Marpe/jaw surgery/Ramieri

[Nahorscend]

Because your tongue will be further forward while your palate stays at the same place hence it won’t fit in the palate.
When it doesn’t fit it adapts and forms so it can fit. What usually happends when your tongue horizontally is too far forward is that the anterior part bends, making it IMPOSSIBLE to seal your whole tongue on it.

Logically it will be two outcomes.
1. Your forced to have it at the bottom of your mouth
2. Forced to point the tip upwards.

Also be aware that you shouldn’t move your mandible forward too much, the resistance increase when you advance it more than 4 mm.

I have this issue naturally lol, i keep it at the bottom and if i wanna keep it on the palate i have to retract it first because it doesnt fit

 

[Denkaren]

I have this issue naturally lol, i keep it at the bottom and if i wanna keep it on the palate i have to retract it first because it doesnt fit

Then use your common sense and ask yourself if an advancement of the mandible would help to place it at the palate or if it would make it worse. Your ap space are too bad because of a too small arch. Have you had extraction or retracted braces before?

 

[Nahorscend]

Then use your common sense and ask yourself if an advancement of the mandible would help to place it at the palate or if it would make it worse. Your ap space are too bad because of a too small arch. Have you had extraction or retracted braces before?

Braces for crowding, no extractions

But you said your movements were lateral + mandible setback, which is the opposite of most bsso, I would move anterior instead of posterior plus no lateral, how did you get the same tongue outcome from a setback that you are suggesting comes from an advancement (lateral one I understood because it decentres the tongue)

 

[Denkaren]

Braces for crowding, no extractions

But you said your movements were lateral + mandible setback, which is the opposite of most bsso, I would move anterior instead of posterior plus no lateral, how did you get the same tongue outcome from a setback that you are suggesting comes from an advancement (lateral one I understood because it decentres the tongue)

You have 100% lost important arch length from retraction which is why you’re forced to have it at the bottom. It also explains why Ramieri wants to advance your mandible. Do not proceed with the surgery.

Your mandible are trapped because of the lack of ap space. If you want to fixed a trapped mandible you can go through an easier route by finding a craniodontist.

I didn’t get the same outcome my guy. My tongue are a few mm further back which makes it too far back to be placed at the incisive canal(the reason as to why my eye tilt right now are negative and beforehand were positive, if you read everything I’ve wrote in this thread you will understand the mechanism behind that.

The reason as to why I developed an open bite and breathing problems was because of the tongue movement. It doesn’t fit in the arch, so it pushes at the incisors instead(this is an emergency I did unconsciously to even breathe at all). It won’t stay at that position during night and since the “decentralisation” of the tongue has made it impossible to have it in the arch it moves backward, unless I find the space and force it back(which I do every night to sleep).

BSSO (bilateral sagittal split osteotomy) is the method of correcting the jaw.

 

[Foreverbrad]

I don’t follow how increasing the oral cavity space with advancement would cause issues for tongue posture. Especially in a bimax rather than an isolated BSSO.

Your case was mandibular setback and a lateral movement that apparently should not have been done at all since it gave you a crossbite.

It’s not exactly great for Ramieri’s reputation and I feel like these are predictable issues that should have been picked up during 3D planning. I would be curious to see your CT scans.

 

[Nahorscend]

You have 100% lost important arch length from retraction which is why you’re forced to have it at the bottom. It also explains why Ramieri wants to advance your mandible. Do not proceed with the surgery.

Your mandible are trapped because of the lack of ap space. If you want to fixed a trapped mandible you can go through an easier route by finding a craniodontist.

I didn’t get the same outcome my guy. My tongue are a few mm further back which makes it too far back to be placed at the incisive canal(the reason as to why my eye tilt right now are negative and beforehand were positive, if you read everything I’ve wrote in this thread you will understand the mechanism behind that.

The reason as to why I developed an open bite and breathing problems was because of the tongue movement. It doesn’t fit in the arch, so it pushes at the incisors instead(this is an emergency I did unconsciously to even breathe at all). It won’t stay at that position during night and since the “decentralisation” of the tongue has made it impossible to have it in the arch it moves backward, unless I find the space and force it back(which I do every night to sleep).

BSSO (bilateral sagittal split osteotomy) is the method of correcting the jaw.

I have plenty of time before taking any decisions and your post is interesting since people here never criticise ram much.

But you say you had an asymmetry case and the tongue exited the arch laterally rather than anteriorly, it doesn't definitely follow from this that a standard forward advancement of the mandible will move the tongue forward so much the bite will open. I mean maybe you are right but aren't bssos performed routinely without a lf1 and this doesn't seem to be a very common issue, any case where the mandible moves much more than the maxilla should be destroying tongue position if you are right. Even a bimax case like @lurking truecel where the bsso was more than 2x of the lf1 should be affecting the tongue.

