BSSO, Sliding Genioplasty or Both? Bite is correct but lower jaw very recessed. (Photo)

Question

I had 4 pre-molars pulled and braces fitted 18 months ago, my bite is now correct but I have a recessed jaw. My upper jaw is in place, but I have a steep occlusal plane, a flat mandible and a recessed lower jaw (please see lat ceph). Is it still possible to get BSSO now my teeth are in place? Where did the space go when they pulled my other teeth, is that still there somewhere? Also, is it possible to move the lower jaw forward, then have the braces after to pull the lower teeth back?

Manish H. Shah, MD, FACS · Answer

Hello sj594,Thanks for your question.If the orthodontic treatment has aligned your occlusion, then your dental treatment is done for all intents and purposes.  A bilateral sagittal split osteotomy (BSSO) at this point would disrupt your occlusion if you are not getting a Lefort type I osteotomy to move your maxilla forward at the same time.  I know you didn't include a photo of your profile, but the soft tissue shadows on your lateral cephalogram seem to indicate good position of your nose and lip already.I think either genioplasty or chin implant are your better options.  They are safer, less expensive and easier to recover from.  It would have been helpful to include a frontal view of your face to see your horizontal facial proportions. Again, from the lateral cephalogram, it seem like a sliding genioplasty would only increase forward projection of your chin and not increase vertical height.  If you added a small bone graft at the time of the genioplasty, you could get both projection and height.A chin implant made from either solid silicone or Medpor, would work well and be the easiest method to achieve facial harmony.I would suggest you speak with a board-certified plastic surgeon with specialization in facial reconstruction to better understand your various options.I hope this was helpful.Dr. Shah

Barry L. Eppley, MD, DMD · Answer

With an established and stable occlusion, only a sliding genioplasty bone surgery can be considered at this point for improvement of you recessed chin. Your chin deficiency in profile is well within the limits of what a sliding genioplasty can well correct.

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