Do you know anything about Maxillomandibular Surgery?

[edm_msu]

The other day I took my wife to see an oral surgeon. While I was there, I discussed Maxillomandibular Advancment surgery. I believe he said it is 90% effective, is less painful than pulling wisdom teeth, and I would have to take one week off from work. Both the upper and lower jaws are moved forward 10mm. This sounds pretty major to me. But it does seem better than UPPP surgery. It is considered a medical, not dental, procedure so my insurance would probably pay for it.

This surgery is not considered nearly as much as UPPP surgery. According to internet research, people usually miss four weeks of work.

Do you know anything about Maxillomandibular Advancment Surgery? Why isn't it done more often for apnea?

Thanks,
Ed M.

[The Choker]

It can be a great thing for a young apneic to have. There are risks with the surgery and recovery is tough - painful. Sometimes there are bad longterm side effects.

If you are young, say under 40, I urge you to seriously consider having MMA surgery. But get yourself fully informed and take at least one year to decide.

Here are some great blogs:

http://www.google.com/search?client=ope ... 24&bih=655

I wish I had a good MMA when I was 18. Oh well, next life.

[themonk]

I have researched it a lot over the past several months since my diagnosis. I am in my late 30's, fit, and have no other health issues/symptoms of apnea, 0 on the Epworth scale, etc. So overall in good health other than than mild/moderate hyponeas which seem to keep me from getting to REM sleep.

I have had fits w/ PAP since I got it in mid-June and honestly now feel without question the worst I have ever felt in my life after being on it for a few weeks. My life is utterly miserable, unbearably so at times - barely sleeping at all, gas, heartburn for the first time in my life, etc. I am giving PAP a good go until July 30th when my 6 week follow up is and will then decide to move forward w/ some other option, including the surgery. I already have a surgeon referred by my sleep doc, someone w/ experience in the surgery and sleep-specific issues.

I will say that it sounds scary as h*ll from the description. However, dying 1,000 deaths from apnea over the next 40 years sounds much, much worse. I like the 90% success rate and think I could deal w/ the pain having tended to my wife after she broke her jaw in two places in a car wreck and seeing how she felt for her recovery. I am concerned about the physical changes to my face. I don't want to look like a primate! I am also concerned about numbness which seems somewhat common.

It is interesting that most people who get it and talk about it seem to like the results.

Anyway, I'll see how the next couple of weeks go and update accordingly. My 'treatment' w/ PAP has been a success but the lack of actual sleep and related side effects have pretty much made my life a nightmare. The surgery looks more and more appealing every day.

[The Choker]

Are you using the software (Encore or SleepyHead) to monitor your CPAP therapy?

Our modern population has become mainly recessed chins and overweight to the point that a fit person with a strong jaw looks odd. Unfortunate.

[themonk]

Are you using the software (Encore or SleepyHead) to monitor your CPAP therapy?

Not sure if this is meant for me or the OP, but I do use Encore. I am around 2 AHI/night with low leak rate.

Our modern population has become mainly recessed chins and overweight to the point that a fit person with a strong jaw looks odd. Unfortunate.

I have gotten used to being called skinny or too thin. I am far from it, 5'11", 175-180 lbs, but like you said, the average person is much heavier than that with a lot of the weight around the middle. I just laugh it off at this point.

[BlackSpinner]

I like the 90% success rate and think I could deal w/ the pain having tended to my wife after she broke her jaw in two places in a car wreck and seeing how she felt for her recovery. I am concerned about the physical changes to my face. I don't want to look like a primate! I am also concerned about numbness which seems somewhat common.

Just be sure that the 90% success rate refers to apnea reduction, not to "Look what a nice jaw you have now".

[edm_msu]

Just be sure that the 90% success rate refers to apnea reduction, not to "Look what a nice jaw you have now".

Another thing is how long does it last? Will there be apnea in 5, 10 or 20 years from now?

[kaiasgram]

I don't want to look like a primate!

I can help you with this concern, Monk -- you already are a primate -- we humans are all primates so no need to worry about it ! Please don't take this as trivializing your concerns at all, I am in the same boat as you, doing worse on CPAP than before. In reality nothing about this is funny at all. But once in a while something triggers a chuckle, and I hope that's the spirit you take my comment in. Sincerely, best wishes on whatever you decide.

[soundersfootballclub]

90% effective? Hmm. I have been told it's a 50/50 success rate by several different docs. That actually sounds optimistic to me because oral appliances aren't even that effective and this surgery is essentially doing the same thing. Those aren't great odds if that is the case. I have also been told the best surgeons for this procedure are at Stanford's Hospital in California. I would want to go to the best in the country if I was having this done. Why not look into getting an oral appliance first and see if that works before going for surgery I say.

[Roobin]

Why not look into getting an oral appliance first and see if that works before going for surgery I say.

I agree about first looking into an oral appliance -- I used one successfully for something like 8 years. I'd be happy to share my experience with you if that would be helpful

[edm_msu]

90% effective? Hmm. I have been told it's a 50/50 success rate by several different docs.

When the doctor said 90% I said I thought it was 50%. He said that was for UPPP and it was actually 40%. He assured me it was 90% for MMA. Just repeating what he said.

I agree about first looking into an oral appliance -- I used one successfully for something like 8 years. I'd be happy to share my experience with you if that would be helpful

I went to a presentation for oral appliances. The dentist said the success rate was 70%. Another sleep study would be needed to adjust and verify the appliance.

What is your experience with your oral appliance? How well does it work if you sleep on your back?

Any soreness or teeth bending? The dentist showed a slide where the lady's teeth were all bent forward from the appliance. That was acceptable to her and she continued to wear the appliance.

[javafriend]

Hi. I am a long time member, just not a talker.
My DH had MMA 10 years ago. He was active duty military at the time, was successful on CPAP and with a dental appliance. However, the military insisted on the surgery because he was not considered world wide deployable on CPAP. He had braces for 1 year prior to surgery to set teeth. His surgery was successful, he has not had a return of sleep apnea. He does snore at times, especially if he gains weight, mainly positional. He had little to no pain after surgery, but does have some trigeminal nerve damage, leaving a small area on his face that is numb. For him the surgery has cured his sleep apnea.
Lisa

[CatherineF]

MMA surgery is the best treatment for sleep apnea, when we think logically about it. When both maxilla and mandible are brought forward there is way smaller chance to have obstructive sleep apnea. Soft palate, base of the tongue goes forward, so what can block the airway? I rwally want to have this surgery but I can't afford it and in my country insurance won't cover it. If you have a chance to do it, I would say DO IT.

[themonk]

I agree about first looking into an oral appliance

I would love to but it is stupid expensive, around 3k based on the discussions I have had w/ local dentists. I wish insurance would cover at least some of it but they won't. In fact, the dentist won't even try to bill insurance.

Honestly I wish PAP would work for me. So far it hasn't, at least in terms of allowing me to actually sleep more than an hour or two a night. I have several issues that I can't seem to resolve and I am getting no support from my doctor and his staff. They act as though no one has ever complained about painful gas before?!? So, I am pretty much on my own, hence the growing appeal of the surgery.

[themonk]

I can help you with this concern, Monk -- you already are a primate

You know, I almost put I didn't want to look more like a primate!