Stiff lip/ chin causing speech issues

[ODog]

Hi guys,

I had jaw surgery 4 months. I’ve talked about some speech problems I’ve had since the surgery, but I didn’t get any answers from my surgeon. He said numbness wouldn’t affect articulation. My ortho reiterated that point, and said my speech restriction is coming from the tightness in my chin which can happen after a genio.

My genioplasty was only about 4 mm, which is not a big movement, and I’ve never heard of anyone having speech issues because of stiffness/ tightness in the lower lip/ chin area.

I’m not sure what to do about this other than to maybe reverse the genio.

FWIW I found a post on RealSelf describing the same issue: https://www.realself.com/question/london-gb-7-months-post-genioplasty-tight-chin-resolve

A surgeon answered with: “In your case the surgeon did a too vertical cut of a too small fragment of the chin bone, then he has rotated this fragment and then applied screws to fix the fragment at a higher position; is this rotation of a too small fragment which includes partially the oral muscles the cause of your discomfort.”

I’m wondering if there a wrong technique/cut was  done on my chin as well...

My x-Ray if it helps at all: https://imgur.com/a/kbO8kWl

[GJ]

That answer from realself seems likely to me. So your chin was rotated clockwise, right? That will pull the muscles.
One easy thing you can try is having the hardware removed. Of course, that's another extra cut if it doesn't fix the problem and you do need full revision of the genio.

[ODog]

That answer from realself seems likely to me. So your chin was rotated clockwise, right? That will pull the muscles.
One easy thing you can try is having the hardware removed. Of course, that's another extra cut if it doesn't fix the problem and you do need full revision of the genio.

 No my chin wasn’t rotated CW it was already long to begin with. I believe it was move up and forward, according to my ortho, who said the lip to chin distance is shorter.

What do you say I need a full revision of the genio? Just to undo the movement?

[GJ]

What do you say I need a full revision of the genio? Just to undo the movement?

To get rid of the tightness and speech issues. If they're related to the genio as you've been told, then it follows you'd need revision to fix that.

[ODog]

To get rid of the tightness and speech issues. If they're related to the genio as you've been told, then it follows you'd need revision to fix that.

Yes if that’s the cause of the tightness. But I’m not certain. There is a thread on another forum of a girl experiencing the same problem with tightness/ speech and she had a BSSO advancement and genio SETBACK, so I don’t understand why she should be experiencing the same sensation.

https://www.archwired.com/phpbb2/viewtopic.php?t=52827

 It’s like all the muscles in the chin/ lip are knotted and there not enough slack to allow fluid, inhibited movement of the mouth.

Maybe it’s the suture technique, the plates/ screws, or simply nerve damage and has nothing to do with the chin being more forward.

Also it doesn’t explain why a 3 mm movement is causing this tightness, when other people routinely get much larger advancements.

[tightchinlip]

Hi ODog,

I'm the girl from the forum you linked. Unfortunately, at 2.5 years post-op, I'm still very very bothered the tightness and pain in my chin and lip. It is exactly as you have described, very uncomfortable pulling and stiffness, and causes my lips to look very off and crooked when I speak. I'm still consulting with surgeons to see what can be done to correct this, because as you can imagine, it has very negatively impacted my life. My whole surgery was a disaster but this is my biggest functional complaint. I really regret it and wish I could have foregone the genioplasty, there was really no point in having it.

I have found ways to manage it a bit better, such as taping the area or pulling a piece of hair tie between my gums, but the best method is simply not talking which is very depressing and of course  not worth the surgery IMO. Let me know if you would like to connect as we work through this.

I've tried botox with no success, so my next step is hardware removal/resuturing.

Is your tightness on one side or both?

[kavan]

Prior, didn't you say part of the reason you got the surgery was because you had speech issues?  Did it help with the speech issues you got it for or is this a thing where it just didn't resolve all of the speech issues you started with?

[ODog]

Prior, didn't you say part of the reason you got the surgery was because you had speech issues?  Did it help with the speech issues you got it for or is this a thing where it just didn't resolve all of the speech issues you started with?

It did help in some ways, yes, but now I have what *feels* like restricted movement of my lower lip/ chin. I sound like I have Bell’s Palsy. My lower lip probably isn’t moving properly because I see people looking at it while I talk. I’m going to have to see a speech pathologist and consult with other surgeons.

My chin is just so damn tight and stiff right now. I thought it was still recovering but now that my ortho said it’s probably from the chin bone stretching out the muscles, it’s actually unbearable to be honest. At least before I had the hope of further improvement/ healing.

Fml.

[ODog]

Hi ODog,

I'm the girl from the forum you linked. Unfortunately, at 2.5 years post-op, I'm still very very bothered the tightness and pain in my chin and lip. It is exactly as you have described, very uncomfortable pulling and stiffness, and causes my lips to look very off and crooked when I speak. I'm still consulting with surgeons to see what can be done to correct this, because as you can imagine, it has very negatively impacted my life. My whole surgery was a disaster but this is my biggest functional complaint. I really regret it and wish I could have foregone the genioplasty, there was really no point in having it.

I have found ways to manage it a bit better, such as taping the area or pulling a piece of hair tie between my gums, but the best method is simply not talking which is very depressing and of course  not worth the surgery IMO. Let me know if you would like to connect as we work through this.

