Question: I can’t breathe after jaw surgery. I had upper and lower orthognathic surgery two years ago which involved cutting into my sinus area. My surgeon found polyps and removed them. Ever since my jaw surgery my sinuses (near the bridge of my nose) have been congested. I can’t breathe out of my nose very well and my left ear feels blocked and pops often. This sinus pressure leads to headaches about 5 times a week. I have been prescribed various antibiotics, nasal sprays, and sinus irrigation – nothing seems to help. I have had a CT scan and an MRI and nothing seems to look abnormal to my surgeon and two ENT doctors that I went to see. My surgeon said all he saw was that my ethmoidal sinuses seemed like debris from the surgery had settled in them, but the ENT said he didn’t agree.
Answer:
I wish I could easily answer your question. There are many different possible causes for why you can’t breathe after jaw surgery. As you know, upper orthognathic surgery may cut through the maxillary (cheek) sinuses or even through the ethmoid sinuses (near the eyes- Leforte III type osteotomies). Orthognathic surgery is done on the bones of the upper and lower jaws, usually by an oral surgeon, to better align the bite and/or to improve ones facial appearance where the lower and upper jaws are too small or too big. While not usual, sinus problems can ensue from this with the best of surgeons. I would think, however, that such a post-surgical sinus obstruction or drainage issue should be found on your sinus films.
One thing that may be more easily overlooked is the development of a nasal valve stenosis or narrowing- The nasal valve is just above the nostrils, where your nose opens and can lose support from surgery or other cause.
This can be diagnosed by pulling out on your cheek, just where it joins the nose inferiorly- and seeing whether that improves your symptoms. The subtle anatomy there can be changed from surgery or other causes and give you nasal obstruction- and be overlooked. Breathe-rite strips may temporarily improve one’s symptoms in this case.
Of course, there are other possibilities that may be unrelated to the surgery- including recurrence of polyps or new sinus problems –
We would be happy to see you here in the sinus center. If you can come in, please bring your most recent sinus CT scans, and earlier ones as well if available.
Frequently Asked Questions
Nasal congestion and breathing difficulties after orthognathic jaw surgery may be caused by changes or damage to the sinus areas involved in the procedure, such as the maxillary or ethmoid sinuses. Additionally, nasal valve stenosis, a narrowing near the nostrils that can occur post-surgery, may cause obstruction. Sometimes the cause may not be visible on imaging, requiring further specialist evaluation.
Nasal valve stenosis is a narrowing of the nasal valve area just above the nostrils that can cause significant nasal obstruction. It may result from surgical changes that reduce support in this region. This condition can be overlooked because the anatomy changes are subtle but may be tested by manually pulling out on the cheek to see if breathing improves.
CT scans and MRIs may not detect subtle anatomical changes such as nasal valve stenosis or minor debris in the sinuses that do not significantly alter imaging appearance. Some post-surgical obstructions are functional or due to soft tissue changes that are not evident on imaging, requiring clinical examination and specialist assessment for diagnosis.
Treatments typically include antibiotics, nasal sprays, and sinus irrigations to address infections or inflammation. In cases of nasal valve stenosis, mechanical aids like Breathe-rite strips may provide temporary relief. Persistent symptoms may require further evaluation to consider surgical or medical options tailored to the specific cause.
Yes, ear symptoms such as blockage and frequent popping can be connected to sinus congestion and nasal obstruction. These issues may affect the function of the Eustachian tube, which regulates pressure in the middle ear. Persistent sinus problems can lead to ear pressure and discomfort.
While sinus complications typically arise soon after surgery, it is possible for issues like debris, scar tissue, nasal valve narrowing, or recurrent polyps to cause symptoms later on. Continuous monitoring and evaluation by an ENT specialist or sinus center can help identify late-onset problems.
If you have ongoing sinus symptoms post-surgery, consult an ENT doctor or sinus specialist who can review your imaging and perform a thorough exam. Bringing your previous sinus CT scans to the appointment is helpful. They can assess less obvious causes such as nasal valve stenosis or recurrent sinus pathology and recommend appropriate treatment.