As for my tongue position I can't tell if it's from genuine lack of space or because I lived my whole life with the tongue on the floor and am not used to the right posture. I can easily fit it on the roof if I place the tip behind the upper arch first and then work backwards to adjust the rest but it's annoying to do. What I can't do is have a straight flat resting tongue on the floor and then lift it up like that, it will get blocked by the upper arch. And my upper incisors aren't retracted, in fact they are protrusive. But a small lf1 would probably help me yes.

 

[Denkaren]

I don’t follow how increasing the oral cavity space with advancement would cause issues for tongue posture. Especially in a bimax rather than an isolated BSSO.

Your case was mandibular setback and a lateral movement that apparently should not have been done at all since it gave you a crossbite.

It’s not exactly great for Ramieri’s reputation and I feel like these are predictable issues that should have been picked up during 3D planning. I would be curious to see your CT scans.

That is because the tongue sort of advance 1:1 with the mandible. If you already before had problem because your maxilla was too short or recessed advancing the jaws equal will leave the tongue at the same restricted space as before. Note that when I say the tongue I specifically speak about genioglossus not the ENTIRY tongue since some part of it isn’t affected at all by jaw surgery.

In my opinion the ideal thing would be to decompensate the upper teeth and advance the maxilla 2-3 mm more than the lower jaw.

First and foremost he didn’t inform me about a setback(I wouldn’t never have agreed if it).

He thought it looked like an easy case, set the mandible back to make my bite class 1 and move it laterall to camouflage that my left palatal side are a few mm wider than the right. Would have been intresting to hear exactly how he resonated when he decided to do the movements. In all honesty I’m pretty sure that he wouldn’t be able to explain why I had the crossbite from the beginning, he doesn’t know how the tongue works. The incels in here has hyped him so much that he thinks his arrogance are justified.

He has no ethical line, a combination of rhinoplasty and what looks like Botox to increase his harmony and seem more approachable for patients in combination with HEAVY marketing has made him appear like he is the best jaw surgeon in the world lmao. I am 100% certain that his team worked overtime in here to boost his reputation(not only here, there are som Reddit warriors that “adores” him too).

 

[Denkaren]

I have plenty of time before taking any decisions and your post is interesting since people here never criticise ram much.

But you say you had an asymmetry case and the tongue exited the arch laterally rather than anteriorly, it doesn't definitely follow from this that a standard forward advancement of the mandible will move the tongue forward so much the bite will open. I mean maybe you are right but aren't bssos performed routinely without a lf1 and this doesn't seem to be a very common issue, any case where the mandible moves much more than the maxilla should be destroying tongue position if you are right. Even a bimax case like @lurking truecel where the bsso was more than 2x of the lf1 should be affecting the tongue.

As for my tongue position I can't tell if it's from genuine lack of space or because I lived my whole life with the tongue on the floor and am not used to the right posture. I can easily fit it on the roof if I place the tip behind the upper arch first and then work backwards to adjust the rest but it's annoying to do. What I can't do is have a straight flat resting tongue on the floor and then lift it up like that, it will get blocked by the upper arch. And my upper incisors aren't retracted, in fact they are protrusive. But a small lf1 would probably help me yes.

Listen I’ve come in contact with 10+ botched case of Ramieri.

Firstly just because their is a botched case the person won’t run in on this thread and write about it.

It is an emotional trauma to have expectation of something that goes south.

Secondly: Many of them are Italians and write in a private Italian Facebook group.

I have the name of 4 English speaking patients on Reddit that you and everyone here that says he barely has any botched cases can get. Ask them about their experience with him.

One person told me he relapsed directly after surgery and the only thing Ramieri offered was a genioplasty revision(which he had to pay the hospital fees for).

He is a professional gaslighter and if your integrity are low your screwed(when your case are botched).

Listen fake like, fake followers, botched cases, conservative isolated set backs, unwillingness to expand the palate, heavy marketing, dreadful chin remodeling should be enough for you to not go by him.

If you decides to proceed with him knowing all of this, then it is what it is.

It’s not about the bite opening my guy, it’s about the tongue not being able to fit inside of the dental arch, when that happends the tongue automatically push at the incisors creating a open bite.

You’re describing a recessed maxilla if that’s what you have to do to fit the tongue in the palate. How the bell would advancement of the mandible and genioglossus improve that?

I mean you say it yourself “they are protrusive”. They’ve done camouflage treatment for your recessed maxilla.
Ramieri recommended mandible advancement… That should also tell you enough about his competence in this field.

 

[Nahorscend]

Listen I’ve come in contact with 10+ botched case of Ramieri.

Firstly just because their is a botched case the person won’t run in on this thread and write about it.

