Genioplasty or DJS for mild sleep apnea/aesthetic concerns? (scan attached)

[runnergirl36]

I have a mild overbite and grinding, as well as mild sleep apnea --AHI sleeping on my side was 7, then I did another sleep study and the AHI/RDI a few years later was 11/14. The surgeon said I had narrow airways, but most orthodontists I've talked to said they can't understand why I'm doing this and they think that I should just stick with the orthodontic camoflauge treatment that I was given as a child.

I'm TERRIFIED of surgery but I'm also 25 and it feels like if I don't get it now, the risk is too much as I get older. I have also seen peoples' philtrums look a lot longer after surgery, and I don't want my philtrum to look longer or my recessed tear troughs to look even worse (but not sure with the proposed movements it would make a difference).

The surgeon recommended some CCW rotation as well as about 5 mm of upper advancement and 8 mm lower advancement with genioplasty.

I was considering just doing a genioplasty because I am insecure about my lower jaws, and I like the way my upper face looks with fillers and am scared that it won't solve my sleep apnea. I'm not sure which path to go down and I'm terrified of my chances of relapsing due to my clenching and grinding.

Has anyone else done DJS due to mild sleep apnea?? Did it help you?? Do you think it's worth it for me??

[thedude]

I think double jaw surgery would probably make a big difference. I take it you’re looking at 8mm advancement at the osteotomy site plus the additional airway expansion you will get from the CCW rotation. I have to imagine that would be pretty life changing. I had sleep study numbers pretty similar to yours and even with less advancement than that (though I would have liked more!) it really changed my life for the better.

It will change your face though and those changes aren’t always that predictable. So if you’re really sensitive about your appearance it’s a little riskier proposition. The people I see that are the happiest with sleep apnea jaw surgeries are the ones that are not too critical of how they look. You kind of need to go into it with the mentality of I might look a little bit worse but it would be worth it to sleep a little bit better. Hopefully you come out pleasantly surprised but even the best planned surgeries are a little unpredictable especially when big movements like for sleep apnea.

[Tomasjohn]

I can't comment on your questions regarding jaw surgery with functional impact because I don't know much about it.

But something you have to be aware of: The position of the lower lip looks not ideal compared to upper lip. A genioplasty could emphasize that even more because the lower lip sometimes rolls in a little bit as the chin comes forward and gives more support to it.

Just a factor to keep in mind..

[runnergirl36]

I think double jaw surgery would probably make a big difference. I take it you’re looking at 8mm advancement at the osteotomy site plus the additional airway expansion you will get from the CCW rotation. I have to imagine that would be pretty life changing. I had sleep study numbers pretty similar to yours and even with less advancement than that (though I would have liked more!) it really changed my life for the better.

It will change your face though and those changes aren’t always that predictable. So if you’re really sensitive about your appearance it’s a little riskier proposition. The people I see that are the happiest with sleep apnea jaw surgeries are the ones that are not too critical of how they look. You kind of need to go into it with the mentality of I might look a little bit worse but it would be worth it to sleep a little bit better. Hopefully you come out pleasantly surprised but even the best planned surgeries are a little unpredictable especially when big movements like for sleep apnea.

How much advancement did you have? And did you get a sleep study afterwards? What happened?

[thedude]

I did around a ten mm advancement on both jaws. Also widened my upper jaw. I saw around a 50% improvement in AHI using my CPAP machine as a measuring device.

I don't put too much stock in sleep studies though as some people are actually well adapted to living with sleep apnea. Someone with a family history for sleep apnea can tolerate much more AHI than someone without a family history of sleep apnea. Also, lower jaw advancement increasingly looks to me to be more about increasing length and quality of REM sleep which in my opinion actually does more to increase quality of life than lowering AHI which seems to be more a function of the upper jaw. So, it's probable you could do the surgery, see a big improvement in quality of life and end up with a sleep study that looks pretty similar to the before. It's also difficult to judge improvement in quality of life. Life is inherently difficult and will still be that way after you have surgery. I see a lot of people that have jaw surgery that don't think it did anything, but I can often pick up on some subtle changes in how they act or how healthy they are that they cannot. So, you kind of have to have a gut feeling it's the right thing to do. It's very obvious to me just looking around that people with bigger jaws are physically healthier so I just kind of use that as my guiding principle.

A couple more thoughts on your individual case. It's not totally clear to me that if you do 5mm upper 8mm lower and CCW rotation that you would also need a genioplasty. CCW rotation increases the perceived strength of the lower face in the same way that a genioplasty does, and so does closing an overbite by advancing the lower jaw more than the upper jaw. Adding genioplasty to that might give you a little bit too strong of a lower third for a woman. I'm not certain but genioplasty is pretty easy to do as a standalone procedure later on and it really doesn't seem to do much for sleep apnea. Your chin might not be perfectly in line with your profile if you forgo it but that isn't quite as important as people think.

Also your comment on how you like filler in your midface and looking at your picture I would say you would be a good candidate for hydroxyapatite cheek augmentation or augmentation via osteotomy along with your jaw surgery. The problem is very few people do that procedure (Gunson is the only doctor I know of that does it routinely in all of his jaw surgery cases) and the traditional approach to cheek augmentation with silicon or other plastic implant material is best avoided. It's a mystery to me why that has not caught on because to my eyes properly done cheek augmentation with either an osteotomy or hydroxyapatite (which basically turns into actual bone) contributes far more to a good aesthetic outcome than just jaw advancement. Management of your nose will be a big consideration as well and will probably have a bigger outcome out how you look than your philtrum. It can get wider or become a bit more upturned. There is quite a bit of variation surgeon to surgeon on how they manage the nose.

