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Oral Surgery/Lip incompetence after jaw surgery/genioplasty

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Question
Hello, I am currently 2 weeks post op from having a lefort, lower advancement, and genioplasty to correct my open bite and weak chin. From the start, I was unable to close my lips together, but I was told at the time that that was completely due to swelling. Now, two weeks later, I still have some swelling, however can just barely make my lips touch. When I try, they sort of pucker up and I have severe mentalis strain in my chin, almost to the point that it hurts. My bottom lip is also significantly thinner, which I am very unhappy about.  I did some researching and found it odd that most everyone else who has had a genioplasty, had a tight bandage wrapped around it afterwords. Apparently, this is to support the muscle and avoid the mentalis from drooping.  My surgeon never used a bandage on me. There were no  bandages at all except for the two small ones on either side of my lower jaw incisions.   I fear greatly that the lack of dressing on my chin may have caused my lip incompetence, and I've been deeply depressed.  I made an appointment with my surgeon in a few days, so I will hopefully address this with him. I hope that he doesn't simply tell me to do exercises, or that it's due to swelling. I thought that genioplasties were supposed to fix mentalis strain, not cause them!  Is it common or okay to not use a genio bandage after surgery? Could this be the issue to my mentalis strain?  Thank you.

Answer
Kayla - First of all, mentalis bandages are not always used when advancing the lower jaw.  In this situation, the tissue is often tight and there is not need for a bandage.  If, however, there was excess tissue or excess bleeding, the surgeon needed to placea bandage to prevent excess buildup of blood and other fluids from the surgery.

I, of course, not being there for your surgery or viewing it now, cannot say if the treatment rendered or the planning for the surgery by the surgeon was completely correct.  Extensive and exact planning is very important to often help in defining what procedures might be necessary to allow a very successful result.  

Lip imcompetence is often due to a strain on the tissues and the muscles in the area.  Especially with an advancement, strain of the mentalis tissues occurs and that is properly planned for by complete lengthening of the tissues to form a more relaxed tissue result.  Over relaxed chin tissue and a bandage is definitely neccessary to help with the proper healing.

So what was important to facilitate a good result is a little difficult for me to determine.  You definitely need to have the surgeon explain everything related to the results.  If you do not get the answers you want, I suggest you get a second opinion from a different board certified oral and maxillofacial surgeon near where you live.

If you have additional questions, feel free to contact me again.  

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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