Has anyone here considered or pursued jaw surgery?

[balor123]

My ENT and oral surgeons claim that jaw surgery would probably eliminate my sleep apnea (AHI 55). My maxilla and mandible are slightly underdeveloped and my palate slightly narrow with slight crowding, leaving me with a tongue that's slightly larger than my mouth has space for. When I sleep, my tongue falls back into my throat and blocks the airway. As that happens, I thrust my tongue forward to open up the airway. That thrusting has caused a slight anterior open bite to develop and the resulting bruxism has worn down a lot of my teeth but especially the back ones. They are pretty sensitive but mostly I think it's from clenching the night before, not the lack of enamel. I've been using a night guard since I was 15 or so but most of the damage was already done by then. The bruxism has turned to clenching lately which is causing orofacial pain. The open bite has a slight impact on my speech, causes me to spit a bit more than usual, and causes me to take a little longer to eat than normal. All this because I've had trouble breathing through my nose most of my life due to untreated rhinitis. At least this is the theory that my ENT proposes. What do you all think of this theory?

The CPAP is pretty effective but not all the time. I use nasal pillows now and they keep my airway open most of the time but not always, as my wife still notices me struggling to breath sometimes. He's thinking about turbinate reduction surgery to help with that. Another ENT mentioned that sleep apnea tends to get worse with age. My open bite is 1.5mm. I don't know if its widening but its become slightly asymmetric over the last decade from the clenching I think. My airway space is 16mm. The oral surgeon says he'd advance both of my jaws about 10mm to correct the sleep apnea, the slight class 3 malocclusion, and to fix the open bite. They'd have to rebuild some of the rear teeth since I've ground them down and they wouldn't make contact anymore.

I'm only 33 so it seems like a lot of problems to have at a young age. Recovery is still pretty good for jaw surgery at this age but decreases as you get older. Odds of an uncomplicated surgery are about 90% with near-full recovery about 70% right now. Those odds drop about 1% a year so when 50 years old odds of a near-full recovery are only about 50%. There's some amount of morbidity associated without the full recovery. At best, you lose some feeling (typicall chin, lower lip, and roof of mouth) and at worst you end up with chronic nerve pain.

So what do you all think? Is it worth the risk and trouble? I'm having a very hard time deciding. Even if you don't have an answer, any advice that will help me come to one would be useful. Thanks!

So what do you all think - is it worth it?

[nanwilson]

I would suggest that you do a search above in the search box with the words jaw surgery... you will get lots of good info.

[Loreena]

Go to ENT Dr. Stephen Park's website and listen to the MMA video with him and Dr. Li at Stanford. Dr. Li is the best in the business and I would trust no one but him to do MMA...he explains that he performs MMA about 3 times a week, compared to others who probably don't perform it as much . Also, he advises to make sure you get references from patients who had this done. If the doc cannot provide references, run like hell. My untreated apnea is 26/hour and I saw Dr. Li a few months back and he determined I was too severe a case. I knew I would never get off cpap, I just wanted my tongue to be moved farther from my airway, which it would do, but I think Dr. Li is hesitant about performing MMA on anyone he deems would not able to get off cpap without first explaining to them what the outcome would be. If I had 80 grand (without insurance), I would definitely get it done, but only by him.

[archangle]

Many surgeons are chop happy and want to cut on everyone given the slightest provocation.

Many of them claim "success" when they simply reduce, but don't eliminate apnea. You may still need CPAP. CPAP may not work as well after the surgery.

The procedure is expensive, painful, and has a long recovery time.

Success rate may be low depending on the exact procedure and the surgeon.

They are working on less invasive procedures. It might pay to wait.

Google for the sleep apnea surgery horror stories.

However, it is good when it works.

[kteague]

A search for MMA on here should be productive. Some very old threads have pics of xrays and some fascinating discussion.

[chunkyfrog]

It baffles me that a person would prefer surgery to cpap.---but that's just MHO.
Many people have unrealistic expectations of surgery, which can be explained by the money involved.

