Jaw Advancement to improve breathing

[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.

[kavan]

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.

Hmmm...usually the septos and turb redux are aimed at helping the breathing.

[april]

Unless the issue really isn't with the nose.
Daniel, yes from your xray the surgeon will be able to see your airway, however, keep in mind the xray is taken while upright, not lying down, so it won't reveal what happens to your airway when you're down.

[dammit_daniel]

Thanks April, right, I hope they can see the problem from sitting up then. I have read some other posts where the surgeon has said their airways are narrow and would be even more narrow when lying down, which might cause breathing issues. Hopefully my surgeon has good eye for these things.

[dammit_daniel]

So I met with the first of 2 max fac surgeons I am seeing and he pretty much said he wouldn't do anything until I had a diagnosis of sleep apnea. He would not even comment on my airways or tell me about normal airway sizes..he did give me the xrays so I am wondering if anyone could comment on my xrays or tell me what measurements would be useful?

I have a side profile view.

https://imgur.com/a/yecWsvJ

Are there any measurements from the top down views which would be helpful?

[wendyl]

Please AVOID using oral appliances!!!! I cannot stress that enough.

I had to undergo double jaw surgery because I wore an oral appliance for 5 years. It affected my jaw joint and tipped all my teeth to the point where the roots were coming out of the bone. Because I was no longer able to chew food properly (no contact with a mouthful of crooked teeth) I was forced to redo orthodontia at 60 years old. The orthodontist insisted I get the surgery as part of the treatment to straighten my teeth. I've always had a weak jaw and a slight overbite and he felt that the jaws needed to be aligned better to give me a proper bite. I paid out of pocket for both the orthodontist and the double jaw surgery, after already investing in a CPAP and $2K oral appliance.

I am a moderate (40 episodes/hr) apnea sufferer. My first sleep study revealed 2 minutes REM sleep in the entire night!  They diagnosed me with Upper Airway Resistance Syndrome as well as Obstructive Sleep Apnea. Initially, with the oral appliance I was down to under 10 episodes/hr if I slept on my side. As my teeth tipped from the constant pressure the device was less effective. I did well with CPAP but could never find a proper mask to fit my very small face and the constant leaks woke both me and my husband. At the time the sleep specialist said the surgery would not fix my sleep problems and to stick with CPAP.

The oral surgeon did an x-ray of my airway and determined that it was nearly pinched off where my jaw meets my neck. I have a really thin neck. The airway on the 3-d image looked bone shaped and very narrow in the middle. The oral surgeon explained that by advancing both jaws he could open the airway at that point to look like the rest of it. In the end he had to advance the upper jaw by 1 cm and lower one by 2 cm (which he said was significant), and on the post-surgery x-ray I now have a normal looking airway.

As for sleep and apnea - I am in recovery, which means sleeping on my back with an elevated head. I quit the CPAP since it is no longer titrated to whatever I am now. In a few months I hope to: 1. sleep on my side, which helps OSA & 2. get another sleep study done. I'm not waking perfectly refreshed, but I am not healed from surgery yet either. I am definitely NOT the mess that I was when I had moderate apnea. I am happy to have a normal airway, regardless. I am looking forward to getting the orthodontist to fix my bite and straighten my teeth to be able to finally chew well.   

Good luck in whatever you decide but carefully consider your options and the long term ramifications.

[sventory]

wendyl, how are you doing now? Were there any concerns at such a major advancement and major surgery considering your age?

[fresh-double-jaw]

Hello, I am 50 and had both upper and lower jaws advanced a full centimeter for sleep apnea issues relating to my throat closing and inability to wear a CPAP.  The surgery totally cured my sleep issues and is just a major healing issue.  I'm 6 weeks out now and still having a lot of pain and issues.  I'm sure I will be super happy about it a few months later.  At the moment I have mixed feelings between, glad I just got a great sleep than "why the hell did I do this to myself".  Its painful and really hard to adjust to..

[dammit_daniel]

I'm at 5 months now and I'm not quite satisfied with how much my breathing/sleep has improved. I am still having to sleep sitting upright or have my head quite elevated. I am much more functional now however. I've seen improvements in memory, energy, wakefulness.
I'm now exploring other options in particular a genioplasty. My surgeon offered me a genioplasty at the time of the bimax, but he said I only needed 2-3mm advancement, so I didn't bother. People on this forum have already advised me on getting a genioplasty for further improvement.

I'm contacting my surgeon but any opinions would be greatly appreciated.

Does anyone here know of people that have had much success with the genioplasty for airway increase?

And any opinions on how much genio advancement I could get away with without looking weird? (I might even go with looking weird if it meant more chance of being cured)

https://imgur.com/a/Tn6nbeP -couple months post op, still had quite a bit of swelling.

Cheers

[Dogmatix]

I'm at 5 months now and I'm not quite satisfied with how much my breathing/sleep has improved. I am still having to sleep sitting upright or have my head quite elevated. I am much more functional now however. I've seen improvements in memory, energy, wakefulness.
I'm now exploring other options in particular a genioplasty. My surgeon offered me a genioplasty at the time of the bimax, but he said I only needed 2-3mm advancement, so I didn't bother. People on this forum have already advised me on getting a genioplasty for further improvement.

I'm contacting my surgeon but any opinions would be greatly appreciated.

Does anyone here know of people that have had much success with the genioplasty for airway increase?

And any opinions on how much genio advancement I could get away with without looking weird? (I might even go with looking weird if it meant more chance of being cured)

https://imgur.com/a/Tn6nbeP -couple months post op, still had quite a bit of swelling.

Cheers

There are different type of genioplasties, specifically designed to open airways, like below.

https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/f5922c5b354a9e3fd5b2f3d0860efbebc323bcb6/4-Figure2-1.png
https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcRZd_4BwpsNx7leZPcpw0sHjzzwJFuNbEk8BlGibRRLTnQnY6l1
https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcSi6jMkU6uRrJEz5V6IvqNdmhUhDRXqL2__9Pxg06mtw1FrJ7IA6A


Aesthetically, I think your profile can handle more advancement. In case of a genioplasty, I think it may be more if it can make your chin look pointy or sharp if it's too much. Also looking at things like labiomental fold etc. Best is probably to ask your surgeon what he can do, and maybe ask specifically for these type of genioglossus advancement, and not normal genioplasty, if you're especially interested in opening the airways.

[dammit_daniel]

As always, really appreciate the input Dogmatix.

I'll make sure to ask about the "Genioglossus advancement" image you linked.
I think my chin may end up looking quite sharp and pointy, as its quite narrow.