I've tried botox with no success, so my next step is hardware removal/resuturing.

Is your tightness on one side or both?

Hey there, I’ve sent you a PM .

[ODog]

Hi ODog,

I'm the girl from the forum you linked. Unfortunately, at 2.5 years post-op, I'm still very very bothered the tightness and pain in my chin and lip. It is exactly as you have described, very uncomfortable pulling and stiffness, and causes my lips to look very off and crooked when I speak. I'm still consulting with surgeons to see what can be done to correct this, because as you can imagine, it has very negatively impacted my life. My whole surgery was a disaster but this is my biggest functional complaint. I really regret it and wish I could have foregone the genioplasty, there was really no point in having it.

I have found ways to manage it a bit better, such as taping the area or pulling a piece of hair tie between my gums, but the best method is simply not talking which is very depressing and of course  not worth the surgery IMO. Let me know if you would like to connect as we work through this.

I've tried botox with no success, so my next step is hardware removal/resuturing.

Is your tightness on one side or both?

I think you should definitely look into hardware removal. What are the surgeons saying is causing this? My surgeon, at 68 years old, said he never had a patient complain of speech issues post-op. So he isn’t much help. However, there’s got to be somebody out there who can specify what is causing the problem and what can be done about it.

[Post bimax]

Many speech pathologists work in conjunction with oral surgeons so try to find one that does. They may have more experience with that sort of thing.

[kavan]

It did help in some ways, yes, but now I have what *feels* like restricted movement of my lower lip/ chin. I sound like I have Bell’s Palsy. My lower lip probably isn’t moving properly because I see people looking at it while I talk. I’m going to have to see a speech pathologist and consult with other surgeons.

My chin is just so damn tight and stiff right now. I thought it was still recovering but now that my ortho said it’s probably from the chin bone stretching out the muscles, it’s actually unbearable to be honest. At least before I had the hope of further improvement/ healing.

Fml.

Could be nerve irritation. But I don't know much about that sort of thing. Keep on your doctor's tail to get explanation or referral.

[ODog]

Many speech pathologists work in conjunction with oral surgeons so try to find one that does. They may have more experience with that sort of thing.

Thanks that’s why my surgeon said but he wasn’t understanding my issue. He was saying since my palate is in a new position it can sound different but that was mostly when I was talking about difficulty with ‘s’ Sounds. In that case, yes speech therapy could help.

But my more general speech problems are more like those in Bell’ Palsy (facial nerve damage).
This is an accurate description: https://www.facialpalsy.org.uk/support/patient-guides/speech-talking/

“The facial nerve is responsible for movement of the lips and maintains good muscle tone in the cheeks. When the facial nerve is damaged the lips can become weak and the muscle tone in the cheek can be lost or reduced. As a result your speech may become unclear and you may feel that your speech sounds different or it feels harder to speak.

The sounds which are most likely to be difficult to make are those which involve the lips. Some examples are ‘p’, ‘b’, ‘m’, ‘f’ ‘v’ ‘w’ and ‘r’. Your speech may sound slightly different and effortful which may make you feel self-conscious especially if your work involves giving talks or presentations. Fatigue may also make speaking more difficult.”


^ that basically describes my problem perfectly, especially the difficulty with sounds where you need to purse the lips together. For example, today I completely butchered the word “remembered” and completely mumbled it, probably because it has ‘r’, ‘m’, ‘b’. I definitely sound like I have Bell’s palsy. Obviously I don’t have facial nerve damage but it’s like the nerve damage in my lower face is causing weakness of the lips/ mouth. 

[ODog]

I had a horrible week with my speech. Stuttering, tripping over words. Absolutely failing to pronounce some words completely because my lower lip mobility is just so restricted and stiff. People looking at my lower lip it’s obviously not movingly properly.

Exactly as Stiffchinlip describes it, and she’s 2.5 years out! Very depressing.

I think it might be because my chin is now too big, which is pulling/ stretching my lip/ chin too much for them to handle, causing restricted range of motion when speaking.. I bet you a vertical reduction genio would’ve mitigated this somewhat, as my chin is quite tall and forward now. Prominent I would say. Perhaps my oral muscles weren’t designed to handle a prominent chin.

That’s the only explanation I could think of. Numbness of the lip doesn’t cause speech problems, it’s just annoyance. This on the other hand is a functional handicap.

My surgery was great on the outside, and so bad in terms of the bite / functionality. This is like the complete opposite of most jaw surgery complaints.

[ben from UK]

Even 1 or 2 millimeter too much bonemovement or an implant that's one or two millimeters too big can cause this as well. Some people need big implants or big movements, but I think many surgeons just do way too much. Subtility is the key. In have a bit of the same problem with my chin (implant is slightly too big). It's not as bad as you people describe here, but there's definately a bit too much force on the muscle. It doesn't bother me a lot but I can immagine if there's speech problems etc. it's really annoying.

"I had a horrible week with my speech. Stuttering, tripping over words. Absolutely failing to pronounce some words completely because my lower lip mobility is just so restricted and stiff. People looking at my lower lip it’s obviously not movingly properly."

So annoying that people immediately react on even the slightest abnormality. Fck, as if the problem in itself isn't already annoying, you get people reacting negatively. Humanity is fcking animalistic.