Segmented DJS vs Expansion then DJS

[LCM9001]

I've been diagnosed with moderate sleep apnea and have been researching what recourse I have.

The ENT that specializes in sleep disordered breathing noted that my jaws are too small for my tongue and narrow in the back.

I'm trying CPAP right now but I hate it and don't want to live like this the rest of my life so it seems that jaw surgery is in my future.

I'm curious about potentially getting a segmented lefort 1 as part of my double jaw surgery to get some expansion rather than having to go through months of say FME and then double jaw surgery.

Are there certain cases where that would not work or might work just as well or better? 

What would indicate whether the segmented approach would be as good or better for somebody?

If it's never as good or better, is there any way to say how much better the expansion then surgery approach is?  Are we talking 5% better or 50% better?

Any information anybody could share on this topic would be greatly appreciated.

[Salemare]

Approximately how old are you and did you ever have any tooth extractions in the past?

Are your teeth positioned in a V--shape rather than a round U shaped arch and do you have a high vaulted palate. I've attached an image that describes that I am referring to.

There are a lot of people with UARS and Sleep apnea who have benefited from a variety of orthodontic and surgery procedures. Treatments such as MARPE can help expand the upper palate and make space for the tongue but also expanded the nasal cavity internally resulting in improved breathing. MARPE is not indicated as a treatment for Sleep apnea but this is anecdotal opinions from a lot of people. Jaw surgery is used to treat sleep apnea, and both the upper and lower jaw forward creates more space for the tongue and the additional effect from moving the lower jaw forward is that it stretches the tissues that have started to sag with age (sleep apnea often develops with aging and becomes more common in your 40's and 50's) it alters the position of the tongue and soft tissues opening the airway. A segmental lefort may also have similar effects in traverse expansion again making space for the tongue. As you can see there are a few ways to skin a cat and there are resources online discussing this specific topic and the specialists who offer treatment. Certainly you want to find an airway orientated orthodontist (not that common unless you are in the US) and likewise surgeon.

In regards to temporary measures, there are mandibular advancement devices which can help reposition your jaw whilst sleeping as well as a myriad of other temporary devices you can dry as well as nasal dilators such as mute. MAD devices are usually available via orthodontists and custom made to fit your mouth.

Whilst I appreciate you may hate CPAP, do not give up on it until you have found alternative treatment, make no mistake untreated sleep apnea is deadly, I know this from personal experience. There are also a myriad of resources on how to optimize your cpap treatment, which different masks and also entering the clinician menu so you can customise and adjust your CPAP machine settings to make it more comfortable.  Often the default settings are poorly set with huge swings in pressure causing you to wake up. Some people also spend the cash to buy a bi-level machine privately which is a more advanced and can be configured to give a more comfortable experience. Depending on where you are, if you make a big song and dance about how much you hate CPAP, your provider will consider changing you to Bipap. These machines are more expensive so they always want to prescribe CPAP first and hope you will stick with that.

[thedude]

Segmental is more invasive and probably carries a greater risk of tooth injury. Still pretty rare I think but surgical skill is going to be a big factor. It also doesn’t expand the nasal aperture (front skeletal opening of the nose) like traditional expansion techniques.

It’s a big timesaver though and there is no gap to close. 

[GJ]

Are you talking about a 3 piece? It's riskier for sure, and the biggest risk being necrosis of the maxilla via loss of blood flow. Surgical skill is a factor, of course...you want someone well trained who's done it a lot. I think Gunson has.