Problems in the current lower jaw surgery (BSSO) treatment.
Problems in the current lower jaw surgery (BSSO) treatment.
The proprioceptors in the human TMJ play an important key role in the identification of mandibular position when the teeth are not occluded. TMJ receptors provide greater afferent activity regarding perceptual awareness of joint position and movement.
In the case of lower jaw surgery (BSSO), it should be performed after correcting the misaligned position of the temporal bone and lower jaw. If a stabilization splint is used to move the lower jaw to a position that matches the misaligned temporal bone (CRO), it is a treatment to move the lower jaw to the misaligned temporal bone.
However, if the three-dimensional position of the lower jaw is placed in the mcb position where the skull moves well, it can be treated while treating the asymmetry by moving the temporal bone. If you do jaw surgery while leaving the misaligned position of the lower jaw and temporal bone intact, you will lose the opportunity to correct the misaligned temporal bone and lower jaw forever.
Then your temporomandibular joint will be in a disorganized state for the rest of your life, sending misaligned proprioception, causing neurologic and neuromuscular disorders, and continuing to make a lot of Substance P.
Then, your overall health will cause a lot of problems.
https://www.hilarispublisher.com/.../recurrence-of-the...
I think the misalignment of the skull is the cause of the misalignment of the upper and lower jaws. So, I think it was the cause of the recurrence of the jaw position after double jaw surgery. //Left roll and posterior pitch recurred after bimaxillary jaw surgery. (5th & 6th picture)
Your problem is a misaligned temporal bone. The lower jaw just followed. If the temporal bone cannot be moved, surgery will be required as it is now.
However, the temporal bone is capable of repositioning.
In the case of lower jaw surgery (BSSO), it should be performed after correcting the misaligned position of the temporal bone and lower jaw. If a stabilization splint is used to move the lower jaw to a position that matches the misaligned temporal bone (CRO), it is a treatment to move the lower jaw to the misaligned temporal bone. However, if the three-dimensional position of the lower jaw is placed in the mcb position where the skull moves well, it can be treated while treating the asymmetry by moving the temporal bone. If you do jaw surgery while leaving the misaligned position of the lower jaw and temporal bone intact, you will lose the opportunity to correct the misaligned temporal bone and lower jaw forever. Then your temporomandibular joint will be in a disorganized state for the rest of your life, sending misaligned proprioception, causing neurologic and neuromuscular disorders, and continuing to make a lot of Substance P. Then, your overall health will cause a lot of problems.
The lower jaw moves to the right.
Change of Horizontal Condylar Angle (HCA)It can be seen that from pre (R/31.6 L/32.3) to post (R/32.2 L/25.0), the left yaw of the lower jaw decreased from 32.3 to 25.0 as it moved to the right.
When the lower jaw is in the mcb position, the condyle, the disc, and the temporal bone are in a non-distorted and balanced state. The MOTILITY disappears, and the condyle is regenerated.
Left ROLL after surgery.
After surgery (2018.6), the left occlusal plane was raised upward before MARPE treatment (2021.6). However, after MARPE treatment(2022.1), the left occlusal surface moved downward and leveled. This change is not due to tooth movement, but canting is treated by downward movement of the left side of the upper jaw. In this patient, the left side of the sphenoid bone is raised, and the upper jaw is down on the left side. They moved in opposite directions. These changes are caused by mcb splint and MARPE (The Crane).
Posterior PITCH after surgery.
In June 2021(pre) than after Maxillomandibular Advancement SURGERY (June 2018), both the upper and lower jaw were retracted due to posterior rotation and posterior tilting of the maxillary incisors, but they have positioned anteriorly (2022.1/post) after MARPE (The Crane) and mcb splint treatment. As for the maxilla, the occlusal plane will be flattened by the forward rotation of the maxilla, not the eruption of the teeth, and the lower jaw will also be positioned a little more forward.
