Jaw surgery? Sliding genioplasty? Orthodontics?

[tara121]

Hello,

I am really bothered by the asymmetry of my jaw, as one side of my mandible has grown longer than the other, causing my chin to be off centre relative to the rest of my face. I have had orthodontics in the past (removed about 12 years ago) which straightened my teeth reasonably well, however the abnormal jaw growth occurred later. I have had a bone scan which showed that my jaw is no longer actively growing so it will not get any worse. I do not have any symptoms or functional problems other than some clicking in my jaw but no pain or difficulties chewing. My bite is reasonably ok. I really just hate the appearance of the asymmetry so any surgery would be solely for cosmetic reasons.

I also feel like the midline of my teeth is off centre relative to the rest of my face (primarily my eyes and nose), however I am unsure if this is a result of the jaw deviation or a separate dental issue.

I have been assessed by an oral maxillofacial surgeon who suggested that I would get a good result with a sliding genioplasty but was unsure whether or not I would need orthodontic retreatment as well.

I would appreciate any input as to what other people think about possible avenues to address it and if it would be worth it.

See link below for photos:
https://www.dropbox.com/sh/qax5f993uwfqsco/AABw7Bzxp_8OOEcYCJoME5LAa?dl=0

[XXRyanXXL]

Your bite seems reasonably good, but I'm rather extremely bothered by the fact that a maxfac would try to mask a jaw deformity with a genio, that is poor judgment. Not only would you then have a deformed jaw, but the offset from the genio would double your problems. 
You want to correct the underlining issue, not disguise it. In your situation, braces aren't required to have a corrective jaw procedure, it's merely a way to fixate the jaw so you don't open and use it while the bone is healing.
I would seek opinions from other surgeons.

[kavan]

Your midline looks OK. One issue you have is the face is wider on the left side (right side of photo). The other issue is that the chin looks likes its going in the opposite direction; skewed to right side of face (left side of photo). Might be possible for genio to move, 'slide' chin more to the left. But the other issue could be soft tissue and perhaps addressed with filler if you want the right side to be as wide as the left.

It is hard for me to tell if your mandible, 'jaw' is longer or if it's mostly a matter of the chin being askew because there is no X ray of the actually bone structure to differentiate.

[strongjawman]

Your bite seems reasonably good, but I'm rather extremely bothered by the fact that a maxfac would try to mask a jaw deformity with a genio, that is poor judgment. Not only would you then have a deformed jaw, but the offset from the genio would double your problems. 
You want to correct the underlining issue, not disguise it. In your situation, braces aren't required to have a corrective jaw procedure, it's merely a way to fixate the jaw so you don't open and use it while the bone is healing.
I would seek opinions from other surgeons.

Why do you seem so shocked at his advice? Her jaw is barely inside the parameters of being "significantly asymmetrical" based on her photos, she has no functional problems and orthodontics proved sufficient to create a good occlusal relationship.

The risk of bimax might potentially outweigh the positives. A bimax might also exacerbate the asymmetry. I am speaking as someone who has a very similar situation to this woman.

Without an x ray or ct scan you also can't tell how far her chin is really deviated relative to the amount of mandibular overgrowth, but if the maxfac suggested a genio then you can assume he has assessed this.

Tara, I'm in a similar boat. I have overgrowth on one side, however if you check my recent thread you'll see that i had a 3D print done of my facial bones, and while I have clear asymmetry, it was also made worse by soft tissue asymmetry. Yours looks mostly boney though.

If your profile is good and you don't have a recessed/convex face, then a genio sounds like it might be a cheaper and more suitable fix imo.

[tara121]

Thanks for your thoughts everyone.

I am getting OPG Xrays done tomorrow so will be able to post photos of them then and would appreciate further input. I agree that it's hard to tell what's boney asymmetry vs soft tissue.

Strongjawman, I've added profile shots from both sides, they look relatively symmetrical to me (moreso than front view anyhow), although one side is definitely more 'defined' than the other, particularly just below my ear. I'm not particularly happy with my profile but can't really identify what it is specifically that I don't like. See link below. 

https://www.dropbox.com/sh/qax5f993uwfqsco/AABw7Bzxp_8OOEcYCJoME5LAa?dl=0

On a side note, I'm in Newcastle NSW, Australia. Can anyone recommend good surgeons in the area? I'd be happy to travel to Sydney as well. My previous consult was with Dr Ian Wilson, and I'm having consults with Dr Michael Bowler and Dr Paul Coceancig in the near future. Has anyone heard anything (good or bad) about any of these surgeons?

Thanks.

[XXRyanXXL]

kavan,

IF the OP posts xrays, both front and side and it shows abnormal growth of one side of her mandible, would you not change your opinion to NOT get a genio unless and until she gets this fixed first? There are several key factors in place here and yes I am very concerned about the advice she got, it's not just about the money or how invasive a jaw surgery can be, but there could be well other underlining issues that could cause problems down the road. If a jaw is misaligned, then there are undue stresses put on it, and it can cause it to deviate further, and by addressing a band-aid genio offset, then you got two problems now. And say she gets this (jaw deformity, if it is that) fixed in the future, then that means the genio will have to be corrected as well. My position is solid on here and will not change due to criticism that you need a correct underling skeletal relationship before going on addressing another issue to cover up for the first.

