Double Jaw Surgery
Q: Dr. Eppley,I am looking to get double jaw surgery for functional reasons related to sleep apnea and I have been doing a lot of research on the aesthetic benefits that double jaw surgery can bring. I believe that if I am going to be getting double jaw surgery, I might as well maximzse the aesthetic outcome. I am currently searching for reputable surgeons to perform the surgery and your name cropped up as an aesthetically minded surgeon trained in both maxillofacial surgery and plastic surgery.
From an aesthetic point of view, there are two main issues that I am having trouble wrapping my head around, and they both involve counter-clockwise rotation of the maxillo-mandibular complex. The first is the position of the dentoalveolar portion of the maxilla relative to the anterior nasal spine and the paranasal area. In the first image that I have attached, you can see how the mouth area of the patient in the ‘before’ is set-back relative to the base of the nose. In the after, you can see how the mouth area was moved forward relative to the base of the nose, reducing the nasolabial angle and creating a forward sloping upper lip. Is this a result that is achievable with CCW rotation in the general sense (barring any other preclusions)? In other words, given that an aggressive CCW rotation is able to be performed on a patient, is that the result that one would expect?
My second question is whether or not counter clockwise rotation of the maxilla around the anterior nasal spine, and thus the movement of the maxilla and mandible ‘forwards’ and ‘upwards’, may be able to reduce the perceived distance between the stomion point and the subnasale point on the face. I surmise this because – with CCW rotation around the ANS – the subnasale point is remaining constant whilst the maxillary incisor tip and the stomion point is not only being moved forwards but also *upwards* relative to the rest of the face. So the linear distance between subnasale and stomion will remain constant, but the perception of the distance by the onlooker will be shorter because of the new angulation created between the two points relative to the true vertical plane. Is this an accurate appraisal?
A: There is a reason you ‘can not wrap your head around’ the aesthetic changes that may occur from a counter clockwise rotation of the maxilla and mandible in double jaw surgery…it just isn’t that simple. How the overlying soft tissues respond with the bony changes is not completely reproducible and may be somewhat different in each patient. While cephalometric and even computerized prediction tracings make it look mathematical, it often doesn’t work as predictable as it looks. It is important to remember that this is surgery on live tissue not a linear drawing on an x-ray. No matter how you choose to view it, orthognathic surgery is a ‘gross’ bony movement procedure and is not really amenable to be critiqued by smaller millimeter measurements or such precise external facial changes. In short it is more than just geometry of bone movements.
Dr. Barry Eppley