Has anyone ever considered MMA surgery?

[CatherineF]

http://www.sailerclinic.com/en/schnarchen.html

http://www.sleepapneasurgery.com/maxill ... ement.html

It is known as the most effective treatment for sleep apnea, great widening of the airway can be achieved (up to 10mm for the maxilla, more for mandible if it was retruded before). Now I am using CPAP but someday I really want to do such a surgery, although I realize it is major and very serious one with quite long (up to 3 months) recovery period. I am just wondering if it will be able to adress my problem enough to solve apnea problem for good. I've got obstruction on the level of soft palate, it is sooo long and collapses obstructing my airway completely. By moving maxilla forward there will be greater posterior width and may be soft palate would not collapse so much to completely block the airway...I know that UPPP would be a cure for me but I can't decide on that... I think I would never do this... rather live with CPAP till my last days.

Do you know where is yours obstruction level? Nasal turbinates, soft palate and base of the tongue are possible causes for our apneas.

[Julie]

Hi, actually UPPP surgery is not considered to be very effective at all, in that it may achieve its purpose to an extent following surgery, but by the end of the following year the majority of patients are back where they started in relation to OSA and may even have new problems as a result of the surgery. I'm not as familiar with MMA surgery, but others here are, and the fact is that Cpap (or Apap, Vpap, etc.) is considered to be the gold standard of treatment for OSA.

Certainly many here have tried various devices and procedures because we're all different and some may have, e.g. issues that nasal surgery of some kind might help with, or palate problems that certain dental answers might also help with, and it's too bad that you haven't been able to make Cpap work for you yet.

Most of us go through different masks, different pressure settings, different DME problems and doctors, etc., but once things are sorted out are very happy to continue using Cpap, at least until such time as another 'gold standard' is really shown to do such an effective job.

[rested gal]

UPPP, a cure? -- probably not.

MMA, a cure? -- often "yes", if a very experienced knowledgable surgeon evaluates you, recommends it, and performs the surgery.

[SleepingUgly]

No. A resounding NO.

[Janknitz]

Yeah, for about 5 minutes. WHY would I want to go through all that pain, time and expense, with all the risks and side effects inherent in the process and no GUARANTEE of improvement???? CPAP can be a PITA to be sure, but it is also painless, non-permanent, and virtually no side effects. And tens of thousands of dollars cheaper.

It is known as the most effective treatment for sleep apnea

How do you know? Did you read it off some surgeon's website or advertising literature? Or are there evidence-based, peer reviewed studies that demonstrate the effectiveness over a broad range of people???

I know you're asking about MMA, not UPPP, but doctors with integrity are now admitting that there is no benefit to the UPPP procedure--read Dr. Park's website or search for "Dr. Steven Park UPPP" here. But there are plenty of downsides. Yet many ENT's continue to perform this procedure, despite mounting evidence against it.

When evaluating claims about these surgical procedures, make sure you understand what is meant by "success". In your eyes, it's a cure, so that you no longer need CPAP. But the definition of success the surgeon has in mind may not be the same.

[codinqueen]

UPPP is NOT a cure. I had one in early 2000's, and it helped maybe 6-9 months, then
I was right back to snoring and stopping breathing through the night while sleeping.


I had my tonsils and adenoids taken out and fiberoptic sinusectomies along with the UPPP and since I was in my 40s, it was a very difficult operation to get over. I was out of work for 3 weeks because I couldn't eat enough due to throat pain from sutures, etc, and was too weak to stand up, let alone drive to work and then work. I would not do it again. And NOW if I am not very very careful drinking liquids, they choke me or come out my nose. And I can no longer eat popcorn because it chokes me up too bad with every bite. My throat is large enough now to drive a Mack truck through, and still I have OSA!

[john6012]

If you want to lose weight, it's a pretty good weight loss program because you hurt so badly that you can't eat.

[SleepingUgly]

This reminds me that I should do my 1-year anniversary of my septoplasty, turbinate reduction, tonsillectomy with pharyngoplasty thread. (BTW, I don't regret those surgeries, and yes, the tonsillectomy wasn't a walk in the park, but neither was my hernia repair or childbirth. It wasn't at its worst for about 4-5 days, and I survived it and even managed to write a few humorous posts during my recovery period, so how bad could it be?!).

