Orthognathic Surgery and Mouth-Breathing

[LLJ]

Hi all,

I have recently been researching the negative health effects of mouth-breathing. As far as I recall, I have always found it more comfortable to breathe through my mouth (I am now 24). This is particularly the case when I go to bed; I just find it too uncomfortable to close my mouth and breathe through my nose.

I will soon be having a BSSO and genioplasty. I have a class II malocclusion. Is this surgery likely to remedy my breathing issue? I mentioned in a previous thread that I have a slightly gummy smile, and that my ortho and surgeon have nonetheless told me that they would not recommend a Le Fort I because they don't think the problem is sufficiently substantial. My worry is that after recovering from a mere BSSO and genioplasty, I will find that I still struggle to breathe through my nose, because the issue is in fact with my maxilla.

I note that, for example, in this analysis, it says 'Airway obstruction and mouth-breathing are often found associated with Vertical Maxillary Excess, both of which usually resolve after surgery.' (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805729/). I have seen on other areas of the web that difficulty with nose-breathing is often caused by a defect in the maxilla.

I have not yet seriously brought this breathing issue up with my ortho or my surgeon, so will do so when I next see one of them. You can find the thread where I talk about the aforementioned discussion I've had with my ortho and surgeon about my maxilla thus far here:

http://www.archwired.com/phpbb2/viewtop ... 15&t=51099

Do you guys have any advice for me?

Thanks, and best wishes.

[shortcircuit]

I would definitely discuss this with your ortho and OMS, however there are other factors that can cause difficulty with nasal breathing (deviated septum, nasal polyps, etc.) that jaw surgery won't necessarily address and you don't want to incur the additional risk of nerve damage, etc. without being sure that the problem is actually caused by skeletal issues. You may have to see an Ear, Nose, and Throat specialist to actually pinpoint the cause.

I have the exact same issues you do with nasal breathing, especially at night, however my problem is a class III with a very narrow upper jaw. Even though I am going to need quite a bit of expansion sooner or later, my ortho wasn't willing to guarantee any improvement in nasal breathing beyond it being "possible."

[snapdresser]

Is this surgery likely to remedy my breathing issue?
...
Do you guys have any advice for me?

As to your first question, I agree with what shortcircuit said. Mouth breathing can be caused by a narrowing of the airway at any point from the base of your tongue all the way up through your nose. A BSSO and genio would address a skeletal (and to some degree soft tissue) issue that's reducing your airway at the base of the tongue. If your airway constriction is higher, at the back of your soft palate, then a Lefort osteotomy and/or UPPP would better address the issue, depending on whether your bone structure or your soft tissues are to blame. If the constriction is in your nose (due to allergic rhinitis, enlarged turbinates, deviated septum, etc.) then some work on your nose would be more fitting to address the issue. How do you know where the constriction is? 1. Your ENT will do a nasopharyngoscopy to take a look and make a good guess on the culprit. If it's nothing wrong with the interior of your nose, he might send you to a maxillofacial surgeon for further diagnosis. 2. Your surgeon will image it (see the example I attached, which is high-tech but your surgeon would do a basic arithmetic version to calculate your airway sizes), determine where the constriction(s) are, and recommend a surgical treatment. It sounds like you've already met with an ENT to rule out issues in your nasal passage, and your surgeon believes your constriction is at the base of your tongue. If you think that might not be the case, ask your surgeon for an explanation of their diagnosis and if they can confirm where they think your constriction is, or go to another surgeon for a second opinion. Good luck!

[madblogr]

Add me as another with similar breathing issues. I have been lucky enough to work with an orthodontist who did his research on breathing issues caused by jaw structure and teeth alignment and was able to refer me to an excellent surgeon as well. I have also been a mouth breather especially when sleeping due to nasal breathing issues. If I tried to keep my mouth closed during sleep it would feel like I was suffocating. I also snored quite loudly/forcibly and was always fatigued. I had a narrow upper jaw (14mm at 5s lingual) and just went through SARPE to expand it. We added 17mm just in expansion and probably a couple more now in adjustments to molars while pulling them into alignment. During surgery, they were unable to nasally intubate me as they found I hand narrow passageways too.

As part of treatment I had to have a sleep apnea diagnosis and had well over 90 episodes per hour Since SARPE, I very rarely snore now and when I do, it is a soft snore. I also am waking up less fatigued and have more focus. Plus I'm finding it easier to breath through nose both day and night although my mouth tends to still want to fall open while sleeping. I'm currently using a CPAP machine due to the diagnosis and will be re-evaluated again in Summer, 2017 after I've had my next jaw surgery (MSDO) and teeth are more aligned. Fingers crossed that with just these two surgeries, most issues will be resolved for me and I won't have to continue using the machine at night. With the amazingly positive results from just the SARPE, I continue to be optimistic. Otherwise surgeon has recommended MMA but only if needed.

I do still feel some restriction in one nasal passage which I'll probably need to have an ENT look at since it could be something higher up than upper jaw. Good luck with finding the solution that works for you!