tongue tied procedure. anyone had it?

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mellew5000
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tongue tied procedure. anyone had it?

Post by mellew5000 » Mon Sep 15, 2014 3:15 am

Get tongue-tied to silence the snoresTongue tying may be the answer to snoring and sleep apnoea. Surgeons are now testing a new device which effectively pulls the tongue closer to the jaw bone, and opens up the airways. They say early results are promising.It's been estimated that as many as one in four adults in the UK are regular snorers and around three million people have sleep apnoea. This condition is linked with heart disease, and even stroke.Snoring and apnoea occur when the airways effectively collapse, blocking the flow of air - in sleep apnoea the flow can be cut off for up to ten seconds at a time.The brain then wakes the sufferer up with a loud snore. The noise is the result of the breath trying to get past the obstruction. Other causes of sleep apnoea can include an elongated uvula, in which case treatment is to reduce it in size. Although the tonsils and muscles in the soft palate are implicated, research shows that the tongue is the culprit in as many as 80 per cent of cases.More follows...{1}In the new procedure - which takes just 15 minutes - surgeons make a tiny incision in the side of the neck and then implant a small metal anchor-shaped device, about 1mm long, in the base of the tongue in the throat. Another metal anchor is implanted into the lower jaw bone.A thin wire connects the two anchors and a spool is turned to tighten the wire until the tongue base is moved far enough forward to make the airway bigger. The wire is then secured to the jawbone anchor. Once in place, the anchors are invisible and according to the researchers, patients are unable to 'feel' the device in their mouth.'Results with the first patients treated are very encouraging,' says Dr Evert Hamans, who is leading a trial of the technique at the University of Antwerp Hospital in Belgium.'It may become the new standard of care when treating patients with moderate to severe sleep apnoea because it is a simple procedure and adjustable according to patient need.'The new surgery - on trial in America, Belgium and Germany - is currently carried out under general anaesthetic, but is expected to be performed with local anaesthesia when the technique becomes more widely available. Conventional ways of tackling snoring and sleep apnoea at present usually involve lifestyle changes.Weight loss is the simplest treatment in those who are overweight, while other techniques include avoiding sleeping on the back and cutting out or reducing alcohol intake, and the use of prescription sleeping pills. Patients could also be given a mouthguard to keep the lower jaw and tongue in a forward position to keep the airway open. This is used to treat snoring and those with mild sleep apnoea. The most common medical treatment for sleep apnoea is Continuous Positive Airway Pressure or CPAP.The system includes a nasal mask that blows air through the nose to keep the airway open during sleep. Though it has been found to be effective, some people find it difficult to use. Other surgery options include removal of part of the soft palate, and radio frequency ablation - where an electric current is used to shrink and stiffen the soft palate to reduce the likelihood of it collapsing....... anyone had thi procedure yet?

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Sclark08
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Re: tongue tied procedure. anyone had it?

Post by Sclark08 » Mon Sep 15, 2014 3:40 am

No but I'm sure going to follow the story. I would do just about anything to get rid of cpap

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archangle
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Re: tongue tied procedure. anyone had it?

Post by archangle » Mon Sep 15, 2014 4:47 am

The original article:

http://www.dailymail.co.uk/health/artic ... nores.html

Gee, there's so much bad info in that article it sounds like a US newspaper.

BTW, it's a 2007 article, and this procedure doesn't seem to have made much progress yet.

The various kinds of apnea surgery have worked very poorly and have tended to have bad side effects.

I AM very hopeful that some simple procedure like the one described in this article does get developed and turns out to be effective. I just don't think we're anywhere close yet.

Be very careful if anyone wants to do apnea surgery on you. There are lots of chop happy surgeons out there with delusions of grandeur and visions of dollars dancing in their heads.

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49er
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Re: tongue tied procedure. anyone had it?

Post by 49er » Mon Sep 15, 2014 5:26 am

archangle wrote:The original article:

http://www.dailymail.co.uk/health/artic ... nores.html

Gee, there's so much bad info in that article it sounds like a US newspaper.

BTW, it's a 2007 article, and this procedure doesn't seem to have made much progress yet.

The various kinds of apnea surgery have worked very poorly and have tended to have bad side effects.

I AM very hopeful that some simple procedure like the one described in this article does get developed and turns out to be effective. I just don't think we're anywhere close yet.

