Can't Breathe After Jaw Surgery | Post-surgical Sinus Obstruction

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.


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.

 Robert Pincus MD
Co-Director NY Sinus Center