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

[Guest guest]

PMD, I wish it was an easy process but there are so many procedures

that try and avoid jaw surgery that it can get confusing. I hear many

have had good results with " repose " tongue suture to move the tongue

forward in conjuction with GA (genioglossus advancement) or

genioplasty. The only issue I can see is both move the tongue forward

and without moving the jaw you may end up with tongue thrust and open

bite cuz your tongue won't have any where to go but forward. I notice

after genio that my tongue wants to lay just outside my fromt teeth

when relaxed but so far no tongue thrust issues.( probably due to

mouth breathing which leaves my mouth open when sleeping.) The rule of

thumb for advancement is you get half the airway increase. so if you

get 8mm lower and 8mm genio you should get 8mm at the airway as I did.

While I got 16mm total advancement I still have a recessed chin but

the genio made it more pronounced. Most procedures to oblate the base

of the tongue seem to help in the short run but relapse is common.

Hyoid suspension helps a little but is also done in conjuction with GA

or genio. Many doctors recommend doing the most at one sitting as they

find if what they try doesn't work the patient becomes discouraged and

stops before cured which I can understand. I really feel that if my OS

had gotten it right the first time I'd be a happy camper and less

sceptical so let me reitterate " the quality of the surgeon can make

all the difference! " I had a chance and wish i had gone to powell and

riley at the time! If in any way you are contemplating getting braces

I'd do that first cuz most orthos will not treat you after surgery.

Lot's to ponder so good luck and keep us informed. 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

[Guest guest]

PMD, I wish it was an easy process but there are so many procedures

that try and avoid jaw surgery that it can get confusing. I hear many

have had good results with " repose " tongue suture to move the tongue

forward in conjuction with GA (genioglossus advancement) or

genioplasty. The only issue I can see is both move the tongue forward

and without moving the jaw you may end up with tongue thrust and open

bite cuz your tongue won't have any where to go but forward. I notice

after genio that my tongue wants to lay just outside my fromt teeth

when relaxed but so far no tongue thrust issues.( probably due to

mouth breathing which leaves my mouth open when sleeping.) The rule of

thumb for advancement is you get half the airway increase. so if you

get 8mm lower and 8mm genio you should get 8mm at the airway as I did.

While I got 16mm total advancement I still have a recessed chin but

the genio made it more pronounced. Most procedures to oblate the base

of the tongue seem to help in the short run but relapse is common.

Hyoid suspension helps a little but is also done in conjuction with GA

or genio. Many doctors recommend doing the most at one sitting as they

find if what they try doesn't work the patient becomes discouraged and

stops before cured which I can understand. I really feel that if my OS

had gotten it right the first time I'd be a happy camper and less

sceptical so let me reitterate " the quality of the surgeon can make

all the difference! " I had a chance and wish i had gone to powell and

riley at the time! If in any way you are contemplating getting braces

I'd do that first cuz most orthos will not treat you after surgery.

Lot's to ponder so good luck and keep us informed. 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