It is an emotional trauma to have expectation of something that goes south.

Secondly: Many of them are Italians and write in a private Italian Facebook group.

I have the name of 4 English speaking patients on Reddit that you and everyone here that says he barely has any botched cases can get. Ask them about their experience with him.

One person told me he relapsed directly after surgery and the only thing Ramieri offered was a genioplasty revision(which he had to pay the hospital fees for).

He is a professional gaslighter and if your integrity are low your screwed(when your case are botched).

Listen fake like, fake followers, botched cases, conservative isolated set backs, unwillingness to expand the palate, heavy marketing, dreadful chin remodeling should be enough for you to not go by him.

If you decides to proceed with him knowing all of this, then it is what it is.

It’s not about the bite opening my guy, it’s about the tongue not being able to fit inside of the dental arch, when that happends the tongue automatically push at the incisors creating a open bite.

You’re describing a recessed maxilla if that’s what you have to do to fit the tongue in the palate. How the bell would advancement of the mandible and genioglossus improve that?

I mean you say it yourself “they are protrusive”. They’ve done camouflage treatment for your recessed maxilla.
Ramieri recommended mandible advancement… That should also tell you enough about his competence in this field.

The claims about ramieri specifically are a different matter and I'm not here to argue with you about that. I'm trying to understand how the logic you are suggesting works, with any surgeon. Again, how is it that BSSO only cases are even possible if the tongue moves 1 to 1 with the mandible, likewise that so many bimax cases have a significantly bigger BSSO than LF1? Shouldn't all of them end up with the tongue not fitting within the arch?

 

[Denkaren]

The claims about ramieri specifically are a different matter and I'm not here to argue with you about that. I'm trying to understand how the logic you are suggesting works, with any surgeon. Again, how is it that BSSO only cases are even possible if the tongue moves 1 to 1 with the mandible, likewise that so many bimax cases have a significantly bigger BSSO than LF1? Shouldn't all of them end up with the tongue not fitting within the arch?

Listen the vast majority of the people that need jaw surgery has bad tongue habits. A tongue that often from the beginning are at the bottom of the jaw. By advancing only the mandible they won’t feel a change since their tongue still are at the bottom. When your hyperaware of things you will notice how a single mandible advancement won’t improve your tongue posture, opposite will make it harder.
Especially since your already forced to move your mandible backwards to fit the tongue inside of the dental arch.

Advancing the mandible a few mm might help with open the airway up a little bit more but it won’t be ideal unless you start having your tongue on the palate.

A bold statement here but imo relapscases are mainly caused by the tongue not being able to be inside of the arch.

I also want to point out that it’s not exactly 1:1 that the genioglossus move, in some cases it’s 1:2, other 1:3. The main point is the positioning of it will be further forward and when you not advance the place where it should rest it will try to adapt but won’t be able to so your bad tongue habits will proceed.

 

[Nahorscend]

Listen the vast majority of the people that need jaw surgery has bad tongue habits. A tongue that often from the beginning are at the bottom of the jaw. By advancing only the mandible they won’t feel a change since their tongue still are at the bottom. When your hyperaware of things you will notice how a single mandible advancement won’t improve your tongue posture, opposite will make it harder.
Especially since your already forced to move your mandible backwards to fit the tongue inside of the dental arch.

Advancing the mandible a few mm might help with open the airway up a little bit more but it won’t be ideal unless you start having your tongue on the palate.

A bold statement here but imo relapscases are mainly caused by the tongue not being able to be inside of the arch.

I also want to point out that it’s not exactly 1:1 that the genioglossus move, in some cases it’s 1:2, other 1:3. The main point is the positioning of it will be further forward and when you not advance the place where it should rest it will try to adapt but won’t be able to so your bad tongue habits will proceed.

But that means if someone's mandible is much more recessed than their maxilla they are just screwed. Imagine you need like 15 mm on the pog to fix your side profile but your maxilla is not recessed much and doesn't have room for too much movement, what are you supposed to do lol. If the tongue theory is true then you have to choose between good aesthetic result but keeping your tongue at the bottom or good tongue posture but not a good aesthetic result.

(of course i am assuming the tongue is not set back before, because then the bsso would bring it forward an appropriate amount. i mean a case where the mandible is way more recessed than the maxilla but the tongue is already normal or even tightly fit inside the arch.)

 

[Denkaren]

But that means if someone's mandible is much more recessed than their maxilla they are just screwed. Imagine you need like 15 mm on the pog to fix your side profile but your maxilla is not recessed much and doesn't have room for too much movement, what are you supposed to do lol. If the tongue theory is true then you have to choose between good aesthetic result but keeping your tongue at the bottom or good tongue posture but not a good aesthetic result.