Be very careful if anyone wants to do apnea surgery on you. There are lots of chop happy surgeons out there with delusions of grandeur and visions of dollars dancing in their heads.
I have a different take.

First of all, if you have done everything you can to optimize your therapy to no avail and dental devices aren't an option for various reasons, then it does come down to picking the best surgical option since normally, not doing anything isn't a good option long term with the exception of some cases of mild apnea. Even if the success rates aren't stellar and frankly, I think that is debatable since I haven't seen any credible research one way or another, even a low success rate would be better than not doing anything at all.

In doing research about apnea surgery even though I am not at that point where I am ready to pursue this option, the reason success rates may be low is that people are choosing surgery that is not appropriate to their situation. Many sleep surgeons seems to be in favor of sleep endoscopies which can pinpoint the blockage and hopefully narrow exactly which type of surgery might work best. However, it should be noted that Casey Li, who does alot of MMA surgeries and is highly respected, says this is not necessary so keep that in mind.

I do agree if you decide to pursue this option, you need to proceed very carefully because yes, there are surgeons who will take advantage of your desperation. Do your research and ask lots of questions. Hopefully, that will lead to the best possible outcome.

49er

aznh

Re: tongue tied procedure. anyone had it?

Post by aznh » Mon Sep 15, 2014 9:58 am

I had 2 sons who were "tongue -tied " and needed to have surgery to correct the problem so I can tell you the complications related to this. It will affect a person's ability to speak especially letters such as L, N, th,V and W. It also affects swallowing. There is NO WAY I would ever willingly have surgery to create this condition.

mellew5000
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Re: tongue tied procedure. anyone had it? 2014 update

Post by mellew5000 » Tue Sep 16, 2014 1:55 am

Mel walsh,
For sleep apnea patients, one major reason why the uvulopalatopharyngoplasty (UPPP) procedure works only 40% of the time is because tongue collapse wasn't addressed. Once you add a tongue base procedure, success rates go up to about 80%. There are a number of options for tongue collapse, but one minimally invasive way of dealing with the problem is to literally tie the base of the tongue to the midline jaw, so that it doesn't fall back while you're sleeping.

This procedure can be performed with basic operating room equipment, but a much more convenient way is to use a kit made by Influent, called Repose. It's an alternative, lesser invasive option to the standard mandibular osteotomy and genioglossus advancement (MOGA) procedure, where a rectangular window is cut in the lower midline jaw and pulled forward, which pulls the back of the tongue forward.

Essentially, a small screw is placed behind the back, bottom midline part of the lower jaw and a permanent suture is attached. This permanent suture is passed through the back of the tongue, looped around, and brought back out in the area of the screw, and tied under gentle tension (see figures below). In effect, this suspends the tongue, so it doesn't fall back when you're on your back or in deep sleep due to muscle relaxation.

This procedure can be done either though the mouth (under the tongue), or through the neck. In most cases, especially with men, an additional hyoid suspension procedure is needed, which has to be performed through the neck. Since you're already in the neck, it's much easier to place the suture through the neck, which results in faster healing and less tongue swelling. I first described this modification and recorded it on the instructional video that the company distributes to surgeons.

Potential complications are uncommon, but weakness or numbness of the tongue is seen occasionally, which usually goes away after a few weeks to months (usually from bruising). Taste changes can occur in theory, but in my experience, I've yet to have anyone report this.

If performed in conjunction with other procedures that address all the areas of obstruction, success rates can be up to 80%. The most common combination is the Repose procedure, along with a hyoid suspension, and a UPPP. If done by itself, patients can usually go home the next day, but if performed in combination with the hyoid and UPPP, you may need to stay in the hospital another 1-2 days, until you're able to swallow.
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mellew5000
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Re: tongue tied procedure. anyone had it?

Post by mellew5000 » Tue Sep 16, 2014 2:01 am

AIRvance System for Obstructive Sleep Apnea
The AIRvance™ System enables surgical treatment of tongue- and hyoid-based obstructive sleep apnea.

