Facial/Cheek Pain 1 year after Jaw Surgery

[Picollo30]

I had a BSSO with 5 mm ccw rotation + Lefort I in February 2016 for helping reduce sleep apnea. after a few months of recovery from the surgery, in August i started having orthodontics again to fine tune my bite.

Last month i finally i had my superior and inferior braces taken off and i'm only using containment braces for when i sleep. Two weeks ago i started having intense pain on the right side of my face, that affects my facial bones. it hurts when i open/close mouth, i cant even close my mouth totally and when i chew. its like a pain/intense pressure in the facial bones accompanied with a grinding sound. i've always had joint problems in my jaws, but this doesnt seem to be affecting the the joint its like the pain/pressure is spreading to the facial bones and the pain is increasing as days go by.

As i said this started when the braces treatment finished, maybe two weeks later.

I need to take Adalgur to relax the facial muscles and reduce the pressure and Advil for the pain. I have a post surgery medical appointment for tomorrow (thank god i postponed it, it was going  to be last october).

Can this be a relapse and why only on one side of the face?


Is this facial pain normal?  What should i tell the maxilofacial surgeon?


Also sleep apnea improved in the first 6 months following the surgery, but now i wake up as tired as before the surgery.

Help me out please

[slysurfz]

Based on the studies I have read a 10mm advancement of lower jaw is needed for permanent sleep apnea reduction. I have consulted 3 surgeons and all have recommended 10mm advancement. Your case might be different, but this is just based on my experience. Also, is your sleep study showing that or you are just feeling that way? Sleep study is the only way to figure out if its gone or not

[Picollo30]

ok guys

had post op appointment with maxilo facial surgeon today. I told him of my facial pain he looked at it and said its muscular but he didnt seem very convinced. He requested an Orthopantomography and  a cephalogram when i told him that my sleep apnea is still like it was before the surgery.

He saw me from profile and didnt like what he saw and said he could still improve my profile a bit and even mentioned sliding genioplasty. Can it be that he sensed a relapse?

Problem is i had the surgery in a public hospital and i was doing the orthodontics in a private clinic.  Now that the orthodontics is finished and i dont have braces anymore, how can i have new surgery without braces?

if he opts for a sliding genio and there's no relapse will i also need braces? Does a public hospital cover the braces if they are needed again?

thanks

[Milli_Meters]

You will not need braces for a genio.

[Milli_Meters]

Also I agree with slysrfz , for sleep apnea typically more advancement is suggested. Maybe you should get an opinion from another surgeon well versed in MMA.

[slysurfz]

if your bite is not off and there is no need for compensatory orthodontics they will just use surgical braces to do the surgery. I am sorry you have to go through more surgery.

[Picollo30]

if your bite is not off and there is no need for compensatory orthodontics they will just use surgical braces to do the surgery. I am sorry you have to go through more surgery.

in fact im kinda happy because he left me with a weak chin, last time in august he said i didnt need genioplasty, but today he changed his mind and said there's more room for improvement and mentioned genioplasty also asked if i liked what i saw aethestically i said my chin could be advanced a bit more and he agreed.

i'm worried about the pain though. next appointment is only in the 16th may and he has prescribed Adalgur N (Paracetamol muscle relaxing, pain reliever pills) 2 pills 8 in 8 hours for the pressure and facial pain. he says the pain is muscular but i dont think so as it only affects the right side and i hear these clicking or grinding sounds when i chew or try to open my mouth.

[Milli_Meters]

The 5mm advancement of the lower jaw. How do you feel about that aesthetically?

[Picollo30]

The 5mm advancement of the lower jaw. How do you feel about that aesthetically?

honestly i dont think he advanced much, but maybe is because he didnt do the sliding genio, but i also read that MMA is not suited for aesthetics purposes. PatrickB a italian doctor who posts here sometimes and has a forum of his own advised me to get a chin wing or get  jaw implants to give those sharp angles that my jaw doesnt have because of weak development in childhood.

What i notice that is different is that the Lefort I made my face a bit more chimp like and changed my nose shape (he said this could happen that's why he also played a bit safe with the amount of advancement i think).

I can post some pics first one is from 2010 when i started my orthodontics treatment and without jaw surgery the other 2 are from november 2016 (my jaw surgery was in february 2016). i had  braces for 7 years because i didnt like the results of the orthodontics class II camouflage treatment so i had jaw surgery (also to improve my sleep apnea).

I had other aesthetic surgeries in between: otoplasty, septoplasty and 2 canthopexies (one failed) + fat injections in the malar area. I think having a weak chin makes my nose a bit bigger or its the other way around so genioplasty and/or rhinoplasty are not ruled out.

I think the doctor is seeing the same as me: still a weak chin and room for more improvement in the lower jaw. I will have my fingers crossed

[attachment deleted by admin]

[attachment deleted by admin]

[Milli_Meters]

Yeah probably you could benefit from a chin wing type procedure.

Did you have all your surgeries in the US?

[Picollo30]

Yeah probably you could benefit from a chin wing type procedure.

Did you have all your surgeries in the US?

No. In Portugal.

Let's see how it goes. Maybe he can advance my jaw and do the sliding genio. I think the sliding genio would be a great improvement. I will also think about jaw implants. Unfortunately chin wing is not covered by insurance as MMA is and from what i could read, its very expensive, only a handful of surgeons can do it and some can even go wrong.

[CCW]

The front looks solid, and I doubt you've relapsed one year post-op. People who require CCW often have TMJ issues, but CCW itself also puts strain on the joints. In fact, jaw surgery can make it worse, so it's always a bit of a gamble. You could get a night guard if the pain continues. Is your bite fine? Have you gotten a sleep study done after your surgery?

[Picollo30]

Hi CCW i always had problems in my joints, and its possible the ccw rotation is putting more pressure on the joints. if so, what can be done if the pain becomes unbearable?

My bite according to the surgeon is fine he has seen me with the containment braces i use to sleep and he said bite looks fine with them on too.

As for the sleep test i havent done one yet post surgery, but i noticed that as i had gains immediately after the MMA (i didnt even need the CPAP), now i wake up very tired and sore all over even with CPAP,  and i get sleepy everywhere throughout the day even though i take lots of coffee to stay awake. I told him this and he had me take a new ceph and ortopanthomography in the next appointment with him and also about the pain he said it seems like a muscular pain but it can very well be TMJ as you said. I seriously hope not.

You said my front looks better than before, but surgeon told me there's more room for improvement in a  profile view, do you think surgeon is talking about new jaw surgery or genio only?