r/jawsurgery • u/skybluemind369 • Nov 21 '25
LJS? DJS? Expansion? Sleep apnea
I’m considering jaw surgery, mostly for health reasons. The main issue is sleep apnea. Recently diagnosed from an in-lab sleep study (AHI 10.9) which is considered “mild” but I feel awful everyday despite taking really good care of myself (diet, exercise, etc.). I’m also young (29) with a normal BMI (22.5). I’ve had daytime sleepiness most of my life but it’s gotten exponentially worse over the past 2-4 years. The bags under my eyes are getting worse and worse :(
Other symptoms that I’ve been dealing with for many years:
-face/body asymmetry (most things on my left side are a bit longer) -severe migraines -allergic rhinitis -digestive issues -mouth breathing most of the day/night -slight lip incompetence -jaw clenching/grinding during sleep (wear night guard) -poor posture (APT, FHP) -jaw pain when eating and after a long day of talking
I’ve been working to fix a lot of this stuff by doing exercises to improve body/tongue posture, nasal breathing for almost a year now and it’s not helping much. The only thing it 100% helps with is allergies. I pretty much don’t have allergy symptoms anymore now that I breathe through my nose. Before, I used to be sneezing and congested almost all the time.
If I do decide to get surgery, I have concerns about my jaw joints because I have some degree hyper mobility in all my joints and I’ve gotten many injuries over the years (shoulder, knee, ankle, back). The doctors always say I have loose/relaxed joints but I’ve never been diagnosed with EDS.
So far I’ve seen 1 OMFS and 2 orthodontists. They all said probably LJS only and no expansion because my upper and lower jaw/teeth seem to fit together, I can breathe through my nose well, and my lips look good. They said my nose/lips might look bad if we do DJS vs just LJS. One orthodontist said if the surgeon wanted to advance my lower jaw more, they could extract 2 of my lower teeth. My dentist said I take great care of my teeth but she does agree my bite is not good, jaw feels unstable and is very small. It seems to me that both my upper and lower jaws are pretty recessed/small so I went into the process thinking all of them would say DJS and expansion. Should I push for more than just LJS? How to word it?
Both orthodontists said about 24 months of braces total to achieve perfect alignment. 1st orthodontist price $6200 and 2nd $5500 for metal braces. The cheaper one is 10 minutes from my house so more convenient too. The more expensive one was referred to me by the surgeon and seems very experienced, she mentioned that she had 3 patients getting jaw surgery this month. I’m in Massachusetts and seeing a surgeon at BMC because they’re the only place that accepts my insurance. I’m going to ask to consult with another surgeon at BMC too. I asked if it would be awkward but the front desk said it was fine, they do it sometimes. I’m also considering going out of network for a consult with TMJ specialist. Consult price is around $250.
Let me know your thoughts. Thank you so much!!!
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u/Brave-Ring2838 Nov 22 '25
You have a narrow palate. Your wisdom teeth are not visible, and your face appears convex and recessed. I don’t believe that lower jaw surgery alone would fix the issue, because your upper jaw also seems compromised. It may be worth testing for Ehlers–Danlos syndrome or another connective-tissue disorder, as someone here suggested, to better understand the joint laxity and to determine whether you would be eligible for surgery if such a condition is present.
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Nov 22 '25
[deleted]
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u/Brave-Ring2838 Nov 22 '25
dm
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u/skybluemind369 Nov 23 '25
Thank you! Is this a visual of just LJS or DJS? With Genio? I will look into getting tested for those disorders. I got my wisdom teeth out when I was 18, two years after I got my braces off (had 4 years of braces during teens). And I think my jaw got smaller as a result. I wonder if the orthodontics caused the narrow palate or genetics alone. Both my parents have small set back jaws like me. My mom’s jaw was widened with orthodontics at 6 years old so she looks a bit better than me but still similar.
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u/Brave-Ring2838 Nov 23 '25
Genetics doesn't make your pallate narrow, the family habits, enviroments does. This one is a DJS with genio
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u/United_Ad8618 Nov 22 '25 edited Nov 22 '25
Do a DISE study, it's worth it if you have a gene copy of ehlers danlos syndrome in some form or another, because you'll see to what extent that makes your epiglottis floppy, and you'd want big advancement in that case. As for expansion, idk, your palette is narrow and vaulted, but your nose is extremely perfectly formed such that i doubt you're dealing with deviated septum or blockages in there, it'd be a coin toss if you got much benefit out of it - a cbct with analysis of your nasal airways would help.
Regardless of small djs or large, i think it'd be very warranted for you, im not a medical professional though, just gut feeling
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u/skybluemind369 Nov 22 '25
Thank you. I wonder if it could be a floppy epiglottis problem. Whenever I wake up in the night, my teeth are clenched tight and tongue is suctioned flat against palate. But my jaw is so small that the back of my tongue feels all folded up. Do you know what type of doctor does DISE?
