Sliding Genioplasty Journey with Dr. Gunson

[PloskoPlus]

Not sure what you mean there, maybe I'm overthinking this statement.

Sliding genio can permanently numb the lower lip just as well as a BSSO, and lower lip numbness is the biggest jaw surgery complaint.

[needadvancement]

Sliding genio can permanently numb the lower lip just as well as a BSSO, and lower lip numbness is the biggest jaw surgery complaint.

True, but SG risks seem to stay at a certain area that makes it so that if it goes very wrong, you can still live with it(unless we're talking general anesthesia complications). BSSO Jaw surgery however has a long list of potential complications and although they are rare, it's a much bigger deal imo. And I really don't mean to scare anyone with this or act like a fear mongerer, but I've read that standard Lefort 1's have even caused blindness in people(tiny percentage of course).

[molestrip]

The complication rate is 1%. Of those, many problems are addressable. For a example, a repeat surgery can address a non-union. You can get a veneer or implant for a dead tooth. Big name surgeons will always have a few bad cases but like a few out of a few thousand. Many of those are exceptional in some way as well, either they have other disorders that put them at greater risk, they're a high risk group (ie old), they didn't follow directions, early in their careers, and yes, sometimes mistakes are made. I don't mean to blanket justify surgery, as every one is different. Do enough procedures and the odds catch up with you. Hit the low hanging fruit and remember to always compare against the alternative, as the status quo isn't perfect either whether you realize it or not. I'm bringing this up now because sleep apnea is prevalent (and increasing actually, along with allergies) and commonly missed. I don't want you to have to learn the hard way and then have to redo it later when the risks are greater. If you don't have it, then you are right, stick to the SG.

Your chin is quite weak, however people with weak chins usually have humped noses. Did you have a rhinoplasty already? Perhaps there is hope for you.

[terry947]

I dont think an SG would address sleep apnea...

Sleep apnea is cured by the advancement of the pre-maxilla and lower jaw so that the tongue and more room in a forwards position. Also it opens up the airways. An SG just stretches the skin in your chin making you look nicer.

[molestrip]

I see mixed opinions about that. Some day that since the tongue is attached to the chin, advancing it opens up the airway behind. Trouble is, there's like 4 spots where the tongue typically collapses and it only addresses one of them. Unclear to me how much the advancement translates to, if it's even true. Does 1mm to chin imply 1mm to airway?

[SGseeker]

Hey everyone!! Thank you so much for your posts they have been SO helpful and informative (even with the back and forth - this is how we learn!). I am definitely planning on doing the CEPH to see if i might be in the sleep apnea range and go from there for a sleep study if necessary. Thanks Terry for the PM as well!!!

Re: Rhinoplasty. I fell on my face when i was about 8 years old and broke my nose and opened up my upper gums. Fell about 2 metres onto concrete face first. Was then rushed to the hospital and spent the night there having stitches and xrays. 16 years later i finally got a rhinoplasty (2 months ago) to remove the bump and fix my severely deviated septum (one nasal valve was completely blocked). The surgeon had to pull out bone fragments during surgery :/

Please continue to provide guidance and thoughts!!! I know my chin is very weak at this point - i am just hoping that the results SG or jaw provide will be worth it from an aesthetic perspective (and health if i have sleep apnea).

Thank you so much again!!

[molestrip]

Wow, your surgeon did a really good job! It looks great. Also, that explains it now. See, we know our stuff 45yo you just gave you a pat on the back. Your plan is a good one. Good luck!

[PloskoPlus]

True, but SG risks seem to stay at a certain area that makes it so that if it goes very wrong, you can still live with it(unless we're talking general anesthesia complications). BSSO Jaw surgery however has a long list of potential complications and although they are rare, it's a much bigger deal imo. And I really don't mean to scare anyone with this or act like a fear mongerer, but I've read that standard Lefort 1's have even caused blindness in people(tiny percentage of course).

That's like a handful of cases out of many thousands of operations.  But I don't want to trivialise anything.  In fact, my upper lip is still partially numb 6 months after the operation.  And they only ever warn you about the possibility of lower lip numbness.  (And I thought I got a lucky break with needing only a single-jaw surgery).

[SGseeker]

Hi Everyone!!

Quick update - got my X-Rays today thanks to TERRY!! Thank you thank you thank you!!!

I am posting them here to hear your thoughts Based on my consult with the orthodontist. IF i had jaw surgery I would need upper and lower jaw surgery as my bite is good already. She recommends just doing the genioplasty and is referring me to Dr. Tocchio in Toronto.

