Do genioplastys bring the tongue forward ?

[ODog]

My surgeon had told me that moving the chin forward brings the tongue muscles forward. This is good in a case of sleep apnea. Is it just the muscles at the back of the tongue that come forward or does the entire tongue sit further forward in the mouth, as in the tip being more forward?

Becuse I imagine this could potentially cause a tongue-thrust issue and/or speech issues like a lisp. Is that possible or no?

[ODog]

Nvm I got my answer - yes genioplasty brings the entire tongue forward.

Well in my case this was very stupid. I already had an open bite pre-op probably at least partially caused by an already pre-existing tongue thrust. Secondly, he did bone burring so that the chin wouldn’t come as much forward as this wouldn’t have looked good with my labiomental fold, but the tongue would still be forward from the advancement. So my net genioplasty was 6 mm, but my tongue probably came 9-10mm forward, maybe more who knows what he did or how much he burred.

Now my tongue sits between my upper and lower teeth at night which has caused bite issues. This is new. I am now biting my tongue at night; this wasn’t the case pre-op.

I am still in braces and elastics 14 months post-op because my tongue is “getting in the way”. Also I feel like it has caused some speech issues. My tongue just feels like it doesn’t fit inside my mouth anymore. I am thinking about tongue reduction surgery so I can feel comfortable again.

My surgeon really is a gigantic moron.

[Post bimax]

I'm sorry this happened to you, I wasn't aware this was an issue. I haven't heard of a genioplasty causing issues with the tongue.

Tongue thrust does need to be addressed in cases of AOB.  I believe I have tongue thrust patterns which is part of why my bite has relapsed.  I intend to start seeing a speech therapist to address this issue when I start orthodontics again.  Maybe you should look into that.  Otherwise your bite will just open back up again.

[GJ]

Where did you see genio brings the tongue forward?
It can see how it would bring those muscles around the chin forward (i.e. tight muscles in the chin area?), but I can't see how it would bring the tongue itself forward since it's connected to the frenulum underneath the tongue, and the hyoid bone in the back. Unless those are detached and the tongue moved, I don't see how that's possible. If it moved, it's likely with the jaws moving not the genio.

[kavan]

Where did you see genio brings the tongue forward?
It can see how it would bring those muscles around the chin forward (i.e. tight muscles in the chin area?), but I can't see how it would bring the tongue itself forward since it's connected to the frenulum underneath the tongue, and the hyoid bone in the back. Unless those are detached and the tongue moved, I don't see how that's possible. If it moved, it's likely with the jaws moving not the genio.

It tightens up the genioglussus muscle (back of tongue) so that the tongue does not relax/ sink backwards during sleep as it does in sleep apnea. No idea if a genio of advancement; 'X'mm brings tongue 'X' + 'Y' mm forward though.

[ODog]

It tightens up the genioglussus muscle (back of tongue) so that the tongue does not relax/ sink backwards during sleep as it does in sleep apnea. No idea if a genio of advancement; 'X'mm brings tongue 'X' + 'Y' mm forward though.

This is what I’m unsure of. If it didn’t bring my tongue forward why would I feel like I have LESS space for my tongue when both jaws were brought forward, and my upper jaw was expanded 3 dimensionally. I never use to sleep biting on my tongue. This has caused an open bite on one side, that’s why I’m still in braces.

There was no posterior open bite in August, a few months after surgery. I think my tongue positioning opened it up over time. 

“Sliding Genioplasty surgery involves cutting the patient’s own bone of the chin, advancing it forward, and using special titanium plates to secure the bone. Some of the muscles of the tongue attach to this bone, which allows the tongue to be advanced forward a bit, subsequently creating the space needed for the patient to breathe more comfortably throughout the night.”

Well what if the patient doesn’t have sleep apnea ?

Like Jesus couldn’t he have just done a 6 mm genio and leave it at that, he decided to advance it more then burr down the extra bone? Like wtf man what kind of stupid calculation is this. I never told him I had sleep apnea. He thinks I DID have sleep apnea. All I told him was that it runs in my family. This was to get him to agree to do a BSSO, not whip up some plan to bring my tongue muscles forward lol wtf.

