Lip incompetence persisting 1 year after surgery

[northwardly]

This will be a long post, as I've tried to include all relevant info. I'm afraid I can't include photos as I'm a new user - I hope what I've described is clear enough without them. Any input would be appreciated!

Over 2 years ago, I began orthodontic treatment for a class II malocclusion and open bite. 1 year ago, I had upper (3-piece LeFort) and lower (sagittal split osteotomy) jaw surgery. Together, these significantly improved my bite, which is great.

However, what has not been fixed is my lip incompetence - I have a large interlabial gap (~8-9mm) that shows my bottom teeth, and requires mentalis strain to close. Over the course of the year since my surgery, my surgeon first attributed this issue to my muscles needing to adapt to their new position, and then, after several months in which it did not change, to my braces taking up room in my mouth. However, I recently got my braces off, and the gap is still unchanged. I'm quite disappointed, as the gap means that I have to exert effort pretty much every waking moment to hold my lips together, and breathe through my mouth when I sleep.

I'll be seeing my surgeon in a couple weeks, but due to his history of dismissing this issue, I'm interested in other feedback. Have other people been left with this issue long after surgery? Has anyone gotten it fixed? If so, how?

I also wonder why this has remained a problem. The changes my surgeon made to my upper and lower jaws seem fine - I show the right amount of gum when smiling, and my jaws fit together pretty well. The only issue with the surgery I can think of is that it didn't include a sliding genioplasty. My surgeon did originally include this in the plan he submitted to my insurance company, but they claimed my chin was pretty normal already, and refused to cover it. My surgeon agreed that it only slightly deviated from normal, and we opted not do do it. However, to me, my chin looks somewhat long and receded, and it seems logical that this might be pulling my lower lip down. On the other hand, I've read that genioplasty isn't a reliable fix for lip incompetence, and might even make it worse (e.g., due to scar tissue). So, I'm pretty unclear about what the origin of the issue is and how it could be solved. Any thoughts would be appreciated!

[jaime]

Hi there, sorry to hear you're still having issues. I had a class II and open bite as well.

In 2015, I had a one-piece Lefort I, BSSO, and a sliding genioplasty and I still have lip incompetence, too. I will probably never know exactly why, but my guess is because of the scar tissue from the sliding genioplasty. It's my lower teeth that show at rest. My gap is probably 5-6mm.

From what I understand having gone through all of this, fixing lip incompetence is tricky and not something that can be guaranteed.

I'm not sure if there's anything you can do to fix it, but I can tell you that I don't seem to sleep with my mouth open anymore even though I do have some lip incompetence. For me, that was my main concern and the surgery seemed to clear that up, so I have just left it be.

I'd be interested to hear what your surgeon says after you talk to him again.

[sarzo14]

I show my upper incisors and have lip incompetence. I show 8mm of teeth, and the surgeon is going to minimise that with a VY sutures in addition to double jaw surger where he's going to impact m maxilla for 2-3mm. Not sure how to fix it when you show your bottom teerh though.

[tdawg7669]

Just wondering if OP ever got an answer/explanation for his lip incompetence.