x-Ray of Cause of obstruction

jskinner · Post by **jskinner** » Mon Nov 19, 2007 8:17 pm

I thought some of you might find the this x-Ray interesting. Its was taken of my head this morning in Halifax when I was having my appointment about the possibility of Maxillo Mandibular Advancement surgery.

Sadly although the surgeon very quickly pointed out the obvious problem (Red Circle), it doesn't look like I will quality for the surgery. Basically he felt they would not be able to pull my jaw forward enough to fix the problem. He is going to do some calculations but didn't think it would work for me.

The following picture dramatically shows what a successful MMA surgery can do. http://www.robotics.com/mma/mmaxrays.jpg You notice that the before picture looks quite a bit like mine airway size wise.

Now back to your regular scheduled CPAP discussions...

kteague · Post by **kteague** » Mon Nov 19, 2007 8:40 pm

Jim,
Wow, what a narrow airway! That on top of your other issues. Let us know about your doc's final calculations and what he says can be done to help you.
Kathy

split_city · Post by **split_city** » Mon Nov 19, 2007 11:05 pm

wow! Are you experiencing desats during the day?? That's quite an obstructed airway there

wabmorgan · Post by **wabmorgan** » Tue Nov 20, 2007 12:01 am

Please post back with your docs final opinion.

(I really don't see a huge difference between yours and the before photo in the MMA x-ray.)

Hopefully he will be able to help you.

Snoredog · Post by **Snoredog** » Tue Nov 20, 2007 12:15 am

did he make any suggestions as to any neck position which may improve the airway space, such as the CPR position (pretty difficult to sleep in that position)?

Sure would be nice to see a series of x-rays of what that airspace does with different head positions?

Split have anything like that?

rested gal · Post by **rested gal** » Tue Nov 20, 2007 12:19 am

Wonder if you could send a copy of your X-ray to Dr. Kasey Li at Stanford?

That's who the poster nicknamed billinseattle thinks very highly of.

I'm sure you've seen the excellent posts by billinseattle on the TAS board. Quite a few discussions that Bill participated in are in the MMA section at the bottom third of this page:

LINKS to surgery, turbinates, Pillar, TAP experiences
viewtopic.php?t=2836

split_city · Post by **split_city** » Tue Nov 20, 2007 1:11 am

Snoredog: Surprisingly, I couldn't really find any studies which looked at changes in upper airway dimensions with alterations in neck/head posture. There are a couple of abstracts which state that they looked at this interaction. Unfortunately, I cannot get full text articles and the abstracts don't go into enough detail.

You can infer changes in airway dimensions by looking at airway resistance. Generally, as the radius of the airway gets smaller, airway resistance increases.

Sleep Breath. 2000;4(4):163-168. Links
Effect of Jaw and Head Position on Airway Resistance in Obstructive Sleep Apnea.Choi JK, Goldman M, Koyal S, Clark G.
Department of Oral Medicine, School of Dentistry, Kyungpook National University, Taegu, Korea.

This study evaluated whether changes in jaw and neck position caused substantial airway resistance (Raw) changes in normal controls and obstructive sleep apnea (OSA) subjects. Subject groups included 12 male nocturnal polysomnographically diagnosed OSA patients and 16 healthy male control subjects. Raw was assessed plethysmographically and measured under the following conditions: neutral head posture with 0/3, 1/3, 2/3, or 3/3 of the subjects maximum forward jaw position; normal jaw (0/3 forward) with fully flexed, extended, right or left rotated head position. Both groups showed a similar significant decrease in Raw upon jaw protrusion. OSA patients showed a significantly higher baseline (normal jaw, neutral head posture) Raw and both subject groups also had a clear increase in their airway resistance with flexion and to a lesser extent with neck rotation and extension. These data document that airway resistance can be significantly influenced by head and jaw positioning with protrusion of the jaw reducing Raw and flexing the neck increasing Raw.

Guest · Post by **Guest** » Tue Nov 20, 2007 1:34 am

Hi James, Split_City, Rested_gal & All,

There is a reserch going on, by injection to the neck that able to reduce the fats. I will look into this....just few months ago in the trial test. Have to re-consult again.

James, You got it right at the sweet spot (that is the main cause next would be the holy grail) Kee the posting and good luck.

Mckooi

Moby · Post by **Moby** » Tue Nov 20, 2007 2:00 am

I can't see your Xray, only the pre and post op Xrays

ozij · Post by **ozij** » Tue Nov 20, 2007 5:25 am

Oh James, that looks so narrow!