Listen tongue at the bottom will never ever give you good or the optimal aesthetic results. So there is no good aesthetic result but tongue at the bottom. That pretty much sums it up according to me though it’s pretty rare to be severely recessed in just the mandible. It’s often about having a downswung mandible that makes you look recessed or being recessed in both jaws, or resorption of the alveolar bone from extraction-retraction. Pretty much a lost case when that has happend unless you advance the maxilla several more mm than the mandible.

This video show what happends to your arch when your palate after extraction-retraction.

From a tongue perspective this is basically the same as setting back your whole maxilla the amount of mm the arch resorbs.

 

[zemult]

Fortunately, I’ve been able to move my trapped mandible forward some mm through myofunctional therapy(independently). That helped fix some of my breathing issues(temporary) until I’ve moved it back to its initial position. I’ve also at the same time been able to restore some of the aesthetic damage, I don’t look like the second rn but that was a picture approximately 11 months after surgery.

First one are beforehand(I was a good looking guy) that had inner demons and convinced myself I needed to be totally symmetrical.

This might not be at the exact same angle but hey, who gives a fuck

It really doesn't look as bad as you make it out to be, a lot of the difference in side profile here can be attributed to the difference in photo quality.

With your functional problems though, and Ramieri's unwillingness to work with you further, that's very disturbing. You don't even look like a Bimax candidate, so this blows holes in Ramieri's whole "ethical" shtick.

@lurking truecel what is your thoughts on this? I don't think he was a typical Bimax case, why would Ramieri agree to do work on him? Obviously all surgeons have botches, but I feel like this could have been easily prevented.. He also claims Ramieri did movements that he was never asked about.

 

[tweaqo]

Fortunately, I’ve been able to move my trapped mandible forward some mm through myofunctional therapy(independently). That helped fix some of my breathing issues(temporary) until I’ve moved it back to its initial position. I’ve also at the same time been able to restore some of the aesthetic damage, I don’t look like the second rn but that was a picture approximately 11 months after surgery.

First one are beforehand(I was a good looking guy) that had inner demons and convinced myself I needed to be totally symmetrical.

This might not be at the exact same angle but hey, who gives a fuck

Wait so the green and black stripy shirt picture is before?

If so that is not good at all. I’m sorry that happened to u

 

[Olympus]

I just joined this forum and want to share something with you.

There seem to be too many in here that hasn’t got a single fucking clue about ascending. What I want to say is the palatal rugae and the maxillary sutures are litteraly the key to beauty. That in combination of a mobile tongue(there can’t be any restriction).
A restricted tongue is the reason why some of you incels have what you called negative canthal tilt.

The maxilla are linked to the Sphenoidbone which are linked to the orbits.

Once you put pressure on the incisive canal your orbits are indirectly affected and you get what’s called a positive cantal tilt.

All this cantal tilt looksmaxxing advice are straight cope, it won’t do a shit. The tongue on the other hand have the ability to change your appearance in an instance if it’s mobile enough.

I also want to point out that the reason as to why people often imo look less harmonious after jaw surgery is because the maxilla wasn’t moved enough forward in relationship to the tongue.

If you do a bimax and advance both of the jaws the same amount your tongue won’t be able to be further forward in the palate.

I also want to point out the importance of dental arch, abnormal expanding from mechanical force(marpe,EASE,FME) will not only make you look like a ogre but also in the long run lead to worse functional(since the sutures has such a big impact on our nervoussystem) fracturing them with mechanical force will lead to scar tissues filled in between.

If you have any question, I can show you example of everything and break it down.

Many that are in here are in here to look better, I don’t know where this uncanny hype to have as wide jaw as possible comes from?

You’ve been isolated for too long and totally lost sense of reality.

I had jaw surgery with Ramieri that was a botch and lead me to a rabbit hole.

I’ve been doing research everyday and would say I have better knowledge than a lot of the jaw surgeons on certain areas. It is an insult to me and the 10+ I’ve come in contact with that was totally botched by Ramieri. Seeing incels call him “the goat” isolated in their mom’s basement is a joke. I seriously start to belive that Ramieri in his staff has many accounts in here to market him. He has no knowledge of the tongue and its importance what so ever.

All the ones that were botched has a similar botch pattern(they all ended up with an open bite). A open bite is created when the tongue hasn’t any place in the mouth to rest(the importance of dental arch). The reason as to why we all don’t go around with open bites is because the tongue formed the dental arch during our youth, moving the mandible laterall or in just any direction to “fix” assymetry will lead to the tongue now finding the arch. When it not finds the dental arch it moves forward pushing at the incisors, not only that it automatically moves backward making your breathing worse.

When your tongue are inside of your dental arch your tongue are able to be in a heigher vertical position which also lifts up your hyoidbone.