Why is this BSSO ascension so good?

[Reoreyh]

https://www.researchgate.net/publication/6450835_A_new_technique_for_mandibular_osteotomy

Why don't all before and after photos look this drastic? Is this some sort of photo frauding?



This is an example of a rare "clockwise" rotation.

 

[Hepatologyscribe]

Because not all surgeons use blackpilled advancment lengths like about a cm or even more. Most only use closer to 6mm. Some have never moved a jaw forward more than 8mm.

And also the rotation aspect. And that is a counterclockwise rotation

 

[Reoreyh]

Because not all surgeons use blackpilled advancment lengths like about a cm or even more. Most only use closer to 6mm. Some have never moved a jaw forward more than 8mm.

And also the rotation aspect. And that is a counterclockwise rotation

It's not a counter clockwise rotation. I'll post the ceph for you. It's a slight clockwise rotation and the publication says so. I get what you're saying though. A rotation affects the length of advancement for certain.

See how they fixed the depth of the overbite? His lower teeth sit lower in the final result than in the initial. The rotated down and away from the maxilla, admittedly increasing gonial angle (usually bad) but still netting him an aesthetic improvement. You can see in the ceph that he's been rotated clockwise, making his lower third taller. Fucking lifefuel.

 

[Hepatologyscribe]

It's not a counter clockwise rotation. I'll post the ceph for you. It's a slight clockwise rotation and the publication says so. I get what you're saying though. A rotation affects the length of advancement for certain.View attachment 282924View attachment 282925


See how they fixed the depth of the overbite? His lower teeth sit lower in the final result than in the initial. The rotated down and away from the maxilla, admittedly increasing gonial angle (usually bad) but still netting him an aesthetic improvement. You can see in the ceph that he's been rotated clockwise, making his lower third taller. Fucking lifefuel.

ur right.

how much advancement?

 

[Reoreyh]

ur right.

how much advancement?

13mm total. Here's the paragraph from under the ceph in the publication:

Radiographic comparison. A. Lateral extra-oral radiograph for preoperative cephalometric investigation of a retrognathic patient. Skeletal image of the retropositioned mandible can be seen in type II occlusal relationship. Soft structures show characteristic deep mentolabial sulcus and small facial height. B. Postoperative lateral extra-oral radiograph. Alveolar osteotomy can be seen from 32 to 42, associated to advancement and clockwise rotation of the mandible making up a maxilla-combined surgery. The surgery begins at the mandible. Rigid fixation miniplates measuring 2 mm are used in an extension of six holes for an advancement of 13 mm. On the maxilla, 1.5 mm rigid fixation may be observed. Soft tissue profile in accordance with skeletal results. In the naso-oro-hypopharyngeal regions, pre- and postoperative images show transversal increase of the area. This result is supported by respiratory improvement, as clinically reported by the patient.

What's confusing me is the mention of rigid fixation of the maxilla. Nowhere else is the maxilla or an advancement thereof mentioned in the publication.

 

[Hepatologyscribe]

13mm total. Here's the paragraph from under the ceph in the publication:

Radiographic comparison. A. Lateral extra-oral radiograph for preoperative cephalometric investigation of a retrognathic patient. Skeletal image of the retropositioned mandible can be seen in type II occlusal relationship. Soft structures show characteristic deep mentolabial sulcus and small facial height. B. Postoperative lateral extra-oral radiograph. Alveolar osteotomy can be seen from 32 to 42, associated to advancement and clockwise rotation of the mandible making up a maxilla-combined surgery. The surgery begins at the mandible. Rigid fixation miniplates measuring 2 mm are used in an extension of six holes for an advancement of 13 mm. On the maxilla, 1.5 mm rigid fixation may be observed. Soft tissue profile in accordance with skeletal results. In the naso-oro-hypopharyngeal regions, pre- and postoperative images show transversal increase of the area. This result is supported by respiratory improvement, as clinically reported by the patient.

What's confusing me is the mention of rigid fixation of the maxilla. Nowhere else is the maxilla or an advancement thereof mentioned in the publication.

I was confuses too but when I looked again you can clearly see the LF1 Plates.

 

[Reoreyh]

I was confuses too but when I looked again you can clearly see the LF1 Plates.

He received no maxillary advancement though. What I'm seeing described under the photos is something called an Alveolar Osteotomy. Maybe @Sergio-OMS can enlighten us?

 

[anti caking agents]

I can see lefort 1 plates and genioplasty plates.

 

[Reoreyh]

I can see lefort 1 plates and genioplasty plates.

It's frustrating that these images are used in the publication but don't mention either a genio or a lefort. Still, it's a great example of a clockwise rotation.

 

[Golden Glass]

Indeed CW rotation, when truly indicated, results in some great transformations.

He also fixed his offcenter and canted jaws quite nicely.

 

[Reoreyh]

Indeed CW rotation, when truly indicated, results in some great transformations.

He also fixed his offcenter and canted jaws quite nicely.

Yeah this is lifefuel for me. I have the exact same soft tissue issues when I bare my teeth, although my chin is nearly perfect, so I don't need a genio like him. Why the fuck does he have plates in his maxilla though?

 

[Golden Glass]

Yeah this is lifefuel for me. I have the exact same soft tissue issues when I bare my teeth, although my chin is nearly perfect, so I don't need a genio like him. Why the fuck does he have plates in his maxilla though?

Not sure, maybe @Sergio-OMS could help explain

 

[Mr.cope]

Bart Simpson

 

[Ghostcel]

I need this ASAP

 

[Reoreyh]

I need this ASAP

Don't get too excited. Still determining what procedures this guy got done.

 

[Sergio-OMS]

He received no maxillary advancement though. What I'm seeing described under the photos is something called an Alveolar Osteotomy. Maybe @Sergio-OMS can enlighten us?

I will be brief, sorry, but I think this explains a lot:

Subapical (block) osteotomy for Mandibular alveolar protrusion

Detailed step by step desription of Subapical (block) osteotomy for Mandibular alveolar protrusion located in our module on Mandible

surgeryreference.aofoundation.org

Not sure, maybe @Sergio-OMS could help explain

I don't know either... but sometimes only a couple of millimeters of discrepancy can justify an upper jaw surgery. Maybe for expansion?

I don't like the extended BSSO, though, it can create TMJ issues and even deformity when advancing.

 

[Reoreyh]

I will be brief, sorry, but I think this explains a lot:

Subapical (block) osteotomy for Mandibular alveolar protrusion

Detailed step by step desription of Subapical (block) osteotomy for Mandibular alveolar protrusion located in our module on Mandible

surgeryreference.aofoundation.org

I don't know either... but sometimes only a couple of millimeters of discrepancy can justify an upper jaw surgery. Maybe for expansion?

I don't like the extended BSSO, though, it can create TMJ issues and even deformity when advancing.

Extended bsso as opposed to a setback bsso? I can't even find an example of a BSSO gone wrong other than relapse.

 

[Sergio-OMS]

Extended bsso as opposed to a setback bsso? I can't even find an example of a BSSO gone wrong other than relapse.

No, extended osteotomy. It's better to do extend the cut up to the second molar (first molar maximum). No offense, but those are too many details to discuss here with non specialists..