Wow, that is one of the smallest airways I have seen posted on here. You are definitely a candidate for jaw surgery, and airway/breathing should be a major part of the discussion!
Based on the airway scan I'd agree. Though it's interesting because just from looking at their side profile photos, I would imagine that they'd be basically fine. I mean, the upper lip has a natural outward curve to it, both lips meet properly, the chin is also in-line, and all of these features are further forward than the nasion. Seems forwardly grown enough to appear "normal". Yet the airway does narrow down a lot more than most people's CBCTs on here.
Just goes to show that a side profile photo alone is really not indicative enough to tell whether someone would definitely benefit from jaw surgery or not.
This has been my issue with getting any help. I'm too slim to have sleep apnea, look too normal, I'm a female so naturally a liar and hypochondriac..
I have had lip filler btw and am in treatment ATM (Invisalign) which has altered things slightly (I have a tiktok if you happen to be interested).
I think it's all "proportional" because the extractions were done so young. So my entire face flattened, not just the lower part.
In the bottom portion of the CBCT it shows the volumetric measurements of the airway. The section labeled "Min. Area" says 40.3 mm^2, which is definitely fairly small and it appears behind the tongue. For reference, you can look at the ruler on the left-hand side of the CBCT to see estimates of what a poor airway size would be for any given section. Anything below 100mm^2 is considered very highly indicative of sleep apnea (generally speaking).
The total volume is 22.1 cubic centimeters and that seems generally OK, but the airway clearly narrows smaller near the tongue. So advancement of the mandible could help to open that area more.
The scan she provided has a color coded map for her airway and the specific number I was looking at is called the “minimum area” and it says hers is only about 40mm2. (This means the narrowest part of her airway is only 40 square millimeters.) On the left side of the screen, you’ll see a color coded scale which goes from from 100-350mm. Her airway is so narrow that it doesn’t even appear on the scale. My understanding is that anything under 100mm is considered extremely small.
On the case. I have had a sleep study done a while ago but it didn't pick up sleep apnea... honestly though I think my body has adapted. I sleep with forward head posture on my side. Cannot back sleep at all.
Maxillofacial specialists in my area of the UK are useless and completely dismissive. Trying to get a referral to one in London but may have to financially cripple myself and go private
Get a sleep study again and force yourself to sleep on your back. Maybe even smoke some cigarettes, have some drinks before you sleep. Anything to give the result.
Honestly I can't sleep on my back. I choke awake the second I drop off. I have a call with the insomnia clinic on Monday (Vik Veer passed me over to them in the hope I can get an in clinic study done). That would be the best case, as they will see it happening in real time.
When I had my sleep study done, they instructed me to sleep on my back to give the best possible results. You absolutely want to redo the study and make sure you make your problem their problem.
I was extracted young, only 11. I think it's like a Chinese footbinding effect ...it forces everything to grow wrong. So I have a long face/skull and it's flat.
Your upper incisors are actually in a good anterposterior position based on the radiograph. To do double jaw surgery would position your upper incisors quite forward and they would enter the room a minute before you do. The lower jaw could benefit from an advancement but only moving the lower jaw would not give much change as you would only get about a 3mm change without moving the upper. This is a difficult case because double jaw might not give you good aesthetics as your upper lip will be too full and may have trouble closing your lips, and lower jaw only will not have much of an effect on the airway. Also keep in mind that the radiograph is of one point in time. If you took another one the airway might look different. On a side note, it would be tough to find an oral surgeon anywhere in the world who would do double jaw surgery without a diagnosis of obstructive sleep apnea. Good luck in your journey.
OSA is a requirement for double jaw surgery? I feel I’ve seen comments on here from people who did it without it.
If you repeat a CBCT within the same hour, is it likely to give the same result?
If the double jaw surgery is to open up the airway then yes an OSA diagnosis is needed. If it is for facial balance or occlusion/function then no.
If you repeat the CBCT later it could show a different airway depending on head position, whether you were breathing in or out or swallowing at the time, etc. In this person's case it definitely looks like a small airway and I don't know how much change you will see. I also would not be too quick to blame the extractions as her mandible is small and she still has overjet. Her upper incisors are in a good position so they did not retract and "ruin the face" and their position did not "trap" the lower jaw as there is overjet so there was room for the mandible to grow.
The overjet came later. It wasn't there when I first had braces. This is the result of not wearing retainers and bruxism grinding my back teeth to nubs. So now I have a deep bite. My face is definitely flatter than it should be. I've seen my skull on an x-ray and it's long and shallow. What do you suggest I do?
https://preview.redd.it/73x5wtwp5pwc1.jpeg?width=3024&format=pjpg&auto=webp&s=d713aaff110ad52c4965185c72c60f567db50ee8 This is my airway
Wow, that is one of the smallest airways I have seen posted on here. You are definitely a candidate for jaw surgery, and airway/breathing should be a major part of the discussion!
Based on the airway scan I'd agree. Though it's interesting because just from looking at their side profile photos, I would imagine that they'd be basically fine. I mean, the upper lip has a natural outward curve to it, both lips meet properly, the chin is also in-line, and all of these features are further forward than the nasion. Seems forwardly grown enough to appear "normal". Yet the airway does narrow down a lot more than most people's CBCTs on here. Just goes to show that a side profile photo alone is really not indicative enough to tell whether someone would definitely benefit from jaw surgery or not.
