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Surgical Correction of Bimaxillary Protrusion with Micrognathia

Homepage Star of January 2012
[ Author:Fushun Ma | Time:2012-03-12 17:14:08 |  Font Size: [Large Medium Small]
Tags: bimaxillary protrusion correction, upper lower jaw protrusion, mouth protrusion

Bimaxillary protrusion also know as upper and lower jaw protrusion or mouth protrusion deformity with a characteristic facial contour of protruded mouth, teeth exposure and lip closure problem. A oral examination could reveal that the upper and lower sets of teeth stick out to the front. The upper and lower incisors normally tilting out to the front. If the frontal teeth are not tilt then the upper and lower jaw bone may protrude to the front in a great deal in those who suffer from bimaxillary protrusion, accompanying symptoms include over exposure of gum when laugh or talk, nostril over exposure and big nasal labial angle. Though many forms of protrusion can exist the fundamental abnormality of bimaxillary protrusion is the upper and lower jaw overgrowth. The reason for this overgrowth is not clear, believing related to gene form, habit, teeth abnormality and some diseases.

When a bimaxillary protrusion sufferer reaches the age of adulthood it is impossible to change the facial structure by stress induced bone development adjustment. And its accompanied function abnormalities will not be able to improve by any other means than surgery. Surgical correction of bimaxillary protrusion can make the candidate looks normal or even beautiful and at the same time to improve the functional abnormalities related to bimaxillary protrusion such as open bite, contact incisor and underbite closure etc. Bimaxillary correction surgery has been performed for many years and is a safe procedure. Under the hand of an experienced surgeon this surgery has very low complication rate, the recovery normally is very quick and no post surgical problems remain. This girl on the page has a obvious bimaxillary protrusion combined with a micrognathia and slightly lateral deviated lower jaw. After a bimaxillary protrusion correction surgery and a forward sliding genioplasty surgery she is satisfied with her post surgery result.

before and after photos of bimaxillary protrustion correction
The lips are bulging out to the front and open, the upper and lower face is not proportional in bimaxillary protrusion sufferer. After surgical correction these problems are fixed.

profile photos of bimaxillary correction surgery
In profile the facial contour line changed profoundly. Post surgery the protruded lips, retrograded chin, the short mandible bone and the lip to chin angle are also improved.

angled view of bimaxillary protrusion correction photos
The lower third of the face is no more like a withdrawn drawer in the post surgery photo. The chin and mandible bone are lengthened .

This beautiful girl let Dr. Ma did bimaxillary correction surgery first. One year later she did her forward sliding genioplasty and another year later nasal bone reduction surgery again. The post surgery photos in this page was token 4 year after her first operation. Time passes by rapidly in four years. However this determined girl has changed her total facial appearance by going into the operating room again and again patiently. During this period of changing she also exhibited her talent in self image design and her communicating skills between patient and surgeon. This is a professional girl. Her success in surgeries proved that she has a good science and good control of self image. This in turn raises her self confidence and the possibility of success in her career.

bimaxillary protrusion CT image
Saggital section CT shows the protrusion upper and lower jaw forming a sharp contrast with the retrograded chin bone.

As previously described this girl underwent three separate surgeries. The first surgery, bimaxillary correction surgery changed her facial contour mostly because bimaxillary protrusion was the biggest problem on her face. Showing on the right side CT image her upper and lower jaw bone and incisors protruded to the front in a great scale. Once this protruding problem is corrected her facial appearance is improved fundamentally. The pre surgery profile photo and the CT image also show that she had a small chin, the difference between angle SNA and angle SND reaches 15 degrees (normally around 6 degrees), which made the protrusion of mouth even more stand out. Though an "H" osteotomy had been used to move the chin forward at the same time of setting back the lower teeth by rotating the freed bone piece, the scale of forwarding chin movement is still not enough to correct the micorgnathia. Another surgery of Forward Sliding Genioplasty also know as Horizontal Osteotomy Chin Sliding Surgery was performed to slid her chin forward for 1 CM. Then she got the satisfactory final result as showing in the post surgical photos.

