In facmax surgery, does the upper jaw limit the advancement of the lower jaw?

[everythingmatters]

I suppose it depends on each case, but assuming someone has a class I malocclusion with a recessive face but not so hardcore and also everything is theoretically speaking without other factors at play such as relapse, stability, etc.

When performing a bimax with le fort I, the one that would be limiting big forward advances of both jaws, would be the upper jaw, right? Because if you move the upper jaw too far forward using lefor I, the face would begin to deform faster because you are NOT moving the whole maxilla (lefort I).

Instead, the lower jaw could be made bigger advances because in this case if you are moving the whole jaw (at least from the front view). Is this correct?

In other words, in theory, if a Le fort II (or even III) instead Le Fort I were performed, could bigger advances be made in the upper jaw (and therefore the lower jaw) without deforming the face?

Please don't shitpost, otherwise you will be blocked and reported.


Could you help with this, please?
@Golden Glass
@Sergio-OMS

 

[Deleted member 4797]

If you do Counter-Clockwise Rotation then you can advance the lower jaw much more than the upper jaw. You can also do mini chin wing/sliding genioplasty to add a lot of millimetres independent of the upper jaw.

 

[everythingmatters]

If you do Counter-Clockwise Rotation then you can advance the lower jaw much more than the upper jaw. You can also do mini chin wing/sliding genioplasty to add a lot of millimetres independent of the upper jaw.

thank you bro

 

[Deleted member 4797]

thank you bro

If you dont have a gummy smile, and need CCW-rotation, then you need a down-graft rather than a maxilla impaction, make sure you go through that with your surgeon (many surgeons cant perform the necessary down-graft)

 

[everythingmatters]

If you dont have a gummy smile, and need CCW-rotation, then you need a down-graft rather than a maxilla impaction, make sure you go through that with your surgeon (many surgeons cant perform the necessary down-graft)

Could you clarify these doubts for me? What is the difference between chin wing, sliding genioplasty, normal genioplasty and geniopaully? How do I know which one I need?

 

[wasted]

@RealSurgerymax

 

[Deleted member 4797]

Could you clarify these doubts for me? What is the difference between chin wing, sliding genioplasty, normal genioplasty and geniopaully? How do I know which one I need?

PM me a pic of your face, front+side+smiling. Once I got those 3 I can assess everything for you, and all the pictures remain 100% private.

 

[Darkstrand]

If you dont have a gummy smile, and need CCW-rotation, then you need a down-graft rather than a maxilla impaction, make sure you go through that with your surgeon (many surgeons cant perform the necessary down-graft)

What exactly is downgraft?

 

[Deleted member 4797]

What exactly is downgraft?

First, you know what CCW is right? Its when you rotate a downward aiming upper and lower jaw to being more up and forward facing, like this:

There's 2 ways to achieve this rotation:

Either you cut a layer of bone from the front of the upper jaw, so that its shorter and more upward facing. This is whats done in cases of people having a gummy smile, it makes the front teeth move to a higher position.

Or you can rotate the upper jaw by moving it downwards at the back teeth area. This wall rotate the front teeth but won't make them higher set. This is whats necessary for people who need CCW rotation of the jaws, but dont have gummy smile.

 

[Darkstrand]

First, you know what CCW is right? Its when you rotate a downward aiming upper and lower jaw to being more up and forward facing, like this:

There's 2 ways to achieve this rotation:

Either you cut a layer of bone from the front of the upper jaw, so that its shorter and more upward facing. This is whats done in cases of people having a gummy smile, it makes the front teeth move to a higher position.

Or you can rotate the upper jaw by moving it downwards at the back teeth area. This wall rotate the front teeth but won't make them higher set. This is whats necessary for people who need CCW rotation of the jaws, but dont have gummy smile.

Highest iq user on here right now...
How limited is the forward advancement with ccw for the maxilla? Cause I'm afraid some 6 or 7 mm won't do it for me

 

[everythingmatters]

PM me a pic of your face, front+side+smiling. Once I got those 3 I can assess everything for you, and all the pictures remain 100% private.

I will PM you, thank you very much bro

 

[Deleted member 4797]

Highest iq user on here right now...
How limited is the forward advancement with ccw for the maxilla? Cause I'm afraid some 6 or 7 mm won't do it for me

Thank you brother, much appreciated.

Im not entirely sure about the limitations, but the more you rotate the upper jaw, the less millimetres of upper jaw advancement are needed to achieve high levels of lower jaw augmentation.

