Your Questions
Your Questions
Q: Dr. Eppley, Which is better for me, jaw advancement or a sliding genioplasty. I think my whole lower jaw is short and needs to be brought forward. I have attached some view pictures of my ideal result and an x-ray of my jaws from the side view. Can you tell me what I really need to give my face/lower jaw a better profile?
A: What you have is a classic Class malocclusion/dental relationship which accounts for the retrognathic lower facial profile and the associated soft tissues effects. A sagittal split mandibular osteotomy would be the ideal procedure which requires some preoperative orthodontic preparation. (as the amount of forward jaw movement is completely controlled by how the teeth fit together afterwards. Whether the amount of forward jaw movement would create the profile change you have shown would have to be determined by preoperative cephalometric tracings.It is possible that a small sliding genioplasty movement may be needed with it as well. But this can not yet be determined until the orthodontics have you prepared for surgery.
If orthodontics are not in the plan, then an isolated sliding genioplasty would need to be done to create the bony chin and profile change. Moving the whole mandible is skeletally better (as it moves the teeth and lower lip forward as well but that completely depends on orthodontic preparation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I believe I have a mentalis strain, my chin starts to dimple and looks somewhat “bubbly.” My chin looks pretty short and recedes to me , but I am happy with the size my lower jaw except for the receding and the strain. Will my lower jaw have to be wider to fix the problem or can i just simply have my jaw moved forward enough to fix the problem without having to change the size of my jaw?
A: Most mentalis strains are the result of a short lower jaw, a horizontal bone deficiency. This makes the mentalis muscle ‘overwork’ to try and achieve lip competence. Whether this is best treated by a lower jaw advancement or just a chin augmentation depends on many factors including one’s existing occlusion (bite), how horizontally deficient the chin position is and what effort one wants to put in to treating the problem. The width of the lower jaw/chin has no impact on the cause of the mentalis strain or in the treatment of it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a chin advancement done several months ago due to my severe lower jaw deficiency. I just want to ask a question. I definitely feel there has been an improvement since having the chin moved, but I was wondering what your opinion is on whether moving my jaw itself would ever be possible in my case because I still feel that my lower jaw deficiency is problematic. I would assume as an oral surgeon it is a procedure you are familiar with. I have had a lot of dental work done which definitely complicates things unfortunately, but the appearance of my lower jaw is still something that bothers me. I am currently 24 years old and have been bothered by it tremendously for years now. I do realize that jaw surgery is very costly unfortunately, but the financial realities aside, I just wanted to hear your opinion about whether it even is a possibility given the dental work I have had done in your opinion. I definitely regret not taking better care of my teeth and would do it all over again if I could because of how much of a toll this problem has taken on me.
A: In looking at your x-rays, you do have an overall lower jaw deficiency with a Class II malocclusion. Your indwelling dental work aside, the question of whether you could ultimately have a sagittal split mandibular advancement first requires an orthodontic opinion. Such orthognathic surgery requires a period of orthodontic preparation and after surgery orthodontic fine tuning. While I suspect you are an orthodontic candidate, how much time that would require and the associated costs would have to be answered by an orthodontic evaluation. This orthodontic process is the rate-limiting step for any patient considering orthognathic surgery as the jaw(s) can not be moved without it in place and having the teeth realigned for such surgery. As an cosmetic camouflage alternative, that is why you have a chin osteotomy initially.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 22 years old and am bothered by my small lower jaw. It is small with about a 1/2 inch discrepancy between my upper and lower teeth. I really dislike my profile. I had an appointment with an orthodontist last week and he recommended getting braces and then having a lower jaw advancement. This sounds too extreme to me. I was wondering if I can just get a chin implant if I’m that unhappy with my looks. If you were me what would you do?
A: Your dilemma is a classic one and the decision is ultimately affected by a patient’s age, whether they have any masticatory functional symptoms, the magnitude of the jaw discrepancy and what they are willing to go through. From a long-term standpoint at your young age, both functionally and aesthetically, you should have the combined orthodontic and jaw advancement surgery. It is most certainly not extreme and is a routinue maxillofacial surgical procedure. A chin implant, while comparatively simple and providing an immediate aesthetic benefit, would offer no functional improvement for your bite, jaw function and TMJ health.
Dr. Barry Eppley
Indianapolis, Indiana