Maxillomandibular advancement surgery AMA

[mrkdilkington]

Hi everyone, I am doing an AMA on Reddit in which I'm sharing my experience with MMA surgery and answering any questions. Reading on Apneaboard was a big help to me when I was first diagnosed with SDB so I thought I'd just pass along this link for anyone to ask me questions they might have about getting corrective jaw surgery. There's a lot of resources online but if you have a question you can't find an answer for I'd be glad to answer it.

https://www.reddit.com/r/SleepApnea/comm...s_and_ama/

[Ostrich]

I cannot use CPAP at all and oral device only gives me pain in my teeth, is this surgery my next step? I'm gonna talk to my doctor next week but I think this procedure is rare in my country.

Always tired makes my life a nightmare.

[49er]

You might want to google Inspire Therapy which is an implantable neurostimulation treatment for people diagnosed with obstructive sleep apnea. If this interests you, I would contact the program manager for a list of Inspire Centers in Europe.

If it doesn't, yes, the next step would be either MMA surgery or some other type of procedure, depending on what the nasoendoscopy or sleep endoscopy showed to be the source of the obstruction.

You wouldn't need one for MMA surgery since it would involve the entire airway. However, there would be plenty of other things you would have to do ahead of time including the possibility of 12 month pre surgical orthodontic treatment.

Meanwhile, do I assume correctly that you have tried troubleshooting why you have had difficulty with CPAP? How long did you give it a try?

The reason why I am asking is in the US, most sleep apnea surgeons will have wanted you to try it for at least 6 months before they will operate.

Best of luck.

49er

[Ostrich]

You might want to google Inspire Therapy which is an implantable neurostimulation treatment for people diagnosed with obstructive sleep apnea. If this interests you, I would contact the program manager for a list of Inspire Centers in Europe.

If it doesn't, yes, the next step would be either MMA surgery or some other type of procedure, depending on what the nasoendoscopy or sleep endoscopy showed to be the source of the obstruction.

You wouldn't need one for MMA surgery since it would involve the entire airway. However, there would be plenty of other things you would have to do ahead of time including the possibility of 12 month pre surgical orthodontic treatment.

Meanwhile, do I assume correctly that you have tried troubleshooting why you have had difficulty with CPAP? How long did you give it a try?

The reason why I am asking is in the US, most sleep apnea surgeons will have wanted you to try it for at least 6 months before they will operate.

Best of luck.

49er

Thank you for for reply. Neurostimulation treatment sounds interesting I'm gonna check that out.

I've been trying for more than 12 months and its still uncomfortable and the noise from the mask during inhale/exhale(Darth Vader) is way to high for me. I've got hypersensitive hearing. I've managed so sleep for 3-5 complete nights but with help from lots of zopiclone combined with "calming" medication and that's not the route I wanna go for the rest of my life.

It's almost impossible to get information about surgery in my country Sweden and almost every physician I've spoken to says its only a temporary relief and within 1-2 years its back to zero again. Sorry for crying out but this lack of sleeping makes my ADHD worse and I feel handicapped.

[49er]

I totally understand your feelings. I think doctors generally are very skeptical of sleep apnea surgery. But what they don't understand is if surgery is your only option, they need to help you make the best-informed decision possible.

Success rates are dependent on so many variables. For example, the UPPP procedures supposedly don't have a good success rate. But if all areas of obstruction aren't addressed, of course, the success rate isn't going to be as high as it should. That is why if a surgeon suggests this procedure, he/she needs to examine your airway ahead of time to see exactly what needs to be addressed.

Regarding the MMA procedure, you might want to google Kasey Li, a sleep apnea surgeon who is located in Palo Alto, CA. You might want to contact his office to see if they have recommendations for surgeons in Europe if going out of Sweden is a possibility. Many people consider him to be the best MMA surgeon so that is why I was suggesting you contact his office.

Here a link to statistics on the MMA success rate.

https://www.ncbi.nlm.nih.gov/pubmed/20189852

The reported efficacy of maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA) is uncertain. We performed a meta-analysis and systematic review to estimate the clinical efficacy and safety of MMA in treating OSA. We searched Medline and bibliographies of retrieved articles, with no language restriction. We used meta-analytic methods to pool surgical outcomes. Fifty-three reports describing 22 unique patient populations (627 adults with OSA) met inclusion criteria. Additionally, 27 reports provided individual data on 320 OSA subjects. The mean apnea-hypopnea index (AHI) decreased from 63.9/h to 9.5/h (p<0.001) following surgery. Using a random-effects model, the pooled surgical success and cure (AHI <5) rates were 86.0% and 43.2%, respectively. Younger age, lower preoperative weight and AHI, and greater degree of maxillary advancement were predictive of increased surgical success. The major and minor complication rates were 1.0% and 3.1%, respectively. No postoperative deaths were reported. Most subjects reported satisfaction after MMA with improvements in quality of life measures and most OSA symptomatology. We conclude that MMA is a safe and highly effective treatment for OSA

Best of luck.

49er

[Ostrich]

Thank you very much for the informative replies I'm gonna fight this badly and the good thing its 100% free of charge so patience is the only problem here.

The one thing that bothers me most is none of the doctors have done a complete examination of my throat/nose etc they just put me on some EMG crap and then threw CPAP and oral appliance in my face.

[49er]

You are very welcome. Again, best of luck.

49er

[Ostrich]

You are very welcome.   Again, best of luck.

49er

Update!

Met one of few specialist in our country regarding procedures for sleep apnea. I asked her about AMA but it's apparently to advanced for our country and needs to be performed in Germany. She also said that I might end up with a "monkey" face because my mouth/jaw is already a bit in front of the nose and forehead, hard to explain


She told me they could perform Tonsillectomy and/or adenoidectomy surgery. With 10-50% reduction apnea give or take. 

[Beej]

Have you determined if it is better or worse sleeping on your side, rather than on your back? For some, it may help.

[Ostrich]

It doesn't matter according to the sleep studies and 80% stomach more or less.