[ODog]

Also the fact that I bite the sides of my tongue at rest is proof that my jaws are way too narrow, even after the 3 piece lefort 1. I should have gone to Europe and had both jaws expanded first. I did this all wrong. Problem is I thought only the US had great surgeons... not true at all.

[ODog]

I'm sorry this happened to you, I wasn't aware this was an issue. I haven't heard of a genioplasty causing issues with the tongue.

Tongue thrust does need to be addressed in cases of AOB.  I believe I have tongue thrust patterns which is part of why my bite has relapsed.  I intend to start seeing a speech therapist to address this issue when I start orthodontics again.  Maybe you should look into that.  Otherwise your bite will just open back up again.

Speech therapy won’t help the fact that I bite down on the sides of my tongue at night.

Your jaws were advanced 10 mm with minimal genio, do you feel like you still have a tongue thrust?

[kavan]

This is what I’m unsure of. If it didn’t bring my tongue forward why would I feel like I have LESS space for my tongue when both jaws were brought forward, and my upper jaw was expanded 3 dimensionally. I never use to sleep biting on my tongue. This has caused an open bite on one side, that’s why I’m still in braces.

There was no posterior open bite in August, a few months after surgery. I think my tongue positioning opened it up over time. 

“Sliding Genioplasty surgery involves cutting the patient’s own bone of the chin, advancing it forward, and using special titanium plates to secure the bone. Some of the muscles of the tongue attach to this bone, which allows the tongue to be advanced forward a bit, subsequently creating the space needed for the patient to breathe more comfortably throughout the night.”

Well what if the patient doesn’t have sleep apnea ?

Like Jesus couldn’t he have just done a 6 mm genio and leave it at that, he decided to advance it more then burr down the extra bone? Like wtf man what kind of stupid calculation is this. I never told him I had sleep apnea. He thinks I DID have sleep apnea. All I told him was that it runs in my family. This was to get him to agree to do a BSSO, not whip up some plan to bring my tongue muscles forward lol wtf.

I'm also unsure and have no idea of knowing; whether or not a genio of advancement 'X' advances the tongue 'X' + 'Y'.

[notrain]

Also the fact that I bite the sides of my tongue at rest is proof that my jaws are way too narrow, even after the 3 piece lefort 1. I should have gone to Europe and had both jaws expanded first. I did this all wrong. Problem is I thought only the US had great surgeons... not true at all.

Your experience has confirmed a somewhat long standing suspicion of mine. Like you, I never had any lateral open bite issues (or any open bite at all really) before surgery, but I also developed an open bite between my 2nd premolars and 1st molars on each jaw some time after my surgery once the braces came off.

Are the sides of your tongue scalloped, i.e. can you see indentations of your teeth on the sides of your tongue where the bite is open? I do have these markings on my tongue and they appear more pronounced right after I get out of bed and almost entirely disappear during the day.

I never bite my tongue during the day, but apparently do so during sleep. You can close the bite again by extruding the teeth, but as you can imagine, this will be temporary. FWIW I did not have any genio, but a large bimax advancement and in order to facilitate that I had two premolars extracted from my lower jaw (to create enough overjet).

[ODog]

Your experience has confirmed a somewhat long standing suspicion of mine. Like you, I never had any lateral open bite issues (or any open bite at all really) before surgery, but I also developed an open bite between my 2nd premolars and 1st molars on each jaw some time after my surgery once the braces came off.

Are the sides of your tongue scalloped, i.e. can you see indentations of your teeth on the sides of your tongue where the bite is open? I do have these markings on my tongue and they appear more pronounced right after I get out of bed and almost entirely disappear during the day.

I never bite my tongue during the day, but apparently do so during sleep. You can close the bite again by extruding the teeth, but as you can imagine, this will be temporary. FWIW I did not have any genio, but a large bimax advancement and in order to facilitate that I had two premolars extracted from my lower jaw (to create enough overjet).

Lol thanks for confirming I’m not crazy. Did you bite down on your tongue at night before surgery?

