And the cause of my OSA is... (Also MMA Consultation)

[Swordz]

I haven't been posting regularly because life is retarded right now w/ school and everything else. I had an MMA consultation @ UK in Lexington, KY, which is where I've gone for my Somnomed MAS as well.

To rewind to last week I must mention my 2nd appointment with an ENT. Quite amazing the doctor was both an ENT and Oral Surgeon, both from Harvard. Because of the doctors reputation, I depended on him for my thorough and complete examination. After having a fiber optic endospy, he noted that no major obstruction was found, either nasal or throat. So the uvula, tongue, palate: none are to blame for my severe apnea. After completing the endoscopy, he noted in his opinion, my apnea was becuase of my "limited throat space" and that an MMA would probably "cure my situation". After showing my several examples of patients he had worked on and their amazing drop in RDI/AHI, I feel very comfortable with the doctor's examination and his thoughts.

Because of the ENT's results of no major obstruction, and his thought of limited throat-space causing my OSA, I went ahead with my MMA/GA consultation. Within 5 minutes of the doctor walking in and looking @ my Xrays from last September when I had my MAS made, he noted, "You have severely degenerative jaw joints." What a great thing to hear @ age 23! He further studied it after I had a new panoramic jaw Xray completed, and just stated what he earlier stated. Apparently since I had orthodonics in 2002, my jaw has "stablized" but is still not in great shape. Because of this, my MMA surgery may be a little more complicated. The doctor also noted that my OSA is severe (AHI ~55/hr) and that I didn't fit the norm of severe OSA sufferers (mid-age, overweight/obese men).

The joints in question are where the mandible (lower jaw) meets the skull, and specifically the left side. I've always had minor TMJ and some popping on that side, but it has been aggravated by the use of my MAS. I basically have advanced my Somnomed until I have results with as minimal TMJ as I can stand.

The doctor was quite thorough and explained why people get MMA, and most of the info was already known because of my internet research. (What an educated patient I am!) I was not aware that with the Maxillo (top jaw) that they do what is called a "Laforte 1", where they seperate it right underneath the nose. After advancing the Maxillo, they reattach it with usually 4 L-brackets.

After also moving the mandible forward, they band, not wire, the jaw shut for anywhere from a few days to over a week. Of course this and many other factors are based on patients recovery, jaw contruction, and other factors. The surgery is quite invasive and requires a stay in ICU for a night, but its actually done quite commonly and not majorly complicated assuming an experienced physician does it.

My doctor, Dr. Van Sickle, also noted my hyoid is farther down then most peoples. I am not sure yet how this might complicate my OSA, but this is involved with reattaching the tongue forward and creating more throat space.

For now, that is the results of my latest appointments. I will probably be having pre-surgery consultation if my financial situation pans out. Being 23 and in college and tying to pay for a 12K surgery is quite overwhelming.

But at least I know what is causing my OSA, and that I have a VERY good chance of getting "cured" through the oral surgery. My doctor does several of these a week, and his results are around the industry standard of 90%+ "cure rate".

To surgery-avoiders/haters, I have extinguished my other options and I am very aware of the results/complications of such an invasive surgery. I have be studying my options and routes of treatment for almost a year now. This website has been a great resourse for help, consultation, and support. It is about dang time that I don't let this stupid disorder take another minute of my life.

I will be OSA free soon! YAY!

[Julie]

Hi, You should look into having the Laforte 1 procedure very carefully, i.e. get a 2nd opinion. It's quite a major undertaking, and while it may be the right thing for you, I would not jump in just like that (I do know well what it's about - almost had one a few yrs ago, plus have worked in the field to some extent). Would the diagnosing MD be the one performing the surg? Not suggesting you don't do it, but definitely get more info. and another panorax from somewhere else.

[sleepyred]

I haven't been posting regularly because life is retarded right now w/ school and everything else. I had an MMA consultation @ UK in Lexington, KY, which is where I've gone for my Somnomed MAS as well.

After completing the endoscopy, he noted in his opinion, my apnea was becuase of my "limited throat space" and that an MMA would probably "cure my situation".

Being 23 and in college and tying to pay for a 12K surgery is quite overwhelming.


I will be OSA free soon! YAY!

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CPAPopedia Keywords Contained In This Post (Click For Definition): RDI

Just a couple of thoughts/questions, if you don't mind swordz:

What is MMA?

When you say 12K surgery, I'd check that our very carefully. I just had some female outpatient surgery and the doctor's office said my insurance company would cover 100% of his part which was 1,800.

I just got the hospital bill and believe it or not, I was only there for 4 hours: surgery/recovery room and my bill was a whopping $7,500! Just about blew my socks off! Insurance will cover 80% of this part and that will be after they (the insurance company) "re-writes" the bill with their contracted amount.

That is interesting about limited throat space. Now I have Upper Airway Resistance Syndrome and use a low pressure of 7. But my throat was closing, not in a typical sleep apnea way, but just enough to keep me out of REM sleep.

Just keep asking good questions and I wish you all the luck in the world with YOUR decision! We all have our opinions on surgery, but Swordz, it's your body and your choice! Good luck!

[WAFlowers]

Swordz, this all sounds very promising for you. Good luck, and keep us informed of your progress.

As suggested, a 2nd opinion never hurts.

My doctor told me I was fat. When I asked for a 2nd opinion he said: "OK, you're ugly too!"

I wish my case was amenable to surgical resolution, but the doc gave me less than a 50% chance that it would "improve" (never mind cure) me. OTOH, xPAP is working very well for me, so I can't complain -- at least there is a solution.

How wonderful it would be, esp. at your age, to be told that all this could be put behind you with only one visit to a hospital!

[Sleeping With The Enemy]

Swordz,

I told you so! I've never even seen you in person but just looking at your picture I said you jaw seemed small and I thought you'd end up being a candidate for MMG.

Good luck!

Heidi

[Guest]

What is MMA surgery?

Here's a set of x-rays from this website: http://www.robotics.com/mma/

[rested gal]

Cory, from what I've read on message boards and in medical papers on the internet, you've chosen the most effective surgery (MMA-GA) of all, short of a trache, to cure OSA if a person absolutely wants off CPAP or can't use CPAP. And you've VERY wisely chosen not to go the UPPP route.

I'm well treated and content with CPAP, but if I were going to look at other methods of treatment, I'd go about it the same way you've been doing. Trying a dental device first (probably the TAP II) and adding Pillar procedure to it if dental device got me "almost there" but not quite.

In your previous posts you described well how you didn't get enough improvement with a dental device, so MMA is the right way for you to go, imho.

I suppose you've been in contact with billinseattle via email or other means. Hope so, anyway, as that man has a wealth of firsthand knowledge about MMA-GA as well as other less effective procedures. I think his MMA surgeon was Dr. Kasey Li.

You're very smart, Cory, and certainly more than capable of making your own decisions. If it were me, I'd be talking with billinseattle as much as possible, and doing a LOT of comparisons between surgeons. The technique and skill of the surgeon is going to mean EVERYTHING in how well a surgery this radical turns out.

I know money is tight for you (understatement! LOL! ) but if I were taking this kind of drastic one-big-chance-at-it step, I think I'd fly out to billinseattle's surgeon with my records and x-rays for a talk about how he'd go about it... and possibly to have him do the surgery itself.

For other readers who are puzzled about what the different kinds of surgery are, MMA is discussed in the links at the bottom of this page:

LINKS to surgery, turbinates, Pillar, TAP experiences