Author Topic: Before and After Bimax CCW Surgery for Airways Improvement  (Read 20767 times)

dammit_daniel

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #15 on: January 06, 2019, 04:24:11 PM »
Please do keep us updated with your progress. I'm keen to see if you see any enhancement in your quality of sleep as your swelling goes down. Also, have you seen a marked improvement in your breathing?

Hi Journey,

I am a little disappointed on the impact on my sleep so far. My breathing in general I would say is much better. I can speak more clearly and I don't struggle to breathing during the day so much. However I still find I am feeling obstruction when I lie down and I continue to sleep almost sitting upright in bed, only in this position I can say I am sleeping better than pre surgery. It has been 6 weeks now, and the surgeon said I should expect to see improvement in my airways now. I am still noticeably swollen in parts of my face so I am hoping there is swelling to go down in my airways still. If my airways does not improve I am thinking about trying CPAP again.

Dogmatix

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #16 on: January 07, 2019, 01:28:19 AM »
Thanks for making the comparison Dogmatix, sorry I didn't see someone commented on the thread, I don't get a notification or anything.
30% increase sounds pretty good.

I think the photos I supplied were on funny angles making it appear that the pog has gone up vertically when it hadn't.

Yes the right and left side of the mandible lining up was what I was refering to. I spoke to the surgeon he said that he corrected misalignment of the lower jaw and upper jaw and it can be seen in the after photo, so no shaving going on.

Cool good to hear you think the upper incisors tips are in the right position. I was sort of worried I didn't get the right amount of advancement, but I think a large part of that was because my lips and face were so swollen making it look like my chin was still recessed, which I've heard is quite common. The surgeon said it all went to plan though.


I think the additional genio would of been 2-3k more, he said it would be cheaper to do it with the bimax than separately, which makes sense.

Don't know if it's a typo, but I meant how much more advancement in mm for the genio, not the cost :)

I think you get best evaluation if you get your photos from your surgeon, they should be most consistent and easiest to evaluate.

When I say 30% wider, that was just something I guessed from looking at the picture. But however, the area and volume increase may be even bigger, depending on the shape of your airways. Airways are normally round shaped, and e.g if you consider it a circle, an increase of 30% in the radius, means that the area increase is squared, 1.3^2 = 1.69%. Best way to evaluate would be if you would get the raw cbct file from your surgeon, both pre and post op so it can be compared in iCatVision or other cbct software.

I'm sorry to hear you don't feel that your airways have improved enough for sleep quality. I'm no expert, but what I've heard from people is that they seem to get almost immediate relief after surgery, and that swelling doesn't affect it so much. But who am I to speak to you about this, you of course have better experience of this. How do you notice and know that you still have obstruction, snoring, bad sleep, or just that it was better with cpap than it's now? Thinking if it's maybe that the airways actually have opened and that it's something else disturbing your sleep? Is it mainly the upper nasal airways you feel still are narrow, or is it all around? As I said, the raw cbct file would be very interesting to look at for your case if you could get that.

How ever, you must have come a long way in the recovery now and things starting getting back to normal?

kavan

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #17 on: January 07, 2019, 10:31:28 AM »
Hi Journey,

I am a little disappointed on the impact on my sleep so far. My breathing in general I would say is much better. I can speak more clearly and I don't struggle to breathing during the day so much. However I still find I am feeling obstruction when I lie down and I continue to sleep almost sitting upright in bed, only in this position I can say I am sleeping better than pre surgery. It has been 6 weeks now, and the surgeon said I should expect to see improvement in my airways now. I am still noticeably swollen in parts of my face so I am hoping there is swelling to go down in my airways still. If my airways does not improve I am thinking about trying CPAP again.