I think the BSSO also brings the tongue forward, but that would be offset by your equal jaw advancement, IF your maxilla was brought forward an equal amount like mine, but I’m assuming it wasn’t? That would explain your issue right there. Your tongue was advanced more as a by-product of the BSSO than your upper jaw was. At least in your case it was I guess unavoidable. In my case, he *deliberately* did bone shaving of the chin so he could bring it forward a large amount, the primary purpose being to bring the tongue forward. He literally went out of his way to create this issue.

My surgeon was too old and scattered, too close to retirement. I told him my father had Sleep apnea and perhaps I’d be at risk for that, nothing more. After surgery he asked me if I still used my machine. Can’t make this up.

I don’t have the scalloped tongue, I don’t bite down too hard. Sometimes in the middle of the night I’ll become aware I’m doing it and have to pull my tongue back and then bite down again.



 

[PloskoPlus]

Genioplasty is supposed to open up the air way by stretching the neck muscles.  (Although some say it's bulls**t and if it does work, it does so only temporarily - the muscles slacken after a while).

[notrain]

Lol thanks for confirming I’m not crazy. Did you bite down on your tongue at night before surgery?

No, never. I had a perfect bite and occlusion before surgery albeit with my teeth heavily tilted to compensate for the big skeletal discrepancy.

I think the BSSO also brings the tongue forward, but that would be offset by your equal jaw advancement, IF your maxilla was brought forward an equal amount like mine, but I’m assuming it wasn’t?

It was not, I had 4mm upper jaw advancement and 14mm lower. I needed the upper jaw surgery mainly for widening (2 piece Lefort1) and it was brought forward a little to allow for a bit more lower jaw advancement.

That would explain your issue right there. Your tongue was advanced more as a by-product of the BSSO than your upper jaw was. At least in your case it was I guess unavoidable.

Yeah, I had a confirmed sleep apnea diagnosis before surgery and in addition to that I looked pretty bad (lower jaw was really recessed).
I'm just glad someone else had a similiar experience (like you said, thanks for confirming I'm not crazy).

[Post bimax]

Speech therapy won’t help the fact that I bite down on the sides of my tongue at night.

Your jaws were advanced 10 mm with minimal genio, do you feel like you still have a tongue thrust?

I didn't mean to diminish your experience if you took it that way.  Your issue with physical tongue space is real.

Despite my bimax I do believe I still have tongue thrust from a lifetime of repeating that muscular pattern.  Sometimes by the evening (especially if I talk a lot) I develop a faint lisp with 's' noises that is reminiscent of the speech issues I had pre-op.  I believe this is due to my tongue pushing on my incisors over the course of the day and then the retainer correcting them at night.  When I wear the Essix (thermoplastic) retainer, I can visually observe the difference in lateral open bite in the morning vs. evening.  It's less pronounced with the Hawley retainer since the Hawley does not fully correct my bite overnight.

[ODog]

I didn't mean to diminish your experience if you took it that way.  Your issue with physical tongue space is real.

Despite my bimax I do believe I still have tongue thrust from a lifetime of repeating that muscular pattern.  Sometimes by the evening (especially if I talk a lot) I develop a faint lisp with 's' noises that is reminiscent of the speech issues I had pre-op.  I believe this is due to my tongue pushing on my incisors over the course of the day and then the retainer correcting them at night.  When I wear the Essix (thermoplastic) retainer, I can visually observe the difference in lateral open bite in the morning vs. evening.  It's less pronounced with the Hawley retainer since the Hawley does not fully correct my bite overnight.

Sorry about my tone I didn’t mean to sound irritable. Speech therapy is a good suggestion, I’ll prob do it eventually.

It just bugs me when my surgeon recommends it, and ignores the fact that all of this is because my tongue is now too forward, which he deliberately sought out to achieve.

Any reasonable surgeon should do a cost-benefit analysis on every procedure... electing to move the tongue a great deal forward to cure serious sleep apnea is probably worth the trade off. Electing do the same in a patient without sleep apnea and who had a pre-existing hypoplastic maxilla and above average tongue size with obvious evidence of tongue thrust is preposterous. It literally has made that issue worse.

Maybe my expectations of people is too high. I expect people to actually care a little bit and think things through.