Lower Lip and Chin Tightness after Jaw Advancement and Sliding Genioplasty
Q: Dr. Eppley, several years ago I had double jaw surgery plus a sliding genioplasty. The jaw surgery itself created what I believe to be alignment issues with my bite, and possibly TMJ and tinnitus.
My major concern right now is that my lower lip and chin tightness, especially when talking or smiling. With my lips it’s like they were turned inward, and are stretched against my teeth. My chin was moved forward and up, and it feels as if the skin is being pulled taught against the new position of the bone and plate.
My question is, will getting the 7mm bent plate on the chin removed be enough to resolve this or should I get a revision of the chin surgery done? I don’t really care about aesthetics at this point. I just don’t want this tight feeling all the time.
My surgeon is concerned about going in and risking nerve damage. He’s not sure this isn’t nerve damage, but from what I understand nerve damage is typically numbness, not a thinner lip and tightness of the chin. It’s like wearing a chin strap when you talk.
A: As best as I can tell from your description you had a combined lower jaw osteotomy with a sliding genioplasty advancement. (the maxillary osteotomy is irrelevant for this discussion) While you did not provide the specific numbers of movement for the mandible and the chin was brought ‘up and forward’ (millimeters of movement?) I will assume that between the two there has been some substantial anterior bony movement and the chin was so done because of the severe retrusion you had where it was sitting down and back so to speak. Given the tissue tightness symptoms you are describing it is reasonable to assume that the soft tissue chin pad is very tight which will also affect the lower lip position.
Without seeing pictures and the x-rays I can only make a general comment that it is not unreasonable to think that undoing some of the bony movement of the chin may be helpful (down and back a bit) for their relief. But without knowing anything else I am certain that just removing the metal fixation plate is not going to relieve your symptoms. This is not due to the metal plate, it is a soft tissue stretch issue from how the bone underneath has been changed.
Dr. Barry Eppley