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Desperate sleep apnea sufferers find relief through facial surgery - ApneaNews - 01-26-2013
Desperate sleep apnea sufferers find relief through facial surgery
By Irene Maher
![[Image: 0430281469_256864c.jpg]](http://www.tampabay.com/multimedia/archive/00256/0430281469_256864c.jpg)
TAMPA - Every night for 10 years, Tim Holler serenaded his family at bedtime with an unwelcome tune: loud snoring. He had to sleep in another room so his wife could get some rest.
"I was so loud, she couldn't even sleep with ear plugs," says the Bradenton small business owner.
A sleep study revealed Holler, 45, did more than snore loudly at night. He had obstructive sleep apnea, a dangerous condition that caused him to stop breathing hundreds of times a night and wake up gasping for breath.
"It would scare me," said Lisa Holler, Tim's wife of 14 years. "He was so embarrassed and self conscious about the loud snoring and gasping, he wouldn't travel or stay in a hotel because he worried about disturbing other people."
In obstructive sleep apnea, tissue and muscles in the back of the throat relax, narrowing the airway. The loose tissue vibrates as you drift off to sleep, causing snoring. Then, as you shift into deeper, more relaxed sleep, the tissue collapses partially or completely, blocking the airway until the brain tells you to wake up and breath.
Susan Yeatts of Tampa sometimes went as long as a minute without breathing, before she awakened gasping. She was diagnosed with obstructive sleep apnea in 1990, but believes she had the problem since birth. "My mother said I snored so badly as an infant that she couldn't keep my bassinette next to her bed," said Yeatts, now 51 and a pharmacy researcher. A sleep study confirmed that she stopped breathing an average of 73 times an hour, all night long. "I was exhausted all the time," she said. "I never got deep sleep. I was always tired."
Mild sleep apnea can usually be resolved with lifestyle changes like losing weight, not smoking, avoiding alcohol before bedtime and sleeping on your side instead of your back. Dental appliances worn during sleep that keep the lower jaw forward and the airway open, also help in some mild cases.
Mild to moderate apnea may be treated with surgery, including removal of tissue from the back of the mouth and throat, including the uvula, tonsils and adenoids; plastic rod implants are also sometimes used to stiffen the soft palate, making it less likely to vibrate.
When apnea is moderate to severe, the gold standard of treatment is continuous positive airway pressure, commonly known as CPAP. This is a machine that delivers air through a hose or tubing connected to a mask worn while you sleep. The mask fits over the nose or has prongs that fit inside the nose. The air pressure is just enough to keep the airway open and prevent apnea and snoring.
Yeatts was prescribed CPAP right after her diagnosis, but found it cumbersome, difficult to sleep with and awkward, especially as a young woman. Still, she used it on and off for 20 years.
"It worked," she admits, "But it's noisy and intrusive and it's for the rest of your life. Who wants that?"
That was Holler's biggest objection, too. "I would have to use it for the rest of my life," he said. Plus, he found that he tossed and turned too much for CPAP, which "requires you to sleep in one position, on your back, and stay there.''
"I wanted a permanent solution," he said.
Holler and Yeatts both turned to Tampa craniomaxillofacial surgeon Pat Ricalde for a radical procedure that moves the mouth, tongue and chin forward permanently to enlarge the airway.
Maxillomandibular advancement, or MMA, isn't for everyone with apnea, said Ricalde, especially those doing well with CPAP or other conservative treatment.
"The people who come to me have severe apnea and are desperate for a solution," she said. Her patients are so sleep-deprived, they aren't daunted by major surgery.
MMA involves cutting several bones in the face and reconnecting them with small titanium screws and plates. It takes about four hours, requires at least two nights in the hospital and means missing work for two weeks. They can resume normal activities and diet in five to six weeks. The hardware is permanent, but won't set off security alarms at airports, Ricalde says of a frequently asked question.
"Yes, the surgery is a big deal, but the condition—obstructive sleep apnea—is a big deal. It's more than just snoring. Their oxygen levels drop so low that, over time, it increases their risk of heart attacks, strokes and some cancers," said Ricalde.
Dr. Tapan Padhya, co-director of the sleep disorders and snoring clinic at USF Health and Tampa General Hospital says MMA is "an appropriate, accepted surgery.'' But few of his patients who are eligible have it done, "usually because of the long recovery period or insurance issues." The cost can run about $40,000.
Yeatts said it took a year before her insurance company would approve the procedure. She had the surgery six months ago.
"It's made an amazing difference," she said. "I'm happier, more alert, I can stay awake later at night and I can breath easier." She still has some numbness in her bottom lip, but said it has been slowly improving.
Holler had the surgery last April and also has some residual numbness in his lower lip and chin. "It's a weird feeling, but it was worth it," he sys.
He snores much less now and his apnea episodes have dropped from 88 an hour to just three. He and his wife are able to sleep in the same room again and recently took a family vacation for the first time in years.
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http://www.tampabay.com/news/health/desperate-sleep-apnea-sufferers-find-relief-through-facial-surgery/1271997
RE: Desperate sleep apnea sufferers find relief through facial surgery - PaulaO2 - 01-26-2013
O.M.G.
There's so much bad information in that article.
Is residual numbness worth the "bother" of not using a CPAP? Not to me it's not!
And who was his "educator" that he thought he could not move in his sleep while using a CPAP? Oh, right, there aren't any!
