Lower/Upper Jaw Advancement

[josh]

Hi,

A plastic surgeon and orthodontist both agree that I am a good candidate to have both my upper and lower jaw advanced. I have already had the UPPP with deviated septum done, to no avail.

So, the orthodontist wants me to fit me for braces...that I have to wear for 6 months to a year before the actual surgery. My question is, does this seem legitimate? I mean, if they are going to move both my upper and lower jaw by 2mm...let's say...won't my teeth theoretically line up the same way they did before the advancement? I just want to make sure that this isn't some kinda milk the cow for all they're worth scheme.

The first problem is that it could take 2 years before the surgery, which is a long time investment on my part.

The second problem is that since the orthodontist would have to fit me for braces, I am talking about $6,000...of which dental insurance would only cover a maximum of $3,000 (for braces). Since I may "need" the braces in order for the surgery...how do I sort this sort of thing out between my health and dental insurance companies?? So far, talking between the two has not been pleasant...

FYI...I am looking to do the surgery because I need to know that I am cured...I mean, I am on CPAP, but I question how well it is. I wake up sometimes with my mask off...

So please, just pretend that I am going along with the surgery...unless anyone has another viable alternative to it (an actual cure)...for example somnoplasty, radio frequency, etc...(I was told those would not help my situation).

Thanks!

[snork1]

I have NEVER heard of UPPER jaw advancement!
As you point out, moving EVERYTHING forward 2mm seems like you could just step forward 2mm and get the same results.

Now making SPACE up above by spreading the pallete might help, based on recent discussions I had with my Sleep apnea certified dentist. I had a "pallete spreader" device when I was a kid and my dentist says I would be in even worse shape for apnea if I didn't have that.

As far as moving the lower jaw forward, this is known as "MMA" and is a VERY expensive procedure that will take you out of work for quite awhile.(and LOTS of pain!) For myself, an MMA would likely help, according to my ENT, but she does not recommend it, and I can't afford the time or money.
Search on "MMA" in the forums to find experiences with this.

So IF jaw advancement is a mechanism that could help your apnea and you are determined to experiment with that as an alternate, you might consider a dental appliance, such as "TAP", as an experiment. I found a good, certified sleep dentist that will set me up with one for $1700, which is a whole lot less cash than what you are considering and does basically the same thing, albeit with some risk of TMJ issues. Which is why you also want the certified dentist to be a TMJ specialist.

Just a thought though.
And there are MANY opinions on the subject

[WillCunningham]

Hi Josh,

I can't comment much on the dentistry aspect, but if your primary concern is a need to know how the cpap therapy is working for you....there might be an easier solution.

I had similar concerns. I did not have trouble keeping my mask on. I discovered that when I replaced my mask I suddenly felt much better. This implied that my mask wasn't working correctly prior to me replacing it. After experiancing this a couple of times I decided I needed a new type of mask. The new mask is working well so far, but I still had that nagging "what if it doesn't work, will I notice in a reasonable time?" It happens so gradually before that even with as close of attention as I pay to how rested I feel, I managed to miss it a few times.

The answer for me was to get a machine that records the usage data. The machine I ordered stores information on how many apneas you had that night along with mask leak data and other useful information. There is software and a card reader to get the data from my machine to the computer and I can monitor it on a daily or eventually weekly basis to check for problems. I have only been using the machine for a couple of days but I already feel much more reassured my therapy is working. That peace of mind is something I am really enjoying.

If that is your primary concern you might want to look into the software. I don't know if the remstar plus listed in your profile has the data capturing capabilities, but even if you had to buy a new machine that would be signfigantly less than the braces.

[kteague]

As already mentioned, there has been much prior discussion on this forum that was highly informative, and again as already stated, the opinions run the gamut. I WAS adamantly anti-MMA due to the risks and recovery involved in any surgery so invasive. I softened my stance due to two reasons. My brother's coworker had everything you've had done and are considering doing due to structural abnormalities that prevented CPAP from effectively controlling his apnea. He said post-surgery and recovery was absolutely brutal, but in his words "it changed my life". The surgery was a desperation move, and for him it worked out. Who am I to argue with personal experience? Secondly, someone in this forum either posted pictures or a link to pictures that showed xrays of a normal throat vs a candidate for MMA. The evidence was there in black and white. My opinion is, if your docs can show you the same black and white evidence, do what you have to do. But see it for yourself, then you won't have to wonder about any ulterior/financial motives. If they cannot produce evidence of surgical necessity, I'd be concerned that it's just another long shot - at your expense.

Some regulars on here will weigh in soon directing you to "the voices of experience" on the subject, and even to the xray examples. I'm sure you will weigh everything carefully or you wouldn't have bothered even throwing it out there for discussion. Best wishes.
Kathy