Posted by sleepsurgeon on April 07, 2009 at 17:04:41:In Reply to: Re: Comments from the sleep surgeon posted by Captin Cannuck on April 04, 2009 at 09:56:11:
Lots of factors go into how to move the jaws and where to put them. I don't believe in any "formulas" or "protocols". I look at the patient's age, facial appearance, the cheek bones, nose, the thickness of the face/lips, relation of the front teeth to the lip, the inclination of the teeth, the severity of sleep apnea, the airway...etc. At the end of the day, all factors contribute to the patient's outcome. If the sleep apnea is much improved but the patient is very unhappy with the esthetics, then it would not be a good outcome. I really do not want to have unhappy patients. It is a balance that you are trying to hit and discussing with the patient before the operation regarding their concerns is crucial. Ultimately, it is the patient's choice on the things are important to them. One thing I would like to point out is the "counter-clock" maneuver. I don't see why some people make it a big deal, because it is not at all. Changing the occlusal plane has been around for YEARS! There is no magic in performing counter-clock rotation and the maneuver does not make the airway so much better. I often do it really for esthetic reasons and trying to lessen the lip changes while still allows for a good advancement of the mandible.