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

October 23, 2004

PMD, due to the fact she stated she has a narrow airway she is

probably on the proper course. The fujuta protocol you mention has a

low success rate for stage 1 when retrolingual narrowing is an issue.

less than 40% (if i remember correctly) which is why many are starting

to move away from upper airway procedures when the base of tongue is

the main source of obstruction. knowing her airway is narrow tells me

that the docs are looking at all areas of obstruction. in my case they

looked up my nose and down my throat and just wanted to carve me out.

then i made them give me a lateral ceph that revealed my airway was

only 5mm when 10mm is normal. needless to say i opted for the MMA in

spite of my ent's premature recommendations. I am happy to say i am

now apnea free even though my follow-up PSG isn't scheduled yet. If

you have a deviated septum the protocol calls for getting that fixed

first as i did but success rate is < 5%. hypertrophy of the inferior

turbinate also usually accompanies a deviated septum and should be

addressed at the same time.

A good board for discussion of the options is:

http://www.sleepnet.com/noncpap15/noncpap15.html

good luck on your journey to a better nights sleep

eric

>

> 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

October 23, 2004