[kavan]

kavan,

IF the OP posts xrays, both front and side and it shows abnormal growth of one side of her mandible, would you not change your opinion to NOT get a genio unless and until she gets this fixed first? There are several key factors in place here and yes I am very concerned about the advice she got, it's not just about the money or how invasive a jaw surgery can be, but there could be well other underlining issues that could cause problems down the road. If a jaw is misaligned, then there are undue stresses put on it, and it can cause it to deviate further, and by addressing a band-aid genio offset, then you got two problems now. And say she gets this (jaw deformity, if it is that) fixed in the future, then that means the genio will have to be corrected as well. My position is solid on here and will not change due to criticism that you need a correct underling skeletal relationship before going on addressing another issue to cover up for the first.

Moot question. I gave her my opinion along with the reasoning of my opinion and did not do it by saying; 'I disagree with xxryan'. You gave your opinion. She may choose what ever opinion she wants. Your coming off AS IF my giving my opinion WAS TO disagree with yours or because my opinion differed from yours you need to 'defend' yourself. I don't have to read anyone elses opinion in order to give mine. Nor do I need to explain to you whether or not I would change my opinion to be the same as yours due to your concerns about the advice she got.

Also, if I have to worry that giving my opinion and giving reason behind my opinion, precipitates a defensive response like this AS IF I was offering it TO disagree with someone else, i will be disinclined to offer it to the recipients it was aimed to offer it to.

[tara121]

UPDATE:

So I saw a surgeon today for a second opinion and he has said that I have anterior mandibular hypoplasia and secondary maxillary hypoplasia, and has recommended Bimax surgery and a double sliding genioplasty to fully correct my asymmetry. He feels that it is having a small jaw that is causing my asymmetry rather than abnormal growth of the mandible. He also thinks that has resulted in 2 of my wisdom teeth not erupting due to crowding.

He painted a pretty grim picture for my future health if I were to not go ahead with surgery: severe obstructive sleep apnoea, secondary asymmetry to my length length and subsequent scoliosis, and a few other things I can’t recall.

I’m quite overwhelmed and confused. I went into process just wanted to cosmetic fix to what I thought was a relatively mild jaw asymmetry and have come out with a recommendation for pretty fully on surgery for significant health concerns. I’m struggling to know whether to trust what the surgeon has said or if he is just blowing things out of proportion to make more money from me? He’s given me an estimate of $30 000 AUD out of pocket costs for the procedure (after Medicare and private health insurance rebates).

Would be keen to hear any opinions or feedback on this advice.

[PloskoPlus]

That's a lot of money for an Australian surgeon.

[kavan]

To my ear, it reaks of poor ethics and  Kind of sounds like that jerk Coceancig who infiltrated here years back to give links to his You Tube videos with a screen name like 'ortho expert' or something like that where he HID disclosure but was eventually caught. Got a tip last year from a potential investor of that 'analize my face' dude who scammed here that Coceancig was part of that scammers network.

'anterior mandibular hypoplasia and secondary maxillary hypoplasia'. Sounds like the SOB is running SUBTERFUGE with that terminology, telling you that you will suffer severe health problems if you don't get surgery with him, SCARE TACTICS.

I wouldn't trust the guy. Get another opinion as IF you never saw that guy at all.

[PloskoPlus]

Did he say how big your airway is? Did he recommend a sleep study? Your chin throat length looks pretty good, so not sure about the sleep apnea.

[tara121]

I’ve had a sleep study in the past which showed no sign of sleep apnoea. He said he was ‘certain’ that my airway would be significantly impacted by my jaw size in the future even if it isn’t at the moment. Didn’t say how big my airway is though.

He did a front-on OPG X-ray at the beginning of the consultation but only looked at it briefly. He seemed to make most of his assessment recommendations just from looking at me visually. Didn’t even ask me to open my mouth. Not sure if this is usual or not?

[april]

Most surgeons will 100% want to examine your mouth.

Stay away from him girl.

[PloskoPlus]

I think he's snowing you.

[kavan]

I’ve had a sleep study in the past which showed no sign of sleep apnoea. He said he was ‘certain’ that my airway would be significantly impacted by my jaw size in the future even if it isn’t at the moment. Didn’t say how big my airway is though.

He did a front-on OPG X-ray at the beginning of the consultation but only looked at it briefly. He seemed to make most of his assessment recommendations just from looking at me visually. Didn’t even ask me to open my mouth. Not sure if this is usual or not?

Yes, he made most of his assessment WITHOUT ANY REFERENCE to the appropriate X-ray (profile ceph) and thereby DEPRIVING you of any information OTHER than his scare tactic prediction which basically resolved to:

'Because I'm the doctor and that's why and IF you don't provide me with the EMPLOYMENT OPPORTUNITY I'm finding for MYSELF in YOUR face, you will suffer dire health consequences in the future.'

ETA: ETA:

If you could or would get ANY of the health consequences he predicted you would get in the future, IF you didn't get surgery, then you have PLENTY OF TIME to seek out an ETHICAL surgeon. There is NO NEED to have what ever he's proposing 'now' or ASAP with HIM.