I get ill just thinking of the number of people who will now rush to have their faces reconstructed just so they won't be "bothered" by having to use a CPAP.
RE: Desperate sleep apnea sufferers find relief through facial surgery - vsheline - 01-26-2013
(01-26-2013, 03:33 PM)PaulaO2 Wrote: Is residual numbness worth the "bother" of not using a CPAP? Not to me it's not!
This surgery is very risky. May become partially paralyzed in the face or have permanent pain.
For balance, the author should have sought out some patients where the surgery results were very bad.
RE: Desperate sleep apnea sufferers find relief through facial surgery - ApneaNews - 01-26-2013
(01-26-2013, 04:18 PM)vsheline Wrote: For balance, the author should have sought out some patients where the surgery results were very bad.
In related news, Bruce Finkelstein of Woolloomooloo, New South Wales was quick to point out that while the MMA facial surgery has risk, for him, "it was worth every dollar I spent".
![[Image: popeye.jpg]](http://web.stonehill.edu/compsci/CS103/Assignments/popeye.jpg)
Finkelstein: "I'm so glad I no longer need CPAP! Yeah, there were
some complications, and now it's harder to eat my Vegemite sandwiches,
but all-in-all, I think I was lucky - I changed my name to
'Popeye Finkelstein'. Now at the local boozer, I get the mate's rate on grog".
RE: Desperate sleep apnea sufferers find relief through facial surgery - zimlich - 01-27-2013
I'm 60 now and elective surgery is a less than attractive prospect. They say people are generally more attractive after the surgery and that would be a vain plus. The thought of stopping my sleep apnea instead of just continuing to treat it is attractive, but I'll have to pass.
RE: Desperate sleep apnea sufferers find relief through facial surgery - Ugly - 01-27-2013
(01-26-2013, 11:57 AM)ApneaNews Wrote: Desperate sleep apnea sufferers find relief through facial surgery
Of course an ugly bugger such as I could always use facial surgery.
A new face could only help my case.
RE: Desperate sleep apnea sufferers find relief through facial surgery - Shastzi - 01-27-2013
I think the article has the loaded statement: "Maxillomandibular advancement, or MMA, isn't for everyone with apnea, said Ricalde, especially those doing well with CPAP or other conservative treatment."
So..there you have it.
RE: Desperate sleep apnea sufferers find relief through facial surgery - TheWerkz - 02-01-2013
A Tracheotomy would be much much cheaper along with a faster recovery time.
From Wikipedia: In extreme cases, the procedure may be indicated as a treatment for severe Obstructive Sleep Apnea seen in patients intolerant of Continuous Positive Airway Pressure (CPAP) therapy.
It just sounds like a no-brainer to me if you don't like CPAP!
Source: http://en.wikipedia.org/wiki/Tracheotomy
RE: Desperate sleep apnea sufferers find relief through facial surgery - genes - 02-01-2013
I agree that the article sounds a little like an imfomercial sp? but I think for some people with sleep apnea that MMA surgery is an acceptable solution. Personally as long as cpap was working well I would stay with cpap and not elect to have the surgery.
I started on cpap with the sleep easy in 1985. It helped but I still had some problems. I think now that most of my early problems were caused by mouth breathing which they said was ok to do and I hadn't figured out yet that nasal cpap does not work when you breath thru your mouth. My doctor sent me to a surgeon who put a lighted tube down my throat and said that the obstruction was at the back of my tongue where the airway was narrow. I had surgery similar to MMA probably 20-25 years ago. It was called Glossus Advance Surgery and Hyoid Suspension. Instead of moving the lower jaw and tongue forward it just moved the tongue forward. A square was cut in my lower jaw bone deep enough to get to the bone that supports the tongue. The tongue bone was then moved forward thru the square and then a pin was inserted to hold the bones together until they grew back together. The bone that pertruded was then shaved off even with the jawbone. I am not quite sure what the Hyoid Suspension did. I agree it was not fun at all but I came thru it fine. I remember I had some numness in my lower jaw or tongue for quite a while. It may have helped my apnea some but I still need cpap. Once I found out about the problems with mouth breathing my cpap worked better. I think that when the sleep apnea treatment is not working as it should at least I would do what ever it takes to get treatment. My cpap is working so I do not plan to ever have more surgery for sleep apnea. When I can I use a dental appliance to hold my jaw forward more which I figure will help hold the tongue forward too.
I recently had a couple of dental implants and talked to my maxio-facial surgeon about MMA. He said he has done quite a few MMA surgeries for sleep apnea and has had good results.
It seems logical that if the cause of your apnea is that your tongue is too far back that surgery that advances the tongue could help. I still would never do it just to eliminate the need to use cpap.
GeneS
RE: Desperate sleep apnea sufferers find relief through facial surgery - Ugly - 02-01-2013
(02-01-2013, 05:41 PM)TheWerkz Wrote: A Tracheotomy would be much much cheaper along with a faster recovery time.
From Wikipedia: In extreme cases, the procedure may be indicated as a treatment for severe Obstructive Sleep Apnea seen in patients intolerant of Continuous Positive Airway Pressure (CPAP) therapy.
It just sounds like a no-brainer to me if you don't like CPAP!
Actually that was suggested to me even before a CPAP was.
I didn't like the idea of more surgery. And now I know it probably would do diddly squat about CSA.