"please keep me updated about oximeters "
Sleep Apnea Forum Bringing Power to the Patient
New? Free Sign Up
Then check our Welcome Center to a Community Caring about Sleep Apnea diagnosis and Sleep Apnea treatment:
CPAP machines, Sleep Apnea surgery and dental appliances.
CPAP Supplies
Latest Activity
a lot about maxillomandibular advancement
I was told that I was a great candidate for MMA surgery (I have a "class 2" jawline and a very suitable overjet), and have been getting prepared for that procedure and its accompanying orthodontic work. I have done some research on the subject, and have been flabbergasted at what seems like results from this operation that are almost TOO good to be true.
To wit: I have not found anything to indicate any sort of lasting pain or serious complications that arise from this surgery. That's a bit unnerving. Is it really as safe/virtually pain-free as my study seems to suggest? I'm VERY worried that I will have a hard time adapting to my new mouth/jaw/tongue architecture, that my mouth will close differently and it will be odd/painful, and that after the surgery I'll just feel weird/hurt/not myself--maybe forever.
Could the sleepguide community please speak to my concerns about such? Are there resources to which I could refer? My oral surgeon and orthodontist have been very helpful and reassuring, but I highly value the input of this group.
I'm not as bothered by some that my face will be altered. I'm not Helen of Troy. I've been told by several that I may look better post-surgery. I don't care if my appearance changes and I'm not disturbed that bone will be sawed through. All of this, plus the braces, plus the jaw-being-wired-shut, plus the all-liquid post-surgery diet, is infinitely more "palatable" (pun intended) to me than any CPAP mask that will ever be created. I'm actually a bit surprised that more people don't feel that way.
I've had a tracheostomy suggested to me. That sounds worse, more antiquated; and even if it is reversible, won't there always be a huge scar on your neck? And an actual gaping hole for all to see? I read that Steven Hawking lost his voice from a similar procedure.
I understand that many are optimistic that a more tolerable treatment than CPAP is just a few years away. I am not. I don't think MMA is a quick fix, but I've been terribly attracted to it ever since it was proposed. What I've worried about is permanent pain, permanent scarring, permanent disfigurement. Those would not be good. Everything else I could make my peace with if it was part of the package deal of being able to sleep properly.
I've been told that a conservative figure for this operation's success, at least in my case, is 80%. That's much better than a UPPP. I've been told that at 62 apnea per hour, I am too severe for a dental appliance. I do plan to once again try and find that magic CPAP mask that will work for me in the months my teeth are being addressed. But MMA seems like the best long-term option. A lot of people recoil when I explain to them what the procedure entails. I wish they wouldn't do that.
To wit: I have not found anything to indicate any sort of lasting pain or serious complications that arise from this surgery. That's a bit unnerving. Is it really as safe/virtually pain-free as my study seems to suggest? I'm VERY worried that I will have a hard time adapting to my new mouth/jaw/tongue architecture, that my mouth will close differently and it will be odd/painful, and that after the surgery I'll just feel weird/hurt/not myself--maybe forever.
Could the sleepguide community please speak to my concerns about such? Are there resources to which I could refer? My oral surgeon and orthodontist have been very helpful and reassuring, but I highly value the input of this group.
I'm not as bothered by some that my face will be altered. I'm not Helen of Troy. I've been told by several that I may look better post-surgery. I don't care if my appearance changes and I'm not disturbed that bone will be sawed through. All of this, plus the braces, plus the jaw-being-wired-shut, plus the all-liquid post-surgery diet, is infinitely more "palatable" (pun intended) to me than any CPAP mask that will ever be created. I'm actually a bit surprised that more people don't feel that way.
I've had a tracheostomy suggested to me. That sounds worse, more antiquated; and even if it is reversible, won't there always be a huge scar on your neck? And an actual gaping hole for all to see? I read that Steven Hawking lost his voice from a similar procedure.
I understand that many are optimistic that a more tolerable treatment than CPAP is just a few years away. I am not. I don't think MMA is a quick fix, but I've been terribly attracted to it ever since it was proposed. What I've worried about is permanent pain, permanent scarring, permanent disfigurement. Those would not be good. Everything else I could make my peace with if it was part of the package deal of being able to sleep properly.
I've been told that a conservative figure for this operation's success, at least in my case, is 80%. That's much better than a UPPP. I've been told that at 62 apnea per hour, I am too severe for a dental appliance. I do plan to once again try and find that magic CPAP mask that will work for me in the months my teeth are being addressed. But MMA seems like the best long-term option. A lot of people recoil when I explain to them what the procedure entails. I wish they wouldn't do that.