WHAT IT IS
AIRvance System for Obstructive Sleep Apnea
ent-repose_postop
To treat obstructive sleep apnea, the AIRvance Tongue Suspension helps prevent the tongue from falling back and blocking the airway while the patient is asleep.
The AIRvance Bone Screw System enables surgical treatment of tongue- and hyoid-based obstructive sleep apnea. Sleep disorders affect approximately 70 million Americans1,2 and have a significant impact on an individual’s health and quality of life,1,3-6 as well as his or her bed partner.7

For treating obstructive sleep apnea, there are two surgical procedures that may be performed with the AIRvance System (see below). The tongue suspension procedure can be done with or without the adjunct hyoid suspension procedure. Advantages of the AIRvance procedures include:

Quick (about 30 minutes for each procedure)
Low technical complexity
Effective8
Reversible
AIRvance Tongue Suspension

The AIRvance Tongue Suspension Procedure is indicated for the treatment of obstructive sleep apnea and/or snoring. The tongue suspension procedure can be performed with or without the adjunct hyoid suspension procedure.

The objective of this procedure is to advance and stabilize the genioglossus muscle to help prevent it from falling back and occluding the airway when the patient is supine and asleep. A small titanium screw with attached sutures is implanted in the lower mandible, then the sutures are looped through the tongue to form a hammock that suspends it.

ent-repose_hyoid
To treat obstructive sleep apnea, the AIRvance Hyoid Suspension procedure suspends the hyoid bone to help maintain an open airway while the patient is asleep.
AIRvance Hyoid Suspension

The AIRvance Hyoid Suspension procedure is indicated for the treatment of obstructive sleep apnea (OSA) and/or snoring. It serves as an adjunct to the AIRvance Tongue Suspension procedure.

The goal of this procedure is to help improve airway patency by providing anterior/posterior and lateral support of the lower airway, as well as lateral support of the base of the tongue. This is accomplished by advancing and suspending the hyoid bone and associated musculature. Two small titanium screws with attached sutures are implanted in the lower mandible, and the sutures are looped around the hyoid bone to suspend it.

*As of August 2011 the Repose® brand was changed to AIRvance.
References

Brain Facts, A Primer on the Brain and Nervous System. Society for Neuroscience, 2008.
Cleveland Clinic. Health Information: Sleep Disorders. Accessed February 10, 2010.
National Heart, Lung, and Blood Institute. Diseases and Conditions – Sleep Apnea. Accessed February 10, 2010.
Sleep Apnea. Am Fam Phys 2005; 72(7):1319-20.
National Sleep Foundation: ABCs of ZZZZs. Accessed February 10, 2010.
National Heart, Lung, and Blood Institute. Sleep Disorders Information: Problem Sleepiness in Your Patient. Accessed February 10, 2010.
Beninati W, et al. The effect of snoring and obstructive sleep apnea on the sleep quality of bed partners, Mayo Clin Proc. 1999 Oct; 74(10):955-8.
Thomas A, Chavoya M, Terris D. Preliminary findings from a prospective, randomized trial of two tongue-base surgeries for sleep-disordered breathing. Otolaryngol Head Neck Surg 2003;129(5):539-546.

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archangle
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Re: tongue tied procedure. anyone had it?

Post by archangle » Tue Sep 16, 2014 3:45 am

aznh wrote:I had 2 sons who were "tongue -tied " and needed to have surgery to correct the problem so I can tell you the complications related to this. It will affect a person's ability to speak especially letters such as L, N, th,V and W. It also affects swallowing. There is NO WAY I would ever willingly have surgery to create this condition.
aznh, am I correct that your sons had a "tongue-tied" condition from birth?

i.e. Their problems weren't caused by apnea surgery, but from some natural condition?

I think the "tongue tied" term is just bad reporting, not a description of this particular procedure. However, things like that are the sort of thing you need to worry about with surgical procedures in this part of the body.

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Nick Danger
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Re: tongue tied procedure. anyone had it?

Post by Nick Danger » Tue Sep 16, 2014 10:04 am

This surgery isn't new. It is sometimes referred to as a genioglossus advancement and is frequently done in conjunction with a hyoid advancement. I had this done 10 years ago and it had a very short term effect - it improved my apnea for a year or two, but then my AHI was right back where it was. The only speech problem I have is that I can no longer roll my r's when speaking Spanish. My front lower teeth are numb due to the surgery to cut the slot in the bone to tie the genioglossus to damaged the nerve.

I wouldn't recommend it.

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aznh
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Re: tongue tied procedure. anyone had it?

Post by aznh » Tue Sep 16, 2014 2:58 pm

Yes, my sons had the frenumum (the little tissue under your tongue) that connected the tongue almost all the way to the tip of the tongue to the base.