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Oral Surgery/Lower teeth numbness

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Question
Dear dr Joel

Im 27 yrs old and im two months post op sliding genioplasty to advance my chin forward and i regain sensation in my lower lip and chin, but my lower anterior teeth is still completly numb and it feels uncomfortable, my surgeon not informed me of that, when i can regain full sensation?
My second quistion is now i have a clear step-off appeared in both sides of the mandible in the place of genio, why that happened and should i do a rivision to correct it?

Thank you

Answer
Jeje - the lack of sensation from the lower anterior teeth is not completely unusual with a sliding genioplasty.  The nerves providing sensation to the lower lip, chin and teeth are all branches of the same nerve, but different forces are applied to each of the different areas.  

Sensation from the lower lip and chin are derived from the mental nerve branch of the mandibular nerve.  The teeth are innervated by other branches.  Trauma to the nerves always occurs during surgery, but most of the time any affect is temporary.  The ends of the roots of the lower front teeth are most likely located just above the bone cut line in the chin.  With this type of bony incision, the nerves can be cut, stretched or just traumatized.  If the surgeon made the cut too high, the roots might have been cut.  So xrays of the area are necessary to determine if the roots were cut.  If not, the teeth need to be evaluated frequently to determine if the nerves and blood vessels to the teeth were affected.  If so, then the nerves within the teeth could be affected and the teeth need to be regularly evaluated to determine is nerve problems develop within the teeth.  

As far as the step, I assume the chin, when it was advanced, was left that way.  With time there sometimes can be a remolding of the bone and sometimes it does not remold.  A simple procedure can be done now to correct the situation.  A surgeon can open the area simply and place an artificial bone graft in the area and mold it to align the chin with the jaw. Minor procedure and minimal discomfort.  So a revision is not usually necessary but something can be done.  Speak with your surgeon and hopefully he knows what to do.  

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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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