Hi,

I'm a 45 YO female with facial asymmetry to the ear, retrognathia (mostly mandibular but also slight maxillary), and mild TMD. For the past several months I have been researching orthognathic surgery and considering it (both jaws, plus a septoplasty because of deviated nasal septum, and a sliding genioplasty). My craniofacial deformity is congenital rather than acquired, as you can see the retrognathia in my baby pics.

My TMD is mild to moderate (intermittent left TMJ click and facial pain daily).

Today I saw a neuromuscular dentist, and now I don't know what to think. He said that I don't need jaw surgery, I only need to give him $4000 for "phase I" (diagnostics plus an orthotic) and then we can take it from there. He also said that I need restorative dentistry (45 seems young for this to me) because my teeth have "flat planes" (lost their ridges) and I have "dropoff" (height of teeth on either side of center drops down on lowers). That would only cost about another $50,000, which I do not have.

I have decided to just take restorative dentistry out of the equation for now. Maybe when I'm 60.....

My jaws bother me for aesthetic reasons -- I have deep nasolabial folds, deep mental sulcus, and lower lip retrusion curl -- as well as possible mild functional issues (possible mild sleep apnea; borderline sleep study to be repeated).

My concerns are that: (1) I will undergo NMD and have slight/subtle improvement in the mandible but not enough to make me happy, but then an oral and maxillofacial surgeon will say that it is not severe enough to correct. (only a few "cosmetic" maxillofacial surgeons will do mild corrections) (2) I will undero orthognathic surgery and then for some reason not be a candidate for the NMD.

The prospect of wearing an orthotic does not appeal to me one bit.

Orthognathic surgery will, of course, entail some orthodontic work pre and post surgery, which I am afraid will make my TMD worse. (The NMD works with an orthodontist but that orthodontist does not do surgical cases, and I have to use an orthodontist that the surgeon will work with anyway.) Also, I have already worn braces twice, and I am worried about root resorption.

Any comments on the above? If anyone here is in the same boat that I'm in or have been down this road before, your feedback would be most appreciated. Thanks!