genioplasty for osa treatment

[NanceK]

I met with a jaw and facial surgeon today to discuss the possibility of a genioplasty(bringing out my chin and along with it, my tongue) to open up my airway which is restricted. My airway at the base of my tongue is 4cm. He said it should be 9-12 cm . Anyone have this procedure done?

[So Well]

You had better check that procedure out very damn carefully. It is usually done for cosmetics alone.

MMA (http://www.sleepapneasurgery.com/maxill ... ement.html) is the standard surgery for obstructive sleep apnea.

Be careful in either case.

[So Well]

This is bothering me. Does this dude specialize or have a strong subspecialty in sleep apnea patients.

You know during the recession cosmetic surgeons are suffering from a steep decline in business. Check this guy out carefully.

What city do you live in? Maybe I can recommend someone for a second opinion.

[NanceK]

Thanks for the concern. Here's one link concerning genioplasty and OSA http://medical-dictionary.thefreedictio ... enioplasty . I am getting a second opinion, but the procedure looks promising. Just wanted to know if anyone else had had it done or knew of someone who had it done.

[BlackSpinner]

Just remember the surgeons' definition of "success" may not be your definition of success. You need to be concerned with AHI - he doesn't. You could do this and still be on xpap for the rest of your life.

[ronilou]

Hi NanceK

Funny enough, i was talking to an ENT about surgery for my OSA today - and he mentioned sliding genioplasty as a good option - in conjunction with tongue and hyoid suspension procedure.

The tongue and hyoid suspension procedure is pretty amazing. A series of screws (2) and permanent sutures keep the tongue from falling backwards when your muscles relax in sleep - and also a suture that pulls the jaw forward just a bit - which is where the sliding genioplasty comes in - as best as i can tell the screws attach to the front of the chin and having it more forward allows more resistance for the suture to pull things forward. Sounds creepy but when you start researching, it is very logical. And once healed, the sutures and screws aren't at all noticeable.

My ENT is part of a group of ENTs, Orthodontists and Facial surgeons who have formed a holistic practice to address sleep apnea solutions. Highly respected (i did my homework) in the Dallas TX area. The Surgical Institute for Sleep Apnea (SISA).

In talking with him & the facial surgeon I had no doubt that it was a legitimate option. MMA is also a choice, a good choice - but the time you need braces before the surgery is long, and this is a good alternative.


a couple of links:
http://www.surgicalsleepapnea.com/
http://www.dallasentgroup.com/

feel free to email me if i can help in any way. i have been researching options for my OSA for years.... gone through cpap, uppp, (painful) dental appliance... lost a job due to sleepiness...

[NanceK]

Thanks, I'm going to ask him about the other procedures. He understands OSA and has worked with other numerous patients to treat it. I was told that I have A 90 percent chance of having instances of AHI eliminated or at least having lower pressures control instances. My numbers are not good now and had a difficult time tolerating higher pressures. My smalll airway needs to be corrected. Thank you all so much for your input. Education helps one make intelligent decisions.

[roster]

.

You may find some of this discussion helpful: viewtopic.php?f=1&t=53983&st=0&sk=t&sd=a

Maybe you can bookmark this post and keep us updated as you gather additional opinions and have more discussions.

Thanks and best of luck.

[NanceK]

Thanks Rooster. I found it ironic that as I'm looking into a procedure to compensate for my jaw structure and open my airway, you resurrected that thread. I'm grateful to my dentist for listening to me and sending me into this direction. It's another option worth looking into.

[Richardin PA]

I had sliding genioplasty and simultaneous UPPP at U Pennsylvania Hosp in 2005 in hopes of freeing myself from BiPAP.

My experiece: first, this surgery was BRUTAL. The surgeon totally misrepresented this to me - post op pain was awful for 3 weeks; after that is was months before I really felt better. Your diet is restricted also - it's simply not possible to chew most foods. I was told I'd have numbness in my chin for a month. I now have chronic parathesia (numbness, tingling, pressure) in my chin and front teeth. The projection of bone in my chin causes chronic ingrown hair at the crease that formed. During intubation they broke my sinus. No one ever acknowledged this or treated me for it; it led to sinus disease and another surgery (successful) to fix my sinuses. None of these adverse outcomes were described to me in my consent.

