oral surgeon suggests major OSA surgery

[Pugsy]

Hey Pugsy, I found one fitting the information you posted about under the name of NanceK. Maybe it is the one you were thinking of...

viewtopic.php?f=1&t=68149&p=649987&hili ... ry#p633192

John

That's her. And I remember her struggles with the machine she never even came close to winning even a little battle much less the war. Not sure if what she had does was Mandibular advancement but it might have been...for sure wasn't the standard 'lets get rid of all that stuff in the back of your mouth" UPPP

[kteague]

I remember others on the forum who have been evaluated for the MMA being an option to help them. There's been extensive discussion about how narrow the airway actually is and how much might be gained from the procedure. I found the x-rays posted here fascinating. For some, the space gained is not enough to merit such a radical surgery, yet for some the airway is so restricted even cpap can't resolve the OSA, so there is little recourse aside from the MMA. For me personally, I don't think I'd subject myself to that surgery unless I'd exhausted nonsurgical options.

My brother told me of a coworker who had the MMA. They said the surgery and recovery was horrible, but that it saved their life. On the other side of it, they were glad they had done it.

[lostsheep]

I've been told I am a good candidate for MMA surgery as well (in my case factors mentioned were normal body weight, and clearly identified area of obstruction).

You would learn more by doing some googling. I have found reports of 90-95% success rate curing OSA with MMA, as well as studies showing high patient satisfaction rate with the surgery. I'm sure it depends on your own unique physiology, and whether you've been properly evaluated beforehand. I've also been admonished that it is critical to go to the best surgeon possible - preferably one who has devoted their practice to this type of surgery.

[apnea2142]

is it months of pain for the jaw surgery? I would do it I think because my OSA CSA is terrible. I'm not sure why I have this narrow airway with big tongue base

[DavidCarolina]

I post in ignornace but definitely try the oral appliances first.

Surgery is ALWAYS a last option, but for some it is the BEST option because of a desperate situation.

Do everything else first, give it six months, and do a minimally invasive thing that wont impair long term options.

[apnea2142]

there was that sad story of the neurologist on Dr. Park's site who did many surgeries and finally had to have tracheostomy to be cured but I guess you would have a tube sticking out of your neck for life
you know I really don't understand why we have to consider surgery; such a strange disease that has crippled my life so young

[kteague]

is it months of pain for the jaw surgery? I would do it I think because it seems that OSA or CSA is terrible. I'm not sure why I have this narrow airway with big tongue base

The MMA is for a specific anatomy issue where the jaw is inset. It is not an option for the other anatomical causes of OSA or for CSA.

[torontoCPAPguy]

I asked my guy what he would do if it was his wife............ "not on a bet" would he allow this massive surgery although if nothing else is working he would assemble a team of experts to render an opinion on the outcome.

This is not minor surgery as I understand it. You are laid up for weeks of healing.

I think I would work with a top notch sleep specialist and respirologist to see if there was any combination of appliances that would work for you. Once you get used to the APAP it's not so bad. I also use an oxygen concentrator as I go into very shallow breathing when in REM. Sleeping well except for my back and side pain that wakes me up at night and the narcotic pain relief I am forced to seek. I was on Oxycontin for a while and it is ten times more addictive and nasty than HEROIN. I got off that and when I told my MD's I was doing so without the use of a methadone clinic they just about had coronaries. But I did; and now I am caught between Oxycocet and Tylenol 2/3..... next step is pain management clinic. Sic. It never seems to stop around here. The pain is the result of back injuries and arthritis now creeping in. My feet "crunch" for the first ten minutes each morning.

But as far as OSA and getting a good night of sleep? You need to be proactive and get opinions and gather data so you can determine what your issues are at the very bottom line. It is quite conceivable that a mouth appliance in combination with the APAP machine will do the trick for you... or infusion of oxygen into your APAP line to keep your SpO2 up during the night; playing with pressures on your own (the docs could never keep up with me... I had to find my own mask and pressures).

Surgery? Last resort if you have nothing else to cling onto.

Anyone I have seen take the surgery route were not happy. On the other hand I have seen several with mouth appliances to adjust their jaw fit along with an APAP machine and suitable pressure and they are AHI=0 nightly and sleeping like a log.

[NightMonkey]

The oral surgeon feels very confident that maxilomandibular advancement (MMA, bilateral advancement) would cure my sleep apnea.

Note that several of the people posting are referring to UPPP not MMA. These are very different surgeries and UPPPs are know for their failure rate and permanent bad side effects.

As for the person who said they have four friends who had the surgery and it was ineffective I am sure he is confused and they had UPPP surgery. It would be very unusual to have four friends with MMA surgery because it is not (yet) performed very often.

