Anyone had success from surgery?

[vdol52]

I am revisiting the surgery thing, and wondering if anyone has had any success from any type of surgery. I am aware of the pain factor, but at this point I am willing to try anything. I am also having my worst time while on my back in the second part of the night. While I am sleepinging on my back, a gurgling sound comes from my throat. I actually dream about being asleep in a roomfull of people and cannot wake up.
I know there is a surgery that moves the jawbone forward.
There is also somnoplasty, laup, and the pillar.
I have been advised that there are temporary in many cases and have to be redone.
Is there anything else.

[fuzzy96]

i've been wondering the same thing. i have a deviated septum and in the process of setting up a surgical correction. as for any other surgery even my doc said no. the pain is not worth the resluts to change the soft palatte. only in extrene circumstances will he even contemplate it. as for moving your jaw foreward- hmmmm that will change your bite,at least. remember cutting into tendons and ligaments take a long time to heal.and this will probabably be irreversable. i had braces as a kid and they moved my jaw back using rubber bands almost 1/2 of an inch!!! that was 25 years ago and my jaw still bothers me.in hind sight it probably contributed to my osa. so i say just be carefull and fully weigh the pro's and con's of what you do. surgery should be a last resort. second opinions never hurt

[Marietjie]

Hello friend ! - please ! ! ! consult experts (more than one) about this surgery - If I were you I'll rather get my sleeping habits right - put some pillows behind (tennis ball) your back - never sleep on your back! - I can't even sit in the dentist chair - I choke! My friend's brother had surgery (to stop his snoring) and for a long time battled to swallow AND his snoring is BACK. Sleep on your side - pillow behind your back and leg pillow between your legs - the pillows make it nice and cosy. Use the shaped (hour glass) leg pillow. (it doesn't slip out) Anyway, dear friend, I truly hope you come right and do what's best for you. Kind regards, Marietjie, from sunny South Africa!

[ozij]

There are three very different kinds of surgery mentioned in the first post.

• Surgery to fix nasal problems that may effect you ability to benefit from CPAP: fixing a deviated septum, reducing turbinates etc. That kind is very effective in helping you use CPAP.
  
  LAUP, UPPP and the like: Surgery purporting to solve your "snoring problem" by cutting parts of your palate and uvula. It doesn't work, keep away from it. It will make using more difficult, and at best achieves a 50% reduction in apneas. http://www.journalsleep.org/ViewAbstrac ... ionid=3185
  
  MMA/GA maxillary-mandibular advancement with a gennio-glossal advancement : That is major surgery, with execlleng results for those who need it and involves moving you jaw and tongue forward. It works for people whose OSA is the result of having a very small jaw and airway.

You will find a review of OSA treatments in the New England Journal of Medicine.
Volume 347:498-504 August 15, 2002 Number 7

Once obstructive sleep apnea is diagnosed, continuous positive airway pressure is the treatment of choice. At centers in which polysomnography is available, this approach is usually used to determine the efficacy and optimal level of continuous positive airway pressure (in terms of reducing the apnea–hypopnea index) at the time of diagnosis. At centers in which portable monitors are used for the diagnosis, an initial trial of self-adjusted continuous positive airway pressure with home monitoring can be used to establish the level of airway pressure needed, with subsequent conversion to a fixed-level device, which is less expensive. In that case, follow-up monitoring at home is reasonable to ensure that the apnea–hypopnea index is adequately reduced (to below 5) with therapy. Symptoms, especially drowsiness while driving, should be reassessed in all patients after therapy is initiated. Weight loss should be encouraged in patients who are overweight, with the understanding that if weight loss is successful, the need for continuous positive airway pressure can be reassessed. If continuous positive airway pressure cannot be tolerated, I would suggest the use of a mandibular-advancement appliance, and I would consider uvulopalatopharyngoplasty only if this approach was unsuccessful

.

[rested gal]

I agree with ozij.

From what I've read over the years on the apnea message boards, this is how I feel about some of the surgeries mentioned:

Turbinate surgery and/or sinus surgery - yes. Not a cure for OSA, but could make using cpap (and nasal breathing while awake) easier.

LAUP or UPPP - no. Removing parts of the soft palate and uvula is almost never a "cure" and can make using cpap much more difficult later when the problem returns. "Stopping snoring" does not mean Obstructive Sleep Apnea is gone.

Reducing size/placement of tongue - no. Almost never a "cure."

MMA/GA - yes. Drastic surgery to permanently move the lower mandible (jaw) and tongue forward, but is very successful in curing OSA. Pick the surgeon carefully!