Views: 9172
Replies to This Discussion
-
Permalink Reply by dr. martin bassiur on
-
I suggest that you speak to your OS about your concerns. Ask him how many orthognathic cases he has completed and his success rate - ask him if has patients that have had the surgery who he may recommend you to speak to. Certainly a trial with a mandibular advancement appliance may give you some idea about the benefits of jaw advancement but if you are severely retrognathic the oral appliance may not be able to advance your mandible as much as you would like it to. All surgery has risks- but in competent hands nerve damage should not be an issue. Keep getting infomation and be well informed so that you can make an educated decision...
-
Permalink Reply by James Skinner on
-
Ross Plotkin said:
So I am greatly distressed that so many people are shouting, "No, no, no!" I want something to fix me permanently, now. So that I never have to do anything about sleep apnea again. It pains me that the consensus seems to be, "Sorry, we're just not there yet, technology-wise. Get used to CPAP, or suffer." Not to be melodramatic, but that's like a sledgehammer to my kidneys.
I have spend a huge amount of time researching different surgery options for OSA. I think MMA is a reasonable option to consider, particularly if your chin is receded to start with. Make no mistake that it is a very serious operation with the potential life long side effects. However OSA is a serious illness and must be treated.
I would do it myself if I was a candidate. See my airway narrowing
MMA has probably the highest success rate short of tracheostomy. Trying an MAD first can give you an idea if MMA will be successful.
-
Permalink Reply by Banyon on
-
j n k said:I believe the rule still holds if you define "success" as getting AHI below 5 in an NPSG in the case of severe apnea. (Admittedly a strict definition, but a valid one if comparing with PAP therapy.)
If the success of oral appliances in treating sleep apnea is compared to CPAP, they are a dismal failure.
Unfortunately oral appliances are becoming the first choice of treatment in many cases. They should be reserved for patients who are failures at CPAP and for adjunct use with CPAP.
If a person is a total failure at CPAP, then the old rule about oral appliances (they don't treat moderate or severe cases) should be thrown out.
We need to think of the practical effects of keeping that old rule around. If we can believe the two studies I cited, then we don't want that old rule discouraging someone who has moderate or severe apnea and is unable to use CPAP from trying a MAD.
Get rid of the rule. If that bothers you jnk, start a new rule that says something like, "Oral appliances are ineffective, but better than nothing for some people."
-
Permalink Reply by D. W. Conn on
-
I agree with Dr. Whitmore’s statement. Also try a combination of dental device and CPAP.
-
Permalink Reply by Crabby Appleton on
-
I am absolutely at the end of my rope. I haven't had a decent night's sleep in weeks. It disrupts every facet of my life. Now my wife, who used to be able to sleep standing up, has sleep issues because I thrash and fight all night. I suggested getting separate beds just so I wouldn't bother her as much. I've been testing different masks for the last 3 months because I'm so dizzy in the morning I can walk straight. I cannot find one that will seal properly. I went back into the "sleep tech" and asked them to fit my mask properly. I was sure it had to be the problem. Here I am 3 weeks later and still wake up to hear the mask whistling. It leaks around my nose bride when I lay one way and it leaks under my chin when my mouth falls open. I've never used a chin strap, but all of this (stuff) hanging off my head every night is cumbersome and impossible to get comfortable while wearing it. I can complain all day long and I don't seem to get any solid advice on how to deal with all of the problems I've had since I started using CPAP.
-
-
My blood pressure is elevated. I had "borderline' BP for quite a while. I told my doc that I was concerned. He told me that it wasn't high enough to be worried about. Long story shorter, I not have LVH, left ventricular hyperthropy. Now I have to take Diovan & Norvasc every day to keep my BP under control, and I have heart damage to boot.
I just felt in my gut that the dizziness was because I wasn't getting enough oxygen at night. I was put on Ambien & Tylenol PM because I cannot get to sleep usually, and once I do drop off, I cannot stay asleep. I wake up (that I know of) 5-6 times a night. It's just become a huge frustrating circle of chasing one thing after another. I'm 48, better than average shape, was very active until all of this came about. I had a pain pump implanted (failed back surgeries & DDD) into my gut about a week shy of a year ago that pumps morphine into my spinal fluid. My pain doc says the pain med is not effecting my sleep, and I tend to believe him, but my sleep doc just reads the feedback off the card and says, "Well, it says you're getting enough air." I have no medical insurance, so chasing around from multiple doctors every day is not an option financially. I feel like I've been dumped and left to fend for myself.
