Unbearable tightness in chin

[Nebcat]

Can you clarify what you mean your jaw is "retracting" if the excercises are not done?

[kplatt2010]

Hi There,
I"m in braces 13 months post; was supposed to be out by 3 to 6 months post op. When I go for several hours wearing the bands (I'm in a box configuration); my jaw can only open up 21 to 22 tongue depressors. Once I stretch it out, I can get 24. That's just one symptom though.

The evidence of retracting is:
(a) Bottom molars tilting in (lingual direction). Based upon Dr. Google (LOL); I believe it is a lingual posterior cross bite. I did not have this prior to surgery and am not sure if it was result of surgery or after. In any case; when I wasn't stretching, it seemed to get worse when I was wearing the bands full time. Box config was supposed to pull the teeth outward (buccal direction). I swear that the teeth were actually going in instead of out when I was wearing the box bands with the first iteration of wearing.

(b) I had septoplasty/rhinoplasty six months post procedure for a severely deviated septum following the jaw procedure. I literally could not breath at all out of left nostril before surgery (septo/rhino). After surgery could breath out of both sides. Approximately 2 -3 months ago; noticed I could not breath again out of left side. When sleeping, I had to lay on right side to breath out of nose. Sinus passages seemed to collapse when laying on left side.

After a seriously long plateau with no movement with braces and an ahha moment; started stretching exercises again. Ortho troubleshooting maneuvers during plateau was to stop elastics and put heavy wire on. When we restarted the rubber bands this time; all of sudden, I can breath out of my left nasal passage. The movement that I felt in those 4 weeks was all in the front top and bottom. I felt as though the tension from the bands along with the stretching opened up the maxilla area. I would put on bands that time and literally could breath again. I could also close my lips naturally where could not before second round.

I don't think what I'm experiencing is normal or at least not typical progression. Hindsight is 20 /20 and looking back the surgeon was ill-prepared with regards to planning out the procedure ahead of time. I was told in great detail what he would do but did not actually see a diagram/picture until I saw him hang it up in the operating room. Afterwards; he told me that he had completed the procedure and then took it all down again to try and pull jaw out further. This along with history of prior genioplasty and associated scar tissue was the cherries on the sundae. I just have to muscle through this and move on.

Finding another surgeon to assume care once another surgeon has messed up on your face, is very challenging.No one wants to take on someone else's complications. I had a second surgeon from Hopkins briefly follow me for the septo/rhino procedure until I started having the pain and inability to open jaw. Then he cut me loose with the comments to follow-up with the original surgeon and he did not "do someone else's complications".

I swore that I would not go back to the original surgeon; however, I've decided that I need to see the original surgeon one more time before ortho takes off braces. I'm very nervous that they'll take a panoramic and see that hardware is loose; that's my big fear. Whatever the outcome is though; I will not go back to Brooklyn Methodist -NY-P hospital EVER..

[CloudyAngel]

OK -- so, I had my surgery on July 16, 2018 to remove a plate in my chin and 3 screws. It was SUPER EASY. I also had injections of steroids to help with the scar tissue, and I had the scar tissue resected. My chin feel SO MUCH BETTER!!!!!!!!!!!!!!
However, I am now having a similar problem in my lower lip. So, I am meeting with a local dermatologist to see if he can work with me to inject me with Steroids because my jaw doctor is in New England ..and I am in Virginia...

My advice _ DO NOT TRAVEL for jaw surgery. Regardless of how many people may tell you it's ok ....it's NOT Ok. I did it for insurance purposes, and because I thought I found a wonderful surgery.

I am concerned that he moved my jaws too forward..... In my opinion, it may be functionally correct, but not aesthetically correct...anyone else have this issue.

[kplatt2010]

OMG Cloudy Angel!! I traveled to NYC for my surgery and I'm MD. I'm so glad to hear you're doing better. Sounds like your having a good recovery.

I finally bit the bullet and reached back out to my original surgeon. Not sure if this is related to the surgery (bottom teeth slightly tilted lingually) or the ortho needs to try something different. Will see if he's willing to see me again; I believe our last interaction was very cordial.

Just out of curiosity; when you had hardware removed and injected, etc. ; did you still have on your braces? Or did they have to put you in some form of braces to stabilize after hardware removal?

I dread my own follow-up but maybe the surgeon will provide insight to the issue.

I'm so happy for you BTW!
Karla

[CloudyAngel]

So, I need to be more clear about a couple of things:

1. When I said my jaw retracts, I meant that when I don't do my jaw exercises, whatever I gained, I end up losing very quickly, and my jaw recedes back to it's original tight position....