She also thinks my airways look large enough (RE:SLEEP APNEA) but I would like to hear your thoughts - she gave me the caveat she isn't an ENT so its just her opinion. Please let me know if you think I should still do the sleep study. Who would be the right person to show the CEPH to for medical verification?

Thank you guys so so so much!!!



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[needadvancement]

^Looking at your airway, it appears to be large enough(almost the same size as mine and I don't have breathing/sleeping problems) and better than most people here who have posted xrays and talked about breathing problems. Maybe the mouth breathing is just a habit? I think that this is when the oral posture theories could really help here. If you keep your tongue on the roof of your mouth(and sticks and stays there because of saliva helping with that) while you're laying in a comfortable position I don't see how snoring or sleep apnea could develop. If the sleep study is expensive IMO it wouldn't be worth it but it's all up to you of course, just my 2cents.

[molestrip]

I don't have my ruler with me now. It's certainly not a the stereotype floss or straw airway but then again, neither is mine. Using a paper quickly and my memory of the norms, I see one spot of concern otherwise not huge but normal. Right now I'd guess she has mild sleep apnea and if so, sliding genioplasty might address this spot as might other conservative surgeries. I'll double check the numbers tonight.

Either way, I still think spending $400 on a home sleep study before surgery is a good idea. She's going to spend much more than that on the surgery itself likely.

[terry947]

Get the sleep study because it's free for us Canadians. So blessed lol.

Tell your doctor you have a hard time sleeping and you feel tired when you wake up. Say an ortho recommended a sleep study. And he'll give you a refferal. I'm going to get one done soon. Also if you do end up going to jaw surgery route. I spoke to one of the best jaw surgeons in Toronto and he said it'd only cost 5,000. Ohip covers everything but ortho work and surgeon fees.

[molestrip]

Ok I doubled checked my numbers. For reference, here's the diagram I'm comparing to. Here's your numbers:

upper retropalatal:~11.4mm (normal is 15-20mm)
lower retropalatal: 13.6mm (normal is 10-16mm)
upper retroglossal: 9mm (normal is 10-17mm)

I didn't both measuring your lower retroglossal space because your face is so long it's completely outside the bounds of obstruction but strictly speaking, it looks more than adequate. My airway is almost identical to yours, except your lower retropalatal is few mm bigger than mine. See how your mandible plane radically changes behind your molars? It's the reason for your weak chin.

I suspect your case is bad enough that any sleep lab could pick it up but to be sure, see if you can swing by Stanford or look for the biggest center nearby if not. Check that they can diagnose UARs. Short term symptoms to watch out for are nocturnal bruxism, tongue thrust, nocturnal reflux/acid damage, morning headaches, chronic fatigue, somnolence, nocturia, elevated blood pressure, and anxiety/depression. Long term symptoms are... just bad. Other indicators would be a high malampati score, high/narrow arch, oversized tongue (w/scalloping), and long soft palate.

Please remember to return and let us know the study results! Even if it comes out negative, try to remember that it's age/weight dependent so you should recheck it every decade to make sure it stays that way.

[Lazlo]

jesus molestrip, you're like a friggin MD. Impressed. Are you male or female? How old are you? And also what are you main concerns. Sorry I've only been reading posts piecemeal these days.

[needadvancement]

Ok I doubled checked my numbers. For reference, here's the diagram I'm comparing to. Here's your numbers:

upper retropalatal:~11.4mm (normal is 15-20mm)
lower retropalatal: 13.6mm (normal is 10-16mm)
upper retroglossal: 9mm (normal is 10-17mm)

I didn't both measuring your lower retroglossal space because your face is so long it's completely outside the bounds of obstruction but strictly speaking, it looks more than adequate. My airway is almost identical to yours, except your lower retropalatal is few mm bigger than mine. See how your mandible plane radically changes behind your molars? It's the reason for your weak chin.

I suspect your case is bad enough that any sleep lab could pick it up but to be sure, see if you can swing by Stanford or look for the biggest center nearby if not. Check that they can diagnose UARs. Short term symptoms to watch out for are nocturnal bruxism, tongue thrust, nocturnal reflux/acid damage, morning headaches, chronic fatigue, somnolence, nocturia, elevated blood pressure, and anxiety/depression. Long term symptoms are... just bad. Other indicators would be a high malampati score, high/narrow arch, oversized tongue (w/scalloping), and long soft palate.

Please remember to return and let us know the study results! Even if it comes out negative, try to remember that it's age/weight dependent so you should recheck it every decade to make sure it stays that way.

Thanks for the info now I can check my own as well.