Do you know anything about Maxillomandibular Surgery?

[phoebe368]

I have done extensive research on this surgery before finally having it done in Jan. 2010. For MMA surgery, there is a 90% chance of a 50% improvement in RDI (respiratory disturbance index). The success rate for this surgery is very misleading but is the best surgery for sleep apnea other than a trach (which I also have). I've never met anyone whose RDI was completely zero after the surgery but most people had a significant reduction. The other surgeries such as UPPP, genioglossus advancement, hyoid advancement have a lower success rate but it all depends on what is anatomically causing your sleep apnea. If you have narrow jaws, receding chin and thus a narrow airway than this surgery may work for you. However, if you have excess palatal tissue and large tongue base than the UPPP/genioglossus may better. The key to MMA surgery success is the degree of advancement of your jaws, the greater the advancement the higher your chances of surgical success. Choice of surgeon is CRUCIAL, I only know a handful who perform it well and they are all at Stanford or Dr. Kasey Li who used to be affiliated with Stanford but now has his own practice in E. Palo Alto. I've know others who had there MMA surgery performed elsewhere with much less success. After your surgery your jaws will be banded shut for 6 weeks, then you will be a soft food diet for 3 months. It will take 6 months before you can chew properly. I don't know where your doc got the 1 one week recovery period from.

[edm_msu]

phoebe368,
Your response about the long recovery makes sense. Moving both the lower and upper jaws forward 10mm would seem to need more than one week off of work.

When he said 90%, I figured he meant that the AHI would be 5 or lower, not 50% improvement in RDI.

I do not have narrow jaws or a receding chin so MMA surgery is not be appropriate for me. How did the surgery work for you?

soundersfootballclub,
The dental appliance would not cost me much as I've already paid my deductable for the year. My sleep tests that I had earlier this year would apply to the dental appliance. I just set up a consulation appointment for a dental appliance next week. The CPAP is treating my apnea well, but I'm still tired and don't want to be hooked up to a machine for the rest of my life.

Thank you to all repliers,
Ed M.

[tiredmama]

On the topic of jaw advancement....has anyone else found that a chin strap pulls their lower jaw back? I wonder if one of the reasons I have such a hard time (and horrible numbers) with a chin strap and nasal pillows is not just because my mouth is presumably leaking, but because it is pulling my jaw backwards. I can feel a definitely difference in my airway when I lay on my back with the chin strap on vs. no strap. But there is no way I can keep my mouth shut without something, so I'm using a full face mask most of the time.

[CatherineF]

I bought an oral appliance after being told by my sleep doc and sleep dentist I was a good candidate. Unfortunately it doesn't work, luckily I can at least use it as a bite guard. I doubt anything outside of CPAP is > 50% effective in treating OSA. Think about it. Your throat is most likely collapsing and possibly at multiple spots. Pulling your jaw forward isn't going to do much for us if this is the case.

I've been using mandibular advancement device also. No help, because in my case the problem was the soft palate and MAD device can do nothing to adress it.

[edm_msu]

soundersfootballclub and CatherineF,

Both of you tried the dental appliance and it did not work. You both seem to think that in hindsight that it makes sense that the device did not work for you. Why did your dentist think it would work before you got it? What criteria did your dentist use? Do you think your dentist almost always says someone is a good candidate? What does your dentist have to say now?

Thanks,
Ed M.

[soundersfootballclub]

soundersfootballclub and CatherineF,

Both of you tried the dental appliance and it did not work. You both seem to think that in hindsight that it makes sense that the device did not work for you. Why did your dentist think it would work before you got it? What criteria did your dentist use? Do you think your dentist almost always says someone is a good candidate? What does your dentist have to say now?

Thanks,
Ed M.

I think my dentist is a good salesman I actually thought it would work because I noticed a difference when just lying down and holding my jaw forward b4 I went ahead with looking into the device. I can actually notice a breathing issue normally just from lying down and still awake although this has gone away recently since I lost about 8 pounds. Unfortunately in my case there is more to my issue because I can tell I am definitely not getting a good nite's sleep when using the device. I have heard different things about the device from different docs. Sleep doc said look into it. I was recently told by my primary that I should have never bothered because it's a throat issue and he appears to be right on this one. I have read on Dr. Park's site that it can only decrease your AHI by 50% and not a cure all. I have also read it's best for those with mild OSA. I am just slipping over into the moderate side with an AHI of 18 in the lab.

[lostsheep]

You will learn more about the surgical success rate and patient satisfaction by doing general searches and looking for medical studies, government or expert publications. One thing I've noticed is that there are not many folks on this forum reporting that they've had MMA. I take it is a hopeful sign, since the idea of surgery is to give up CPAP!

To learn about the pain & recovery, try orthognathic surgery forums:
http://www.jawsurgeryblog.com/forums/
http://www.archwired.com/phpbb2/viewforum.php?f=15

There are also MANY individuals blogging on their jaw surgery, but most often I find they are doing it to address orthodontic issues. The application to sleep apnea is relatively recent; I read that jaw surgeons started to observe it clinically as an unintentional benefit. The surgeon I consulted with does orthognathic surgery exclusively, and currently has 25% of patients in for sleep apnea.

As someone previously mentioned, individuals vary on anatomical causes for apnea; you need to be an appropriate candidate for MMA. Age is not a direct limitation, but from my own consultation I can say that general health, tolerance to anesthesia, bone density, gum health and TMJ condition are some aspects that are considered. Cost can be high, and some insurance plans cover MMA for apnea, some don't.

The time delay depends on treatment goals, and mostly concerns the orthodontal aspect - the bite is being repositioned, and you'd likely have to wear braces for a while. The amount of advancement depends on the person's facial geometry.

BTW, you don't necessarily get the same advancement from an appliance, and certainly not the benefit of top jaw advancement. There are also different issues with the appliance (so far discouraging me from trying it) - potential TMJ stress & long term tooth pressure. But I was told that if the appliance works, it can provide useful info that the surgery might work.

Hope that helps.

[SleepingUgly]

Which appliances have you all tried?