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

[Guest guest]

PMD, MMA stands for maxillomandibular advancement. it encompasses both

jaws moved forward the same to maintain bite. the upper tightens up

the soft palate and the lower tightens the genioglossus muscle so the

tongue doesn't fall back and close the airway. it is usually done in

conjuction with genioplasty to further tighten the muscle as it

attaches to the backside of the chin. if just your lower is moved your

bite will change so unless you have an overjet and get ortho first

both should be moved. I had septoplasty two years ago so i could wear

the cpap. it helped my breathing a little but a turbinate reduction

should have been done at the same time. neither of which would have

helped my apnea as base of tongue was my main obstruction. I

eventually gave up on the cpap and opted for MMA. If I had it to do

over I think I would have gone with the genioplasty alone first to see

how that worked as my RDI/AHI was at 34 (moderate to severe) and I was

retrognathic (recessed chin). If that didn't help enough I would have

got braces again and gone for a 5mm lower advancement to close up my

overjet. Of course if my upper advancement had gone well the first

time I'm sure i'd say that the MMA was the right call (hindsight is

20/20 but you can't change the past!) I've yet to deal with my

hypertrophied inferior turbinate but one thing at a time i guess.

Here's a couple links I found helplful that should assist you in your

journey. If you have any questions feel free to ask and hopefully i

can steer you to the answers. eric

http://ajrccm.atsjournals.org/cgi/content/full/162/2/641

http://www.chestjournal.org/cgi/content/full/116/6/1519

> > >

> > > 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, MMA stands for maxillomandibular advancement. it encompasses both

jaws moved forward the same to maintain bite. the upper tightens up

the soft palate and the lower tightens the genioglossus muscle so the

tongue doesn't fall back and close the airway. it is usually done in

conjuction with genioplasty to further tighten the muscle as it

attaches to the backside of the chin. if just your lower is moved your

bite will change so unless you have an overjet and get ortho first

both should be moved. I had septoplasty two years ago so i could wear

the cpap. it helped my breathing a little but a turbinate reduction

should have been done at the same time. neither of which would have

helped my apnea as base of tongue was my main obstruction. I

eventually gave up on the cpap and opted for MMA. If I had it to do

over I think I would have gone with the genioplasty alone first to see

how that worked as my RDI/AHI was at 34 (moderate to severe) and I was

retrognathic (recessed chin). If that didn't help enough I would have

got braces again and gone for a 5mm lower advancement to close up my

overjet. Of course if my upper advancement had gone well the first

time I'm sure i'd say that the MMA was the right call (hindsight is

20/20 but you can't change the past!) I've yet to deal with my

hypertrophied inferior turbinate but one thing at a time i guess.

Here's a couple links I found helplful that should assist you in your

journey. If you have any questions feel free to ask and hopefully i

can steer you to the answers. eric

http://ajrccm.atsjournals.org/cgi/content/full/162/2/641

http://www.chestjournal.org/cgi/content/full/116/6/1519

> > >

> > > 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