points to the issue being jaw/tongue/airway related

My general goals
- ascend and achieve all my aesthetic goals listed above
- get a huge volume increase in airway
- better sleep as my sleep is horrendous
- if i do have POTS or dysautonomia, hopefully improve those symptoms
- fix my neck pain from forward head posture due to my body compensate for barely being able to breathe

Questions
- help me and lmk if there are different types of jaw surgery movements/ cuts
- i removed lower wisdom teeth and my ortho says i'll have to remove upper wisdom teeth, is there anything i can do to save them
- what other info should i be knowing
- are my movements realistic, like would the surgeon actually do the movements
- how do i push my surgeon to match my goals and movements
- what can i do to improve my plan
- is Dr Nigel Johnson (brisbane) and Dr Lydia Lim (sydney) good surgeons
- what good jaw surgeons are there in australia (gotta do australia as my insurance covers this)
- would i qualify for a high cut quadrangular lefort 1 or lefort 2
- any advice about marpe and damon braces
- are there any people that have similar cases to me and their results

•