MMAs are quite different and very effective when the candidate is selected appropriately and the surgery is done by a surgeon with a track record of success with MMAs.

I would like to comment though, that I can't imagine that having a jaw surgery would make CPAP less effective afterward. If anything, you are moving the jaw into its correct position. Logic would tell me that a mask would fit more properly.

The people telling you this are confusing MMA with UPPP. An MMA would not make CPAP less effective.



If you are as young as the person in your avatar looks then an MMA might be the very track you want to go. (I have a personal goal to have MMA surgery before I turn 30.)

Being in top shape helps with the recovery and helps deal with the pain during recovery. Youth can handle a lot that older people have great difficulty with.

The surgery is not without serious risks and there can be unwanted side effects longterm. The one that I have read about most is chronic jaw pain.

Nonetheless, you have to weigh the fantastic potential benefit over, as you said, 40 years of your life as compared to using CPAP which is rarely without significant problems and always great inconvenience.

I'm going to seek opinions from my sleep doc, dentist, possibly and ortho, and probably another oral surgeon.

You have a good plan for making the correct decision. Use the internet and keep reading. I know one person in his early forties and in only average shape who had the surgery, recovered in six weeks and was back at work, is doing fantastic and as an added bonus is more handsome!

Good luck and if you have the surgery I would personally appreciate reading in this thread about your experience.

[KrisasMan]

I would recommend a clear conversation with the surgeon regarding what they are expecting and how they define 'success'. I have a friend who is an oral surgeon and is brought in on cases involving OSA and he says they define 'success' as a 50% decrease in AHI but they often don't get it. Unless your AHI is 10 this won't get you off the CPAP.

On the flip side a 50% reduction in AHI will likely decrease your therapy pressure possibly improving your tolerance if pressure is part of your issue. This also gives you some room for increasing pressure as you age (as you age your tissues get looser and often your therapy pressure has to go up).

[SleepingUgly]

All I can offer is my experience .. and in that case, it is not my experience but experience of friends. And the situation is that none of the four people I know have had it resolve their OSA issues. And in a couple cases, it made it impossible for them to tolerate CPAP.

John, you know 4 people who had MMAs and 0 of them were cured? A 9/10 cure rate is being touted for that procedure, I believe... (although I'm not sure I believe that...)

[SleepingUgly]

I've been told I am a good candidate for MMA surgery as well (in my case factors mentioned were normal body weight, and clearly identified area of obstruction).

How did they clearly identify the area of obstruction? Through what means?

[SleepingUgly]

I have an extremely weak jaw line (recessed jaw) which causes my airway to close.

I'm not sure how "extreme" it could be, as it's not visible in your avatar. If anything, when I saw your avatar, I thought it was someone who'd had MMA posting!

[NightMonkey]

I would recommend a clear conversation with the surgeon regarding what they are expecting and how they define 'success'. I have a friend who is an oral surgeon and is brought in on cases involving OSA and he says they define 'success' as a 50% decrease in AHI but they often don't get it. Unless your AHI is 10 this won't get you off the CPAP.

Another one who is confusing UPPP and MMA!

[lostsheep]

Sleeping Ugly -

An orthodontist found my problem while looking at my bite, TMJ, etc., with what's called a cone-beam CT scan.

He measured my airway at only 30mm² in cross section, and it actually touches in the middle - sort of shaped like a figure 8. Apparently this is considered extremely restricted. He strongly encouraged me to consider corrective jaw surgery = MMA. He said that when they do MMA surgery the goal is 150mm² cross section (if I remember correctly).

This ortho is pretty high-tech, and I am so grateful that he discovered this major issue. I don't snore, and don't normally feel sleepy, so despite some family history of sleep apnea, none of my doctors suspected this. Now I suspect a connection between my small airway, past and present bouts of chronic-fatigue type illness (typically following seasonal respiratory illness!), and at times a low-level chronic cough. Yes I have a relatively small and narrow jaw.

While I'm explaining here -The ortho said that when one is young the nervous system can do a better job of holding the airway open during sleep, but with age someone like me is going to have increasing difficulty with REM stage. Everything he predicted was confirmed by a sleep study the following week. At the sleep lab I spent most time in stage 2 sleep; very little REM or deep sleep. It was explained to me that REM function is necessary to properly transition to deeper sleep stages. (Anyone who understands that, feel free to chime in.)

The sleep doc agrees that opening my airway would fix me for life - I asked the question just like that. I am way past 30, but still healthy enough to have a surgical option. I haven't decided what to do. For the near term I've been determined to "master" CPAP, but after 3 weeks I'm not feeling any better.

Whatever has caused my fatigue issues, I'm exasperated that I've spent so much time with ill health, uncomprehending fear and frustration.