The baby with Pierre Robin syndrome born with a small jaw. The Class II adolescent with braces and impacted third molars. The middle-aged overweight person with sleep-disordered breathing (SDB) and a new diagnosis of obstructive sleep apnea (OSA) supported by a high apnea-hypopnea index (AHI) score. These are all the same person but at different stages of life. What unites them is their small mandible, or what Dr Paul Coceancig calls AMHypo.
Figs 1 and 2
Anterior mandibular hypoplasia, or AMHypo, is the most common form of the small mandible in people of Caucasian descent. AMHypo arises because of a small anterior tongue (with normal jaw joints), and it leads to dewlap (poor chin-neck contour), dental crowding, impacted third molars, a range of dental malocclusions, and retroglossal tongue displacement into the upper airway (with associated neck posture issues). A person born with a small mandible relative to the rest of their body will always have that disproportion as their body ages (Fig 1); overbites, camouflage orthodontics, big tonsils, and eventually OSA often follow in its wake (Fig 2). It is why most youths today end up in the orthodontist’s chair, because a small mandible isn’t just short—it is also narrow and relatively squat, meaning it can contain fewer teeth, resulting in dental crowding, impacted teeth (especially third molars), and worse, a bad bite. However, traditional orthodontic treatment does not address the cause of these issues—the AMHypo itself—and instead only treats these dental effects, leaving these patients in the same anatomical situation they were in prior to orthodontic treatment (Fig 3).
Fig 3
Figs 4 and 5
With modern medical imaging, we can now explain the link between the small mandible, bad neck posture, a receding profile, and of course the very real medical dangers associated with snoring and OSA. As someone who personally traveled the journey from camouflage orthodontics to jaw pain and breathing difficulties and eventual OSA, Dr Coceancig has devoted much of his career to treating patients with AMHypo, developing several surgical protocols that cure the problem entirely. His true workhorse is IMDO, or intermolar mandibular distraction osteogenesis, which expands the mandible (Figs 4 and 5) to eliminate the problems of crowding and impaction while supporting the profile and facial esthetics of the patient (Fig 6). More important is that as distraction advances, the back of the tongue is pulled forward as well, eliminating the potential for OSA (Fig 7).
Figs 6 and 7
Of course, IMDO is not always possible, which is why Dr Coceancig has developed GenioPaully, BIMAX, SuperBIMAX, custom PEEK, and SARME as well. Together with IMDO, these make up his 6Ways to Design a Face, and he has compiled all of them into a new book of the same name. In it he explains and demonstrates why small jaws are common, what causes them, the problems they create, and more importantly, how to treat them to eliminate those problems. His unique journey has enabled him to see the problem for what it is and find solutions that work in real life. Read his story and preview chapter 1 here: http://www.quintpub.com/PDFs/book_preview/Coceancig_Preview.pdf
6Ways to Design a Face: Corrective Jaw Surgery to Optimize Bite, Airway, and Facial Balance
Paul Coceancig
In this innovative and paradigm-busting book, the author asserts that almost all bad bites have their origin in a small mandible, what he calls anterior mandibular hypoplasia, or AMHypo, and further claims that surgical management is the only means to correct it. AMHypo arises because of a small anterior tongue, and it leads to dewlap (poor chin-neck contour), dental crowding, impacted third molars, a range of dental malocclusions, and retroglossal tongue displacement into the upper airway. Traditional orthodontics often camouflage the small jaw by extracting “extra” teeth that don’t fit and controlling growth with various appliances, effectively leaving the patient in the same medical predicament they were before having their teeth straightened and their occlusion fixed. After all, for every patient with a bad bite, there are three combined, interwoven, inseparable treatment considerations: occlusion, airway, face. In this book, the author outlines the anthropologic underpinnings of the small jaw and then outlines his six surgical methods of designing the face to optimize bite, airway, and facial balance: IMDO, GenioPaully, custom BIMAX, SuperBIMAX, custom PEEK implants, and SARME. IMDO, or intermolar mandibular distraction osteogenesis, is a surgery less invasive than third molar surgery that can expand the mandible by as much as 16.5 mm and effectively bring the tongue forward to eliminate the potential for airway issues down the line, not to mention improve the patient’s profile dramatically. The surgeries and protocols in this book will have you rethinking your approach to patient care and asking yourself how you can better care for your patient now AND in the future. The author sees no reason why we should not expect to carry all 32 of our teeth for our adult lifetime in a Class I occlusion and free of crowding or impactions or airway collapse. Do you dare to join him?
256 pp; 774 illus; ©2021; ISBN 978-0-86715-966-0 (B9660); US $178
Paul Coceancig is a Commonwealth-trained jaw correction surgeon—with a unique practice based in New South Wales, Australia—dedicated to the treatment, and surgical cure, of obstructive sleep apnea. From prevention to active management, Dr Coceancig has helped develop concepts, ideas, protocols, methods, and instruments that will revolutionize how we manage the small jaw and glossoptosis and malocclusion.