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Alternatives to CPAP… Do They Really Exist??
I recently stumbled onto this website, and immediately found it extremely interesting to get an insight into the lives of people living daily with OSA. As an oral & maxillofacial surgeon practicing in NYC, whose practice mainly focuses on the treatment of OSA and snoring, it is not always easy to understand the struggle that my patients face daily.
In my practice, I offer patients a variety of treatment options, from conservative treatment with oral appliances, to surgical treatment. Most patients come to me because they cannot tolerate CPAP, and many have already tried some sort of surgical procedure, which has not worked. From my experience, it seems that patients consider surgery as a last option because they do not believe that their expectations can be met. However, I find surgical results to be fairly predictable. Most patients are very familiar with ENT procedures, but few are familiar with the treatment options that oral & maxillofacial surgeons offer. In fact, we complement each other very well, as we actually focus on different parts of the airway, and the airway has to be comprehensively evaluated to really figure out the cause of OSA. When clinically indicated, I find that a combined approach often has the most predictable result in patients with OSA.
I have browsed through some of the previous discussions, and have not found too many topics on oral appliances or surgical treatments. Therefore, I would be happy to answer any questions that you may have on these 2 topics, which I believe can be very attractive options to people who do not want to use CPAP. I will therefore let you guide this discussion if anyone finds it interesting. Feel free to browse my website if you’d like to know more about me, and then let me know if there are any specific questions that you may have which I can answer! My website address is www.ParkAvenueFaces.com
Views: 1531
Replies to This Discussion
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Permalink Reply by RockRpsgt on
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The interviews showed people that recovered very fast and well. Could have been planned or picked for the occasion. The mouth is one of the fastest healing areas of the body. I was really impressed with the entire presentation. The end result for those in need was truly amazing.
Ginny Edmundson said:Hi Rock~ How "rough" is it to go through this type of surgery??? Remember, I am a wimp! :)
RockRpsgt said:The lecture I recently attended gave a 93% success rate for this type of surgery. It's amazing how many pts I have seen since that I believe would benefit from this.
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I have heard the exact opposite about this type of treatment. I have been told by several docs that it is very hard to prove that it is anything other than cosmetic surgery.
Dr. Ruben Cohen said:I have been doing these procedures for a long time, and as far as I know, we have always been able to get them approved by medical insurance companies.
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Permalink Reply by Ginny Edmundson on
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My question too! Who does one go to? My sleep apnea MD has not mentioned anything about my tongue. It is just my deduction. As soon as I have nasal pillows on shortly after I "poof" and I wake up. With a chin strap (God awful uncomfortable) it does NOT happen.
Mike C (STILL at the Beach!) said:Therein lies MY biggest problem. How to best determine if this would even be appropriate in MY case....
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You would need to find a doc that specializes in this type of surgery. I would start with my PCP or dentist. These types of surgeons need to work with an orthodontist for maximum effect. The doc I recently listened to was both a dentist and a surgeon.
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If your PCP is no help talk to your dentist.
Mike C (STILL at the Beach!) said:PS, I am going to ask my PCP for some way to get me to the type person you suggest since an oral appliance is the ONLY thing not yet tried short of more surgeries.
RockRpsgt said:You would need to find a doc that specializes in this type of surgery. I would start with my PCP or dentist. These types of surgeons need to work with an orthodontist for maximum effect. The doc I recently listened to was both a dentist and a surgeon.
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Permalink Reply by Dr. Ruben Cohen on
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RockRpsgt: these procedures are very effective; your doctors may not be familiar with them. I would certainly not consider these procedures “cosmetic surgery”. You can see volumetric airway scans before & after surgery on my website. ENT surgeons typically do not perform these procedures; you need to look for an oral & maxillofacial surgeon in your area, who commonly performs OSA surgeries. This person would be able to properly examine you, diagnose you, obtain the insurance pre-authorization needed for the surgery, and perform the surgery. Otherwise, come on up to NYC and I would be happy to treat you!
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With Medicare??? :)
Dr. Ruben Cohen said:RockRpsgt: these procedures are very effective; your doctors may not be familiar with them. I would certainly not consider these procedures “cosmetic surgery”. You can see volumetric airway scans before & after surgery on my website. ENT surgeons typically do not perform these procedures; you need to look for an oral & maxillofacial surgeon in your area, who commonly performs OSA surgeries. This person would be able to properly examine you, diagnose you, obtain the insurance pre-authorization needed for the surgery, and perform the surgery. Otherwise, come on up to NYC and I would be happy to treat you!
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I am going to give my oral appliance another try, I think.
RockRpsgt said:If your PCP is no help talk to your dentist.
Mike C (STILL at the Beach!) said:PS, I am going to ask my PCP for some way to get me to the type person you suggest since an oral appliance is the ONLY thing not yet tried short of more surgeries.
RockRpsgt said:You would need to find a doc that specializes in this type of surgery. I would start with my PCP or dentist. These types of surgeons need to work with an orthodontist for maximum effect. The doc I recently listened to was both a dentist and a surgeon.
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Im sorry Dr. Ruben it was not me that thought these procedures were cosmetic. I recently attended a conference on this type of treatment. I understand the need. I was told by the docs that many insurance companies still view this type of surgery as cosmetic.
Dr. Ruben Cohen said:RockRpsgt: these procedures are very effective; your doctors may not be familiar with them. I would certainly not consider these procedures “cosmetic surgery”. You can see volumetric airway scans before & after surgery on my website. ENT surgeons typically do not perform these procedures; you need to look for an oral & maxillofacial surgeon in your area, who commonly performs OSA surgeries. This person would be able to properly examine you, diagnose you, obtain the insurance pre-authorization needed for the surgery, and perform the surgery. Otherwise, come on up to NYC and I would be happy to treat you!
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Permalink Reply by ds on
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Mike...Wow, that is way too much.
In addition to OSA, I have a condition called pseudo tumor cerebri. alot of the symptoms that you describe are familiar to me ( severe headaches, hearing pulse swishing in your head stand out particulary). This is diagnosed by excluding everything else and having a spinal tap to measure the intracranial pressure. I am treated successfully with diamox. It is unusual diagnosis and not all are well versed so I had to mention it. Good luck to you.
Mike C (STILL at the Beach!) said:Moderate-severe. AHI of 28 with the worst while rolling onto my back. I have several things I use to attempt keeping me OFF my back.
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.....At least we had a chance...... Hey we are not Dead yet!!! cranky, creaky,not doa yettttt
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I have been told by my dr. to use an apnea mouth appliance. CPAP mask really made me sick for several days with sinus trouble.
Where in the world (or at least in Alaska) can I find such a thing? My oral surgeon doesn't do them.
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