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

[Guest guest]

:

Thank you for the reply (and the reference to the sleep apnea site).

Couple of clarification questions:

Does MMA include both lower and upper jaw surgery? Or did you just

do lower jaw surgery? I have had two recommendation from different

surgeons. One claimed both upper and lower jaw surgery are required

to address sleep apneea. The second recommended lower only based on

my ceph xray.

Can you confirm that you had the nasal surgery IN ADVANCE of the MMA

surgery? Would you do both at the same time if you had to do it

again?

I appreciate your comments.

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]

:

Thank you for the reply (and the reference to the sleep apnea site).

Couple of clarification questions:

Does MMA include both lower and upper jaw surgery? Or did you just

do lower jaw surgery? I have had two recommendation from different

surgeons. One claimed both upper and lower jaw surgery are required

to address sleep apneea. The second recommended lower only based on

my ceph xray.

Can you confirm that you had the nasal surgery IN ADVANCE of the MMA

surgery? Would you do both at the same time if you had to do it

again?

I appreciate your comments.

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