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Oral Surgery/Will jaw surgery fix my problems?


I'm a 36 year-old actor whose appearance and speech are really important to me.  I had first had braces when I was 22 to treat a Class II Div 2 malocclusion (deep overbite), but I had a relapse and I'm now wearing them for a second time.  4 teeth were extracted first time round; 2 this time (however, I do have wisdom teeth which are yet to fully erupt.)  My aim is to widen my arch and make my smile wider and more prominent.

However, there are a number of related issues:

(1)  I've just realized I have a tongue thrust issue.  My 'S' sounds have always been rather slushy sounding and I'm going to see an OMT who'll give me exercises to train my tongue to sit against my top palate.

(2)  I have a slightly recessed bottom jaw which results in a less than ideal side profile.

(3)  I'm worried about yet another relapse after my current course of orthodontics.

Did the tongue thrust cause the malocclusion which, in turn, pushed my bottom jaw back?  And, assuming I retrain my tongue, would orthognathic surgery improve my profile, prevent a relapse and make retainers not quite as necessary?

Both my local surgeon and orthodontist suggest my recessed jaw is not severe enough to justify the risks.  (I've not measured it but it's perhaps no more than 1-2mm out.)  They say surgery could lead to permanent numbness and affect my speech even more. What I'm most worried about is not being able to work for 6-8 weeks!

Graham, Your tongue thrust can cause a malocclusion but did not push your lower jaw back. Orthognathic surgery would improve your profile and would not necessarily lead to permanent numbness. This was true about 5 to 10 years ago and still true with some surgeons. If you can find a surgeon who uses and has a lot of experience with lower jaw surgery without causing numbness you should be fine. When I perform lower jaw surgery, I use a piezoelectric drill to avoid damaging the nerve. Usually, my patients wake up with complete sensation of their lower jaw and some get their feeling back in approximately 3 days. The recovery time for lower jaw surgery is about 2 weeks out of work. That should be enough time if the proper hardware is used.  

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon


Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at


Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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