This is what a CCW rotation of 6° (down-grafted) with only 4mm of upper jaw advancement looks like. The lower jaw was advanced 17mm in total (9mm BSSO, 8mm mini chin-wing):

 

[RealSurgerymax]

@RealSurgerymax

• Yes the lower jaw advancement is limited by the upper jaw position to maintain good bite, pre surgical orthodontics can move teeth to optimize this though.
• Unless there is a misunderstanding in what you mean, the fact you are not moving the whole maxilla” would not cause it to “deform faster” however a very large LeFort I (1cm+) would have a higher relapse rate and would probably result in palpable and/or visible visible contour irregularity at the osteotomy step-off. Bone grafts can help with this up to about 10mm as an advisable maximum.
• The advancement possible by LeFort III is actually more limited because that depends on the position of the eyes. Most people seeking aesthetic LeFort III will not have the degree of exophthalmos to allow a large LeFort III.
• A LeFort II is actually much less common than a LeFort III because most people don’t have a limited central midfacial hypoplasia.
• A LeFort III/I combined advancement is common and would allow more advancement, advancing at 2 levels at the same time.
• A LeFort II/I had been show to be unstable.
  

 

[Darkstrand]

• A LeFort III/I combined advancement is common and would allow more advancement, advancing at 2 levels at the same time.

So it is possible to advance the whole lefort 3 area, and the lefort 1 area even further all at the same time? How much advancement could one expect in total?

 

[RealSurgerymax]

If you do Counter-Clockwise Rotation then you can advance the lower jaw much more than the upper jaw. You can also do mini chin wing/sliding genioplasty to add a lot of millimetres independent of the upper jaw.

This is also good advice

So it is possible to advance the whole lefort 3 area, and the lefort 1 area even further all at the same time? How much advancement could one expect in total?

Yes it is.

A non-syndrome LeFort III Advancement will rarely be beyond 5-6mm. The LeFort I advancement could add another 6 or 7. So reasonably about 12mm.

Relapse would be expected in such a large movement. Research from 1999 specifically examined the stability of of Combined LeFort III/I (Schmitz, “Stability of Simultaneous LeFort III and LeFort I Osteotomies” in Journal CMF Surgery.)

Interestingly LeFort III relapse is not usually the set-back relapse seen with BSSO and traditional LeFort I but sometimes even a forward and down post-surgical movement. The relapse is still usually less than 2mm which is the threshold considered insignificant at least from an aesthetic soft tissue perspective.

 

[Deleted member 4797]

This is also good advice


Yes it is.

A non-syndrome LeFort III Advancement will rarely be beyond 5-6mm. The LeFort I advancement could add another 6 or 7. So reasonably about 12mm.

Relapse would be expected in such a large movement. Research from 1999 specifically examined the stability of of Combined LeFort III/I (Schmitz, “Stability of Simultaneous LeFort III and LeFort I Osteotomies” in Journal CMF Surgery.)

Interestingly LeFort III relapse is not usually the set-back relapse seen with BSSO and traditional LeFort I but sometimes even a forward and down post-surgical movement. The relapse is still usually less than 2mm which is the threshold considered insignificant at least from an aesthetic soft tissue perspective.

Do you have any pics of combined LF3/1?

 

[everythingmatters]

• Yes the lower jaw advancement is limited by the upper jaw position to maintain good bite, pre surgical orthodontics can move teeth to optimize this though.
• Unless there is a misunderstanding in what you mean, the fact you are not moving the whole maxilla” would not cause it to “deform faster” however a very large LeFort I (1cm+) would have a higher relapse rate and would probably result in palpable and/or visible visible contour irregularity at the osteotomy step-off. Bone grafts can help with this up to about 10mm as an advisable maximum.
• The advancement possible by LeFort III is actually more limited because that depends on the position of the eyes. Most people seeking aesthetic LeFort III will not have the degree of exophthalmos to allow a large LeFort III.
• A LeFort II is actually much less common than a LeFort III because most people don’t have a limited central midfacial hypoplasia.
• A LeFort III/I combined advancement is common and would allow more advancement, advancing at 2 levels at the same time.
• A LeFort II/I had been show to be unstable.

thanks man, can I pm you?

 

[RealSurgerymax]

thanks man, can I pm you?

Yes

 

[Eduardo DOV]

@DatGuyYouLike are you still around?

 

[Deleted member 4797]

@DatGuyYouLike are you still around?

yes, whats up