What can I do about deviated septum following orthognathic surgery? (Photos)

We have not seen a patient develop a crooked nasal appearance and nasal obstruction after jaw / TMJ / malocclusion surgery - but the exact nature of your surgery is not clear, and the septum is attached to the floor of your maxilla, so it's conceivable. Issues like "Limited opening, difficulty chewing, constant tension headaches." should improve with time, depending how far postoperative you are. If your oral surgeon cannot answer your jaw questions, get a second opinion.Insofar as your nasal appearance and breathing, consider consulting with several reputable rhinoplasty specialists so you can see what to expect. Wishing you well. Dr Joseph

When a deviated septum and crooked nose develop after upper jaw orthographic surgery, either septoplasty was not done or it was carried out inadequately.  Septoplasty, and possibly rhinoplasty, are then necessary to improve breathing and correct the nasal deformity.  To restore proper visibility of your upper teeth, upper lip shortening is an option for you.  Although I am not advocating this, repeat orthographic surgery to undo the undesired/unfavorable changes could be done.

Hello and thank you for your question and sharing your photos. You seem to have a deviated septum. You will likely benefit from a rhinoplasty and septoplasty. My best advice is that you discuss your concerns and aesthetic goals with a board-certified plastic surgeon with extensive experience in performing rhinoplasty. I would ask to see before and after pictures of their real patients. It's important that you trust your surgeon's skills and ability to achieve the results you are looking for. In particular, pay attention to your surgeon's experience with rhinoplasty. Best,
Pejman Aflaki, M.D.

Johns Hopkins-trained double board-certified plastic surgeon

Hello and thank you for your question. Based on your photographs and history of orthognathic surgery, you may benefit from rhinoplasty and septoplasty.  This can be designed to help straighten your nose and improve breathing.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system.  You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon.  If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. 
Best wishes and good luck.


Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon
 

Since the cuts to do a LeFort I osteotomy are done across the base of the septum, it is not rare to develop a new or more pronounced septal deviation after surgery depending upon the maxillary movement that was done. This is most manifest in maxillary impaction which your before and after pictures suggest is what has been done in the upper jaw part of your bimaxillary procedure. The septum and nose can be straightened and you may need to consider an upper lip lift to shorten the lip-nose distance and have a little more tooth show. Also one of the common adverse sequelae of maxillary surgery is nostril widening, which you also have, which could be narrowed in your septorhinoplasty procedure. 

 To make a diagnosis of the deviated septum requires a thorough internal examination of the back of the nose. If there's a deviated septum present along with airflow restriction, then a septoplasty can improve airflow dynamics. A septoplasty will not change the shape of the nose. To straighten the nose requires a cosmetic rhinoplasty. Be prepared to pay for the cosmetic component yourself.  Functional and cosmetic nasal surgery can be performed under one anesthesia with one recovery period.

Hi there and thanks for posting on Realself.Septal deviation is not uncommon after orthognathic surgery, because the palate and upper jaw either moves upwards or sideways or forward or back relative to the nose which remains stationary or gets dragged a little. The nose can there fore look a different and the septum may buckle.The good news is that it's fixable. A good rhinoplasty surgeon should be able to get you breathing and improve any cosmetic issues you have with your nose. Your jaw issues need to be addressed by a surgeon who does orthognathic surgery. You should return to your original surgeon or get another opinion as they sound quite debilitating. The nose is usually done after orthognathic surgery (or occasionally at the same time).I hope this helps.