No wonder you're having such a hard time. Please keep us updated.

O.

Slinky · Post by **Slinky** » Tue Nov 20, 2007 7:08 am

Wow! What a difference, James. Sure makes you wonder what took so long for your sleep problems to start!

But, that doesn't explain the horrible swelling you had to the bridge of the nose/eye area last year, does it? These xrays show as dramatic a difference as did the pictures of you before and during that swelling. Like two different people!

Have you never gotten any explanation for that swelling or did I miss a post somewhere?

Moby · Post by **Moby** » Tue Nov 20, 2007 7:31 am

Oh I've found it. Clever way to make the link.
Not much breathing room there.

jskinner · Post by **jskinner** » Tue Nov 20, 2007 3:45 pm

split_city wrote:Are you experiencing desats during the day?? That's quite an obstructed airway there

Nope but I am very aware of the obstruction during the day. I find swallowing harder than it should be often. I also find if I sit or lye in specific positions then I reduce or cut off the airflow. I can sometimes 'hear' the air restriction when awake. I can experience the airflow constriction when lying down after I relax a bit.

Snoredog wrote:did he make any suggestions as to any neck position which may improve the airway space, such as the CPR position (pretty difficult to sleep in that position)?

He didn't, no. I have learned a bit on my own just though trial and error. Having my torso elevated seems to help a bit. Unfortunately I hate sleeping in that position. It became a necessity from April - Oct however when the postnasal drip was bad becase it didn't take much to block up that hole. I slept for a while on the sofa with a kink in my neck which seemed to help too.

rested gal wrote:Wonder if you could send a copy of your X-ray to Dr. Kasey Li at Stanford?

I will try to do that, anyone have more contact info on him?

Mckooi wrote:There is a reserch going on, by injection to the neck that able to reduce the fats. I will look into this....just few months ago in the trial test. Have to re-consult again.

Anymore info on this technique would be appreciated.

ozij wrote:No wonder you're having such a hard time.

One wonders why the 5 minute x-ray isn't done on everyone as soon as they are diagnosed with sleep apnea.

Slinky wrote:Sure makes you wonder what took so long for your sleep problems to start!

I suspect its been going on for a long time. I have had terrible trouble sleeping all my adult life.

Slinky wrote:Have you never gotten any explanation for that swelling or did I miss a post somewhere?

Nope never figured it out. I was a result of not being able to breath due to the nasal swelling but its never been solved.

rested gal · Post by **rested gal** » Tue Nov 20, 2007 3:51 pm

jskinner wrote:
rested gal wrote:Wonder if you could send a copy of your X-ray to Dr. Kasey Li at Stanford?
I will try to do that, anyone have more contact info on him?

http://www.sleepapneasurgery.com/about.html

http://www.sleepapneasurgery.com/about_dr_kasey_li.html

http://med.stanford.edu/shs/update/arch ... /fact.html

Guest · Post by **Guest** » Tue Nov 20, 2007 7:22 pm

Hi James,

This is a very prominent OSA doctor with great reputation. Was close but no luck during my teenage time in SF-BayArea. Will keep searching for the infor on injection for neck fats reduction and keep in the loop.

Mckooi

Kasey Kai-Chi Li, DDS, MD
Kasey Kai-Chi Li is the Associate Director of Sleep Surgery, Center of Excellence in Sleep Disorders Medicine, at the Stanford University School of Medicine, and is Clinical Assistant Professor in Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine.

Dr. Li earned his DDS degree at the UCLA School of Dentistry and his MD at Harvard Medical School. He served residencies in Oral and Maxillofacial Surgery, General Surgery, and in Otolaryngology - Head and Neck Surgery at Harvard Medical School, as well as a Fellow in Facial Plastic and Reconstructive Surgery at UCI Medical Center in Orange, CA.

He has also had academic appointments at the Harvard School of Dental Medicine, Harvard Medical School, University of California College of Medicine at Irvine, UCLA School of Dentistry, and Stanford University School of Medicine.

Dr. Li has co-authored numerous articles for peer-reviewed journals; has co-authored chapters for medical textbooks, and has been a frequent lecturer on surgical issues related to the treatment of sleep apnea

Humidifier

Additional Comments: ozzie heated hose.

Humidifier

Additional Comments: ozzie heated hose.

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