Actually, if your airways don't improve that much after all the swelling goes down (the swelling could be cramping in on the airways), consider thinking about getting the GENIO that was originally offered to you because that's the part related to genioglossus muscle advancement as part of  'whole package' to alleviate breathing problems.  The fact that your doc let you opt out of it during the main surgery but also told you, it would be more expensive during a later separate surgery is basically same as his saying you have the option to have it later down the line.
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JourneyToSerenity

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #18 on: January 08, 2019, 07:14:15 AM »
Hi Journey,

I am a little disappointed on the impact on my sleep so far. My breathing in general I would say is much better. I can speak more clearly and I don't struggle to breathing during the day so much. However I still find I am feeling obstruction when I lie down and I continue to sleep almost sitting upright in bed, only in this position I can say I am sleeping better than pre surgery. It has been 6 weeks now, and the surgeon said I should expect to see improvement in my airways now. I am still noticeably swollen in parts of my face so I am hoping there is swelling to go down in my airways still. If my airways does not improve I am thinking about trying CPAP again.

Hey, Daniel, it's disheartening to read that you haven't felt any improvements in your sleep despite going through with jaw surgery. Have you mentioned this to your surgeon? I would definitely follow Kavan's advice and speak to your surgeon about considering a genio if you see no improvements, or at least find out what benefits you would see from potentially getting it done. Also, I wouldn't discount their being another issue at play esp with your nose/palate, would be wise to consult with an ENT who has a background in treating patient who have sleep apnea.

From my very basic understanding, the benefits of a genio are to do with the muscles attached to the chin which are in turn connected on the other end to the hyoid bone. With a BSSO and SG you in turn make the hyoid bone pull upwards and out, which in turn pull the tongue + epiglottis[both attached to the hyoid bone] in the same direction increasing the support and area for air to pass through in the larnygopharnx. The video below should help in giving you an insight on what i'm trying to say:

https://www.youtube.com/watch?v=gU5QOv8IdbI

kavan

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #19 on: January 08, 2019, 09:08:13 AM »
Hey, Daniel, it's disheartening to read that you haven't felt any improvements in your sleep despite going through with jaw surgery. Have you mentioned this to your surgeon? I would definitely follow Kavan's advice and speak to your surgeon about considering a genio if you see no improvements, or at least find out what benefits you would see from potentially getting it done. Also, I wouldn't discount their being another issue at play esp with your nose/palate, would be wise to consult with an ENT who has a background in treating patient who have sleep apnea.

From my very basic understanding, the benefits of a genio are to do with the muscles attached to the chin which are in turn connected on the other end to the hyoid bone. With a BSSO and SG you in turn make the hyoid bone pull upwards and out, which in turn pull the tongue + epiglottis[both attached to the hyoid bone] in the same direction increasing the support and area for air to pass through in the larnygopharnx. The video below should help in giving you an insight on what i'm trying to say:

https://www.youtube.com/watch?v=gU5QOv8IdbI

Wow!. You said that very well.
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GJ

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #20 on: January 08, 2019, 09:11:52 AM »
Strange. I never heard of a genio helping breathing.
Millimeters are miles on the face.

kavan

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #21 on: January 08, 2019, 09:53:53 AM »
Strange. I never heard of a genio helping breathing.

I guess something attached to the base of the tongue  goes along for the ride that also has an association with obstructing the airway which is most likely why it's part of the whole sleep apnea package.  Journey to Serenity gave good elaboration on it.
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dammit_daniel

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #22 on: January 08, 2019, 10:10:46 AM »
Very interesting points guys. Dogmatix, the surgeon said the genio would be 2-3mm I think to get a more aesthetically pleasing result.

I am very glad/worried you brought up the genio/hyoid bone guys because thats exactly where the obstruction I am feeling seems to be and when I push on the hyoid bone slightly my throat seems to close up completely. Before you mentioned it I was noticing that it seemed be a point in my airway that was very narrow.

Is it possible that there is swelling causing pressure on/around the hyoid bone causing obstruction? I notice that when I am sleeping I am still point up my head upwards which I think actually pulls my hyoid bone outwards. It still feels very firm and hot around the lower jaw tissue. I am not sure if I had a problem with the hyoid bone area before the surgery.

With a BSSO and SG you in turn make the hyoid bone pull upwards and out..

Does the BSSO  by itself help to pull the hyoid bone out?