Just some things to think about. I'm no expert so don't put too much stock is what I say. You might post on Reddit to get some additional feedback. This forum is pretty dead these days.

[kavan]

The suggestions by the doctor are in the venue of improving your sleep apnea (opening the airways) and also improving on your profile. Lower jaw is recessive and liking your midface (you say 'upper' but I think you mean midface) with FILLERS could mean there is recession there being masked by the fillers. There would be more cause for aesthetic concern IF the surgeon were offering to advance upper jaw same distance as lower jaw and NOT offering CCW. Share your aesthetic concerns with the doctor. Sometimes distance displacements can be adjusted subsequent to some preferences. However, if concerns boil down to; 'Will I like what I see in the mirror after the surgery?', that can't be answered here. Just to say, the proposal sounds to be consistent with improvements to form and function.

[ForeignCartographer]

Is teeth grinding (sleep bruxism) a contraindication for MMA?

I think the sleep-disordered breathing is probably the cause for bruxing in the first place. But what happens if the body has already made grinding habitual, even after the airway is improved? Can teeth grinding after MMA make the surgery unstable?

[runnergirl36]

The suggestions by the doctor are in the venue of improving your sleep apnea (opening the airways) and also improving on your profile. Lower jaw is recessive and liking your midface (you say 'upper' but I think you mean midface) with FILLERS could mean there is recession there being masked by the fillers. There would be more cause for aesthetic concern IF the surgeon were offering to advance upper jaw same distance as lower jaw and NOT offering CCW. Share your aesthetic concerns with the doctor. Sometimes distance displacements can be adjusted subsequent to some preferences. However, if concerns boil down to; 'Will I like what I see in the mirror after the surgery?', that can't be answered here. Just to say, the proposal sounds to be consistent with improvements to form and function.

Considering my sleep apnea is only mild at this point, do you think it would be worth it from your perspective?

[runnergirl36]

@gj would love your perspective

[kavan]

Considering my sleep apnea is only mild at this point, do you think it would be worth it from your perspective?

You may use what I said in my prior post to determine any 'worth' in question.

[kavan]

Is teeth grinding (sleep bruxism) a contraindication for MMA?

I think the sleep-disordered breathing is probably the cause for bruxing in the first place. But what happens if the body has already made grinding habitual, even after the airway is improved? Can teeth grinding after MMA make the surgery unstable?

Can be due to anxiety or stress, in which case medication or behavior therapy is used.

Night grinding needs night guard to protect teeth from getting worn down.

Having bruxism does not preclude having jaw surgery. Tell the surgeon you have it so they can accommodate with what ever modality is needed to include with pre and post surgical protocol.

[GJ]

I'm unsure on the advancement part of that plan. CCW-R, yes, that would probably create a good improvement, but I think 5mm of linear maxilla advancement is too much. 3mm max on a female with your profile is my instinct. The thing is, you have a large overjet from what I can see, and that means they can slide the lower forward quite a bit (probably 3 or 4mm right there, but get some definite numbers) before thinking about the upper jaw. You might be able to get away with lower jaw surgery only and then a genio is what I am getting at. Fix the bite's relationship with the lower jaw movement, then maybe advance and rotate the chin CCW. I'm not positive, but I'd explore that. As a female, you don't really want the maxilla touched unless it's 100% necessary for all the reasons you mentioned. Longer philtrum (not really, but it's an illusion), wider nose that men can get away with better, impaction issues (1mm minimum from the bone cut alone), etc. My overall take is to do as little as possible in your case, and to explore the option of lower only.

[runnergirl36]

I'm unsure on the advancement part of that plan. CCW-R, yes, that would probably create a good improvement, but I think 5mm of linear maxilla advancement is too much. 3mm max on a female with your profile is my instinct. The thing is, you have a large overjet from what I can see, and that means they can slide the lower forward quite a bit (probably 3 or 4mm right there, but get some definite numbers) before thinking about the upper jaw. You might be able to get away with lower jaw surgery only and then a genio is what I am getting at. Fix the bite's relationship with the lower jaw movement, then maybe advance and rotate the chin CCW. I'm not positive, but I'd explore that. As a female, you don't really want the maxilla touched unless it's 100% necessary for all the reasons you mentioned. Longer philtrum (not really, but it's an illusion), wider nose that men can get away with better, impaction issues (1mm minimum from the bone cut alone), etc. My overall take is to do as little as possible in your case, and to explore the option of lower only.

The surgeon is actually planning not to impact--he's planning to "de-impact" about a millimeter.

1. Do you think just LJS would help the sleep apnea?
2. These orthodontists haven't been very clear about what to do. Most are saying to extract my premolars so I can create as much of an overjet as possible and maybe just get away with lower jaw surgery, but I think you mentioned in another post somewhere that this can create a lack of tongue space. Others were saying interprox reduction and TADs, but that this wouldn't create as much overjet so I would have to do UJS for sure.

[mediumdrinkofwater]

How Many mm Overjet do you have exactly?

[runnergirl36]

How Many mm Overjet do you have exactly?

currently 3-4 mm.