Your Questions

Q: Dr. Eppley,I am interested in a LeFort osteotomy. My bite relationship is significantly off, though, and I’m still wearing braces.  I’d suspect my upper jaw exceeds my lower jaw by at least 7-10 mms.  My orthodontist is under the impression that my bite relationship is fine, but I think that either extractions or upper jaw surgery would be necessary to shove my upper jaw back and even out my profile view.  I think the jaw surgery might be a better bet than a chin implant, in this case, since i like my lower jaw position but not my upper jaw position.  Do you perform upper jaw surgeries?  Could you show me an image of what an upper jaw surgery might look like, in terms of shoving my jawline back?

A: I have performed many maxillary (LeFort osteotomy) upper jaw surgeries. You can not really push your upper jaw back more than 1 to 2mms. It may go significantly up (impaction) or forward but it can not be moved any significant amount back as a total jaw unit. You may have the first premolars removed and have the pr maxilla (bone that contains the front 6 teeth) moved back by orthodontics or even by a premaxillary osteotomy but whether that is a reasonable thing to debased on your tooth relationships and facial profile is a questions for your orthodontist and their participation in integral in this process.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, my husband had maxillofacial surgery for an under bite and put cheek implants in to balance his facial features about five years ago. He has had problems with the left cheek implant moving slightly and when he blows his nose his left cheek gets swollen and you can feel bubble like things moving around implant. It has caused him a lot of pressure and pain and this happens more often. I have begged him to go to the Dr but the entire experience of the surgery has traumatized him and so I’m trying to figure out what’s wrong. Please help me try to help my husband.

A:  Undoubtably what your husband is experiencing is what one may call a ‘blowhole’ in the simplest of terms. When a maxillary osteotomy (LeFort I osteotomy) is done, the bone cut across the upepr jaw exposes the entire maxillary sinus. While most osteotomy lines experience complete bony healing afterwards, some do not particularly larger maxillary advancements and those that may have been vertically elongated. Any large unhealed bony openings allows air to escape from the maxillary sinus up into the cheek facial area, particularly when the air is forced such as blowing one’s nose. A cheek implant may be laying right next to or even over the original osteotomy line. This air being forced into and around a cheek implant (if it is not secured with a screw) make make it move slightly from the air pressure. Air into the subcutaneous tissues of the face is known as crepitus, which you more commonly call ‘bubbles’.

Thus there is a bony hole right next to the cheek implant as the culprit of all of these symptoms. This is a relatively easy problem to fix by covering the bone hole (sealing the sinus from the face) and stabilizing the implant to the bone with a screw. This is a simple outpatient procedure done under general anesthesia with minimal recovery. The only question is what to use to seal the bone hole as a variety of materials can be used to accomplish that end.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking to have corrective jaw surgery for my long face.  I don’t have an under/overbite but I do have longer face which I would like to be shortened. What are the options  available for doing this? I have attached a picture for your assessment.

A: There are two fundamental approaches to aesthetically shortening the long face. The first is a vertical chin reduction osteotomy in which only the chin length is reduced. (shortening of the lower third of the face) I have attached an imaging picture of what that may look like on you. This would be the simplest technique but it only deals with one area of vertical excess, the chin. A true long face is most people involves the entire face. The second approach, which is usually combined with vertical chin reduction, is a maxillary impaction or shortening. This requires that the patient has a vertical maxillary excess to start with as reflected in having a lot of tooth exposure and/or a gummy smile and lip incompetence. This shortens the middle part of the face which when combined with vertical chin reduction gives the maximal shortening effect. This is a more extensive approach requiring a LeFort I osteotomy and, again, requires that the patient have vertical maxillary excess. Your pictures suggests that you have that to some degree based on your tooth show/lip incompetence at rest. This is a harder area to image given that it is in the middle part of the face.

Which approach is best for any patient depends on how much vertical shortening they need and what one is prepared to got through to get what degree of shortening.

Dr. Barry Eppley

Indianapolis, Indiana