Will A Sliding Genioplasty Provide Improvement for My Obstructive Sleep Apnea?

Q: Dr. Eppley, I am writing to get your opinion on whether I should pursue a genioplasty with you vs. jaw surgery. I have sleep disordered breathing and after having a CT scan and seeing how small my airway is — it’s only 3mm wide at the narrowest — I feel like I’m a textbook case for MMA with counterclockwise rotation. However, I’ve seen six or seven different doctors with this problem and have been essentially dismissed by all of them. I have a consultation with a surgeon coming up in October but after that I’m about ready to throw in the towel and seriously consider other options.  

I am curious whether you think a genioplasty would be able to provide enough augmentation considering how small my chin is, and whether it would make an appreciable difference in my breathing. My other concern is about the upper lip. I’m self conscious about how long and flat my philtrum is, and I’m guessing jaw surgery would help support it whereas a genioplasty wouldn’t make any difference. A lip lift would help, but I don’t want to make my gummy smile or lip incompetence any worse than it is. Would you suggest any other options?  

Thank you for any advice.

A: Thank you for your inquiry and sending your pictures and x-rays. Why you would not be a candidate for bimaxillary advancement for your OSA I can not say. But your chin can probably support a 12 to 14mms horizontal advancement. Usually if one gets above 10mms there is some modest OSA benefit as that is very similar, if not more, than a genioglossus advancement OSA procedure.

A sliding genioplasty or orthognathic surgery has no impact, positive or negative on the upper lip shape or length. That requires a direct upper lip lift approach, which if kept in the rule of thirds, will not create a gummy smile or lip incompetence.

Dr. Barry Eppley

Indianapolis, Indiana