u/Helpful-Wolf-1206

I have good natural bone structure and good skeletal mandibular projection, However, I have a severe malocclusion and it forces my mandible to slide backwards into an unnatural position just to make the teeth touch.

To get any relief or comfort, I have to constantly posture my jaw forward artificially. this relaxes the squeezed muscles, gives my tongue space, and restores my natural soft-tissue profile.

However, I just had a meeting with a surgeon who told me I only need palate expansion. He refused to address the backward resting mandible, saying it isn't necessary.

Has anyone here had a "trapped" or backward-shifted mandible that was completely fixed just by doing palate expansion (SARPE/MARPE)? Should i insist on a bimax or go for the palettes expansion only ??

My tongue is litterly twisted all the time.

The Medical Background:

Hey everyone. 24M here. I’ve been dealing with chronic TMJ pain, a bilateral crossbite, a tilted occlusal plane, and a 2mm midline deviation. My orthodontist just finalized my surgical blueprint and is sending me to the maxillofacial surgeon for a Bimax (Maxillary expansion and mandibular recentering).

My cephalometric numbers show I am Skeletal Class I (SNA 77°, SNB 76°, ANB 1°). However, I have a very steep, hyper-divergent mandibular plane.

My Surgical Fear / Question:

Because my main issues are transverse (crossbite) and asymmetry, I am terrified of the surgeon drastically altering my vertical profile.

I actually really like my current facial harmony. I have a naturally long midface/lower third, and a very strong, prominent chin. I want to fix my bite and TMJ, and maybe get a slight horizontal advancement since my SNA/SNB are a bit retruded.

However, because I am hyper-divergent, I know surgeons love to use CCW rotation (impacting the posterior maxilla). I know this swings the mandible up and forward.

My biggest fear is waking up with a drastically shortened lower face, or having my naturally strong chin over-projected into a "witch chin."

Questions for the veterans:

For those with long, hyper-divergent faces who had CCW rotation, did it noticeably reduce your anterior facial height? Did you feel like your face looked "crushed" vertically?

Can a surgeon choose a specific "center of rotation" to flatten the occlusal plane for better projection without impacting the maxilla and losing that vertical length?

Any advice on how to firmly communicate to my surgeon that I want to prioritize my current vertical height and avoid a genioplasty?

Thanks in advance. Getting closer to starting the treatment and the anxiety about my face changing shape is getting real.

Surgeon suggested ONLY palate expansion, but my mandible is physically trapped backward causing TMJ pain. Do I need Bimax?

Ortho ordered Bimax for crossbite/TMJ. I'm Class I Hyper-divergent and terrified CCW rotation will shorten my face. Advice?