Protruding Mouth Correction with Counterclockwise Rotation Surgery
- Dr. Park
- Feb 27
- 3 min read
Hello, I'm Dr. Park Jong-cheol, a specialist in oral and maxillofacial surgery.
Today, I'd like to explain a surgical procedure that's familiar to medical professionals but may be somewhat unfamiliar to the general public: "counterclockwise rotation surgery for a protruding mouth." This surgery can be an effective alternative for those who wish to improve retruded chin, protruding mouth, and gummy smile simultaneously.
What is Counterclockwise Rotation Surgery for Protruding Mouth?
Counterclockwise rotation surgery for a protruding mouth is a procedure that combines ASO protruding mouth surgery with Le Fort I osteotomy of the maxilla. In other words, it achieves the following effects by performing protruding mouth surgery and maxillary single jaw surgery simultaneously:
Gummy Smile Improvement: Reduces gingival exposure through Le Fort I osteotomy of the maxilla, improving gummy smile.
Protruding Mouth Improvement: Moves the protruding mouth to an ideal position through ASO protruding mouth surgery.
Retruded Chin Improvement: As the maxilla is moved upward, the mandible rotates anterosuperiorly around the temporomandibular joint's rotation axis, resulting in anterior movement of the chin.
Facial Length Improvement
Advantages of Counterclockwise Rotation Surgery for Protruding Mouth
The temporomandibular joint has a fixed center of rotation. Opening the mouth around this axis rotates the chin posteroinferiorly, and conversely, closing the mouth after opening rotates it anterosuperiorly. You can try this yourself as you read this article.
This movement is used to improve retruded chin and gummy smile. Raising the upper jaw upward to improve gummy smile naturally causes the lower jaw to rotate upward, resulting in the chin naturally moving forward.
Retruded Chin Improvement Without Mandibular Advancement: Reduces condylar burden caused by mandibular advancement.
Overcoming Limitations of Protruding Mouth Surgery: Creates vertical changes that are difficult to improve with protruding mouth surgery alone, allowing the lips to close naturally.
Improvement of Posterior Dental Occlusal Relationship: Improves the occlusal relationship of molars, bringing positive changes in functional aspects.
Indications for Counterclockwise Rotation Surgery for Protruding Mouth
Counterclockwise rotation surgery for a protruding mouth is effective for those who have the following symptoms simultaneously:
Excessive gingival exposure (gummy smile)
Protruding mouth
Retruded chin
Surgical Procedure and Results
The surgery proceeds through the following steps:
Surgical Planning: Analyzes the patient's skeletal structure through 3D CT and establishes a movement plan.
Surgical Planning: Analyzes the patient's skeletal structure through 3D CT and establishes a movement plan Surgical Procedure: Performs Le Fort I osteotomy of the maxilla and ASO protruding mouth surgery simultaneously.
Le Fort I osteotomy of the maxilla and ASO protruding mouth surgery Post-Operative Management: Arranges teeth into an ideal position through orthodontic treatment and verifies whether the surgery was performed as planned using STL files. The surgical error is approximately 0.37 mm.
surgical error is approximately 0.37 mm
Actual surgical results can be confirmed through 3D CT and clinical photographs, and individual variations may occur depending on the patient's condition.
Although the vertical movement of the maxillary anterior teeth immediately after surgery was 6.9 mm, it is measured that the maxillary anterior teeth moved approximately 5.4 mm upward at 7 months post-op compared to pre-op. In other words, the maxillary anterior teeth were extruded by approximately 1.5 mm during orthodontic treatment. This extrusion of teeth can be caused by various factors, but it seems to be related to moving the teeth to close the residual space by tilting the maxillary anterior teeth lingually during post-op orthodontics.
The amount of upward movement of the upper lip itself is minimal at 1.18 mm. However, upward movement of the lips is also confirmed when based on the stomion between the upper and lower lips.
Differences Between Counterclockwise Rotation Surgery for Protruding Mouth and Bimaxillary Protruding Mouth Surgery
Counterclockwise rotation surgery for a protruding mouth brings similar anteroposterior and vertical changes to bimaxillary protruding mouth surgery, but it has limitations in improving left-right asymmetry. Bimaxillary protruding mouth surgery may be more suitable for severe asymmetry.
Conclusion
Counterclockwise rotation surgery for a protruding mouth is an effective surgical procedure that can simultaneously improve retruded chin, protruding mouth, and gummy smile. It can be a good alternative for those with severe gingival exposure and both protruding mouth and retruded chin. For further inquiries, please consult with a specialist.
Protruding Mouth Correction with Counterclockwise Rotation Surgery
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