oral surgeon suggests major OSA surgery

[torontoCPAPguy]

Just remember what puts food on the table for an oral surgeon, with all due respect. This is why we want second and third opinions from surgeons that will not have the opportunity to actually do the surgery in question - you are looking for opinion only.

I had a hole from my root canal into my sinus years ago and the first doc I saw (an oral surgeon by heavens!) wanted to put me in the hospital the following day; do a workup over the weekend and operate on Monday, removing the roof of my mouth, cleaning and cauterizing and sewing my head back together as best he could with no guarantees of avoiding massive nerve damage etc. I saw two other surgeons who were tripping over their feet to get in there and do the same surgery and then saw one who said that if it was his brother he wouldn't recommend this surgery for all the tea in China. Just take antibiotics if infection began to rear its ugly head and eventually the body would heal itself in this case.... it did just that. My only point being that for those that need to make car and house payments, these complex and lengthy surgeries are meat and potatoes. It's what puts the food on the table.

Remember that and take what you hear with a grain of salt.

[apnea2142]

I wish I had UPPP 2 years ago because I seem to be brain damaged from this terrible disease, I could have avoided all this damage if I found a willing surgeon. but my ENT kept on milking me for money with visits and no surgery

[rickmarkokc]

Thanks everyone for the feedback. As one user mentioned, there is a lot of confusion going on here between surgeries like UPPP and the MMA surgery.

Someone mentioned that i 'don't appear to have a recessed chin in my avatar.' Typically recessed chin is most noticable upon viewing the side profile.

Still not sure what to do. I have a follow up with the oral surgeon on Wed. He is going to do a workup, where he will explain the procedure, how far forward they plan to move my jaw, etc.

I'm going to talk to the dentist about appliance options for moving the jaw forward, and also his opinion of MAA. I also like the idea of getting a second oral surgeon opinion.

[SleepingUgly]

Studies have been done about how far forward the jaw has to be advanced in order to get the desired results. A doctor once told me how far forward it needs to be and that studies have shown that any less and it doesn't work well. I forgot how many mms, but it was substantial, and markedly more than when MMAs are done for aesthetic purposes.

If CPAP doesn't work well, what's to say an MMA would? I would be more inclined to believe an MMA would work if CPAP worked.

[SleepingUgly]

But based on the fact that x-rays shows how my jaw is closing down my airway...

Do you mean cephalometic x-rays? If it's that clear-cut, every surgeon looking at it should agree with that recommendation.

There are only a handful of doctors in the U.S. who do A LOT of MMAs. If I were considering an MMA, there is no way I would go to anyone but one of those. At the same time, I'd recognize that they have the most incentive to tell me what I want to hear.

BTW, I've never heard of anyone trying CPAP for as short a period of time as you have and considering an MMA. I am not going to tell you that CPAP is one of the great pleasures in life (although you'll find others here that will) but you are considering a very drastic surgery considering you might just find that having to use CPAP is not nearly as bad an outcome as you might think...especially considering the possible things that can go wrong from a surgery like that, not the least of which is the possibility of no cure.

[SleepingUgly]

I googled MMA and Sleep Apnea and images, and then clicked on some of the images to get to people's blogs about their experience with MMA. I clicked on 3 of them and didn't read them comprehensively, but clearly none of the 3 was cured. There may have been some improvement (or not), but these were not people who were "cured". Did I just click on a nonrandom sample (maybe the cured ones don't write blogs?)? Who knows.

My advice: Proceed with great caution. (Translation: Proceed so slowly that by the time you're ready to decide yes or no to the surgery, you're at least a year into CPAP...)

Just my two cents.

[BlackSpinner]

My advice: Proceed with great caution. (Translation: Proceed so slowly that by the time you're ready to decide yes or no to the surgery, you're at least a year into CPAP...)

Just my two cents.

I agree. If you are using your cpap properly, with low AHI and a good leak line then the cpap is doing what you expect the surgery to do - keeping your throat open. If this is not making you feel better, I question whether the surgery will help you feel better. All it may do is take you off cpap.

[BasementDwellingGeek]

I had the UPPP, it didn't work for me. Only when I take ridiculously large gulps does any thing enter my nasal passages.

I did discuss the MMA and tracheotomy with him as well. The latter he said would almost be guaranteed to work. Both were too radical for me.

[rickymarkokc]

Yes I had the xrays and we looked at them together, with the surgeon explaining why my airway was so narrow.

Agree that MMA surgery should be LAST RESORT. Also agree with giving CPAP more time. Its only been a month. I'm not taking lunch naps any more but I look so tired in the eyes. To me its not about MMA surgery being more effective. To me it comes down to- do I want to wear a CPAP for the next 40 years?

Also going to look into an oral appliance. Typically only approved for milder sleep apnea, but due to the fact that my lower jaw sits back too far, I'm very interested to find out what a device like the TAP 3 could do for me. Basically moves the lower jaw forward to improve air flow.

I just feel like its important to explore options. CPAP is very effective when used properly, but I'm learning more and more that compliance rates are very pooor.

[NightMonkey]

I'm very interested to find out what a device like the TAP 3 could do for me

Don't forget your 40-year question. It applies to MADs (mandibular advancement devices) as well as CPAP.

I can't imagine a MAD for forty years.

[BlackSpinner]

I just feel like its important to explore options. CPAP is very effective when used properly, but I'm learning more and more that compliance rates are very pooor.

Most people drop out in the first month, many due to mask issues and lack of support. You are already feeling the benefits even if your eyes still look tired This could also be due to leaks into the eyes - try eye drops or a different mask. Don't base your therapy choices on other peoples issues.

[chunkyfrog]

I would go along with the others and not do anything irreversible for at least a year--and a LOT of research.
In the meantime, work with the cpap; it took awhile for even me to feel real improvement.
Don't worry about the future. There are people working on something all the time.
One day somebody may come up with something else that actually WORKS.
Even if you have only 40 years; we spend but a third of our lives in bed--that's only 13 years and 4 months.
With cpap, you could add a few more to the total. Certainly beats starting that dirt nap too dang soon.