I am looking at my pre op cone beam images, am I seeing the hyoid bone here that I have outlined, there is a top down view and side view linked

https://imgur.com/a/L43WsGA
« Last Edit: January 08, 2019, 10:57:08 AM by dammit_daniel »

dammit_daniel

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #23 on: January 08, 2019, 11:54:12 AM »
https://www.ncbi.nlm.nih.gov/pubmed/11890065

Quote
The hyoid bone moved forwards horizontally in 78 per cent of the subjects, backwards in 17 per cent, and in 5 per cent of patients it retained its pre-operative position.

The amount of horizontal and vertical change of the hyoid bone was associated with the corresponding change of the mandible after surgery.

Just from this one study only on mandibular advancement and hyoid bone movement I am hoping I got some beneficial movement to my hyoid bone..I am really hoping it is just swelling I am feeling...

Dogmatix

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #24 on: January 08, 2019, 12:03:11 PM »
Strange. I never heard of a genio helping breathing.

https://www.ncbi.nlm.nih.gov/pubmed/25721920

Quote
The upper airway may be further opened by an advancement genioplasty

It also makes sense when looking at the anatomy of what the part being mobilized in a genioplasty is connected to. It also looks like the epiglottis could be coming forward with this, as discussed earlier.

http://orlandomedicalnews.com/files/image/rev_fig_2.jpg

Dogmatix

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #25 on: January 08, 2019, 12:16:28 PM »
https://www.ncbi.nlm.nih.gov/pubmed/11890065

Just from this one study only on mandibular advancement and hyoid bone movement I am hoping I got some beneficial movement to my hyoid bone..I am really hoping it is just swelling I am feeling...

I don't think there's any magic going on that the hyoid bone is only moved by a genioplasty. Moving the entire package seems like it should move everything that is included in a genioplasty as well. An additional genioplasty would just be further advancement of what is already advanced. With this, I can also speculate that if you already had 14mm advancement, 2-3mm additional would be a lot less additional improvement from what you got in the surgery you had. The major movement and improvement is already done.

JourneyToSerenity

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #26 on: January 09, 2019, 08:07:20 AM »
Does the BSSO  by itself help to pull the hyoid bone out?

I am looking at my pre op cone beam images, am I seeing the hyoid bone here that I have outlined, there is a top down view and side view linked

https://imgur.com/a/L43WsGA

Yes, I would assume so providing you had CCW + large advancement of the mandible. However, don't take my word for it, speak to your maxfax surgeon he's the one who should be able to shed more light on this. The only way to really gauge the amount of movement of the hyoid bone is by looking at scans pre and post surgery. As for the airways, I know various surgeons who use ICAT[cbct] where it calculates the improvement of the airways.
 
If I was in your position, I would wait for the swelling to subside before doing anything, however, I would still speak to your surgeon[notify him of your concerns with regards to your sleep/benefits + advancement of a poss genio/your desire to start CPAP etc], see what he says, then either take his opinion on board or maybe get a second opinion, and then take it from there.

I still think you should definitely consult with an ENT[i know i've said it before but it's imperative he's experienced in sleep apnea] once the swelling subsides and get them to use a scope to check your nose/throat/airways etc where any potential areas of obstruction can be highlighted. The last thing you want is to undergo the pain and expense of another surgery while the underlying problems go untreated and you don't experience any benefit whatsoever.

Dogmatix

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #27 on: January 09, 2019, 12:07:38 PM »
Below you can see why it's interesting to look at the cbct after such surgery. In this case the airway improvement is obvious, and if you had the cbct it could probably easy be seen how the surgery has affected your airways.

https://www.instagram.com/p/Bnis742giHZ/

dammit_daniel

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Re: Before and After Bimax CCW Surgery for Airways Improvement
« Reply #28 on: January 10, 2019, 10:25:45 PM »
Yeah I'll just wait for now, maybe I am a odd case or maybe the size of the mandible movement has something to do with the swelling persisting. Thanks for the tips regarding airway imaging and seeking a ENT. I'll post an update in the future, hopefully with some good news  :P