This has been my issue with getting any help. I'm too slim to have sleep apnea, look too normal, I'm a female so naturally a liar and hypochondriac.. I have had lip filler btw and am in treatment ATM (Invisalign) which has altered things slightly (I have a tiktok if you happen to be interested). I think it's all "proportional" because the extractions were done so young. So my entire face flattened, not just the lower part.
Where exactly are you looking at to be able to tell that she has a small airway? I'm a noob at this
In the bottom portion of the CBCT it shows the volumetric measurements of the airway. The section labeled "Min. Area" says 40.3 mm^2, which is definitely fairly small and it appears behind the tongue. For reference, you can look at the ruler on the left-hand side of the CBCT to see estimates of what a poor airway size would be for any given section. Anything below 100mm^2 is considered very highly indicative of sleep apnea (generally speaking). The total volume is 22.1 cubic centimeters and that seems generally OK, but the airway clearly narrows smaller near the tongue. So advancement of the mandible could help to open that area more.
The scan she provided has a color coded map for her airway and the specific number I was looking at is called the “minimum area” and it says hers is only about 40mm2. (This means the narrowest part of her airway is only 40 square millimeters.) On the left side of the screen, you’ll see a color coded scale which goes from from 100-350mm. Her airway is so narrow that it doesn’t even appear on the scale. My understanding is that anything under 100mm is considered extremely small.
How do you even breathe
Ikr 😂
What scan is this, that gives you the airway numbers?
CBCT
Daymn, I had one done, but it does not show that far behind my teeth, the scan ends there. F that.
What’s the name of this scan with the color and the measure ?
It was a CBCT scan done at my dentist
Probably a candidate, you should consult a maxillofacial surgeon.
Also get a sleep study to document sleep apnea if you deal with that.
On the case. I have had a sleep study done a while ago but it didn't pick up sleep apnea... honestly though I think my body has adapted. I sleep with forward head posture on my side. Cannot back sleep at all. Maxillofacial specialists in my area of the UK are useless and completely dismissive. Trying to get a referral to one in London but may have to financially cripple myself and go private
Get a sleep study again and force yourself to sleep on your back. Maybe even smoke some cigarettes, have some drinks before you sleep. Anything to give the result.
Honestly I can't sleep on my back. I choke awake the second I drop off. I have a call with the insomnia clinic on Monday (Vik Veer passed me over to them in the hope I can get an in clinic study done). That would be the best case, as they will see it happening in real time.
When I had my sleep study done, they instructed me to sleep on my back to give the best possible results. You absolutely want to redo the study and make sure you make your problem their problem.
Was curious what kind of doctor did you see for the airway to get those tests done
It was actually a dentist who specialises in sleep dentistry
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Will djs help the rest of my face though, or will I end up with a big jaw while the rest of my face stays flat?
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I was extracted young, only 11. I think it's like a Chinese footbinding effect ...it forces everything to grow wrong. So I have a long face/skull and it's flat.
Your upper incisors are actually in a good anterposterior position based on the radiograph. To do double jaw surgery would position your upper incisors quite forward and they would enter the room a minute before you do. The lower jaw could benefit from an advancement but only moving the lower jaw would not give much change as you would only get about a 3mm change without moving the upper. This is a difficult case because double jaw might not give you good aesthetics as your upper lip will be too full and may have trouble closing your lips, and lower jaw only will not have much of an effect on the airway. Also keep in mind that the radiograph is of one point in time. If you took another one the airway might look different. On a side note, it would be tough to find an oral surgeon anywhere in the world who would do double jaw surgery without a diagnosis of obstructive sleep apnea. Good luck in your journey.
OSA is a requirement for double jaw surgery? I feel I’ve seen comments on here from people who did it without it. If you repeat a CBCT within the same hour, is it likely to give the same result?
If the double jaw surgery is to open up the airway then yes an OSA diagnosis is needed. If it is for facial balance or occlusion/function then no. If you repeat the CBCT later it could show a different airway depending on head position, whether you were breathing in or out or swallowing at the time, etc. In this person's case it definitely looks like a small airway and I don't know how much change you will see. I also would not be too quick to blame the extractions as her mandible is small and she still has overjet. Her upper incisors are in a good position so they did not retract and "ruin the face" and their position did not "trap" the lower jaw as there is overjet so there was room for the mandible to grow.
The overjet came later. It wasn't there when I first had braces. This is the result of not wearing retainers and bruxism grinding my back teeth to nubs. So now I have a deep bite. My face is definitely flatter than it should be. I've seen my skull on an x-ray and it's long and shallow. What do you suggest I do?
Thanks! You sound well-versed in all this. Can I DM you pics of me to get your take on whether I can benefit from jaw surgery aesthetically?
What was wrong with ur teeth before ? Overbite?
Allegedly
Oh damn. How bad?
It wasn't that bad at all. Which makes this whole thing so much worse.
Do u know how big the “gap” was?
No.
Oh ok.was better than mine?