Fixing my Breathing and Posture

[jawzmcgee]

Hi all --

I've been on a quest to fix my posture, breathing and fatigue symptoms for years now.

Late 20s.
I am chronically fatigued (and use adderall to compensate), despite sleeping enough and mouth taping (used to mouth breath/drool at night).
I have a forward head posture (that seems at least partially due to the tightness of all of my secondary breathing muscles: SCM, scalenes, pec minor, traps).
I have an (improving) anterior pelvic tilt with associated back pain.
I have been looking into jaw surgery as a possible root cause for why it has been so difficult for me to fix these issues, and why even as a young kid I was always tired.
Other symptoms: Cold hands/feet, long face, very noticeable adam's apple, narrow nose that tends to get stuffy especially if I sleep on my left side or if I am face down (such as during a massage), tight calves, high arched feet, chronic overactive upper traps. Anxiety (I think it's in part due to feeling like I can't easily breathe).
Additionally, I get easily out of breath (despite being in excellent physical shape 190lbs/6'2", lean, work out 3-5 times a week). I regularly either yawn or take automatic big inhales throughout the day.

My MaxFac surgeon said from my ceph my airway looks to be ~5mm diameter which he thinks is small for someone of my size and that I have both recessed maxilla and mandible. He recommended MMA but only after a positive sleep study (TBD). My ortho says my jaws are slightly narrow. I personally find my tongue to not fit inside my teeth, it does not fit in the roof of my mouth without overlapping my molars, and in resting position is folded up against my front teeth.

Ceph: https://imgur.com/a/njvoaqF

I have already done a lot of the things that are suggested to address these issues:

• Foam Rolling / lacrosse ball /etc.
• Stretching
• Diaphragmatic breathing exercises
• YTWLs / Wall angels (These are all too hard for me to do for more than a few reps / short holds, despite being very strong otherwise)
• Core exercises (anti-rotation, anti-extension and hip extension)

I also regularly try to remind myself to tuck my chin throughout the day, and every time I do it I feel a clicking (non-painful) of the muscles in my throat/front neck. Trying to swallow when in a chin tucked/neutral position is very uncomfortable. I basically have to have a forward head posture to swallow comfortably.

I am very hesitant to go through with the MMA because:

• Significant risks
• I'm not unhappy with my aesthetics, even if my long face and small jaws could be improved
• Not sure if it would fix my two biggest problems: Posture and Fatigue/Breathing

Anyone had similar problems / considerations? Anyone been able to solve these problems? Does the surgery make solving these problems easier?

[kavan]

Sounds like and looks like your a candidate for jaw surgery.

[jawzmcgee]

Thanks Kavan,

Do you mind elaborating why you think this? Is it simply that you see the ceph and agree with the surgeon that the airway is narrow and can be enlarged? My worry is that the enlarged airway wouldn't solve the problem and I've had needlessly injured myself.

What do you see in my ceph?

[kavan]

5mm diameter for airway is very small and your breathing woes could be from sleep apnea. ceph also shows double jaw recession. the surgery opens up the airway for better breathing.

ETA: the jaw surgery moves (part of) your head (your face) forward for you so you don't have to hold your head forward to breath.

[jawzmcgee]

Do you know of any alternatives that are known/proven to fix this in a less risky manner?

[kavan]

no and this isn't a 'NOT jaw surgery' forum. It's a jaw surgery forum.

[GJ]

no and this isn't a 'NOT jaw surgery' forum. It's a jaw surgery forum.

Sometimes no surgery is the best option, though.

But in this case, it sounds like the physical problem of breathing would make it worth it. How is your bite? It looks a bit open in the front.
You have an ethic nose that will likely straighten (the hump), and the nostril base will widen a bit.

Your case looks like a classic CCW case. Rotate CCW to flatten your bite plane, and then make up the rest, if any, via the chin.

Sounds like your surgeon is smart and has your best interest in mind in recommending a positive sleep study first. I agree with that. From your prior posts, it sounds like you're using Kaiser -- I've heard of some bad stories there, so that gives me pause. PM me the surgeon if you would.

[kavan]

Sometimes no surgery is the best option, though.

But in this case,it sounds like the physical problem of breathing would make it worth it. How is your bite? It looks a bit open in the front.
You have an ethic nose that will likely straighten (the hump), and the nostril base will widen a bit.

Your case looks like a classic CCW case. Rotate CCW to flatten your bite plane, and then make up the rest, if any, via the chin.

Sounds like your surgeon is smart and has your best interest in mind in recommending a positive sleep study first. I agree with that. From your prior posts, it sounds like you're using Kaiser -- I've heard of some bad stories there, so that gives me pause. PM me the surgeon if you would.

Yes. I told him it sounded and looked like he would be a good candidate for jaw surgery and basically why that was so. I don't see any avoidance of it by the other things he mentioned being a good substitute.

[jawzmcgee]

My bite is technically normal, slight overbite. It does feel uncomfortable to fully bite down, my facial muscles get really tense from it. My lips close just fine, and I would say that my bite seems to be closed, even if only by a little bit with mouth closed, at rest, teeth not touching.

I found that I have pretty much all the symptoms of UARS (ADHD, fatigue, low blood pressure, GERD, unable to sleep on back, anxiety, etc.), despite two ENTs not seeing anything of note during an endoscopy. Going for a consult with a well known sleep ENT in LA Dr. Zaghi for which I am paying out of pocket ($350) to get his opinion before I move forward with DJS.

Definitely seems like I need to do something, and I would rather do MMA which would be over and done with in ~1 year (ortho says my teeth aren't bad so I could do 6 months of braces before and after surgery), compared to these slightly less invasive options that may not have the same success rate or be covered by Kaiser..

Edit: I should mention I initially went in for a consult on the MSE appliance, an that ortho recommended surgically assisted MSE to expand by 10mm (possibly twice if I get screw drag...) in combination with a face mask for 2 years to pull the jaw forward (wear at least 14 hours every day or risk it not working!). The maxfac surgeon said it was kind of an absurd recommendation. His recommendation (preliminary) is MMA + CCW rotation.. says possibly need to extract teeth which I hope to avoid..