Which surgeon to see?

[balor123]

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[LSAT]

Personally, I would see NONE OF THE ABOVE. I have seen no indication that any surgery stops sleep apnea. Some people on this board that have had surgery, have seen a reduction in their symptoms but still require CPAP to eliminate them. From what I have heard...it's a painful surgery. You are getting opinions from surgeons that get paid $$$$ for doing surgery.

[Wulfman...]

Ditto on what LSAT said.

The phrase "A fool and his money are soon parted." come to mind.

The probability is that you will STILL need to use XPAP therapy at some point after the surgery. Did they tell you THAT???


Den

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[Julie]

The majority of people who have surgery of various kinds (like PPP, palatal reduction, tonsillectomy) sometimes experience improvement for a few months, then revert to OSA and have a worse problem with Cpap than they did to begin with. MA may have some good points, but I wouldn't do it (and have known and read about it for years) when all I have to do is let a small quiet machine blow some air into my mouth overnight when I'm asleep (as would be anyone else in the bed).

[balor123]

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[StuUnderPressure]

I personally would not do either of those surgeries.

But, if someone was really contemplating such surgery, I would get past patient names from the Doctor(s) that I could call & discuss their particular outcomes. The patients, of course, would have had to agree to this.

[squid13]

Just because you wear a full face mask is no sign you have to mouth breath. I wear one and breath through my nose all night. I'm not a mouth breather, I just couldn't keep my mouth closed at night.

[phoebe368]

I had the MMA surgery done in 2010 by Dr. Kasey Li. My lower jaw was advanced 12 mm. I don't know how much my upper jaw was advanced. I think anything less than 12 mm is too low, especially with your high AHI. The higher degree of advancement, the greater your chance of improving your sleep apnea. You also want to make sure you get the correct advancement the first time because revision MMA surgery is very difficult. Also, try to get the genioglossus advancement at the same time you get the MMA. MMA and GA in combo will increase your chances of success. Be careful of turbinate reduction surgery - it could lead to "empty nose syndrome." Do a google search and read the empty nose syndrome forum where people who got their turbinates reduced ended up suffering from debilitating symptons. I had deviated septum surgery done and it really helped with the nasal breathing.

[LSAT]

I had the MMA surgery done in 2010 by Dr. Kasey Li. My lower jaw was advanced 12 mm. I don't know how much my upper jaw was advanced. I think anything less than 12 mm is too low, especially with your high AHI. The higher degree of advancement, the greater your chance of improving your sleep apnea. Also, try to get the genioglossus advancement at the same time you get the MMA. MMA and GA in combo will increase your chances of success. Be careful of turbinate reduction surgery - it could lead to "empty nose syndrome." Do a google search and read the empty nose syndrome forum where people who got their turbinates reduced ended up suffering from debilitating symptons. I had deviated septum surgery done and it really helped with the nasal breathing.

I was looking back at a previous post about surgery...

viewtopic/p871321/viewtopic.php?f=1&t=8 ... 76#p780876

It may not be exactly the same surgery, but, In this post , you stated....

I've always been very wary of this surgery. Very few people have had their apnea events fully resolved and many have had complications. Also, cpap is more difficult to use afterwards. I've also heard of several instances where AHI worsened after UPPP surgery even when performed at Stanford. I have enclosed a link to Andrew's OSA Diary. He too had UPPP surgery at Stanford which resulted in a worsening of his apnea. It's quite long but for a quick summary read the conclusions section at the bottom. Overaggressive removal of tissue can result in scar tissue formation causing stenosis - a narrowing of the airway, causing a worsening of sleep apnea.

[phoebe368]

Yes, I remember that post. It referred to the UPPP surgery which should only be done by a really good surgeon otherwise airway stenosis can develop. I am definitely NOT a surgery advocate. If you can find a non-surgical method to treat your SA than stick with it. Surgery should be only used as a last resort. However, there are those out there myself included, where non-surgical methods do not work. If you are severely affected by SA to the point where you can no longer support yourself and your family and where you have exhausted all other non-surgical options than I do not think that it is inappropriate to have an open, intelligent discussion on surgery given that this is a cpap oriented forum.

[balor123]

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[49er]

I wasn't familiar with Winx - I guess I should give that a shot too. I get my Aveo tomorrow so will see how it works out. Eliminating the clenching is huge for me right now. Thinking about it more, I think my new splint is causing problems b/c its designed for a class 1 occlusion and I have a class 3 malocclusion so my lower teeth aren't sitting on the right part of the guard.

I can see a lot of the hell that people on here go through with surgeries. The main reason I've limited surgical options to MMA and tongue reduction is that I have significant dental issues anyway. Tongue reduction has two benefits in my case as well here: it might help with the apneas and it reduces the chance of relapse after an MMA.

Anyway, it sounds like Dr Kasey Li is really the person to go to here for an opinion, no? Can I trust him to give me an honest assessment of how to proceed?

Hi balor123,

I have heard that Dr. Li is the person to consult. You might want to do a google search as I vaguely recall blog entries from people about their experiences with him.

And of course, ask him the necessary questions to make sure you are comfortable with what he is saying.

Best of luck.

49er

PS - As an FYI, in spite of my screen name, I don't live anywhere near the bay area in case you were wondering.