The combined change in my tongue position and the change in my palatte did NOT get me off BiPAP. It most probably reduces the pressure required. I'm told that opening your tongue takes a high pressure, my current APAP machine rarely goes above 8.5 cm.

I would endorese UPPP for someone with snoring, palatte-related apnea. Given the choice, I don't think I would choose the genioplasty. In any case, beware because surgeons live with the big checks they get; they don't live with the negative outcomes they create.

[chunkyfrog]

Success, definitions:
Surgeon: getting paid
Patient: being cured, or at least significant improvement, worth the expense and pain.

[Billy6]

Google "crane facemask". This may be a way to move your jaws forward to open the airway without surgery and without causing any occlusion problems

[jwerley]

Thanks for the concern. Here's one link concerning genioplasty and OSA http://medical-dictionary.thefreedictio ... enioplasty . I am getting a second opinion, but the procedure looks promising. Just wanted to know if anyone else had had it done or knew of someone who had it done.

My ex-husband had it done in 1985. He had severe sleep apnea and snored like a freight train. He also had his toncils and adenoids removed at the same time. His surgery was very successful.......Surgey was recommended for him right off the bat, so he never went through the c-pap trial. After he healed he did not snore ever again nor did he stop breathing or have any other problems. He felt so much better and did not need to take naps or did he ever feel sleepy again during the day. The surgery itself is quite brutal and painful, so be prepared to have help and support.....The best of luck to you!

Janice

[johnthomasmacdonald]

Blackspinner writes: "Just remember the surgeons' definition of "success" may not be your definition of success. You need to be concerned with AHI - he doesn't. You could do this and still be on xpap for the rest of your life. "

funny in that your statement reminded me of a conversation I had with my best friends sister who was a surgeon, she was specializing in primary liver cancer surgery ( this was about 30 years ago ). I asked her WHY would she want to specialize in THAT - wasn't it true that ALL her patients died anyway? I'll never forget her answer: " Yes, but I don't care about that as it's not my fault, I'm technically excellent"

[Eric Kezirian, MD]

Although I cannot post links in this reply, a search using my name will identify my website and blog, where more information about these procedures and topics can be found.

The posts in this thread raise a number of excellent points. First, genioplasty is different from genioglossus advancement. Genioplasty is a cosmetic procedure, whereas genioglossus advancement is a procedure for sleep apnea. As a sleep surgeon, I can say that many patients obtain excellent results with genioglossus advancement, typically when performed in combination with soft palate surgery. However, those who do best tend to be somewhat thinner, have less-severe sleep apnea, and do not have major issues with their jaws (such as a small lower jaw, or mandible).

As far as surgery, maxillomandibular advancement (MMA) is NOT the only sleep apnea surgery or the state of the art. While I do perform this procedure, it is not for everyone. It has a 2-3 month recovery period instead of the 2-3 week recovery period of other procedures. While MMA does work well, the true results are not as good as what is reported in some studies that have highly-selected groups of patients. Most people would agree that MMA is for those who do not tolerate CPAP, are not great candidates for oral appliances, and have not responded to previous first-line surgeries. Basically, some patients can do well with MMA as a first step, but for others it is like taking a sledgehammer to drive in a nail.

Concerning outcomes, the points noted previously are absolutely correct. It is important to have a reasonable sense of what outcomes might be, as some patients are better and worse candidates for surgery. Determining how to select various procedures for sleep apnea has been the major focus of my research as a sleep surgeon for the past 10 years. It is important to remember, however, that CPAP is not 100% effective, even in those who tolerate it well. One excellent study showed that 75% of patients who were wearing CPAP and who were happy with it had an apnea-hypopnea index above 5 when tested 1 year later WHILE ON CPAP. The point is that AHI is not everything. I discuss surgical outcomes in more detail on my blog.