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Jaw Advancement to improve breathing

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dammit_daniel:
Hi all. I have an appointment to see a maxillofacial surgeon concerning my poor breathing, especially worse at night when I lie down, I have to arch my neck back to get sufficient air. I always wake up unrefreshed, so I had a sleep study done but they said I did not have apnea, however my sleep architecture was very poor, getting little deep sleep, and also having quite a few arousals. Even though the sleep study came back negative for apnea I am still convinced that breathing difficulties at night time are causing my poor sleep, this is because I have had some improvement in my sleep using jaw advancement devices and cpap(both however I cannot tolerate consistently).  I believe my receding jaw is to blame for this, as it feels like my tongue is constantly pressing against my soft pallet making it difficult to breath. Can anyone answer the following questions?

1) Do you think the maxillofacial surgeon will perform the same type of surgery for sleep apnea(bimax and genio?) to open up my airways even though I dont have sleep apnea?
2) From the xray do you think the doctor will be able to say with some certainty that "x" is causing my poor sleep/poor breathing? i.e are there some common anatomy traits that leave some more predisposed to poor breathing during sleep/in general?
3) Has anyone had an improvement in speech after having surgery for a receding jaw?

Thanks.

bex:
Hi there,

Do you know if your sleep study ruled out the possibility of Upper Airway Resistance Syndrome (UARS) https://www.sleepassociation.org/sleep-disorders/more-sleep-disorders/upper-airway-resistance-syndrome/? Many of the symptoms are similar to OSA. However, those with UARS might not experience snoring or oxygen desaturation the way someone with OSA would.

If you do have UARS and can provide documentation of the diagnosis, and demonstrate that you cannot tolerate CPAP/oral devices long term, then I think you might have a shot at getting approval for bi-max + genio, depending on your insurance co. Those were the steps I had to take for getting my surgery approved (though I have OSA, not UARS). That said, UARS can also be a result of soft tissue issues, so you'd need to have a surgeon determine where you are having obstruction issues. This would then determine which procedure(s) would be effective for resolving the obstruction.

kavan:
Your eggs are not all in one basket in so far as what your desires to have max fax surgery relate to. Nor is any X ray here. Your other X ray in an other post was a PANORAMIC and that type is not used to look at airways or jaw imbalance.

Are you wanting to know IF insurance will pay for it? NO, if it does not pan out as 'apnea' from the tests.

Are you wanting to pay for it yourself because you want to improve the AESTHETICS of your receding jaw and ALSO because your bite is 'not right'? IF 'yes' to those 2 things, then the max fax can LOOK at the part of the airway which will increase in dimention subsequent to advancing the jaw(s). Nothing 'lost' IF the surgery will improve your aesthetics and bite even if the part of the airway being increased in dimention is not the part of it giving you breathing problems.

If all you want to consider is getting 'some surgery' aimed at breathing better that is not maxfax when done with either the priority of 'apnea' OR jaw/bite imbalance, then you would need to probably consult with some rhinoplasty doctors to see if anything in your NOSE is kicking up breathing problems.

dammit_daniel:
Hi Bex,

Yes, I think I do have UARS. The sleep study unfortunately did not measure Respiratory Disturbance Index, which I think would of been vital in a diagnosis. I have tried a mouthguard, it has definitely helped. The only problem is a get ringing ears from it and I need to take sleeping tablets to help with the discomfort, which is not ideal long term. I tried CPAP , not sure if my anatomy is not suitable for it or something but I haven't been able to get used to it.

What surgery did you have for OSA?

Thanks

dammit_daniel:
Hi Kavan,

I see, yes I got the panaromic from my dentist, as I have no proper xrays yet. I do have a max fac appointment tomorrow with xrays/imaging involved, which I'll post if it shows anything interesting.
I have had a septoplasty and turbinate reduction, so I think my nose is quite clear.
Awesome, thanks for the info.

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