[marylandcpap]

I had the MMA surgery May 9. It was not curative. I am still on an APAP at a lower pressure. My speech was affected quite a bit for about a month, and I was
on a no-chew diet for 6 weeks. I had arch bars on my teeth for 6 weeks. When they were taken out, they gave me six shots of novacaine in the mouth. The first two weeks were the worse, fatigue etc. I used a syringe to take in liquid for the first week or so. I can pretty much eat anything now. I still have numbness. There was very little pain. I had a 10mm/10mm advancement. I pretty much had a normal jaw alignment to begin with. My nose is somewhat 'turned up'' looking now. I had this done at a teaching hospital in Washington, DC. If I had it to do over again, I would do it, but I would go to Dr. Li.

[pedror414]

Hello everyone...I am new member to this forum.

[CatherineF]

marylandcpap thanks for your first-hand report about this surgery, I wonder why it wasn't a total cure for you...

codinqueen I am sorry that it wasn't a cure for you, so much pain and no effect...

I am now so messed up mentally due to my tiredness and brain fog and it is just hard for me in the beggining... I also feel bad that I am going to be addicted to the machine till my last days, I don't feel comfortable with it for many reasons. Maybe someday they will find a 100% cure because it must exist! What are we people so different that we've got apnea and others don't? What is different in them so much that can't be "copied" to us? I am very oriented on healing causes not symptoms, though I really do appreciate existence of CPAP, it will keep me and thousands of hundreds people alive, I know that very well, because I entirely realize to what untreated apnea leads.
I know also that mine will worsen over time, because I am 22 years old, I am very thin and I find it quite difficult to breathe even during the day, if I am taking a deep breath there is a "snoring" sound. What when I will be older, fattier? It will get worst I know it....

[Julie]

Hi - You might want to consider that you won't have to use Cpap for life, probably not even close, because the way technology is changing every day now, it's much more likely that another 'fix' will be available fairly soon and Cpap will seem like a dinosaur...but isn't it great that there is at least something now that you can use rather than just not waking up one morning?

[CatherineF]

Julie of course I am HAPPY that such a thing exists

though I really do appreciate existence of CPAP, it will keep me and thousands of hundreds people alive, I know that very well, because I entirely realize to what untreated apnea leads.

I wrote this in my previous post

[kteague]

...I am very thin and I find it quite difficult to breathe even during the day, if I am taking a deep breath there is a "snoring" sound...

I wish I had the links to prior threads with x-rays of demonstrating an airway compromised by an inset jaw. There is a possiblity for the airway being so narrow that surgery is indicated. Before I would ever consider something so invasive, there would have to be absolute evidence that my jaw position indeed was the issue, and an indication of how much was to be gained from correction. And it would have to be to the degree that it caused even cpap to be unable to deliver adequate air. My brother worked with a guy who had it done. He said it saved his life. That's my basis for not automatically ruling it out.

[CatherineF]

I wish I had the links to prior threads with x-rays of demonstrating an airway compromised by an inset jaw. There is a possiblity for the airway being so narrow that surgery is indicated. Before I would ever consider something so invasive, there would have to be absolute evidence that my jaw position indeed was the issue, and an indication of how much was to be gained from correction. And it would have to be to the degree that it caused even cpap to be unable to deliver adequate air. My brother worked with a guy who had it done. He said it saved his life. That's my basis for not automatically ruling it out.

And that's why everyone suffering from sleep apnea should have an x-ray done. In my case the problem is not in retruded jaws (although my mandible is retruded because I've got deep bite), airway are quite wide, behind the tongue it is 10,3mm and behind my soft palate is some 7mm only and it collapses in a strange way outside the arch of hard palate . For soft palate issue CPAP works very well, opening the airway can be achieved with lower pressures if the obstruction is there. If there is narrowing behind the tongue CPAP is less likely to work well and higher pressures are needed. That is how I see it.

http://www.cda-adc.ca/JCDA/vol-67/issue-11/652fig.html I don't know whether this person would take advantages from CPAP therapy, airway are very narrow.