-
-
I don't have anxiety attacks, but I have a terrible time with my mind "racing" at night. If I wake up, my mind starts racing about what I have to do at work, etc. That's why they put me on the Ambien, to try and keep me asleep. Pain has always been a major issue at night. I'm an orthopedic nightmare. I am so sleepy when I get up in the morning that I fall asleep constantly while reading the paper. Luckily I am self employed, so I can start work whenever I want, but getting up at 7 am, eating some oatmeal, falling asleep in the middle of the paper, then having to take a 20 minute nap before I can get going every morning is ridiculous. I would give anything to be able to sleep 6 solid hours a night. Even more frustrating is talking to people who have no sleep issues at all. They just can fathom how anyone could not sleep at night. It's maddening and I have nowhere to turn.
-
-
Most "remedies" have so far have not helped, but I'm willing to try anything. I've been listening to sleep cd's lately trying to calm my mind and help me get into a deep sleep, but nothing so far. Thanks for the advice.
-
Permalink Reply by Mack D Jones, MD, SAAN on
-
Ross, I can't tell you what's best for you, but I can tell you my take on MMA in regards to my own situation. For me, MMA for most of us SAs like myself is, how can I put this delicately, "not quiet as good a procedure as some would have you believe." Here's why: It doesn't get rid of the apneas, it only REDUCES them. You still need your PAP machine to take care of the apneas that you are left with.
Read the fine print and learn what "success" really means. It means a reduction of your AHI by more than 50% or a drop below 20. It doesn't reduce your AHI to 0 (only PAP or a trach can do that).
Oh, and there are a few risks, including permanent loss of feeling in the chin, upper mouth, teeth and lips, but they occur at a low percentage of cases. And of course the procedure is irreversible.
Who in there right minds would go through all that surgery, risk, prolonged healing, and co$t to try to reduce their AHI by over half and still be left with sleep apnea? The word "success" as it is used in the ENT literature, is "failure" where I come from.
To me, it is simple. PAP is where it's at, until something better comes along, get used to it. Everything else comes up short (except a trach, which is your backup parachute when your main one fails).
-
Permalink Reply by Tim on
-
I am one of the people who have had an MMA and have a permanent loss of feeling in my lips, upper mouth, and teeth; I have also had a UPPP -- and I am also still on CPAP. My surgeon warned me about the potential of nerve damage, he also led me to believe that I would no longer have to use CPAP.
I wish I knew what the chances of success were when I had both surgeries. There were no apnea forums on Usenet, AOL, or Prodigy at the time I had my surgeries.
-
-
I rented a basement apartment from a lady who had this surgery. She was a nurse at a large well known hospital here in North Carolina.So, she obviously had access to a database of good doctors. However, her life has never been the same! She has nerve damage to her face so severe that she says her lips have a searing pain, as if they are on fire! She is heavily medicated for pain to the extent that she can hardly function. She says the pain NEVER goes away, even with the medication. She is totally disabled, of course, and soon will be on assisted living because of this surgery! I know this is probably rare, but it shows what can happen. I myself have apnea and use a CPAP and sometimes wonder if it's doing exactly what I need , as I'm still very tired during the day sometimes. Maybe my machine needs re-calibrating, but I personally would never consider letting someone permanently dis-figuring my face and my life with so many other options out there!
-
Permalink Reply by Mary Z on
-
This does sound like a good choice for you. The time commitment and orthodontic work involved scared me off (I don't even know if I have the type jawline for the surgery). I agree it sounds like a good option, and I've read, as you said, that most people think they look better after the surgery.
I think with your knowledge and the research you have done you sound like a very good candidate. Your fears are the same as any of us might have. If you are willing to go through all the work- as I said the orthodontics scare me most. I just did my research on the web and seem to have found the same information you did, as well as some photos of the othodontic work. Since you're a really good candidate I say go for it. You're well prepared and 80% is a darn good chance for success. I see very little drawback since you are so well informed.
Please, Ross, keep us involved in the process and timeline. You'll exucate a lot of people regarding this particular therapy.
Mary Z.
- ‹ Previous
- 1
- 2
- 3
- 4
- Next ›
© 2024 Created by The SleepGuide Crew.
Powered by