[49er]

Go to ENT Dr. Stephen Park's website and listen to the MMA video with him and Dr. Li at Stanford. Dr. Li is the best in the business and I would trust no one but him to do MMA...he explains that he performs MMA about 3 times a week, compared to others who probably don't perform it as much . Also, he advises to make sure you get references from patients who had this done. If the doc cannot provide references, run like hell. My untreated apnea is 26/hour and I saw Dr. Li a few months back and he determined I was too severe a case. I knew I would never get off cpap, I just wanted my tongue to be moved farther from my airway, which it would do, but I think Dr. Li is hesitant about performing MMA on anyone he deems would not able to get off cpap without first explaining to them what the outcome would be. If I had 80 grand (without insurance), I would definitely get it done, but only by him.

Great post Loreena as if I were to have MMA, he would be the only doctor I would consider going to even though I live far away from him.

To the OP, someone wrote a blog about his MMA experience which you might want to try to google. Unfortunately, that is all I can remember.

Best of luck.

49er

[kteague]

It baffles me that a person would prefer surgery to cpap.---but that's just MHO.
Many people have unrealistic expectations of surgery, which can be explained by the money involved.

If a one time surgery could guarantee a future free of CPAP, or a reasonably good chance, I can see that possibility being enticing. Especially if I were younger and looking at maybe 50 years ahead of me. I do remember someone on here who needed the MMA because their airway was so compromised even the CPAP couldn't open it enough. Even when they were awake they couldn't get enough air to feel comfortable. My brother worked with someone who had the MMA. His coworker described it as life saving. But everyone says it's barbaric, so I'm like you. I'll stick to my CPAP.

[sleeplessinaz]

Nope! I'd rather keep using my CPAP!

[hueyville]

Luckily my ENT considers himself an ear doctor and not a plastic surgeon nor sinus surgeon. He and I are friends and except when he is out of town eat breakfast together weekly. He claims most sinus surgery is snake oil tbat lubricates the pockets and wives of folks that are proceedure happy. Says that in his opinion 80% of these surgeries are better treated other ways as the risk of complication especially of sinus surgery is huge being just a centimeter or so from the brain. My wife is a R.D.H. and says she sees so many complications from jaw surgeries that she reccomends avoid it too unless absolutely mandatory. As an extra bonus for all who read, if you have any viable teeth keep them if possible and dont let someone talk you into pulling them and getting dentures. Blood flow is provided to your jawbone via the teeth. Tbus when all pulled your jawbone is going to resorb and soon your new dentures will not fit. So if you do this purchase value models first set then when your jawbone stabilizes then you can buy some premium choppers. Have had two ENT's recommend sinus surgery for me. As my friend is ofi ialy retired I have to see the docs that purchased his practice. But based on 20 years of treating me be tells me to tell them to stuff the idea. Seems like most of his patients that were fine got some sort of proceedure pushed. He says the big new building tbey built and their car collections and plastic surgeon enhansed wives require lots of proceedures to pay for. Your mileage may vary but I would say to be sure and get an independent opinion. 7 out of 10 spine surgeons want to cut my back and my neck. The heads of brain and spine department of three teaching hospitals have said surgery will give me at best a 30% reduction in pain but 100% chance at follow up surgeries to correct all the issues that will result from the initial surgeries. Be very careful to research your surgeons and always get second opinions before cutting unless it is a life or death emergency. I have had my share but never until seen by a second surgeon of repute. If 1 say yea and 1 say nae then get a 3rd. Once cut you can never go back.

[jbt1125]

Yes, I considered it. It was recommended to me when I was 25, even younger than you. I am 40 now. For me it started because of terrible TMJ I have, fairly advanced. I went to see an oral surgeon and after he explained the surgery to me I think I almost had a panic attack onsite. Sawing through my jaw, reattaching with hinges, etc. I went to see my primary doctor who I trusted a lot, and here is what she told me -if you can eat, breathe, and talk with your jaw, regardless of the particulars, you should think long and hard about this surgery. I ended up not doing it.

Separately, she has since told me about my sleep apnea - while there are definitely exceptions, the greatest treatment for sleep apnea is to lose a bunch of weight, which almost ALWAYS helps the condition. I am now 5'11 and 210, she is convinced that if I lose 30lbs, my mild to moderate sleep apnea will dramatically improve.

In the meantime, I am trying to use CPAP.

[sleeplessmommy]

My husband was recommended to have this surgery in his 30s. He ended up deciding against it after viewing some of the YouTube video blogs about it. There are a bunch of people who documented the recovery process which he found helpful to decide if he wanted to undergo the surgery. Might be helpful for you as well.