Me...I'll stick with good old "cpap."

If I were going to look into something else (which I'm not) I'd look into dental appliances that hold the lower jaw forward during sleep and are removed in the morning. Something like the TAP (Thornton Adjustable Positioner.)

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

[Analog-X]

My Wifes uncle had the Pallet (SP?) type of surgery and now he has to be careful when he eats, he has a higher chance of choking on food, you know the kind that everyone says "it went down the wrong pipe".

[jnk]

http://ebm.bmj.com/cgi/content/extract/11/4/106

https://roseworthy.adelaide.edu.au/news ... 41/The.pdf

http://erj.ersjournals.com/cgi/content/ ... t/31/1/110

http://pats.atsjournals.org/cgi/content/full/5/2/193

More links to further support the insightful summaries given by ozij and rested gal.

[allinknots]

I have always had sinus issues and struggled with allergies for years. Years ago, my nasal passages always seemed swollen, and for years I could only get air in and out of one nostril. It always sounded like I had a cold or something as the other nostril sounded very congested.

In addition to tight nasal passages and allergies, I also had large turbinates and a deviated septum. This was all before OSA, or before I noticed OSA. Anyways, I had the surgery for the deviated septum and had my turbinates lasered twice by an excellent surgeon in our area.

My recuperation was a bit rough and painful, but I'm very glad I did it! Even though my nasal passages are still narrow, at least I can breathe out of that bad nostril. (Allergy injections helped with the allergy issues, too.)

I've never been sorry that I had the deviated septum/turbinates repaired! As far as the other surgeries go, I'm not sure about those.

All in Knots

[irishpeacock]

I've been scheduled for the summer to get my tonsils out and fix my deviated septum. My doctor said that since I was on the low end of the scale, there was a chance it would lower my AHI a few (significant) points. I'm willing to do anything that will help. I'll get back to you after I get cut up.

[ozij]

Glad you brough that up, Irishpeacock!
We've had a number of members who've gained tremendously from having their tonsils out. Look for posts be Socknister for example. While not curing her apneas, it certainly cleared the way for the cpap pressure - and after surgery she needed far less pressure to keep her airway open.

O.

[rested gal]

Excellent links, jnk. The last one is particularly interesting reading. One of the authors is Dr. Kasey Li at Stanford.

Dr. Li is the surgeon "billinseattle" had perform his successful MMA/GA surgery. billinseattle posted detailed accounts of his surgical journey in the MMA topics in my lonnnng "Surgery" links.

Ditto to what irishpeacock and ozij said about tonsillectomy. That can help.

[sleepydoll]

I've had UPPP done 12 years ago....(removing parts of the soft palate and uvula), having the surgeon promissing me that everything would be ok with my snoring problems.....
BIG MISTAKE !!!!!
1. My snoring was just "different"; more of a suffocation...
2. I couldn't pronounce my "r" s for almost 2 years afterwards.
3. it indeed made using cpap much more difficult later when I realized that I needed it.
4. Obstructive Sleep Apnea was never delt with at all....
5. And I don't even whant to rethink about the pain

Please reconsider this way out...been there, done that! You will not be a happy camper!
D.

[danmc]

Ive had UPPP. Absolutely do not recommend it. As mentioned elsewhere - it changed some things but none for the better. Didn't stop the snoring or apnea one little bit. Seems to have made swallowing amongst other things...funny?...Awkward?..Hell I cant even describe it. Who knows though, perhaps my success with cpap is related to having had it done? Still would not recommend it without serious investigation.
I had turbinates done. Not sure of the details as I was particularly ignorant when I had it done (wouldnt have done it otherwise) I cant say that the balance has been positive from these either. Perhaps slightly improved on balance? I seem to have Empty Nose Syndrome in a small measure.
I had deviated septum corrected - no problem with that one.
I had two more procedures, cant recall what they were and they were all done in the one operation (don't recommend that idea folks). On balance I wish I had gone in a different order - Sleep study , then CPAP , then surgery if still necessary rather than the other way around.

I do have a few side effects - stuff coming out my nose when I swallow etc. After I eat I often blow my nose and find half the food was stuck in there. For a bout 6 months after when I drank the liquid would come out my nose quite often etc. It was hard to swallow for a long time - part of the removal of the palate I guess. Hard to breathe even though I know my nose is clear etc.

It's difficult for me to figure which procedure caused what improvement/change/negative. All I can say is not much changed for the better till cpap.

[Snoredog]

Ask your ENT surgeon this one question:

Will having this surgery prevent my tongue from falling into the back of the throat?