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Oral Surgery/Oral Surgery: where to start?


lateral ceph
lateral ceph  
QUESTION: I'm a 30 year old Asian female.

My initial complaint was my crooked teeth and lip incompetence. So first I consulted with orthodontists, nobody told me I have jaw problem till I consulted online with 6 doctors.

All of them said I have skeletal problem, maxillar vertical excess, and orthognatic surgery to impact maxillar is needed.

And one doctor mentioned I have narrow airway problem from the ceph xray. This reminds me of my difficulty breathing I always have, I always want to open my mouth big to feel at rest, and I do have difficulty swallowing liquid fast which was mentioned by my mom even when I was a kids.

It somehow made me want to relate the above to my nose problem. I have deviated septum, large terbinate on one side which was diagnosed 5 years ago, however ENT doctors didn't recommend me to have surgery to corret them although I've been suffering frequent sinus congestion, pain, headache, post nasal drips, etc.

I was also tested positive for dust mites allergy. I don't know if it's mites or my septum, once I go to my bed I got congested nose, so I always have to open my mouth big when sleeping, and find myself drooling as well as dry mouth, sore throat when wake up. I often feel not rested after long hours of sleep.

I also got bad bite from a quitted Invisialgin treatement one year ago. Now I constantly feel teeth ache and jaw pain. Dentist told me my teeth has been worn out a lot.

So now I'm really confused and worried, where should I start to seek treatment? Orthodontist, Oral surgen, or ENT doctor?What exactly is my main problem? What are the consequences of what? What should be my treatment plan?

Thank you very much!

ANSWER: Hello Xiang

You definitely have an orthognathic problem which needs straightforward treatment. From your X-ray, you have bimaxillary protrusion, vertical maxillary excess and microgenia. Your first step is to consult an Oral surgeon specializing in Orthognathic surgery, he will then refer you to an orthodontist for initial preparation prior to surgery. No ENT help is needed and septal correction will be done at the same time and will help your breathing problem by the way.

All the best,

Chawket MANNAI, DDS,Ph.D

---------- FOLLOW-UP ----------

QUESTION: Thank you! Dr. Chawket MANNAI.
I  appreciate your opinion so much and I'm going to follow your advice.
Now I live in New York City, but my families are in China. Do you think I should have the surgery in US or in China?
I mean, do you think there are skilled orthognatic surgeons in China compared with in US? And do I need families to take intensive care of me after the surgery?
Also, do you have any recommendations for oral surgeons in NYC?
Thank you very much and have a great day!

I think Chinese surgeons are skilled but I would choose  the US or Europe for experienced teams in Orthognathic surgery . You don't need family since most cases don't go to Intensive care.
YOu can contact on my behalf:

Dr. Mario Tuchman
30 Central Park South
Ste 5-C
New York, NY 10019-1628
(212) 813-1780



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Chawket MANNAI, DDS,Ph.D Diplomate ABOMS


I am a US board certified Oral & Maxillofacial Surgeon trained at UCLA and Parkland Memorial Hospital (Dallas) with more than 25 years of experience and will provide answers to all questions pertaining to the Oral& Maxillofacial Surgery region including Orthognathic Surgery, Trauma,TMJ, Implantology, tumour surgery (excluding cancer and Oral Dermatology),reconstructive surgery...


Extensive in all fields for the past 25 years hospital and office based.

American Association of Oral & Maxillofacial Surgeons American College of Oral & Maxillofacial Surgeons British Association of Oral & Maxillofacial Surgeons

2006: Mannai Chawket Early implant loading in severely resorbed maxilla using xenograft, autograft, and platelet-rich plasma in 97 patients. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2006;64(9):1420-6. Bayonne, France. 1998: Bell W H; Mannai C [An interview with Dr. W.H. Bell and Dr. C. Mannai. Interview by Colette Orival-Demange.] L' Orthodontie franšaise 1998;69(1):225-9. 1988: Abemayor E; Zemplenyi J; Mannai C; Webb D J; Canalis R F The fixation of malar fractures with the transnasal Kirschner wire. The Journal of otolaryngology 1988;17(4):179-82. Division of Head and Neck Surgery, Harbor-UCLA Medical Center, Torrance 90509. 1988: Wald R M; Abemayor E; Zemplenyi J; Mannai C; Lesavoy M A The transoral treatment of mandibular fractures using noncompression miniplates: a prospective study. Annals of plastic surgery 1988;20(5):409-13. Division of Plastic Surgery, Harbor/UCLA Medical Center. 1988: Di S; Bell W H; Mannai C; Seale N S; Hurt W C; Taylor J; Waite D E Long-term evaluation of human teeth after Le Fort I osteotomy: a histologic and developmental study. Oral surgery, oral medicine, and oral pathology 1988;65(4):379-86. Division of Oral and Maxillofacial Surgery, University of Texas Health Science Center, Dallas. 1988: Bell W H; Mannai C; Luhr H G Art and science of the Le Fort I down fracture. The International journal of adult orthodontics and orthognathic surgery 1988;3(1):23-52. 1986: Mannai C; Schwartz H C Juvenile nasopharyngeal angiofibroma presenting as a facial swelling. A case report. Journal of maxillofacial surgery 1986;14(6):329-31. 1986: Mannai C; Leake D; Pizzoferrato A; Ciapetti G; Sangiorgi C Histologic evaluation of purified bovine tendon collagen sponge in tooth extraction sites in dogs. Oral surgery, oral medicine, and oral pathology 1986;61(4):315-23.

DDS,Ph.D Fellow and Diplomate American Board of Oral & Maxillofacial Surgery Residency training:Harbor-UCLA MedicalCenter 1982-1985 Fellow OMFS Parkland Memorial Hospital Dallas Texas with William H.BELL

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