The nasal bone reduction rhinoplasty was designed by the girl herself. After the first two surgeries of protruding correction and chin forward sliding Dr. Ma believed that her facial appearance was good enough. However the girl didn't think so. She insist that her nose was too wide for her face. Only then Dr. paid attention to her nose and found out that her nasal bone was really a little too wide to match her already narrowed face after two sets of surgical intervention. So Dr. Ma agreed to do the rhinoplasty for her, after surgery her nose is narrower and this do improved her overall facial appearance. This shows the girl's  strong awareness of self image.

For those who suffer from bimaxillary protrusion the correction surgery is undoubtedly a high reward investment. Choosing the right indication and calculating the right amount of bone movement are key for a successful correction. An under scaled set back of bone may not completely correct the protrusion, an over scaled set back may make the candidate in an aging facial appearance. Thanks to the modern CT technology surgeons can calculate the scale of protrusion acutely and analyze the relationship between the upper and lower jaw bones, and also their relationship to the other facial bones prior to the operation. This can make the bone movement very accurate and the operating time shorter.

Facial contour surgical design could be vary even for the same face. Dr. Fushun Ma believes the principle for plastic and cosmetic surgery is to achieve the goal by doing minimal times of surgeries. For this girl as an example some consultants or every surgeons may recommend surgeries around the mouth like augmentations of nose, chin and nasal labia fold to cover the mouth protrusion. But these kinds of surgeries can't solve the main facial problem or may even make the facial structure more unbalanced.

Regarding how many surgeries can be done at one session there is no strict role. Dr. Ma does not recommend to do too many surgeries at one time and to perform a prolonged cosmetic surgery. Some surgeries can't go together. It is not a good idea to do many surgeries from head to toe at one session. If the surgery is done under general anesthesia a prolonged surgery could make the surgery receiver to take a long time to recover from the anesthesia. All cosmetic surgeries are selected surgery, not aimed to cure disease. Taking the risk of a prolonged general anesthesia only for the reason of combining surgeries together is not rational. If the surgery is under local anesthesia a prolonged surgery will cause troubles such as local anesthetic agent overdose and surgery intolerance induced by long time stiffness.

The surgeries this girl toke can't be done at the same session. First of all bimaxillary protrusion correction surgery can't go with the forward sliding genioplasty. In order to augment the chin an "H" osteotomy was performed at the protrusion correcting surgery, the lower jaw bone has already been cut through, no way to do the horizontal osteotomy. Is it good to do the genioplasty or upper and lower jaw protrusion surgery together with the rhinoplasty? The answer is no. Because the previous two surgeries are done through the mouth incisions, after surgery the swelling around the mouth and throat cause by the surgical trauma compromises the oral airway. If a nasal surgery which could block the nasal airway was performed at the same time then the whole airway is in jeopardy. For the reason of post surgery safety a combination of nasal and oral surgeries together should be avoid as possible.

In addition the interval between surgeries varies depending on different situations. For example this girl's surgeries all concentrated on the face. The final result of the previous surgery has a impact on the design of the next surgery. So her intervals between each surgery exceeded one year. Only after enough long period of settlement the surgery result from the previous surgery could be stable. Thus the next surgery can have a solid base.

Though Bimaxillary Protrusion Correction Surgery is a safe and has been done for many years, this surgery is still not very popular and many indicated person still do not get the right correction surgery. The reason for that has many. Not like a double eyelid surgery which can be performed by almost every plastic surgeon, fewer properly trained and experienced surgeons can perform protruding mouth correction surgery. When the candidate go for their consultation they may in a good chance of not finding a proper surgeon or a well informed surgical consultant, or the existing protrusion may be neglected, or even no proper surgeons that can do this surgery handy, the indicated candidates may well be advised to take some other complimentary surgeries.  The surgery seeker's knowledge toward bimaxillary protrusion all contribute to the selection of the right surgery. If a indicated candidate dose not have any idea of mouth protrusion, Dr. Ma bet most candidates do not have this information, they may not be able to find the right surgeon or right place to go to solve their problem in a right way.

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