Q: Dr. Eppley, I had my jaw fractured and repaired several years ago. Even though it is fully healed, it has never been quite right. I have attached multiple photos. When my jaw is relaxed, my bottom teeth show fully. I don’t know off hand what type of mentalis muscle resuspension surgeries were done. However, both were done making use of screws but the first one made use of multiple screws. That one completely failed after about 4-6 months. The second one which I underwent only about 3 months ago, the surgeon removed the other screws and used only screw where he went in under the chin with small incision and also sewed the soft tissue below the bottom lip to my inside gumline. where I have a dental bridge and no teeth blocking (also as result of trauma). Both of these surgeries seemed to focus on central part of the chin and muscle.
The lower right side where mandible was most severely fractured and had the most work done to it seems to be where the suspension needs to be done and muscle reattached. Left side is now and always has been slightly higher than right leaving smile looking crooked and chin with no definition but just hanging below. It looks as if I have a much larger chin or even an implant when in fact it’s just unattached muscle hanging. However, it’s more than just the looks but the sensation and placement of nerves as both times recently after resuspension, it feels good and right and then after time goes by and starts slipping again then feels as if I am sucking on my lower jaw because the muscle has slipped below chin and lower teeth and jaw gives feeling as if further inside my mouth (If that makes any sense).
Do you think there is anything that can be done to attain a semi permanent resolution to this matter that has plagued me for the past two years or am I stuck with what I have currently? I don’t want to keep undergoing more surgery for no added benefit but just to accumulate further edema and added scar tissue.
A: The low hanging lip, regardless of the cause, is always a difficult problem to correct. Having had two ‘failed’ attempts at chin pad/mentalis muscle suspension is not an encouraging history and would suggest that any further efforts would meet a similar fate. You have even had the ultimate mentalis resuspension surgery procedure which is only possible when there are no teeth in the central alveolus. With that not working, there are no other suspension techniques available. I didn’t see mention of a V-Y mucosal lip advancement with the suspension although this alone is not the magical missing piece.
The right side of the chin/jawline issue is not really a muscular problem as there are no significant muscles that attach there. It is a soft tissue sag although not muscular per se. That is a difficult area to try and reattached because of the mental nerve and the potential of any existing metal hardware in the area. Do you have any x-rays that show the lower jaw and the repaired fracture?
Dr. Barry Eppley