PMD Re: Lefort 1, BSSO, and Genio. Advancement for Sleep Apnea

[Guest guest]

Thanks again .

I am beginning to get my arms around all this stuff! I appreciate

your comments.

I also have a recessed chin, an overjet (mandibular deficiency), a

deviated septum, enlarged turbinates, and moderate sleep apnea.

I agree with your " retrospective " suggestion of genioplasty first,

braces and lower jaw surgery second only if necessary, and upper

last only if absolutely necessary. P.S. I am sorry you had

difficulties with your upper jaw surgery.

I want to eliminate my sleep apnea and realize improved cosmetics

(eliminate recessed and short chin, eliminate " double chin " ,

eliminate curled lower lip below upper lip). But I also want to do

the most conservative and appropriate approach first.

I had asked about trying the genioplasty and nasal surgery together

first (and then the braces and lower jaw advancement at a later date

only if necessary). My surgeon suggested that it would be difficult

to achieve optimal aesthetic outcome by doing the genioplasty in

advance of the jaw surgery. I am not sure if he was concerned about

the chin being too advanced if I ended up needing a lower jaw

advancement AFTER the genioplasty? Or if he was concerned about not

being able to achieve enough chin extension by doing the genioplasty

without the jaw advancement? But nonetheless he suggested the

nasal surgery first and then the lower jaw advancement and

genioplasty second at the same time?

I am going to go for an second opinion from another local oral and

maxofacial surgeon.

Thanks again for sharing your input.

Sincerely, PMD

> > > >

> > > > Dear Shirley (bizegrammatx)

> > > >

> > > > Have you considered the " phased surgical protocal " for

dealing

> > with

> > > > your sleep apnea? This is the approach advocated by

and

> > > > Riley (sleep apnea experts) from Standford. The jaw

advancement

> > > > surgery/s are the second (and last) phase of the approach.

The

> > > > first phase may involve one or many of the following

procedures:

> > > >

> > > > 1) Nasal: Correct nasal obstruction depending on anatomical

> > > > deformity (septum, turbinates or nasal valve deformities)

> > > >

> > > > 2) Pharyngeal: UPPP or equivalent and tonsillectomy if

tonsils

> > > > present

> > > >

> > > > 3) Hypopharyngeal: Inferior sagittal mandibular osteotomy

and

> > > > genioglossus advancement, hyoid myotomy and suspension, or

laser

> > > > midline glossectomy and lingualplasty, or partial

glossectomy.

> > > >

> > > > *** After phase one is completed a period of 4-6 months is

> > allowed

> > > > for sufficient healing, weight stabilization and neurologic

> > > > equilibration. Then a repeat polysomnogram accompanied with

a

> > sleep

> > > > assessment and clinical examination is done to assess the

> > clinical

> > > > outcomes. Those patients who are unchanged or incompletely

> > treated

> > > > are offered either further surgery (Phase two) or medical

> > management

> > > > (CPAP).

> > > >

> > > > Definition of Phase Two: (-Riley) If our protocol was

used

> > > > previously, the only region that should be left incompletely

> > treated

> > > > is the hypopharynx ( base of tongue ). A choice now is made

> > among

> > > > the remaining methods:

> > > >

> > > > 1) maxillomandibular advancement surgery, tracheotomy or

nasal

> > CPAP.

> > > >

> > > > NOTE: I believe the the Hypopharyngeal procedures noted in

phase

> > 1

> > > > can be done with or without aesthetic changes.

> > > >

> > > > I would be curious if you considered this alternative. The

jaw

> > > > procedures seem particularly challenging.

> > > >

> > > > I also have sleep apnea and I am considering alterantive

options

> > to

> > > > the jaw surgery. The upper jaw surgery worries me most

because

> > I

> > > > already have sinus issues due to a deviated septum. It

worries

> > me

> > > > because the upper jaw surgery seems to affect the nasal area?

> > > >

> > > > Just some food for thought. I am just a layperson that is

also

> > > > seeking the correct appropriate treatment.

