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

[Guest guest]

:

BTW, I have a slightly reduced middle pharyngeal airway space ...

BUT ... a significantly reduced airway space at the valecula level

of the lower airway space. I also have increased contact length of

soft palate and posterior tongue and an elongated tongue base to

tongue tip length. Basically, it seems most of my problem is

related to nasal issues and the base of my tongue.

So, based on the first phase addressing upper airway issues

primarily, it appears that jaw surgery (second phase) is most

appropriate for my situation given my issues are related to the base

of my tongue.

Thanks for hearing me speak out my concerns and questions. I will

of course confirm with my doctor but your insight is valuable.

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]

:

BTW, I have a slightly reduced middle pharyngeal airway space ...

BUT ... a significantly reduced airway space at the valecula level

of the lower airway space. I also have increased contact length of

soft palate and posterior tongue and an elongated tongue base to

tongue tip length. Basically, it seems most of my problem is

related to nasal issues and the base of my tongue.

So, based on the first phase addressing upper airway issues

primarily, it appears that jaw surgery (second phase) is most

appropriate for my situation given my issues are related to the base

of my tongue.

Thanks for hearing me speak out my concerns and questions. I will

of course confirm with my doctor but your insight is valuable.

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