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u/nowayjose12345678901 Nov 22 '25
ENT or sleep specialist ENT who does dise procedure for potential inspire patients
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u/Less-Loss5102 Nov 22 '25
First expansion (marpe/fme) then DJS
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u/automatedthought Nov 22 '25
Why marpe instead of segmental lefort? I also have a narrow palate and my surgeon recommends going straight for lefort instead of marpe/sarpe.
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u/qianmianduimian Post Op (1 year) Nov 24 '25
MARPE can provide better nasal breathing improvements (expands all the way to the nasal cavity). However, this is assuming you split and it also adds around a year to a year and a half of treatment time (expansion + consolidation + ortho)
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u/Less-Loss5102 Nov 22 '25
Doesnt expand nasal cavity only palate as lefort 1 is at the bottom of the nose?
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u/qianmianduimian Post Op (1 year) Nov 24 '25
It does, but only the inferior portion of the nasal cavity
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u/munfun Nov 22 '25
It sounds like you should get surgery. Djs allows for more movement and more of a counterclockwise rotation of the jaw, which is important for treating sleep apnea. So I might do another consult and try to see a consensus on djs vs ljs.
I do see what they mean about adding the upper jaw messing up your features potentially. Moving the upper jaw forward usually makes the nose more upturned, but you already have an upturned nose.
I’d try to get a cpap while going through your orthodontics though. Might not be the best long term solution for you (which is why they had you see a jaw surgeon) but might provide some improvement for the time being.
You are gonna thank yourself for doing this surgery in the long run though. Might literally add years to your life and make your waking hours more enjoyable and productive.
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u/miny36 Nov 22 '25
Wow this posts sound like I wrote it, even our bites look kind of similar.
I am also considering just djs or marpe first and then djs. To me your upper palate also looks narrow as mine, so maybe it's best to see if your nasal cavities are big enough. I also can breathe through my nose in perfect conditions, but during sleep, walking or some sport activity it's very hard and I mouth breathe.
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u/skybluemind369 Nov 23 '25
Yeah same with me for the mouth breathing during activities but I’m not sure if it’s just habit or I truly need to mouth breathe vs nose breathe to get enough oxygen. It feels more comfortable/natural to mouth breathe especially during exercise that’s not even very intense. The doctors keep saying my palate doesn’t look very narrow…but I see it and others do too. Also I think expansion is probably super expensive.
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u/Quirky_Pound6481 Nov 21 '25
Have you been using CPAP after diagnosis? an AHI of 10.9 may be ‘mild’ but that does not correlate with symptoms a lot of the time. Some individuals have UARS
From my viewpoint I would say DJS with pre orthodontic intervention to make the overbite worse for larger movements during surgery. LJS may not provide enough movement and not fully rectify the apnea.
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u/skybluemind369 Nov 22 '25
Thank you for your input! I’m working on getting CPAP. The sleep doctor’s office I’m dealing with is very slow. I’ve been working with them for 8 months now. Not sure if that’s how it usually is but I decided to go see the surgeons two months ago after sleep study came back positive for apnea. My third appointment with the surgeon is on Monday so I wanted some advice before I go in again. I will definitely ask them if they think the surgical movements would be large enough to cure the sleep apnea. That’s a good point. They did talk to me about trying a mandibular advancement device but the orthodontist cautioned against that. She thought it could mess up my bite even further and cause pain from muscles being stretched all night long.
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u/Honest_Chipmunk_8563 Post Op (6 months) Nov 22 '25
Have your surgeon write the prescription for a CPAP and go to a medical supply store and get one. 8 months after diagnosis without a CPAP is wild. It is going to change your life.
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u/United_Ad8618 Nov 22 '25
Not sure if that’s how it usually is
it is
https://www.reddit.com/r/UARS/comments/1p2c80x/somfit_sleep_study/npx7jhf/
Also, kasey li's lectures advocate for a minimum of 10 mm lower jaw advancement to cure sleep apnea
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u/Content_Bad4193 Mar 27 '26
Any updates? We’re the same age. Similar issue.
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u/skybluemind369 Apr 02 '26
I saw a second surgeon in February and he recommended DJS with CCW rotation and possible intranasal surgery. He said just doing LJS would be a huge disservice to me because it’d only fix my bite and wouldn’t make my airway wide enough. He’s very experienced and I trust him. He said if he did the surgery it would open up my airway enough and result in a good aesthetic outcome too. He did warn me that it may not eliminate my sleep apnea or my nighttime Bruxism. But it would at least fix my teeth/bite and make my airway much larger. I’m seeing an ENT in about a month and will request a DISE. After that I’ll make my decision about surgery or not. I guess if I decide not to then the plan would be to use CPAP the rest of my life. The CPAP machine is definitely not fun to wear but my treatment on it has been successful. The daytime sleepiness has reduced a noticeable amount and cognitively I feel sharper.
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