2. I AM having tightness in the area again just under my lower lip....and the bottom portion of the lip. I am meeting with an ENT/Plastic Surgeon and Dermatologist to discuss the issue. I am also going to the ENT to try Botox for my Jaws/Massetter muscle because my jaws are EXTREMELY tight. In fact, my jaw surgeon and his resident recommended botox for me.... I will keep you posted.

[CloudyAngel]

Also, my hardware removal was not significant enough to warrant stabilization or braces. I did not have braces in, though, I am finishing up Invisalign on my bottom teeth.

[kplatt2010]

Hi Cloudy Angel,
Same here with two steps forward one step back. My surgeon contacted me back and I made an appointment to see if he has any insight as to why the lower jaw and teeth are tipping in. I looked back at my pano to see if it was present immediately after surgery and it was pretty bad. I'm going the last week in August so maybe a miracle will happen in the meantime and the tippy teeth will rotate out. Highly unlikely.

I know some folks have said having hardware out was a piece of cake and done in the office. I don't think that I could have that done as I have multiple plates and associated screws with each. Not sure if that would help in any case from listening to your feedback.

Keep us posted on your progress.

[Sara123456789]

Hi Cloudy Angel,

Thank you so much for your reply.

Would you say the chin hardware removal was worth it then? Did you have the lip tightness before or did it start after the hardware removal?
Im really scared of making this worse

Do you know what steroid your surgeon used?

Thank you

[CloudyAngel]

Hi there. The steroid that was used is called Kenalog. I think the removal of hardware has improved the situation. I would like to ask you if you have noticed that your midface was sagging at all. My face is apparently sagging... And I am visiting my jaw doctor's associate tomorrow. I am PETRIFIED.

[Sara123456789]

Thank you. Ive already asked my surgeon about kenalog and he refused for some reason. I really need to address this issue of what happens when I talk (the stiffness is getting unbearable) but its really hard to find accounts where hardware removal really did improve the issue.

I only had my lower jaw and genioplasty done. Ive noticed a witches chin which is sagging of the chin pad muscle mostly when I talk.

[kplatt2010]

HI Sara,
You know I vaguely remember my surgeon talking about Physical Therapy if tongue depressor exercises did not work. I wonder if there is such a thing?? I had PT for tennis elbow and it helped - massage, heat, and exercises. Perhaps ask about if it's really an option??
Karla

[Sara123456789]

Hi Kayla,

Thanks. I actually saw a PT. Granted he was super young so I'm not sure how experienced he was, but he didn't think PT could help. Again, its not stiff muscles around my TMJ joints, I can actually open very wide (4 fingers). Its localized stiffness in my chin and lip that gets stiffer as I speak making it unbearable to talk.

[laitholiel]

I get a lot of this as well. I had a the works -- Lefort, BSSO, and genioplasty. I had a recessed chin with a lot of mentalis strain, so it's almost difficult for me to unlearn the habit of clenching my chin to close my mouth. When I relax it, it does hang open still. The muscle was stretched so far forward that it still resists and tries to move back into it's old position. I'm three months post-op now, and after I got the bands removed I'd wake up with my mouth wide open. I started wearing a wrap around my head at night to hold it closed, which I think is helping. I've also found that I had to stay on top of exercising it frequently. Speaking frequently also *really* helps. If you don't have speeches to give at work like I did, try reading a book out loud or talking/singing to yourself. It helps to break up the scar tissue and gives you some mouth articulation back. I also massage along the place where my stitches were to directly break up scar tissue. Also, believe your doctor when she constantly keeps telling you to apply heat to your face -- it really does help to relax the muscle! I would use my heat sock and afterward massage the outside of my face (sort of following a lymphatic drainage technique).

[kplatt2010]

Hi laitholiel,
One of my PT exercises was to sing along to the radio when I'm in the car by myself. I would try to be very facially expressive when I did it so definitely by myself LOL!!

In regards to your mouth hanging open; I've always been a mouth breather and mouth would also hang open. Same after surgery until the ortho fine tuning started to come together and now my mouth is pretty much closed when I sleep.

I slept the first few months with a humidifier so my throat did not get too dry and start aching.
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Karla

[Sara123456789]

Hi

Thank you. I read outloud and try to sing all the time. It doesn't help at all. It just feels tighter and tighter and begins to physically hurt. Any movement of the lip hurts. I honestly have no idea where to go from here. I have 0 quality of life. I would rather move to a new city and just tell everyone I am mute and not talk at all then feel this constant discomfort. This has been the worst year of my life.