> > > >

> > > > Good luck, PMD

[Guest guest]

Thanks again .

I am beginning to get my arms around all this stuff! I appreciate

your comments.

I also have a recessed chin, an overjet (mandibular deficiency), a

deviated septum, enlarged turbinates, and moderate sleep apnea.

I agree with your " retrospective " suggestion of genioplasty first,

braces and lower jaw surgery second only if necessary, and upper

last only if absolutely necessary. P.S. I am sorry you had

difficulties with your upper jaw surgery.

I want to eliminate my sleep apnea and realize improved cosmetics

(eliminate recessed and short chin, eliminate " double chin " ,

eliminate curled lower lip below upper lip). But I also want to do

the most conservative and appropriate approach first.

I had asked about trying the genioplasty and nasal surgery together

first (and then the braces and lower jaw advancement at a later date

only if necessary). My surgeon suggested that it would be difficult

to achieve optimal aesthetic outcome by doing the genioplasty in

advance of the jaw surgery. I am not sure if he was concerned about

the chin being too advanced if I ended up needing a lower jaw

advancement AFTER the genioplasty? Or if he was concerned about not

being able to achieve enough chin extension by doing the genioplasty

without the jaw advancement? But nonetheless he suggested the

nasal surgery first and then the lower jaw advancement and

genioplasty second at the same time?

I am going to go for an second opinion from another local oral and

maxofacial surgeon.

Thanks again for sharing your input.

Sincerely, PMD

> > > >

> > > > Dear Shirley (bizegrammatx)

> > > >

> > > > Have you considered the " phased surgical protocal " for

dealing

> > with

> > > > your sleep apnea? This is the approach advocated by

and

> > > > Riley (sleep apnea experts) from Standford. The jaw

advancement

> > > > surgery/s are the second (and last) phase of the approach.

The

> > > > first phase may involve one or many of the following

procedures:

> > > >

> > > > 1) Nasal: Correct nasal obstruction depending on anatomical

> > > > deformity (septum, turbinates or nasal valve deformities)

> > > >

> > > > 2) Pharyngeal: UPPP or equivalent and tonsillectomy if

tonsils

> > > > present

> > > >

> > > > 3) Hypopharyngeal: Inferior sagittal mandibular osteotomy

and

> > > > genioglossus advancement, hyoid myotomy and suspension, or

laser

> > > > midline glossectomy and lingualplasty, or partial

glossectomy.

> > > >

> > > > *** After phase one is completed a period of 4-6 months is

> > allowed

> > > > for sufficient healing, weight stabilization and neurologic

> > > > equilibration. Then a repeat polysomnogram accompanied with

a

> > sleep

> > > > assessment and clinical examination is done to assess the

> > clinical

> > > > outcomes. Those patients who are unchanged or incompletely

> > treated

> > > > are offered either further surgery (Phase two) or medical

> > management

> > > > (CPAP).

> > > >

> > > > Definition of Phase Two: (-Riley) If our protocol was

used

> > > > previously, the only region that should be left incompletely

> > treated

> > > > is the hypopharynx ( base of tongue ). A choice now is made

> > among

> > > > the remaining methods:

> > > >

> > > > 1) maxillomandibular advancement surgery, tracheotomy or

nasal

> > CPAP.

> > > >

> > > > NOTE: I believe the the Hypopharyngeal procedures noted in

phase

> > 1

> > > > can be done with or without aesthetic changes.

> > > >

> > > > I would be curious if you considered this alternative. The

jaw

> > > > procedures seem particularly challenging.

> > > >

> > > > I also have sleep apnea and I am considering alterantive

options

> > to

> > > > the jaw surgery. The upper jaw surgery worries me most

because

> > I

> > > > already have sinus issues due to a deviated septum. It

worries

> > me

> > > > because the upper jaw surgery seems to affect the nasal area?

> > > >

> > > > Just some food for thought. I am just a layperson that is

also

> > > > seeking the correct appropriate treatment.

> > > >

> > > > Good luck, PMD